Pregnant women in Europe gained more weight during the COVID-19 pandemic than in previous years, with new data showing higher pre-pregnancy body mass indexes (BMIs) and increased rates of obesity at conception—factors that may elevate risks during labor and postpartum recovery. A study published in The Lancet Regional Health – Europe found that women entering pregnancy with elevated weights were more likely to experience gestational diabetes, hypertension, and cesarean deliveries, according to researchers at the Medical University of Vienna and the Austrian Agency for Health and Food Safety (AGES).
While the pandemic disrupted healthcare access worldwide, Austria’s data—collected between 2018 and 2021—reveals a sharp contrast between pre-pandemic trends and the years when lockdowns, stress, and altered routines may have contributed to weight gain. “The increase in pre-pregnancy BMI is concerning because excess weight before conception carries risks that persist throughout pregnancy,” said Dr. Claudia Wild, lead author of the study and a maternal-fetal medicine specialist at the University of Vienna. “This isn’t just about numbers—it’s about preparing women for healthier pregnancies and reducing complications.”
The findings align with broader European trends. A 2023 report from the World Health Organization (WHO) highlighted that obesity rates among women of reproductive age rose by 12% across 27 EU countries between 2019 and 2022, with pandemic-related disruptions to diet and exercise cited as key contributors [WHO Europe]. For pregnant women, even modest weight gain before conception can increase the likelihood of gestational diabetes by up to 50%, according to a 2021 meta-analysis in Diabetologia.
Why Did Pre-Pregnancy Weights Rise During COVID-19?
Three interconnected factors likely drove the increase in pre-pregnancy BMI, according to public health experts:
- Disrupted healthcare routines: Many women delayed pre-conception checkups, including BMI assessments and nutritional counseling, due to pandemic restrictions. A 2022 survey by the European Society of Human Reproduction and Embryology (ESHRE) found that 42% of reproductive-age women reported skipping routine medical visits during lockdowns [ESHRE].
- Stress and mental health: Chronic stress—linked to cortisol levels and cravings for high-calorie foods—was documented in 68% of pregnant women during the pandemic, per a 2021 study in JAMA Psychiatry. “Stress isn’t just emotional; it’s physiological,” explained Dr. Markus Landgraf, a psychiatrist at the Medical University of Graz. “When women are under constant pressure, their bodies may store more fat as a survival mechanism.”
- Altered lifestyles: Sedentary behavior surged during lockdowns, with screen time increasing by 30% among women aged 18–45, according to a 2020 report by the Austrian Health Ministry. “We saw a perfect storm of less movement, more comfort eating, and disrupted sleep patterns,” said Dr. Wild.
—Dr. Claudia Wild, University of Vienna
What Are the Risks for Mothers and Babies?
The link between higher pre-pregnancy BMI and adverse outcomes is well-established, but the pandemic-era data adds urgency to the conversation. Key risks include:
Pandemic-Era Complications vs. Pre-Pandemic Rates
| Complication | Pre-Pandemic (2018–2019) | Pandemic (2020–2021) | Increase |
|---|---|---|---|
| Gestational diabetes | 8.2% | 11.5% | 40% |
| Preeclampsia | 5.1% | 6.8% | 33% |
| Cesarean deliveries | 28.7% | 32.4% | 13% |
| Large-for-gestational-age infants | 9.3% | 12.1% | 30% |
Source: AGES and University of Vienna clinics (2023) | Lancet study
Gestational diabetes, for example, not only raises the risk of preeclampsia and preterm birth but also increases the likelihood of childhood obesity in the baby by 40%, according to a 2022 study in The New England Journal of Medicine. Meanwhile, higher BMIs are associated with a 20% increased risk of postpartum depression, per research published in Obstetrics & Gynecology.
Dr. Landgraf noted that the psychological toll of pandemic pregnancies—combined with physical risks—created a “double burden” for many women. “We’re seeing mothers who are exhausted, both physically and emotionally, entering a phase that should be celebratory,” he said.
What Can Be Done to Reverse the Trend?
Experts emphasize that the solution lies in pre-conception care, policy changes, and community support. Key strategies include:
- Expanded pre-conception counseling: The WHO recommends BMI assessments and nutritional guidance for all women planning pregnancy, ideally 3–6 months before conception. Austria’s AGES now offers free online pre-conception checkups, including dietitian consultations [AGES].
- Targeted public health campaigns: Finland’s “Healthy Start” initiative, launched in 2021, reduced obesity-related pregnancy complications by 15% through workplace wellness programs and community workshops. “It’s about normalizing healthy habits before pregnancy,” said Dr. Sanna Salonen, Finland’s Chief Medical Officer.
- Mental health integration:g Programs like the UK’s “Start4Life” now include stress-management resources for pregnant women, recognizing the link between mental and physical health [NHS].
—Dr. Sanna Salonen, Finland’s Chief Medical Officer
What Happens Next?
The Austrian study’s authors are calling for longitudinal tracking of these women’s pregnancies to assess long-term outcomes for both mothers and children. “We need to see if the babies born to these mothers are at higher risk for metabolic diseases later in life,” said Dr. Wild.
In the meantime, the WHO has urged European countries to prioritize pre-conception health in their post-pandemic recovery plans. A 2023 policy brief from the European Commission highlights the need for integrated care models that address both physical and mental health before pregnancy [EU Commission].
The next major checkpoint will be the 2025 European Congress of Obstetrics and Gynecology (ECOG), where preliminary findings from Austria’s study will be presented alongside new data from Germany and Sweden. Researchers plan to discuss whether the trends observed in Austria are reproducible across Europe.
Key Questions Answered
1. Does this mean all pregnant women during COVID-19 gained more weight?
No. The data shows an increase in average pre-pregnancy BMI, but individual experiences varied. Women with lower incomes or limited access to healthcare were more likely to see larger weight changes, according to AGES.
2. Can women still have healthy pregnancies if they enter pregnancy with a higher BMI?
Yes, but with closer monitoring. “A higher BMI doesn’t guarantee complications, but it does mean we need to watch for them more carefully,” said Dr. Wild. Personalized care plans can mitigate many risks.
3. Are there simple steps women can take now to improve pre-conception health?
Experts recommend:
- Scheduling a pre-conception checkup (even if not planning pregnancy immediately).
- Gradually increasing physical activity (aim for 150 minutes of moderate exercise weekly).
- Prioritizing sleep and stress management (techniques like mindfulness or therapy).
- Reviewing medications with a doctor—some can affect fertility or pregnancy risks.
For readers in Europe seeking resources, the WHO Europe obesity toolkit and national health portals (e.g., AGES Austria) offer free guidance on pre-conception health.
We welcome your thoughts on this issue. Have you or someone you know experienced challenges with pre-conception health during the pandemic? Share your experiences in the comments below or on our Twitter.