Obese and pregnant

[OpalMoose]

Hi everyone,
I'm about 7 weeks pregnant, went to the first midwife appt today and got told as I'm obese I need to take aspirin, potentially BP tablets and i need to inject myself with blood thinners every day. Anyone else had/have this experience? I'm not particularly happy about having to do all this for 8 months given I don't take any medication right now. 🫢 thanks!

Yup. Am obese. Took aspirin in both pregnancies.

Aspirin improves blood flow in the placenta, reducing the risk of pre-eclampsia and small baby. Think of it as just another tablet to take alongside your folic acid.

Thanks thats helpful. It's not so much the aspirin I'm bothered about but more the blood thinning injections. Did you do those too? And after your pregnancies did you just stop? And have you had any issues since because of it? And final question...! Did you get lots of bleeding when you gave birth, that's my other worry.

Sorry for all the questions!

I rang my GP to get the higher dose folic acid but haven’t been told anything about aspirin or blood thinners. I have had my booking appointment with a midwife as well, who also didn’t mention any of that.

Would recommend Dr Sara Wickhams excellent book Plus Size Pregnancy. Lots of discussion about the evidence/pros/cons of these interventions to help you decide what's right for you. All her books are excellent btw, especially those on induction.

Well you have been assessed as being a high risk pregnancy due to your weight, and will be managed as such. Your risk of clots is much higher than a normal BMI woman. You don't have to take the recommended medication, but it is recommended for the safety of both you and your baby.

Currently 30 weeks pregnant with my first and obese. My midwife has been great to be honest and said early on she hates basing things off bmi. She put me on higher dose folic acid and vitamin d at booking in. It wasn’t until I saw my consultant at 16 weeks (under their care due to bmi) and had a high blood pressure reading (make sure they use the right size cuffs if you have bigger arms) that I was then put on aspirin and a low dose of labetalol to control the blood pressure, this was because they classed me as too early for this to be caused by pregnancy so said I likely had it prior to pregnancy. No mention of blood thinners. Have recently been diagnosed with gd but no one’s blamed bmi (because anyone can develop or not develop it) and they’ve been quite good at saying they want to stick with normal delivery as much as possible. Look up the heavyweight midwife on Facebook/Instagram as she has lots of useful information, especially if you are with a hospital who aren’t so understanding and like to push outdated view on bigger mums.

I had to have the blood thinning injections with my first it was only for 6 weeks after birth and with my second it was from about 26/28weeks until 4 weeks after birth. Also recent pregnancy (ended in miscarriage) at booking appointment they said I would have to have them again from 28weeks.
I found doing them in my thigh better than stomach didn’t sting as much. You get used to them and work out what way of administering is best for you.

@OpalMoose Sorry I missed the blood thinners bit of your post completely. I do apologise. I only had them while I was admitted to hospital, and then 10 days postnatally. As I was induced, the injections were stopped in advance. I had also stopped taking aspirin as well by that point. I did not bleed much after either birth. AFAIR it was less than 100ml with my first (vaginal birth), and 400ml with my second (C-section).

There will be a reason for it. If I may ask, what is your BMI? If it is higher than 40, that's probably it. Otherwise, do you have any other history like recurrent miscarriage, or a blood clotting disorder, or artificial heart valves that could also be a reason? Or any family history?

It does feel daunting at first, but you do get used to the injections eventually. And there is an end point to it all.

Wasn't obese but on the high end of overweight and about to turn 40, with two recent miscarriages. Was put on 75mg aspirin and progesterone and my DS is 20!

Obese and took asprin but due to diabetes not my weight. Not been given blood thinners. told you need to have 3 risk factors and obesity is my only one so no blood thinners for moi! but depends on how high your BMI is i guess. Mine was 37 at booking i think

In my area you need to have at least three risk factors to be put on thinners - in my case it was age, weight, and a non-pregnancy related condition that was suddenly diagnosed at 10 weeks. I took thinners from that point up until the other condition was cured, at 20 weeks, when they said I didn't need them any more as they were unnecessary just for my age and weight. It might depend on your bmi though? Mine was about 30 when I got pregnant. I haven't been told to take aspirin either.

Well seems I'm the only one then. Great. Not sure what my bmi is exactly but it's in the high end of obese for sure, also scored on smoking (which i stopped when I found out I was pregnant but apparently I'm still down as a smoker because it takes 3 months to leave your system) and varicose veins. I really just think it's a bit much to have 2 types of blood thinners at once for such an extended period of time. But hey, what can you do. Thanks for the advice all. Will definitely check the FB page and book.

You should also be on a higher dose of folic acid.

My BMI has been in the 40s for both my pregnancies.

1st pregnancy I was on aspirin throughout and then blood thinners after my c-section but not before.

2nd pregnancy no aspirin as my bmi is the only risk factor.

The risk factors are things like, bmi, 1st pregnancy, high blood pressure, family history etc... so you must've hit a few for the injections.

Not obese, also had aspirin and blood thinning injections but in my second pregnancy due to complications with my first. Aspirin was for elevated blood pressure, blood thinning injections were to help prevent blood clots in labour and post partum. Injections weren’t overly painful at all. Aspirin was like taking paracetamol. In 8 months it’ll be over! You may have to take the injections for 6-8 weeks after whilst your body ejects the pregnancy tissue.

I had a bmi of 30.11 at booking and didn't get prescribed anything like that, had to have a glucose test at 28 weeks which is a good job as I have gestational diabetes and I'm now on 4 metformin a day, don't think I'd cope with other medication on top of that!

Why wouldn't you want to be safe?

That's what I'm trying to figure out, the safety. Ordinarily aspirin and clexane should not be taken together for a start. They say obese women are at increases risk of severe bleeding when giving birth which is understandable given the double dose of blood thinners. Also, from what I've found the risk of VTE is still really low for obese women anyway. It goes from 0.2% to 0.5%, so basically double the chance of nothing. Of course it all depends on individual factors but it's a hard decision to make. I'm personally going to see if I can get an appointment with a consultant and see what evidence they have to support their treatment plan as I'm not convinced at this point. Will update if I find out more.