Being overweight or obese is endemic in the United States. A body mass index between 25 and 30 is overweight, over 30 obese, over 35 grossly obese and over 40 morbidly obese. According to these criteria, more than 25% of women are obese when they conceive. There are 4 million births each year in the US, so about a million deliveries involve obese women.
The consequences are enormous. Routine care is more difficult starting with basic clean-catch urine specimens and venipuncture no longer being straightforward. Palpation, blood pressure measurement and ultrasound readings are compromised so monitoring presents problems. Co-morbid conditions of diabetes and hypertension are exacerbated or develop during pregnancy so these pregnancies move towards the high-risk category with increasing surveillance requiring more frequent visits, wider investigations and greater expense.
As BMI increases, so do complications and caesarean section rates, both of which add to costs according to an in-depth study by Chu et al (NEJM 2008;358:1444-153). Their research showed the increased use of all antenatal facilities with rising obesity and these strongly favoured doctors rather than nurses as well as more frequent outpatient attendance and longer in-patient stays. The greater the BMI, the greater the complications and the costs, which is a huge concern to health management organisations.
There is a strong association of rising BMI with decreasing socio-economic status in the US, so it appears those who can least afford to are placing themselves at risk and need most medical care at greater financial hardship.
