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Peripartum care and obesity: A scoping review of evidence-based recommendations and practical modalities for implementation

      Objective

      Despite the growing prevalence of obesity among reproductive aged individuals in the U.S., evidence-based guidelines for peripartum care are lacking. The objective of this scoping review is to identify obesity-related recommendations for peripartum care, evaluate grades of evidence for each recommendation, and identify practical modalities (e.g., checklists, toolkits, care pathways, bundles) to support their implementation in clinical practice.

      Study Design

      We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to December 2020 for eligible studies addressing peripartum care in individuals with obesity. Inclusion criteria were published evidence-graded recommendations and practical modalities for peripartum care of individuals with obesity. Data were extracted by pairs of independent reviewers and a third reviewer resolved any conflicts.

      Results

      Of the 18,315 screened articles, 10 met inclusion criteria including 7 evidence-rated articles and 3 practical modalities (2 checklists and 1 care bundles). Content focused exclusively on peripartum management of individuals with obesity or addressed high-risk conditions during pregnancy, inclusive of those posed by obesity. Thirteen recommendations were based on expert opinion. Recommendations related to surgical antibiotic prophylaxis and subcutaneous tissue closure at the time of cesarean delivery (CD) received the highest-grade of evidence (Table 1). The practical modalities were a checklist from the US regarding anticoagulation after CD (evidence supported recommendation), a bundle for surgical site infections after CD in Australia (evidence did not support recommendation), and a checklist with 20 items for several aspects of peripartum care from Canada (evidence supported >50% of recommendations).

      Conclusion

      The recommendations for peripartum care for individuals with obesity are based on limited evidence and few practical modalities for implementation exist. Future work should focus on developing practical modalities based on high quality studies.
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