Obesity is increasing in prevalence worldwide and has become the focus of major initiatives to try to prevent its occurrence and reduce the long-term health implications of the obese state. In obstetrics and gynaecology, obesity both with and without polycystic ovarian syndrome is associated with an increased rate of ovulatory infertility. Once pregnancy is established in the obese, recognized risks include increased rates of gestational diabetes, venous thrombo-embolism and hypertension. Routine antenatal care can be made more difficult by difficult venous access, limited value of abdominal palpation, and attenuation of the ultrasound signal impairing assessment of fetal anatomical abnormality and subsequent studies of late pregnancy fetal growth. Labour in the obese is more likely to be prolonged and unsuccessful. Operative delivery by Caesarean section is likely to be complicated by difficult access and problems with intra-operative management of complications. Post-delivery care is again a time of high risk for venous thrombo-embolism as well as wound infection. Physiological changes in energy balance in pregnancy can result in a net increase in body fat over the pregnancy, which may be difficult or impossible for the woman to lose in the months after delivery. The infant of the obese mother is at increased risk of late intra-uterine death, pre-term birth, low Apgar score, macrosomia and neural tube defects. Neonatal intensive care unit admission is more common in the offspring of the obese gravida.
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