PREGNANT IN A LARGER BODY: WHAT’S NORMAL, WHAT TO WATCH FOR, AND HOW TO ADVOCATE FOR YOURSELF

Bodies, whether pregnant or not, come in all different shapes and sizes, and all kinds of bodies have healthy babies every day. Still, if you’re plus size, you may have questions about what to expect during pregnancy and how best to take care of yourself and your baby. 

What is considered a plus-size pregnancy?

You're considered overweight if your pre-pregnancy body mass index (BMI) is between 25 and 29.9 and obese if your BMI is 30 or higher. It's healthy to have a BMI between 18.5 and 24.9.

Although having a BMI between 18.5 and 24.9 is considered normal, it isn't all that typical: About half of first-time mothers in the United States are overweight when they become pregnant, and about half of first-time mothers gain more weight than is recommended during pregnancy.

Keep in mind that BMI is only a rough estimate of body fat based on your height and weight: It doesn't take genetics, race, or age into consideration, and it isn't a perfect tool for assessing overall fitness. Nevertheless, researchers have consistently found that as BMI increases, so does the risk of many pregnancy and labor complications.

How important is your weight during pregnancy?

What you weigh when you become pregnant – and how much weight you gain during pregnancy – can affect your pregnancy and your baby. Gaining too little weight can put women at risk of premature delivery and having a baby with low birthweight, while gaining too much can put you at higher risk for other pregnancy complications.

Starting pregnancy at a healthy weight is ideal, but keep in mind that most women who fall outside the weight recommendations still have normal pregnancies and healthy babies. Many of the conditions and complications linked to an overweight pregnancy are manageable – and in some cases preventable.

“Lots of plus-size women go on to have healthy pregnancies,” says BabyCenter Community member Pharmama0406.

Health conditions associated with plus-size pregnancies

If you’re entering pregnancy with some extra weight, certain complications can be more likely – but knowing your risks helps you take charge and stay ahead of them.

Gestational diabetes

Gestational diabetes causes elevated blood sugar during pregnancy. Your healthcare provider will evaluate your blood sugar during glucose screening and tolerance tests, which are usually done between 24 and 28 weeks of pregnancy. (They may be done earlier if you're overweight at conception or have other risk factors.)

Nearly 5% of pregnant women develop gestational diabetes, and the risk increases along with BMI: Overweight women are twice as likely to have gestational diabetes, and obese women are four to eight times as likely to have it. 

High blood sugar levels can increase the risk of:

• Hypoglycemia (low blood sugar), jaundice, and breathing problems in your baby after birth
• Having a large baby, which also increases the risk of injury and shoulder dystocia – a rare but serious situation in which the baby becomes stuck behind the mother's pubic bone during delivery
• Developing diabetes yourself in the future
• Having a child who develops type 2 diabetes and/or obesity
• Needing a Cesarean section

Preeclampsia

Preeclampsia is a serious condition that's diagnosed after 20 weeks of pregnancy (or during labor or postpartum) if you have high blood pressure along with at least one other symptom. These can include protein in your urine, liver or kidney abnormalities, persistent headaches.

About 6 to 12% of overweight pregnant women are diagnosed with preeclampsia, compared to about 4% of women with a BMI in the normal range.

Preeclampsia affects your blood vessels, which raises your blood pressure and affects organ systems throughout your body. Preeclampsia can range from mild to severe and progress slowly or rapidly. In severe cases, it can cause growth problems for your baby and the following for you and your pregnancy:

• Kidney and/or liver problems
• Low platelets and bleeding problems
• Low amniotic fluid
• Placental abruption, a serious condition in which the placenta separates partially or completely from your uterus before your baby is born
• Eclampsia (seizures)
• Heart attack
• Stroke

Gestational hypertension

If you develop high blood pressure (a reading of 140 over 90 or higher – even if only one of the numbers is elevated) after 20 weeks of pregnancy but don't have any evidence of preeclampsia, you'll be diagnosed with gestational hypertension, sometimes called pregnancy-induced hypertension.

Roughly 10% of obese women have gestational hypertension, versus around 4% of women with normal BMI.

If you had high blood pressure before pregnancy, or are diagnosed with it before 20 weeks of pregnancy, that's called chronic hypertension. Chronic hypertension is a heart risk, but gestational hypertension is usually mild and probably won't cause any noticeable problems for you or your baby.

However, it does put you at higher risk for:

• Preeclampsia
• Intrauterine growth restriction, also called fetal growth restriction
• Preterm birth
• Placental abruption
• Stillbirth

Obstructive sleep apnea

Obstructive sleep apnea means that you stop breathing for short periods during sleep, temporarily decreasing the amount of oxygen in your blood. Being overweight or obese puts you at higher risk of sleep apnea. In fact, the heavier you are to begin with and the more weight you gain during pregnancy, the more likely you are to have trouble breathing during sleep.

Sleep apnea during pregnancy can lead to fatigue and increase the risk of:

• High blood pressure
• Preeclampsia
• Heart and lung problems

Longer labor

Research shows that a higher BMI can be linked to longer labor – especially the early part, before you reach about 6 cm dilation. That said, averages aren’t destiny: This doesn’t mean your labor will automatically take longer, just that your body may follow a slightly different timeline.

That’s why it’s worth talking with your healthcare provider ahead of time about what “normal” labor progress can look like for plus-size women. Making sure everyone’s on the same page can help avoid rushed decisions – including unnecessary C-sections – especially since monitoring your baby during labor can sometimes be a bit trickier in larger bodies.

Labor complications

A study of over 250,000 women found that pre-pregnancy BMI and gestational weight gain are associated with other labor complications, too, including:

• C-section. Overweight women are roughly 50% more likely to have a C-section than women who are at a normal weight, and obese women are twice as likely to have a cesarean.
• Preterm birth. One Swedish study of over a million pregnancies found that maternal overweight and obesity during pregnancy were associated with increased risks of preterm delivery (both spontaneous and medically induced), especially extremely preterm delivery.
• Pregnancy loss and stillbirth. The higher the woman's BMI, the greater the risk of stillbirth.

Are there any risks for your baby?

If you're plus-size and pregnant, there are a few things to keep an eye on when it comes to your baby's health – here's what to know.

Large baby

While most plus-size women have average-size babies (around 7 pounds), obesity is considered a risk factor for macrosomia, or having a large baby (at least 9 pounds, 15 ounces). About 1% of babies are macrosomic. Your baby is more likely to be large if you have undiagnosed or poorly managed gestational diabetes, have a family history of large babies, or go past your due date.

If your fundal height – the distance from your pubic bone to the top of your uterus – is measuring ahead, it might mean your baby is on the bigger side. But it could also be due to more amniotic fluid or extra tissue around your belly. (For plus-size moms, these measurements can be less accurate, so try not to stress.)

Ultrasounds can give a better estimate of your baby’s size than a tape measure – but even those are just that: estimates. The only way to know your baby’s actual weight is after birth, and late-pregnancy ultrasounds can be off by about 10%.

If your baby is measuring large, it can increase the chance of a C-section, and babies born with more body fat may be at higher risk for obesity later on. But remember: Size alone doesn’t determine your birth story or your baby’s future.

Birth defects

Researchers aren't sure why, but if you're overweight or obese, your baby has an increased risk of birth defects, such as heart defects and neural tube defects (NTDs).

Neural tube defects (NTDs) are problems with how a baby's brain and spinal cord develop. The overall risk is very small (around 1 in 1,000 births), but overweight and obese women are twice as likely to have a baby with an NTD as women at a normal weight.

You can also ask your healthcare provider for a screening test between 15 to 20 weeks to screen for NTDs, using the hormone alpha fetal protein or AFP. If that test suggests a possible problem, ultrasound and amniocentesis can provide more information.

How to stay healthy during a plus-size pregnancy

The best time to lower your risk of pregnancy complications is before you conceive – and even small changes in weight can make a difference. But if you’re already pregnant, take a deep breath: Most of the guidance for staying healthy applies to every body, and there’s plenty you can do right now to support a healthy pregnancy and baby. Here’s where to focus.

Seek good prenatal care

Work closely with your healthcare provider throughout your pregnancy. Pregnant women who are overweight sometimes delay or avoid seeing a prenatal provider because they're afraid of being judged. It's very important to get regular prenatal care to monitor for complications and learn about and prepare for any special considerations for your pregnancy, labor, and delivery.

Find a provider you're comfortable with, even if that means meeting multiple providers. Also keep in mind that some community hospitals and birth centers aren't equipped with the special equipment and staff to safely care for women with a BMI over 50. You may need to travel to a larger hospital or academic center to get the care you need.

You'll be working hand-in-hand, so it's important to have a provider you feel good about during your pregnancy. Need some advice? Read more on how to choose an ob-gyn, and whether a midwife or ob-gyn might be right for you.

Gain the right amount of weight for your pregnancy

The Centers for Disease Control and Prevention (CDC) recommends that overweight women gain a total of 15 to 25 pounds and obese women gain 11 to 20 pounds. (If you're pregnant with twins, those numbers are 31 to 50 pounds for overweight women and 25 to 42 pounds for obese women.) 

Eat well

Pregnancy isn’t the time to focus on weight loss, but it is important to focus on what fuels you. Prioritize nutrient-packed foods – think lean protein, healthy fats, and lots of colorful produce – and try to limit added sugars and processed snacks when you can. If you're managing something like gestational diabetes, talk with your provider about how nutrition plays a role and what’s best for you and your baby.

Take your daily prenatal vitamin

In addition to basic vitamins and minerals, your prenatal vitamin also contains the folic acid, calcium, and iodine your body needs during pregnancy. Ask your provider if you need additional supplementation of any of these (or other) nutrients.

Stay hydrated

The American College of Obstetricians and Gynecologists and the Institute of Medicine recommend that pregnant women drink 10 8-ounce glasses of water each day to stay hydrated. If you're plus sized, you need even more water than smaller women. The best way to tell if you're getting enough water is to look at your urine. If you're drinking enough, it should be pale yellow or colorless, not dark.

From hydration reminders to prenatal checklists, the BabyCenter app helps you stay on top of the small things that make a big difference.

Stay active

Work with your healthcare provider to come up with a good exercise program. The CDC recommends you get at least 150 minutes weekly of moderate-intensity aerobic exercise during pregnancy. The most important thing to remember is to keep moving – even if you're just taking walks after meals. Stay active!

Learn about any conditions that may affect you

If you're at risk for gestational diabetes or hypertension, for example, learn all you can about how you can manage or prevent the condition. Follow your healthcare provider's advice, and call them right away if you experience signs of problems, such as a severe or persistent headache, rapid weight gain, intense pain or tenderness in your upper abdomen, puffiness or swelling in your face or extremities, or vision changes. It's also a good idea to become familiar with pregnancy symptoms you should never ignore.

Your body is already doing something incredible – and you deserve care that’s informed, respectful, and judgment-free. With the right support, you can have a healthy pregnancy and baby, no matter your size.

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2026-01-21T07:47:35Z