What to expect with a High BMI

[Mays12]

Hello,

I am currently about 10 weeks pregnant and at my booking appointment the midwife told me that I would be getting some extra appointments due to my higher BMI to monitor the babies growth.

I am not really concerned about being a 'higher risk' because although I have a high BMI I am fit and healthy and I have just always weighed more than I should due to my build. However I was wondering if anyone had any details of the extra appointments you do tend to have because of this?

The midwife advised I should ring to book at appointment with her when I know when I will be 16 weeks. I was wondering if anyone has had this additional 16 week appointment and what to expect from it.

I also have read that it can be more difficult for abdominal ultrasounds if you have extra weight around your stomach. I don't mind if its rougher or more likely to bruise but I was wondering how difficult it would actually be to see? I dont have an awful lot of fat around my stomach but obviously there is a bit there. I was planning to book an appointment for a private scan on when i would be 11.5/12 weeks but dont want to be disappointed and wondered if i should wait for the NHS scan?

Sorry for all the rambling thoughts but any information from people who have experienced this will help to settle my mind!

I'm not 100% certain but I thought people with a higher BMI had to take aspirin during pregnancy and/or blood thinning injections. Dont quote me on that though. You will likely get sent for a gestational diabetes test, but this isn't usually until around 28 weeks. My BMI was normal but I still had gestational diabetes during both my pregnancies and I know others with a higher BMI who didn't have it, so I wouldn't worry at this stage.

Congratulations on your pregnancy.

There are a few reasons who you would be referred for consultant care (extra appointments and scans) with a raised BMI. Quite what they are would depend on your BMI.

The 16 week midwife appointment is a standard one though for all women, she is just asking you to ring after your scan so that it is booked around 16 weeks as often if it is booked at start you think might be 16 weeks based on your period it ends up needing to be moved. This appointment will be to catch up, make sure you've had your scan and are happy with your plan of care as well as to start talking about things like baby movements, how bonding and talking to your bump supports baby's brain development and to start thinking about your thoughts and feelings around feeding. So lots of lovely things to discuss.

With regards to BMI one of the main things is keeping tabs on baby's growth as with a raised BMI there is a higher chance of them being on the small side but also measuring your tummy isn't as accurate so depending on BMI they may recommend extra scans later in pregnancy to check growth. Your midwife is the lead on everything normal but the consultant you see will look at all your history and current pregnancy and make recommendations for your care. This may be signing you off and back to midwifery care or it may be to have additional appointments depending on your individual circumstances.

You should be offered glucose test at 24-28 weeks as you are more at risk of developing gestational diabetes. My bmi is slightly high an d found out just before Christmas. If you do you need to monitor bloods and they will do more growth scans.

Depends how high your bmi is as to what impact it will have on your care. You’ll certainly be offered a glucose tolerance test and may also need extra scans and aspirin. Maybe heparin injections to avoid blood clots depending on whether there are additional risk factors for that.

in my experience the sonographers will usually write something to cover themselves on the scan report like “reduced image quality due to raised bmi” but I’ve never actually known of any problems seeing the images/getting measurements. They press hard but it shouldn’t bruise you. For any early scans you might be offered a transvaginal scan if they don’t feel the abdominal scan is clear enough.

The 16 wk appt is a routine catch up that everyone has.

I’ve had 3 kids while I had a BMI of between 35-38. No big deal really - I don’t remember any extra appointments. I had to have fragmin injections after my 2 c sections but that’s it really. No aspirin or anything. No problems with scans.

Oh yes and had no GTT with DC1 (BMI 35, age 25).

One GTT with DC2 (age 27)

2 GTTs with DC3 (age 33). Because there is no possible way i could have not had diabetes at my weight 😆

(I never had GD)

Thank you all for your replies, that's all really helped!

I tend to overthink and was struggling to find what the difference would be as she mentioned I would receive extra appointments but no idea what they were yet!

Depends a bit on how high your BMI is. In addition to the obstetric/midwifery care you may also be referred to an anaesthetic clinic. There’s a useful info leaflet on raised BMI and obstetric anaesthesia on the labourpains website that may give you ideas for questions to ask. HTH

Totally depends on whether your BMI is 26 or 36!

The former, probably no difference really. Depending on whether you carry a lot around your belly it might mean growth scans later as it will be harder to assess bump growth by measuring. Maybe a GTT.

The latter, potential for more monitoring, higher risk for quite a few complications, and possible restrictions on birth options, depending on the rules in your local trust.

Lots of women breeze through with a high BMI, so hopefully you'll be fine. But be reassured they'll monitor you more carefully in case you're one of the ones whose weight causes problems.

Why book a private scan for 11.5-12 weeks when you will have the standard nhs scan about that time anyway? I would save your money.
As long as you drink sufficiently prior your scan will be fine. My bmi was 36 and never had a problem with scans, they might just press a bit harder at points.
The extra appointments will be growth scans, you will have a lot of midwife appointments for a 1st pregnancy anyway.

I'm currently 15+4 and have a higher BMI. So far I've just been recommended the glucose test when I'll be around 25 weeks and have an additional appointment in a couple of weeks to speak to a consultant to see whether I need to be consultant led or midwife led. Have been told everything else is fine and a higher BMI is my only risk factor. I have started taking the 75mg Aspirin every day as was told it just helps the blood flow between the placenta and the baby to ensure it gets all the nutrients it needs. Scan wise, I had a private scan at 9 weeks and had no problem seeing the baby, was just a normal external scan, all they did was go underneath the fat on my stomach lower down and got a perfect picture, same goes for the 12 week scan.

I'm going through this now. My BMI is around 40.

I had a private scan at 8 weeks and we could see the baby that way but went trans vaginal to be able to see the heartbeat properly. There was no problem at all with my 12 week scan (except baby kept wriggling which made it hard to measure) sonographer could see and measure everything needed. I have been put on low-dose aspirin due to pre-eclampsia risk (I'm a little grumpy about it as my blood pressure is 100/44 which is low end of normal so I'd prefer to just keep monitoring but still taking it). Also on much higher folic acid (5mg compared to the 400mg you get in shops). I've been told I'll likely be doing an insulin resistance test at some point (even though my HbA1c was 28 which is normal too) and I've been given an appointment with the metabolic clinic here but I don't know what that will be related to yet as not yet happened, From research I think they might be making me do food diaries.

Overall, I am worried about being overly intervened with but try not to get angry and health professional about it. I'm going to be quite firm near the end of my pregnancy about not wanting interventions due to my BMI. I'm not overly convinced of the scientific research about high BMI causing problems in pregnancy once you control for hormonal issues/hard to conceive pregnancies/ blood pressure and blood sugar, all of which don't apply to me.

I’ve had 2 DC with a high BMI, no complications in either pregnancy. Both were consultant led, the consultant in my first pregnancy put it very well, he explained that the potential complications that come with high BMI are not any different from those that anybody could get with any pregnancy (such as gestational diabetes, high blood pressure etc) but the chances of those happening are a bit higher so they like to keep extra tabs on us. It just meant a few extra scans and appointments for me, and a diabetes test. One thing I did notice though was that some doctors and midwives almost seem to look for problems because they expect them to be there, I had one midwife in my second pregnancy who was convinced I would have high blood pressure, it got to the point that I had to measure it every week at home, yet I had never once had a high reading! I didn’t mind the extra checks though.
I had no trouble with my scans, and I had a private 8 week scan with both pregnancies and was able to see baby clearly at both despite my extra tummy fat!

I'm 16 weeks and at booking I was only just over 30 BMI, I'll have to have extra appointments but everything is normal so far, blood pressure is normal and all my blood results have been within normal ranges.

Try not to worry too much now you're pregnant, you can't change it - I asked my midwife if I should be thinking about weight loss and she said no, just try to eat as healthily as possible but making sure to eat enough (easier said than done when you're battling tiredness/nausea!)

Mine in both pregnancies BMI started between 30-35

the only “extra” thing I was offered was the GTT - first time around was covid so I didn’t have it, this time I’ve got it booked in quite late as the first appointment letter didn’t get to me. Was still offere home birth or midwife led births with both and wasn’t really mentioned, nor was my age which is over 35. I was prescribed blood thinner injections for 10 days after the first birth so assume will be five those again. You are still entitled to birth how you want, eg home birth, it might be outside guidance but they can’t actually stop you!

Oh and I had no extra appointments, no extra scans, was completely midwife led. No issues with scans either, but my weight is mainly on boobs bum and thighs!

I had a high BMI last pregnancy (he's 10 months now) and had to take higher dose folic acid from the start, aspirin from 12 weeks and fragmin injections at home daily from 24 weeks and 10 days after section - but it depends on how high it actually is. I had severe hyperemisis with him and lost 9 stone throughout the pregnancy, currently 20 weeks and no longer classed as high BMI.

If it does cause an issue seeing baby (which .. I was a size 24 before my son and they managed with me if that's any help) they can always go transvaginally (wee probe up your hoo hoo instead of your tummy if views are obscured). We had 3 extra private scans, just for my own reassurance (I work in Fetal Medicine, so you can imagine all the sad things I see and how my brain works) and can honestly say they were invaluable to me, it's personal choice but they absolutely helped me.

Best of luck!

Hello!

I was just over 30 BMI at my booking appointment, i had my usual scans and appointments with no issues but was asked to do a GTT precautionary..
I had my GTT test last week at 26 weeks and was borderline for GD so im now having extra scans every month and extra appointments, the consultant mentioned baby may be brought earlier than my due date but other than that ive had no difference 🙂

You are still entitled to birth how you want, eg home birth, it might be outside guidance but they can’t actually stop you

Of course but I would also urge every first time mum to look at their own personalised stats as to whether natural birth is likely to be successful as it is quite significantly impacted by age and BMI:

www.ncbi.nlm.nih.gov/pmc/articles/PMC7839088/

It’s not clear though if it’s actually higher risk because we interfere more with women with a high BMI - eg pushed into early induction which is more likely to then lead to forceps or C-section etc, if there’s no other health issues then I would definitely be sceptical of the “risks”.
I was very fit and healthy with a BMI over 30, I was teaching 5/6 hot yoga classes a week, had 2 horses and had no issues with blood pressure etc. I turned down an induction (unrelated to BMI but baby size) and had a great vaginal delivery, easy recovery etc. who knows what birth I’d have had if I had accepted induction.

www.instagram.com/p/ClxsMfntHVg/?igshid=YmMyMTA2M2Y=

this explains it better than I could - dr sara wickham is great for this stuff!

Worth noting that this study was done at Shrewsbury & Telford maternity unit - subsequently investigated in the Ockenden review and said to be the biggest maternity scandal in the UK, with multiple failings in care. Not saying that disproves the study findings of course, but something to consider when looking at the data.

If anything that hospital underplayed need for CS, so the rates may even be higher than that.

For me it's a gestational diabetes test and two extra scans at 28 and 36 weeks

I also have to take aspirin every day