EASO Position Statement: Women with Obesity across the Reproductive Life - Fertility, Preconception, Pregnancy, Postpartum, and Breastfeeding.

Background: Obesity management in women presents distinct challenges across their lifespan. However, there is limited evidence or recommendations focused solely on women living with obesity.

Summary: This European Association for the Study of Obesity (EASO) position statement is based on an expert comprehensive review and summary of the available scientific evidence on women living with obesity. It aims to guide the health and medical assessment of these women during their reproductive life (fertility, preconception, pregnancy, postpartum, and breastfeeding).

Key messages: 1. To better diagnose obesity in women beyond BMI, the use of at least one additional anthropometric measure, like waist-to-height ratio (WHtR), is strongly recommended. When available, the use of bioelectrical impedance vector analysis is encouraged. 2. Women with obesity should be offered obesity management counseling and psychological support. 3. Obesity can negatively impact fertility; weight loss of 5-10% over 6 months improves fertility. 4. In women with Polycystic Ovary Syndrome (PCOS), treatment with metformin and GLP-1 receptor agonists or surgery can be considered. 5. Current recommendations for pregestational obesity suggest a gestational weight gain (GWG) of 5-9 kg. Lower GWG targets should be considered, particularly for class II or III obesity. 6. There is limited clinical data on the safety and efficacy of obesity medication during pregnancy or lactation. 7. All pregnant women with obesity should be offered prenatal screening for fetal anomalies, with discussion of the potential limitations of diagnostic tests and additional growth ultrasounds offered on an individual basis. 8. All pregnant women with a BMI ≥30 kg/m2 should be screened for gestational diabetes in early pregnancy. Measures to prevent preeclampsia should be taken and the need for thromboprophylaxis assessed. 9. Intrapartum fetal surveillance is recommended during active labor. 10. Postpartum weight management is needed to mitigate the risk of adverse outcomes for the mother and for subsequent pregnancies. The assessment of appropriate contraceptive methods during the postpartum and breastfeeding period is crucial.