Risk Calculator

Is your pregnancy at risk?
Use this quiz to help determine if you have any conditions that might contribute to an at-risk pregnancy.
This quiz is free, confidential, and just takes a few minutes to complete. When you complete it, please click on the print icon at the bottom and bring a copy or PDF with you to discuss with your doctor.
If you have any questions or concerns about your answers, please call the High Risk Pregnancy Center today at 702-505-8986 or request an appointment using our easy online form.

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Do you have a history of:

Hypertension*

Yes

Hypertension - Hypertensive patients have an increased risk of preeclampsia (a disorder of high blood pressure in pregnancy sometimes associated with an increased need for early delivery), fetal growth problems due to issues of possible decreased placental blood flow, and stillbirth. Closer monitoring of mothers and their developing babies during pregnancy is recommended. Patients with pre-existing hypertension often require every 3-4 week ultrasound for growth and fetal assessment (a test of fetal well-being) in the 3rd trimester. Maternal-fetal medicine evaluation, treatment, and follow-up are commonly utilized.

Diabetes pre pregnancy or diagnosed prior to 24 weeks*

Yes

Diabetes - To decrease the risk of miscarriage and congenital disabilities, diabetic patients ideally should undergo preconception counseling. Detailed ultrasound (usually performed by maternal-fetal medicine specialist or a provider with specific specialized training is warranted and often only available within maternal-fetal medicine subspecialist offices. Furthermore, close follow-up of growth, glucose levels, and antepartum fetal testing (a test of fetal well-being) is needed. A fetal echocardiogram is recommended to rule out heart defects at a visit between 18-24 weeks of pregnancy. Fetal echocardiography also requires specialized training and equipment usually performed only by maternal-fetal medicine subspecialists or pediatric cardiologists. Centers accredited in fetal echocardiography by the American Institute of Ultrasound in Medicine may be found at the following link looking under the specialty of fetal echocardiography - click here Due to the specialized ultrasound required and intensive follow-up, maternal-fetal medicine follow-up is recommended.

Asthma*

Yes

Asthma - Women with mild asthma, not requiring medications, may progress through pregnancy, often with minimal complications. However, obstetric societies and medical experts recommend close follow-up of growth via ultrasound in the late second and third trimester for patients on regular medications for their asthma or worsening of previously mild asthma. Antepartum testing for assessment of fetal well-being should also be performed in the third trimester. Specialists in pulmonary medicine and maternal-fetal medicine often possess advanced knowledge of medications required, effects of the types of drugs upon the pregnancy, and changes within the woman with asthma specific to pregnancy.

Seizure Disorder*

Yes

Seizure disorder - Epilepsy poses two significant problems in pregnancy, the occurrence of seizures and the possible effect of medications on your baby. Before becoming pregnant, a discussion with your neurologist, obstetric provider (OB/GYN, midwife, or nurse practitioner), or a maternal-fetal medicine specialist is recommended. Due to the medications required and the possible risks of congenital disabilities. Some drugs are associated with fetal heart abnormalities. A specialized look at the fetal heart (fetal echocardiography) is recommended by an accredited center (American Institute of Ultrasound in Medicine or American College of Radiology) with specialized ultrasound providers and equipment. Centers accredited by the American Institute of Ultrasound in Medicine may be found at the following link looking under the specialty of fetal echocardiography - http://www.aium.org/accreditation/directory.aspx

Kidney Disease*

Yes

Renal disease - Patients with moderate to severe kidney problems may be aided by seeing a maternal-fetal medicine specialist and nephrologist (kidney specialist) in conjunction with their obstetrician. Renal disease in pregnancy increases the likelihood of preeclampsia, and the pre-existing kidney disease may make it more challenging to diagnose. An increased risk of preterm birth, fetal growth restriction (FGR), and stillbirth occur in gestations complicated by renal disease. Medications customarily used for this condition may have to be discontinued due to effects on the baby, and possible medication alternatives should be immediately discussed with your obstetric provider, maternal-fetal medicine provider, or nephrologist. Generally, patients with moderate to severe kidney disease should undergo close follow-up of blood pressure and kidney function with more frequent visits, blood tests, and urinalysis. In addition, patients should be followed closely with regular ultrasound for growth to screen for FGR and have fetal monitoring in the third-trimester pregnancy to prevent stillbirth.

Systemic Lupus Erythematous, Sjogrens Syndrome, or other rheumatologic diseases*

Yes

SLE or other rheumatic diseases in pregnancy - Patients with a history of lupus are frequently followed in conjunction with a maternal-fetal medicine specialist. Some authorities feel strongly that management with a maternal-fetal medicine specialist should occur if there is a history of lupus in association with any effect of disease upon the major organs (lungs, heart, kidneys), history of stroke, recent lupus flare, history of problems with pregnancy (such as preeclampsia or recurrent miscarriage), or antibodies that could affect the baby (antiphospholipid antibodies, or SS-A or SS-B antibodies). Patients with SLE may have a worsening of their lupus during pregnancy that requires close disease follow up with laboratories, treatment with medications due to worsening symptoms, increased ultrasound follow up due to an increased risk of fetal growth problems, and antepartum fetal testing in the third trimester (biophysical profile or modified biophysical profile) to help prevent stillbirth. The presence of SS-A or SS-B antibodies in patients may lead to effects on the fetal heart, and authorities believe frequent monitoring of the fetal heart in the second and third trimester by a maternal-fetal medicine specialist or pediatric cardiologist is warranted (every 1-2 weeks) to possibly prevent the permanent need for a pacemaker for the baby.  

Other rheumatologic diseases during pregnancy generally do not have as severe a course as SLE, but there may be some overlap of the disorders, especially in response to laboratory findings and need for follow up by a rheumatologist or a physician specialized expertise in high-risk pregnancies (usually a maternal-fetal medicine specialist)

HIV*

Yes

HIV - Care with specialists familiar with HIV and treatment is associated with improved outcomes for pregnant women and decreased transmission of HIV to your baby. The choice of the proper drug regimen is critical in this situation. First-trimester ultrasound to assess dates and second-trimester ultrasound to look for an abnormality of your baby is essential. Due to an increased risk of growth problems in women with HIV, third-trimester ultrasound for growth is recommended. Invasive procedures such as amniocentesis may increase the risk of transmission to your baby, and consultation with a maternal-fetal medicine specialist is recommended. This risk may be dramatically decreased in patients on proper drug regimens and an undetectable viral load. Alternative tests and their risks and benefits should be discussed, and this may be improved with the help of a maternal-fetal medicine subspecialist. Proper laboratory tests for other infectious diseases and immunizations are important before and during any pregnancy in a woman with HIV. Optimal care may be assisted with the help of an infectious disease specialist and a maternal-fetal medicine specialist. Care during delivery in conjunction with an infectious disease or maternal-fetal medicine specialist may assist in using medications in labor and care to reduce HIV transmission.

Heart Disease*

Yes

Heart disease - is one of the highest risk factors for maternal death or morbidity. Risks of pregnancy with heart disease are dependent on the type and severity of the condition. Due to increased workload on the heart in pregnancy and especially delivery, consultation with a physician such as a maternal-fetal medicine specialist and cardiologist may be necessary to assess changes and risks properly. To monitor risks to the developing baby, ultrasounds for growth and fetal antepartum assessment are often recommended.

Cancer*

Yes

Cancer - Cancer itself is a group of diseases. The type, stage, and recency of cancer are essential concerning the outcome for the mother and her unborn. Patients with recent or current cancer may benefit from the assistance of a maternal-fetal medicine subspecialist. This maternal-fetal medicine subspecialist may assist the effect of medications upon the developing baby and provide insight into the possible delivery timing.

Brain surgery, malformation, aneurysm, or tumor*

Yes

Brain surgery, aneurysm, malformation, or tumor - Patients with a current abnormality will often benefit from a consultation with a high-risk pregnancy specialist. Aneurysms and arteriovenous malformations may be exacerbated by changes in labor and delivery, and specific recommendations on timing and delivery route (vaginal or cesarean) are extremely important. Cesarean delivery is often indicated. Maternal changes in pregnancy may cause increased symptoms or tumor growth. A maternal-fetal medicine subspecialist may help counsel regarding the safety of treatments. Changes in maternal condition during labor and delivery may require specific recommendations to assist with the mother's safety during delivery.

Hypothyroidism*

Yes

Hypothyroidism - Patients with hypothyroidism should undergo close monitoring and adjustment of drug levels at their first office visit during pregnancy. The fetus is entirely dependent on maternal thyroid hormone levels before 13 weeks, and undertreatment of the mother in the first trimester is associated with a decreased baby IQ. A mother’s blood volume increases from 5 liters prepregnancy-pregnancy to approximately 8 liters by the third trimester. This increase in blood volume will lead to a decreased concentration of thyroid medication in the larger blood volume if adjustments are not made. Frequent monitoring of thyroid tests up to 20 weeks of gestation will optimize proper medication adjustment. In addition, other lab tests (anti-thyroperoxidase antibodies) may help screen people at increased risk for complications with their babies and the growing threat of worsening of their hypothyroidism after delivery. Maternal-fetal medicine specialists are trained in the changes in mothers during pregnancy and may play a key role in treatment. Endocrinologists or obstetric providers with specialized experience may also play a role in these patients.

Hyperthyroidism*

Yes

Hyperthyroidism - Pregnant women with moderate or more severe hypothyroidism require treatment during pregnancy. Medications used to treat the disease cross the placenta and affect the baby. Thus, mild hyperthyroidism may not require treatment. Furthermore, antithyroid drugs may also affect the mother’s liver or blood cells. Recent guidelines have suggested a change in therapy in the United States to utilize different medications at different times in pregnancy to minimize risk. Untreated moderate to severe hypothyroidism may lead to an increased risk of fetal growth problems or stillbirth. Hence, frequent ultrasound and antepartum fetal testing (a test of fetal well-being) are often indicated. Patients with current hyperthyroidism and even patients with previously treated hyperthyroidism before pregnancy (via radioactive iodine or surgery) may possess antibodies that cross the placenta and may cause the fetal thyroid to be overly activated (fetal thyrotoxicosis), which can be problematic. Measurement of these antibodies that may scratch the placenta has been recommended in these patients with current or past Graves’ disease. Maternal-fetal medicine specialists may play a vital role in treating hyperthyroidism due to their knowledge of medication effects, laboratory diagnosis and follow-up, and usage of fetal tests for well-being.

Clotting problem such as DVT, Pulmonary embolus, TIA or stroke*

Yes

Past or current history of clotting disorder - Patients with a current clotting problem such as DVT (deep vein thrombosis) or PE (pulmonary embolus) require anticoagulation. Dosing of anticoagulation and assessment for a pre-existing clotting problem is often co-managed by a hematologist or maternal fetal medicine specialists. Usually, injectable anticoagulants are used during pregnancy, and these do not cross the placenta. The usage of anticoagulants during pregnancy does have some maternal risks (almost always outweighed by the benefits in those with a recent clot), but these should be discussed. Tests for patients with an increased risk of clotting (thrombophilia) are warranted. Data on thrombophilia are controversial, and patients with thrombophilia may have an increased risk of miscarriage or stillbirth. Effects of some thrombophilias on a baby’s growth, premature and sudden placental separation (abruption), and preeclampsia do not seem to be associated. A maternal-fetal medicine subspecialist may play a vital role in the team of personnel working with a pregnant woman with PE or DVT to drive appropriate medication use, the timing of delivery, and the resumption of medications after delivery.

A history of a blood clot within the brain (TIA or stroke) warrants workup for clotting disorders. Injectable blood thinners are often recommended during pregnancy and the period after delivery. Timing and severity of the stroke may dictate different management strategies regarding delivery. This plan may be best assisted with input from a neurologist, neurosurgeon, and/or maternal-fetal medicine specialist.

Do you have a prior pregnancy history of:

Preeclampsia*

Preeclampsia prior to 34 weeks

Preeclampsia after 34 weeks

History of preeclampsia after 34 weeks - A history of severe preeclampsia dramatically increases the risk of preeclampsia in the subsequent pregnancy to as high as 65%. Maternal-fetal medicine specialists may suggest low-dose aspirin or antihypertensive medication to further decrease risks or test to clarify gestational risk. In patients with early-onset preeclampsia, assessment of specific hematologic disorders may be warranted. Consultation and management by a maternal-fetal subspecialist are highly recommended.

History of preeclampsia prior to 34 weeks - a past history of severe preeclampsia dramatically increases the risk of preeclampsia in the next pregnancy to as high as 65%. Maternal fetal medicine specialists may suggest medications to decrease risks or testing to further clarify the risk and may be especially helpful in these circumstances. Consultation and management by these specialists is highly recommended.

Preterm delivery*

Preterm delivery 34-37 weeks

Preterm delivery prior to 34 weeks

Spontaneous Preterm birth between 34-37 weeks (also applicable to rupture of membranes <34 weeks) - Patients with a preterm birth during this time interval have an increased risk of preterm birth. Medications can be given to decrease this risk by as much. A one-time assessment of cervical length by vaginal ultrasound may be helpful for some patients at the time of their screening ultrasound of the baby when the anatomy is being examined in the second trimester. Again certified providers such as those within maternal-fetal medicine offices are more likely to have attained the appropriate certification. Non-certified providers have more significant variations in measurement, leading to the inaccuracy of the assessment. Further clarification may be sought from a maternal-fetal medicine subspecialist.

Spontaneous preterm birth prior to 34 weeks or PROM prior to 34 weeks - A history of severe preeclampsia dramatically increases the risk of preeclampsia in the subsequent pregnancy to as high as 65%. Maternal-fetal medicine specialists may suggest low-dose aspirin or antihypertensive medication to further decrease risks or test to clarify gestational risk. In patients with early-onset preeclampsia, assessment of specific hematologic disorders may be warranted. Consultation and management by a maternal-fetal subspecialist are highly recommended.

Rupture of membranes prior to 34 weeks*

Yes

Rupture of membranes < 34 weeks - Patients with a preterm birth during this time interval have an increased risk of preterm birth. Progesterone may be administered to decrease the risk of preterm birth. Cervical length assessment by vaginal ultrasound should be performed every two weeks from 16-24 weeks of gestation and is recommended by major obstetrical professional organizations. Again certified providers such as those within maternal-fetal medicine offices are more likely to have attained the appropriate certification. Non-certified providers have more significant variations in measurement, leading to the inaccuracy of the assessment. Further clarification should be sought from a maternal-fetal medicine subspecialist.

Cerclage*

Yes

Cerclage - Patients with a history of cerclage in one pregnancy have a recurrence risk of approximately 50%. Close follow-up of cervical length and evaluation of the clinical history of the past pregnancy may be beneficial in patients with this history to develop a plan of management to decrease the risk of preterm birth.

History of uterine anomaly*

Yes

History of uterine abnormality - Patients with a uterine abnormality have been reported to have increased risks of miscarriage, preterm birth, fetal growth problems, cervical incompetence (weakening of the cervix), abnormal fetal presentation such as breech presentation, and cesarean delivery. Growth ultrasound in the third trimester and transvaginal sonography to assess cervical length from 16-24 weeks of gestation by the rare obstetric physician with expertise in patients with uterine disorders or, more commonly, a maternal-fetal medicine subspecialist may provide critical insight into follow up and treatment.

Stillbirth after 14 weeks*

Yes

Stillbirth after 14 weeks - The risk of recurrence of stillbirth and other pregnancy complications depends on the cause, timing, and history of other pregnancy problems in the past, such as fetal growth restriction (FGR) or abruption (a separation of the placenta). Patients with no known cause still possess an increased risk of preterm birth, growth problems, and abruption. If a cause is found, recurrence is dependent upon the reason. Patients with a history of stillbirth from 14-24 weeks have an increased risk of preterm delivery as high as 30-40% and stillbirth. A maternal-fetal medicine specialist may be of assistance before a subsequent pregnancy for evaluation and during a current pregnancy to evaluate and assist with a plan for the pregnancy to proceed.

Fetal growth restriction (FGR)*

Yes

FGR (fetal growth restriction) - Patients with a history of FGR are at increased risk for the recurrence of fetal growth problems in their subsequent pregnancy. Also, patients with a history of FGR are at risk of developing other issues such as preterm birth, abruption (placental separation), and stillbirth. Some authorities have recommended medication (low-dose aspirin) for possible prevention of growth restriction. Early ultrasound to establish proper dating may be ideal. Assessment of a baby’s growth is warranted as well as appropriate history. An experienced obstetric provider or maternal-fetal medicine specialist can perform these critical clinical tasks.

Two or more consecutive first trimester losses*

Yes

Recurrent pregnancy loss - the reasons for recurrent pregnancy loss are varied. Before pregnancy, evaluation is recommended for a complete evaluation, as some tests cannot be performed during pregnancy. Recent information has shown that usage of low-dose aspirin may assist patients in increasing their chance of a live-born infant. This problem may be monitored by an experienced obstetric provider or assisted by a maternal-fetal medicine specialist.

Does your current pregnancy have any of the following conditions:

Oligohydramnios- low fluid*

Yes

Oligohydramnios (low fluid) - A history and specialized ultrasound evaluation should be performed to look for maternal diseases, placental problems, congenital abnormalities, or ruptured membranes. Due to the complexity of the ultrasound required and the common need for advanced equipment, this procedure should be performed by a maternal-fetal medicine specialist or the rare obstetric provider with specific specialized training- https://www.aium.org/resources/guidelines/obstetric_detailed.pdf see page 3094 under training). Patients also may require fetal antepartum assessment (biophysical profile or modified biophysical profile), weekly to twice a week, dependent upon the severity, to help decrease the risk of stillbirth.

Polyhydramnios - excessive fluid

Yes

Polyhydramnios (excessive fluid) - Excessive fluid during pregnancy has been associated with preterm birth, abnormalities of the baby or the baby’s chromosomes, and premature placental separation. To screen for congenital fetal disabilities, a detailed ultrasound is recommended. Due to the complexity of the ultrasound required and the common need for advanced equipment, this procedure should be performed by a maternal-fetal medicine specialist or the rare obstetric provider with specific specialized training- https://www.aium.org/resources/guidelines/obstetric_detailed.pdf see page 3094 under training).

The risks of complications increase with the severity of the excess amount of the fluid. Tests to analyze the fetal chromosomes may be warranted, and appropriate genetic counseling is recommended in these instances. Genetic counseling services are more frequently found within offices of maternal-fetal medicine specialists. Fetal monitoring of well-being is recommended for cases of moderate to severe polyhydramnios (amniotic fluid index > 30)

Current decreased fetal growth or fetal growth restriction (FGR)

Yes

FGR - A detailed history and ultrasound are recommended in patients with fetal growth problems. Specialized comprehensive ultrasound may assist in detecting and ruling out congenital fetal disabilities associated with the condition. Due to the complexity of the ultrasound required and the common need for advanced equipment, this procedure should be performed by a maternal-fetal medicine specialist or the rare obstetric provider with specific specialized training When the onset of the fetal growth problem is early in pregnancy (before 32 weeks) and/or severe, the Society for Maternal-Fetal Medicine recommends evaluation of the fetal chromosomes by amniocentesis and a special genetic test on the amniotic fluid called Microarray analysis, and appropriate genetic counseling is recommended in these instances. Genetic counseling services are more frequently found within offices of maternal-fetal medicine specialists. In addition, fetal monitoring (biophysical profile or modified biophysical profile) and fetal blood flow monitoring by Doppler ultrasound have decreased the risk of stillbirth and cesarean delivery.

Fetal anomaly detected on ultrasound

Yes

Fetal anomaly on ultrasound - When an abnormality is noted on ultrasound, a patient is often sent to a maternal-fetal medicine specialist for further evaluation of the problem and to look for other abnormalities that may change the diagnosis or management of the pregnancy. Due to the complexity of the ultrasound required and the common need for advanced equipment, this procedure should be performed by a maternal-fetal medicine specialist or the rare obstetric provider with specific specialized training- https://www.aium.org/resources/guidelines/obstetric_detailed.pdf see page 3094.

On ultrasound, some fetal abnormalities are associated with chromosomal problems that may be evaluated by appropriate testing and should be offered with genetic counseling. Genetic counseling services are more frequently found within offices of maternal-fetal medicine specialists.

IVF pregnancy

Yes

IVF pregnancy - Pregnancy by IVF is associated with an increased risk of miscarriage, multiple pregnancies, preterm birth, fetal growth problems, and congenital abnormalities. Screening for congenital disabilities in these patients requires a comprehensive ultrasound. Due to the complexity of the ultrasound necessary and the common need for advanced equipment, this procedure should be performed by a maternal-fetal medicine specialist or the rare obstetric provider with specific specialized training - https://www.aium.org/resources/guidelines/obstetric_detailed.pdf see page 3094.

In addition to congenital disabilities, there is a specific increase in fetal heart defects, which indicates fetal echocardiography. At a visit between 18-24 weeks of pregnancy, a fetal echocardiogram is often performed. These exams also require specialized training and equipment, often seen mainly in the offices of maternal-fetal medicine subspecialists. Centers accredited by the American Institute of Ultrasound in Medicine may be found at the following link looking under the specialty of fetal echocardiography - http://www.aium.org/accreditation/directory.aspx

35 years of age or older on due date

Yes

Advanced maternal age - Patients over 35 have an increased risk of babies with chromosome abnormalities. Data should be reviewed for this patient population, and tests discussed thoroughly. This is best performed with in-depth genetic counseling, more commonly found in maternal-fetal medicine subspecialist offices. Due to the increased risk of congenital disabilities in older women, a detailed ultrasound is often recommended from 18-24 weeks. Due to the complexity of the ultrasound required and the common need for advanced equipment, a maternal-fetal medicine specialist should perform this procedure or the rare obstetric provider with specific specialized training- https://www.aium.org/resources/guidelines/obstetric_detailed.pdf see page 3094.

Other complications that occur more often in mothers of advanced maternal age are preterm birth, fetal growth abnormalities, and stillbirth. Fetal monitoring is recommended after 37 weeks of pregnancy by some authorities.

Multiple gestation

Yes

Multiple gestations - multiple births are associated with increased risks during pregnancy, including preterm birth, fetal growth problems, and stillbirth. It is critical to find out the type of chorionicity (single or multiple placentas) of twin gestation early in pregnancy due to the association of certain kinds of twin gestations with different defects.

Patients with a monochorionic (single placenta) have an increased risk of fetal anomalies, fetal cardiac defects, and the development of twin-to-twin transfusion syndrome. To look for anomalies, comprehensive sonography is recommended. Due to the complexity of the ultrasound required and the common need for advanced equipment, this procedure should be performed by a maternal-fetal medicine specialist or the rare obstetric provider with specific specialized training- https://www.aium.org/resources/guidelines/obstetric_detailed.pdf see page 3094.

Due to the increased risk of fetal heart defects in monochorionic pregnancies, a fetal echocardiogram is recommended. These exams also require specialized training and equipment. Centers accredited by the American Institute of Ultrasound in Medicine may be found at the following link looking under the specialty of fetal echocardiography - http://www.aium.org/accreditation/directory.aspx

All multiple pregnancies are at increased risk of fetal growth abnormalities, and follow-up ultrasounds for growth are recommended. Cervical length measurements for twins identify a group at increased risk for preterm delivery. Still, treatment options for change are limited, and hence this follow-up may be performed but is controversial. The usage of low-dose aspirin may reduce the risk of preeclampsia in multiple gestations. Evaluation by a maternal-fetal medicine specialist is warranted.

Do you have any history of substance use?

Yes

Utilization of substances during pregnancy can lead to multiple effects for both mothers and their fetuses and are dependent upon the timing of exposure, dosage utilized, and substance used.

Opioids have been associated with preterm birth, low birth weight, reduced head and brain size, sudden infant death, neonatal abstinence syndrome, congenital malformations such as spina bifida, cleft lip or palate, and fetal cardiac anomalies. A detailed ultrasound by a maternal-fetal medicine specialist is recommended.

Methamphetamine is associated with decreased fetal growth, preterm delivery, abruption, and stillbirth. There has been some association between specific fetal anomalies of abdominal wall closure of the fetus and limb defects. A detailed ultrasound by a maternal-fetal medicine specialist is recommended. Growth sonography for follow-up for prolonged exposures would appear to be prudent.

Recreational marijuana use has not been consistently associated with an increased risk of congenital fetal abnormalities. A decrease in fetal growth has been reported in some studies. Deficits in attentiveness and cognitive functioning have been reported in children exposed to marijuana in utero.

Obesity (Use BMI Calculator Below)

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Obesity - Patients with obesity have an increased risk of miscarriage, diabetes, preeclampsia, large infants, and cesarean section. Another issue that is now well known is that obesity increases the risk of birth defects and targeted ultrasound is indicated. Due to the complexity of the ultrasound required and the common need for advanced equipment, this procedure should be performed by a maternal fetal medicine specialist or the rare obstetric provider with specific specialized training- (http://www.jultrasoundmed.org/content/33/2/189.full.pdf+html see page 190 under training). Obesity also changes the goals for weight gain during pregnancy (http://iom.edu/~/media/Files/Report%20Files/2009/Weight-Gain-During-Pregnancy-Reexamining-the-Guidelines/Resource%20Page%20-%20Weight%20Gain%20During%20Pregnancy.pdf)

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