High BMI in Pregnancy: A Case for Referral.

Obesity leads to higher risks of complications in pregnancy and at the time of labor and delivery, including preterm delivery, shoulder dystocia, operative vaginal delivery, and cesarean delivery. In addition, there is a dose-response relationship between increasing obesity class and risk of severe maternal morbidity at the time of delivery to include acute renal failure, heart failure, mechanically assisted ventilation, anesthesia complications, postpartum hemorrhage, and blood transfusion. In this brief review, we highlight the importance of referral specifically for delivery due to higher risk of complications for pregnant patients with elevated BMI, although certainly referring to a tertiary care center early in pregnancy would be preferred for medical optimization, detailed fetal anatomic evaluation, and delivery preparation.