Individual research recommendation details

Recommendation ID

NG121/3

Question

Is obesity an independent risk factor for perinatal morbidity and mortality?

Any explanatory notes
(if applicable)

It is more difficult to monitor fetal heart rate, uterine contractions and fetal position in women who are obese. These women are likely to have more complications and growth restriction is more likely to have been missed from earlier scans, making accurate fetal monitoring particularly important in the intrapartum period.

However, there was no evidence that continuous cardiotocography improves outcomes compared with intermittent auscultation. So the committee agreed to recommend monitoring based on the woman's preference and obstetric indications in line with the NICE guideline on intrapartum care for health women and babies.

There is variation in management during the intrapartum period for women who are obese. This is because of a lack of agreement on whether women with uncomplicated obesity should be offered continuous fetal monitoring in labour, receive further antenatal ultrasound scanning, including amniotic fluid volume assessment and umbilical artery Doppler scans, or be offered early induction.

Research to date has not established the effect of stratified BMI on perinatal outcomes. Current research is mainly retrospective, using data dating back to the 1970s and 1980s when BMI was usually self-reported and not stratified according to WHO categorisation. The committee agreed to make a research recommendationto inform future guidance.

How the recommendation might affect practice

There is a wide variation in the use of continuous cardiotocography and intermittent auscultation for women who are obese. However, the recommendation is unlikely to mean a large change in current practice.

Full details of the evidence and the committee's discussion are in evidence review I: obesity.

Source guidance details

Comes from guidance

Intrapartum care for women with existing medical conditions or obstetric complications and their babies

Number

NG121

Date issued

March 2019

Other details