Maternity obesity, defined as a body mass index (BMI) of 30 or higher during pregnancy, is a growing public health concern worldwide. As global rates of obesity continue to rise, more women are entering pregnancy overweight or obese, posing significant risks to both maternal and foetal health.
A 2016 study by the National Library of Medicine stated that Malaysia had a maternal obesity prevalence of 14.6 per cent, while mothers of advanced age (45-49) exhibited the highest prevalence at 69.2 per cent.
Meanwhile, the “Consensus Clinical Guideline on Obesity in Pregnancy”, published in 2022 by the Director General of Health Malaysia’s National Technical Committee, revealed the following prevalence of obesity in pregnancy based on a report from a hospital in Malacca:
- Obesity class I (BMI 27.5-34.9 kg/m²): 45.6 per cent
- Obesity class II (BMI 35.0-39.9 kg/m²): 11.8 per cent
- Obesity class III (BMI > 40 kg/m²): 9.4 per cent
The risk of maternal obesity
Speaking further about maternal obesity, Sunway Medical Centre Consultant Obstetrician & Gynaecologist and Maternal-Fetal Medicine Specialist Dr Vicky Ho shared insights on the risks of obesity during different stages of pregnancy.
“Obese women may experience difficulty conceiving due to hormonal imbalances and Polycystic Ovarian Syndrome (PCOS). Many may require assisted reproductive technique to achieve conception.
“During pregnancy, they may be at a higher risk of miscarriage and fetal abnormality, hence, a detailed scan for fetal structural survey is strongly recommended to rule out any abnormality,” shared Dr Ho.
In later stages, maternal obesity can lead to complications such as pre-eclampsia (a high blood pressure condition during pregnancy), venous thromboembolism, and gestational diabetes.
Overweight and obese mothers tend to have bigger babies, and this may sometimes lead to higher chances of premature birth and obstructed labour. As such, they too are at elevated risk of needing a caesarean section and excessive bleeding during childbirth. Unfortunately, due to the thickened adipose tissue, the healing process may take longer with the possibility of wound infection.
Adding further, Dr Salleha Khalid, a Fertility Specialist at Sophea Fertility Centre in Selangor, explained how maternal obesity can impact the baby’s development in the womb.
“It can influence the baby’s metabolism, hormone regulation, and even how their body stores fat later on. These babies may have a higher risk of childhood obesity, diabetes, or even heart issues in adulthood,” she added.
Managing early
Good weight control before pregnancy is crucial, advised Dr Ho. In Malaysia, pre-pregnancy clinics are now available to assist women with overweight or obesity issues before conceiving.
“We encourage all women of reproductive age to consult a gynaecologist before embarking on pregnancy — especially if they have underlying medical problems such as obesity. By attending to this clinic and consulting the right doctor, their condition can be optimised to achieve a better pregnancy outcome.”
The President of the Malaysian Obstetric Medicine Society (MOMS) added that mothers will be introduced to weight management programmes — such as diet, exercise, medication, and bariatric surgery.
“Obesity is often linked to high blood pressure, diabetes, obstructive sleep apnoea, and nutrient deficiencies, and these conditions can be identified and treated promptly.”
With pre-pregnancy clinic readily available for mothers both in private and government health care settings, women are now able to embark on pregnancy in their best health status and be ready for their exciting pregnancy journey ahead.
Dr Salleha shared a case involving a patient with PCOS who had struggled to conceive despite several attempts.
“She had gained weight and didn’t realise how much it was affecting her cycles and hormone levels. We focused on small, sustainable changes — no crash dieting, just realistic goals suited to her lifestyle.”
The patient eventually lost weight, improved insulin sensitivity, and conceived naturally.
“Her pregnancy went smoothly, and both mother and baby did well. It shows how early counselling can make a big difference — physically and emotionally.”
Misconceptions about weight gain
The amount of weight gained during pregnancy is often misunderstood. Many people associate high weight gain with a healthy foetus, but this is not always true.
According to Dr Ho, excessive weight gain may put the mother at high risk of gestational diabetes and pre-eclampsia.
“We tend to advise our pregnant mothers to not gain so much weight in pregnancy, however, there isn’t any guide which tells us the exact weight a pregnant mother should be gaining throughout her pregnancy. For a mother living with obesity, we would aim for neutral weight, and perhaps roughly five kilogrammes is acceptable. I have seen pregnant moms with the misconception that she should gain 10 to 20 kilogrammes during her pregnancy, for the baby to grow bigger and stronger. However, a mother’s weight is not equivalent to the baby’s weight,” she explained.
Dr Vicky added that there were mothers who gained very little weight, yet they gave birth to a baby with a healthy weight. Hence, she said that the mother’s weight gain during pregnancy does not always reflect the baby’s birth weight. Furthermore, the mother will have a hard time shedding this ‘baby-weight’ postpartum.
Gaps in medical care for obese mothers
While the opportunities for care exist, they are not always fully utilised in Malaysia, due to limited awareness and manpower shortages. Dr Ho also highlighted a critical, often overlooked aspect: mental health.
Obese patients are more prone to mental health challenges due to hormonal imbalances.
“Many already experience anxiety and depression, and after giving birth, they may spiral into post-partum depression. Moreover, they often face social stigma for their weight,” she noted.
Post-partum depression, triggered by hormonal changes, can sometimes appear up to a year after delivery.
“At Klinik Kesihatan (government clinics), doctors conduct mental health screenings during antenatal visits. Yes, we are improving — but there’s room for more improvement, particularly in empowering women of reproductive age to understand the clinical impact of obesity,” said Dr Ho.
“There are complications that can arise during pregnancy and postpartum — it’s all about educating and empowering them.”
Bearing the stigma
As a mother herself, Dr Salleha shared that motherhood changed her perspective.
“I now understand how hard it is to prioritise yourself while caring for others. The guilt, the exhaustion, the pressure — it’s real.”
In her clinic, she strives to see beyond numbers and lab results. When assessing patients, she also asks about their sleep, stress levels, and support systems.
“Sometimes, a woman doesn’t need another instruction. She needs someone who sees the bigger picture and reminds her that she’s doing okay.”
Stigma related to maternal obesity has deeper impacts than many realise. Dr Salleha noted that some patients avoid check-ups for fear of being judged or lectured about their weight.
“Some say they feel invisible during appointments. When women feel judged, they stop asking questions — and that’s when problems go unnoticed. Pregnancy is already a vulnerable time. The last thing a woman needs is to feel ashamed of her body.”
Meeting women with empathy and respect leads to better engagement and outcomes.
“Women are more likely to make healthy changes when they feel supported,” said Dr Salleha.
When asked about worrisome trends in women’s pre-pregnancy health, Dr Salleha mentioned the rise of undiagnosed insulin resistance and hormonal imbalances, especially PCOS.
“Many have regular periods and don’t realise anything’s wrong until they try to conceive.”
She also noted that many women lead high-stress, low-movement lifestyles — long hours sitting, skipped meals, and late-night eating. These habits quietly affect egg quality, ovulation, and fertility.
As a fertility specialist, she encourages women to do a basic health check-up before trying to conceive.
“Simple blood tests, nutritional tweaks, and regular movement can go a long way. Prevention is easier than treatment later on.”
