Title Fetomaternal Outcomes in Pregnancies Complicated with Obesity at London District General Hospital

Objective:

This study evaluated maternal and neonatal outcomes in pregnancies complicated by BMI ≥35 at Croydon University Hospital.

Design:

Obesity in pregnancy is an increasingly significant issue at Croydon University Maternity Unit, particularly due to the diverse ethnic population. Alarmingly, this is becoming more prevalent in young and adult age group. This is posing young antenatal patients to complications such as gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, thromboembolism, and increased rates of caesarean sections, leading to higher care costs. This study aimed to assess compliance with the management of obese pregnant women against RCOG Guideline No. 72, NICE Guidelines 189 and 190, and departmental guidelines

Method:

This retrospective study included 100 pregnant women with BMI ≥35 who delivered at the Croydon Maternity Unit from January to December 2023.

Results:

The majority of obese women (31%) were aged 36–40 years, while 8% were aged 20–25 years. Most (66%) were Class 2 obese (BMI 35–39.9), and 1% had a BMI >50. Of the study population, 30% were of Black ethnicity.

The department demonstrated over 90% compliance with national guidelines for antenatal counselling; venous thromboembolism and pre-eclampsia assessments; and fetal scanning for structural anomalies and biometry. Anaesthetic referrals were made for 79% of women with BMI ≥40, while 26% were referred to dieticians.

Poor compliance was observed in preconception counselling, discussions about induction of labor at term, postpartum contraception advice, and referrals for nutritional support and weight management. Approximately 32% of women developed gestational diabetes, 16% had large-for-gestational-age babies, and 10% had small-for-dates babies. Hypertension in pregnancy was reported in 7% of cases, and venous thromboembolism in 1%.

Induction of labor was performed in 20% of cases. Among the women studied, 40% had vaginal deliveries, with 6% requiring operative vaginal delivery. Caesarean sections accounted for 60% of deliveries, with 53% attributed to obesity-related complications (e.g., failure to progress, large-for-dates babies) and 7% performed for maternal request. Of the study population, 65% delivered at term, 5% preterm, and 30% post-dates. No neonatal unit admissions were recorded.

Intrapartum complications such as shoulder dystocia, obstetric anal sphincter injuries, and difficulty in siting regional anaesthesia were observed in 2% of cases each. Postpartum complications included wound infections and endometritis in 10%, postpartum hemorrhage in 6%, and sepsis in 5%. 

Conclusions:

This study concluded that while department is compliant in several parameters, compliance with preconception counselling, antenatal discussions on induction of labor, dietician referrals, and postnatal support requires improvement. To address these gaps, we aim to update departmental guidelines, establish preconception counselling clinics, and create comprehensive checklists.

References:

Royal College of Obstetricians and Gynaecologists, Care of Women with Obesity in Pregnancy (Green‑top Guideline No 72, 22 November 2018), https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/care-of-women-with-obesity-in-pregnancy-green-top-guideline-no-72/ accessed 8 June 2025.

National Institute for Health and Care Excellence, Obesity: identification, assessment and management (Clinical guideline CG 189, June 2014), https://www.nice.org.uk/guidance/cg189 accessed 8 June 2025.

National Institute for Health and Care Excellence, Intrapartum care (NICE Guideline NG 235, September 2023), https://www.nice.org.uk/guidance/ng235 accessed 8 June 2025.

Croydon Health Services NHS Trust, Policies and procedures, Croydon Health Services NHS Trust website, 2025, https://www.croydonhealthservices.nhs.uk/policies-and-procedures accessed 8 June 2025.