Dr. Marc Dommergues. We have already discussed several conditions and pregnancy. One of them is obesity, which is common around the world. Obesity is increasing. What are the nuances of managing pregnancy when a woman is obese? I am not sure these are truly new answers, at least from a French point of view. Dr. Marc Dommergues. We are not that much used to obesity as people in the United States. The most important thing is to welcome people with obesity. Do not consider them as guilty people who just come here to annoy doctors because they have a thick abdominal wall, and the Cesarean section is going to be difficult. Or the epidural anesthesia placement is going to be difficult. Dr. Marc Dommergues. Medical second opinion. And so on. Dr. Marc Dommergues. I don't know how it is in different countries, but this is a problem obese people report. They feel such attitudes, at least in our country. Probably this is something to do with the organization of care for obese pregnant women, at least in countries in which obesity is not so common. Dr. Anton Titov, MD. There are two levels of pregnancy care in obesity that can be considered very diagrammatically. The first level is the medical risk. This is related to the patient's BMI. Patient risks having complications of obesity, respiratory problems, diabetes, etc. In a BMI over 40, for example, there is an increased risk of anesthesia, risk of complications of delivery, risk of gestational diabetes, hypertension. Dr. Marc Dommergues. We know that all obstetrical complications are more common in obese pregnant women. One of the possible answers is to screen for the risk of complications. Also, it's possible to induce delivery early, for example, at 39 weeks of pregnancy, before those complications occur. Dr. Anton Titov, MD. There are some new accumulating data in recent years that shows that with a very high BMI inducing labor a little bit earlier than in women with normal weight can be useful to avoid complications. Of course, welcoming pregnant patients with obesity is very important. You probably need to have a maternity hospital with a sufficient number of pregnant women with a BMI over 40 so that all staff is trained to care for pregnant patients with obesity. This includes obstetricians, anesthesiologists, nurses, people who will carry the patient. Dr. Marc Dommergues. Medical second opinion. And talking about carrying an obese patient. BMI will help us determine the gross level of medical risk. But there is a logistical risk in obesity. It is related to the weight of the patient. This is something that one needs to consider, at least in countries, in which we are not very used to very heavy people. All logistics chain of patient care must be adapted to obese pregnant women. This includes chairs in the waiting room, examination tables, ultrasound table, delivery room table, blood pressure measuring cuffs, and so on. Dr. Marc Dommergues. We do not want to become stuck at a particular moment of patient care, because there is a problem with a patient's table or whatever device. Dr. Anton Titov, MD. So this is the logistics part of caring for pregnant women with obesity. It is very important. It's important to think about it beforehand to avoid situations, which are very painful for patients. At seven months of pregnancy, they are suddenly told, "Dear lady, you are too fat to be delivered here, go elsewhere." This is painful for the patients. It makes them have an extremely distressing feeling. Dr. Anton Titov, MD. So if there's a triage to be made, the earlier it's done, the better. If pregnant women with obesity are sent right away to a hospital where they are welcome, then things will be simple. Dr. Anton Titov, MD. So that's one point to make. Dr. Marc Dommergues. I have one thing about obesity to ask women to remember. Dr. Marc Dommergues. Were you obese in the past? Did you benefit from bariatric surgery? When you become pregnant, you often forget you had bariatric surgery ten years ago. But there's a major risk if you had obesity surgery and you become pregnant. You require vitamin therapy, and you need to continue this vitamin therapy or restart taking vitamins while you are pregnant. If you had bariatric surgery, and you consider pregnancy, please tell your nutrition doctor. Dr. Anton Titov, MD. So that she can check your vitamin levels and your vitamin requirements before you start a pregnancy. Of course, obesity is a significant and growing problem around the world. But it is very interesting that we're here in Paris, and in France, it is less of a problem. From a clinician's perspective and experience, what is it that France is doing, right? Why is there is less obesity here? I haven't got a clue, because I'm not a specialist in nutrition. Dr. Marc Dommergues. Medical second opinion. And , of course, being French, I will tell you that we probably eat better. But things are getting worse and worse. One of the reasons why things are getting worse and worse is that people are getting poorer and poorer, and they can get only food with very high energy density. This is a major problem, which is probably related to the fact that people are growing more and more poor these days in France.