Should antenatal testing be performed in patients with a pre-pregnancy BMI ≥ 35?
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Q: Should antenatal testing be performed in patients with a pre-pregnancy BMI ≥ 35? Evidence-based answer:Possibly. Elevated BMI is associated with an increased risk for stillbirth (strength of recommendation [SOR], B; cohort studies and meta-analysis of cohort studies). Three studies found an association between elevated BMI and stillbirth and one did not. However, no studies demonstrate that antenatal testing in pregnant people with higher BMIs decreases stillbirth rates, or that no harm is caused by unnecessary testing or resultant interventions. Still, in 2021, the American College of Obstetricians and Gynecologists (ACOG) suggested weekly antenatal testing may be considered from 34w0d for pregnant people with a BMI ≥ 40.0 and from 37w0d for pregnant people with a BMI between 35.0 and 39.9 (SOR, C; consensus guideline). Thus, doing the antenatal testing recommended in the ACOG guideline in an attempt to prevent stillbirth is reasonable, given evidence that elevated BMI is associated with stillbirth.
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