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Practice bulletins > #156 Obesity in Pregnancy > Flashcards

#156 Obesity in Pregnancy Flashcards

1
Q

What is the most common health care problem in women of reproductive age?

A

Obesity

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2
Q

What is the prevalence of obesity in women of reproductive age (20-39yo) in US?

A

31.8%

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3
Q

What is the prevalence of overweight and obese women of reproductive age (20-39) in US?

A

58.5%

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4
Q

What is BMI range for underweight category?

A

Less than 18.5

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5
Q

What is BMI range for normal weight category?

A

18.5-24.9

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6
Q

What is BMI range for overweight category?

A

25-29.9

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7
Q

What is BMI range for obesity class I category?

A

30-34.9

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8
Q

What is BMI range for obesity class II category?

A

35-39.9

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9
Q

What is BMI range for obesity class III category?

A

40 or greater

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10
Q

Does obesity affect risk of pregnancy loss? If so, how?

A

Increased risk of spontaneous abortion and recurrent miscarriage. 40% more likely to experience stillbirth.

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11
Q

Does obesity affect risk of congenital anomalies? If so, which ones?

A

Increased risk of pregnancies affected by neural tube defects (spina bifida); hydrocephaly; and cardiovascular, septal anomalies, orofacial (cleft lip and palate), anorectal atresia, and limb reduction anomalies.

Decreased risk of gastroschisis

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12
Q

Are obese women at greater risk of preeclampsia?

A

Yes

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13
Q

Are obese women at greater risk of gestational diabetes?

A

Yes

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14
Q

Area obese women at greater risk of proteinuria?

A

Yes

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15
Q

True or false, black obese gravidas have higher risk of stillbirth compared with white obese gravidas?

A

True

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16
Q

True or false: Obesity increases risk of fetal death, stillbirth, perinatal death, neonatal death, and infant death

A

True

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17
Q

What intrapartum complications are obese women at greater risk for?

A

Increased risk of cesarean delivery, failed TOLAC, endometritis, wound rupture or dehiscence, VTE

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18
Q

Is pregravid obesity associated with depression?

A

Yes, increased risk of depression

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19
Q

How is pregravid obesity associated with breastfeeding?

A

Associated with early termination of breastfeeding

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20
Q

Is pregravid obesity associated with higher or lower postpartum H&H?

A

Associated with postpartum anemia

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21
Q

What percentage of obese pregnant women have gestational weight gain in excess of IOM weight gain guidelines?

A

46%

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22
Q

How does growth of fetuses of obese gravidas compare to fetuses of normal weight gravidas?

A

Increased risk of macrosomia and impaired growth

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23
Q

What are long-term risks of offspring of obese women?

A

Increased risk of metabolic syndrome and childhood obesity. Also associated with childhood asthma, increased risk of autism spectrum disorders, developmental delay, and ADHD (although many confounding factors)

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24
Q

What is the most effective intervention to improve medical comorbidities of obese women planning pregnancy?

A

Weight loss before pregnancy

25
Q

Are medications for weight management recommended during the time of conception or during pregnancy?

A

No

26
Q

What are the primary weight management strategies used during pregnancy?

A

Dietary control, exercise, and behavioral modification

27
Q

BMI calculated at what time (prepregnancy, initial prenatal, 1st, 2nd, or third tri) should be used to counsel on appropriate weight gain?

A

Prepregnancy BMI should be used to provide diet and exercise counseling by IOM recomendations; if this info not available, BMI at first prenatal visit should be used

28
Q

What are the IOM recommendations for weight gain for underweight BMI?

A

28-40lbs

29
Q

What are the IOM recommendations for weight gain for normal BMI?

A

25-35

30
Q

What are the IOM recommendations for weight gain for overweight BMI?

A

15-25

31
Q

What are the IOM recommendations for weight gain for obese (all classes) BMI?

A

11-20

32
Q

What are the IOM recommendations for weight gain in 2nd and 3rd trimester (lbs/wk) for underweight BMI?

A

1 (1-1.3)lbs/wk

33
Q

What are the IOM recommendations for weight gain in 2nd and 3rd trimester (lbs/wk) for normal BMI?

A

1 (0.8-1)lbs/wk

34
Q

What are the IOM recommendations for weight gain in 2nd and 3rd trimester (lbs/wk) for overweight BMI?

A

0.6 (0.5-0.7)lbs/wk

35
Q

What are the IOM recommendations for weight gain in 2nd and 3rd trimester (lbs/wk) for obese (all classes) BMI?

A

0.5 (0.4-0.6)lbs/wk

36
Q

What fetal outcome(s) are associated with inadquate weight gain and gestational weight loss in obese pregnant women?

A

Increased risk of SGA

37
Q

How does detection of fetal anomalies by ultrasound change with increasing BMI?

A

Decreases with increasing maternal BMI by at least 20% in obese women compared with normal-weight women.

38
Q

What are potential means to optimize ultrasound image quality in obese pregnant women?

A

Transvaginal approach in first trimester. Using maternal umbilicus as an acoustic window. Tissue harmonic imaging.

Can do fetal MRI, but limited use because of cost and availability

39
Q

Detection of which ultrasound markers for aneuploidy are not altered by BMI?

A

increased nuchal fold, echogenic bowel, and echogenic cardiac focus

40
Q

Does maternal obesity affect measures of serum analytes for neural tube defect and aneuploidy screening?

A

Yes. Weight adjustments for analytes improve detection of neural tube defects and trisomy 18, the adjustment does not improve detection of Down syndrome

41
Q

True or false: obese women should be screened for glucose intolerance and OSA at the first antenatal visit?

A

True

42
Q

What patient history is concerning for OSA?

A

snoring, excessive daytime sleepiness, witnessed apneas, or unexplained hypoxia

43
Q

Compared to women without OSA, women with OSA are more likely to experience what pregnancy complications?

A

Preeclampsia, eclampsia, cardiomyopathy, pulmonary embolism, in-hospital morality

44
Q

Should obese women undergo routine antepartum fetal surveillance?

A

Recommendation cannot be made for or against routine antepartum fetal surveillance in obese women

45
Q

Is maternal obesity an indication for induction of labor?

A

No

46
Q

Are obese women at increased risk of a prolonged pregnancy?

A

Yes, and have increased rate of labor induction

47
Q

Is increased maternal BMI associated with longer or shorter labor?

A

Longer. Longer first stage of labor, does not affect 2nd stage

48
Q

Does BMI affect success rates of VBAC? How?

A

Yes. Normal BMI has success rate ~80%. BMI > 29 has success rate 68%

49
Q

Do women with class III obesity have increased risk of PPH after vaginal and/or cesarean delivery?

A

Increased risk of postpartum atonic hemorrhage after vaginal delivery (5.2%), but not after cesarean

50
Q

What should be considered regarding labor analgesia in obese women?

A

Higher risk of epidural analgesic failure. More technically difficult to place. Early epidural placement should be considered as may reduce decision-to-incision interval for emergency CS. Higher rates of hypotension with prolonged fetal heart decels after placement.

51
Q

At what weight should you consider a 3g ancef does?

A

> 120kg (265lbs), although there is lack of evidence

52
Q

What is the optimal skin incision for primary cesarean section in women with class II and III obesity?

A

Has not been determined. Transverse and vertical both acceptable. Can consider supraumbilical incision in women with large panniculus.

53
Q

During closure of cesarean section, what is recommendations regarding subcutaneous tissue?

A

Closure of subcutaneous tissue with a depth greater than 2cm significant decrease incidence of wound disruption. Do not routinely use subcutaneous drains

54
Q

If using LMW heparin for VTE prophylaxis in obese women after cesarean section, how much should you use?

A

Results of one study suggest that weight-based dosage may be more effective than BMI-stratified dosage. (0.5mg/kg enoxaparin q12hrs)

55
Q

What is the rate of surgical site infection after cesarean delivery?

A

Up to 18.4%

56
Q

Does obesity affect risk of surgical site infection after cesarean delivery?

A

Yes, increases risk of infection

57
Q

True or false: excessive gestational weight gain is associated with short-term and long-term postpartum weight retention?

A

True

58
Q

What outcomes are associated with subcutaneous drains placed at time of cesarean section?

A

Increased risk of wound complications

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