#156 Obesity in Pregnancy Flashcards
What is the most common health care problem in women of reproductive age?
Obesity
What is the prevalence of obesity in women of reproductive age (20-39yo) in US?
31.8%
What is the prevalence of overweight and obese women of reproductive age (20-39) in US?
58.5%
What is BMI range for underweight category?
Less than 18.5
What is BMI range for normal weight category?
18.5-24.9
What is BMI range for overweight category?
25-29.9
What is BMI range for obesity class I category?
30-34.9
What is BMI range for obesity class II category?
35-39.9
What is BMI range for obesity class III category?
40 or greater
Does obesity affect risk of pregnancy loss? If so, how?
Increased risk of spontaneous abortion and recurrent miscarriage. 40% more likely to experience stillbirth.
Does obesity affect risk of congenital anomalies? If so, which ones?
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
Are obese women at greater risk of preeclampsia?
Yes
Are obese women at greater risk of gestational diabetes?
Yes
Area obese women at greater risk of proteinuria?
Yes
True or false, black obese gravidas have higher risk of stillbirth compared with white obese gravidas?
True
True or false: Obesity increases risk of fetal death, stillbirth, perinatal death, neonatal death, and infant death
True
What intrapartum complications are obese women at greater risk for?
Increased risk of cesarean delivery, failed TOLAC, endometritis, wound rupture or dehiscence, VTE
Is pregravid obesity associated with depression?
Yes, increased risk of depression
How is pregravid obesity associated with breastfeeding?
Associated with early termination of breastfeeding
Is pregravid obesity associated with higher or lower postpartum H&H?
Associated with postpartum anemia
What percentage of obese pregnant women have gestational weight gain in excess of IOM weight gain guidelines?
46%
How does growth of fetuses of obese gravidas compare to fetuses of normal weight gravidas?
Increased risk of macrosomia and impaired growth
What are long-term risks of offspring of obese women?
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)
What is the most effective intervention to improve medical comorbidities of obese women planning pregnancy?
Weight loss before pregnancy
Are medications for weight management recommended during the time of conception or during pregnancy?
No
What are the primary weight management strategies used during pregnancy?
Dietary control, exercise, and behavioral modification
BMI calculated at what time (prepregnancy, initial prenatal, 1st, 2nd, or third tri) should be used to counsel on appropriate weight gain?
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
What are the IOM recommendations for weight gain for underweight BMI?
28-40lbs
What are the IOM recommendations for weight gain for normal BMI?
25-35
What are the IOM recommendations for weight gain for overweight BMI?
15-25
What are the IOM recommendations for weight gain for obese (all classes) BMI?
11-20
What are the IOM recommendations for weight gain in 2nd and 3rd trimester (lbs/wk) for underweight BMI?
1 (1-1.3)lbs/wk
What are the IOM recommendations for weight gain in 2nd and 3rd trimester (lbs/wk) for normal BMI?
1 (0.8-1)lbs/wk
What are the IOM recommendations for weight gain in 2nd and 3rd trimester (lbs/wk) for overweight BMI?
0.6 (0.5-0.7)lbs/wk
What are the IOM recommendations for weight gain in 2nd and 3rd trimester (lbs/wk) for obese (all classes) BMI?
0.5 (0.4-0.6)lbs/wk
What fetal outcome(s) are associated with inadquate weight gain and gestational weight loss in obese pregnant women?
Increased risk of SGA
How does detection of fetal anomalies by ultrasound change with increasing BMI?
Decreases with increasing maternal BMI by at least 20% in obese women compared with normal-weight women.
What are potential means to optimize ultrasound image quality in obese pregnant women?
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
Detection of which ultrasound markers for aneuploidy are not altered by BMI?
increased nuchal fold, echogenic bowel, and echogenic cardiac focus
Does maternal obesity affect measures of serum analytes for neural tube defect and aneuploidy screening?
Yes. Weight adjustments for analytes improve detection of neural tube defects and trisomy 18, the adjustment does not improve detection of Down syndrome
True or false: obese women should be screened for glucose intolerance and OSA at the first antenatal visit?
True
What patient history is concerning for OSA?
snoring, excessive daytime sleepiness, witnessed apneas, or unexplained hypoxia
Compared to women without OSA, women with OSA are more likely to experience what pregnancy complications?
Preeclampsia, eclampsia, cardiomyopathy, pulmonary embolism, in-hospital morality
Should obese women undergo routine antepartum fetal surveillance?
Recommendation cannot be made for or against routine antepartum fetal surveillance in obese women
Is maternal obesity an indication for induction of labor?
No
Are obese women at increased risk of a prolonged pregnancy?
Yes, and have increased rate of labor induction
Is increased maternal BMI associated with longer or shorter labor?
Longer. Longer first stage of labor, does not affect 2nd stage
Does BMI affect success rates of VBAC? How?
Yes. Normal BMI has success rate ~80%. BMI > 29 has success rate 68%
Do women with class III obesity have increased risk of PPH after vaginal and/or cesarean delivery?
Increased risk of postpartum atonic hemorrhage after vaginal delivery (5.2%), but not after cesarean
What should be considered regarding labor analgesia in obese women?
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.
At what weight should you consider a 3g ancef does?
> 120kg (265lbs), although there is lack of evidence
What is the optimal skin incision for primary cesarean section in women with class II and III obesity?
Has not been determined. Transverse and vertical both acceptable. Can consider supraumbilical incision in women with large panniculus.
During closure of cesarean section, what is recommendations regarding subcutaneous tissue?
Closure of subcutaneous tissue with a depth greater than 2cm significant decrease incidence of wound disruption. Do not routinely use subcutaneous drains
If using LMW heparin for VTE prophylaxis in obese women after cesarean section, how much should you use?
Results of one study suggest that weight-based dosage may be more effective than BMI-stratified dosage. (0.5mg/kg enoxaparin q12hrs)
What is the rate of surgical site infection after cesarean delivery?
Up to 18.4%
Does obesity affect risk of surgical site infection after cesarean delivery?
Yes, increases risk of infection
True or false: excessive gestational weight gain is associated with short-term and long-term postpartum weight retention?
True
What outcomes are associated with subcutaneous drains placed at time of cesarean section?
Increased risk of wound complications
