Do pregnant women with a height below 150cm require earlier registration for prenatal care?

Maternal Height Below 150cm and Early Prenatal Registration

Pregnant women with height below 150cm should register for prenatal care as early as possible, ideally before 10 weeks gestation, due to their increased risk of cesarean delivery and potential cephalopelvic disproportion, though they do not require specialized referral based on height alone unless combined with other high-risk factors.

Risk Profile for Short Stature

Women below 150cm height face specific obstetric challenges that warrant early engagement with prenatal care:

• Cesarean section rates are significantly elevated in very short women (122-136cm) at 43%, compared to 35% in women 137-151cm tall and 23% in women 160cm tall 1
• Short stature (≤150cm) identifies approximately 71% of women who may develop cephalopelvic disproportion, making this a clinically relevant screening threshold 2
• Women below 150cm should be considered at higher risk for failing spontaneous vaginal delivery and benefit from delivery planning at facilities equipped for cesarean section 2

Timing of Prenatal Registration

Early prenatal care initiation is critical for all women, with particular importance for those with risk factors:

• Care initiated at 10 weeks or earlier improves pregnancy outcomes across all populations 3
• Early registration allows for comprehensive risk assessment and appropriate care pathway determination 4
• Height should be recorded at the initial prenatal visit to calculate BMI and identify women requiring enhanced monitoring 5

When Specialist Referral Is Indicated

Height alone does not trigger automatic specialist referral before 20 weeks, according to established pre-eclampsia risk stratification 6, 4. However, referral before 20 weeks is indicated when short stature is combined with:

• Previous pre-eclampsia 6, 4
• Multiple pregnancy 6, 4
• Pre-existing hypertension or booking diastolic BP ≥90 mmHg 6, 4
• Pre-existing renal disease or significant proteinuria 6, 4
• Pre-existing diabetes 6, 4
• Presence of antiphospholipid antibodies 6, 4
• Any two other risk factors from standard risk assessment 6

Monitoring Approach for Short Women

Women below 150cm without additional high-risk factors should follow standard prenatal monitoring schedules but with heightened awareness of delivery planning needs:

• Standard antenatal visits per local protocols if no other risk factors present 6, 4
• Assessment every 3 weeks maximum between 24-32 weeks if one additional risk factor present 6, 4
• Assessment every 2 weeks maximum from 32 weeks to delivery if one additional risk factor present 6, 4
• Delivery should be planned at facilities capable of performing cesarean section given the elevated risk 2

Age-Specific Considerations

The combination of short stature with extremes of maternal age significantly increases cesarean risk:

• Women ≤150cm who are under 19 years old have significantly higher cesarean rates (P<0.05) 7
• Women ≤150cm who are over 39 years old also have significantly higher cesarean rates (P<0.05) 7
• Advanced maternal age (≥40 years) alone carries a relative risk of 1.68-1.96 for pre-eclampsia 8, 4

Common Pitfalls to Avoid

Do not automatically classify short stature as requiring high-risk obstetric care - height below 150cm is a risk marker but not an absolute indication for specialist management unless combined with other factors 7. The key is early registration to allow proper risk stratification and delivery planning, not automatic escalation of care level.

Ensure delivery planning occurs well before term - the primary concern is access to cesarean capability when needed, not necessarily preventing cesarean delivery 1, 2.