2018 72 Obesity in Pregnancy

Question 1

** What conditions does weight loss reduce the risk of? **

Answer 1

Stillbirth
Hypertensive conditions
Fetal macrosomia
Chances of VBAC

Question 2

** What BMI triggers nutritional supplements & which ones? **

Answer 2

BMI ≥ 30
5mg folic acid (1 month pre-conception to end of 1st trimester)
Vitamin D

Question 3

Which women should have a moving & handling assessment?

Answer 3

All BMI ≥ 40
Some other individuals

Question 4

** What advice should be given to obese pregnant women? **

Answer 4

Risks & minimisation
Dietetic advice
Don’t use weight loss drugs

Question 5

** What risk assessments are needed in obesity in pregnancy? **

Answer 5

1. Anaesthetic assessment for BMI ≥ 40
2. Tissue viability
3. VTE

Question 6

** What maternal medicine conditions need to be considered in obesity? **

Answer 6

1. Gestational diabetes
2. Hypertension & PET
3. VTE
4. Mental health conditions

Question 7

** What are the moderate risk factors for pre-eclampsia? **

Answer 7

1. BMI ≥ 35
2. Primiparity
3. Maternal age > 40
4. Family history of PET
5. Multiple pregnancy

Question 8

** What are the special considerations for antenatal screening in obesity? **

Answer 8

1. Chromosomal screening less effective
2. TVUS may be better than TA for NT
3. Serial measurement of SFH from 24/40
4. Serial growth scans for BMI ≥ 35

Question 9

** When is IOL considered in obesity? **

Answer 9

1. At term to reduce risk of CS
2. Where macrosomia is suspected

Question 10

** What specific interventions in labour are needed in obesity? **

Answer 10

1. Inform anaesthetist of all class 3
2. Continuous midwifery care
3. Early venous access
4. Active management of 3rd stage

Question 11

** Which women should have suturing of the subcutaneous tissue? **

Answer 11

> 2cm subcutaneous fat

Question 12

** What are the postnatal considerations in obesity? **

Answer 12

1. Breastfeeding support
2. Appropriate contraception
3. Nutritional advice
4. Follow-up if GDM
5. Weight loss support

Question 13

** How is pregnancy managed after bariatric surgery? **

Answer 13

1. Minimum post-op time 12-18 months
2. Identify & treat nutritional deficiency
3. Consultant-led care as high risk
4. Dietician referral

Question 14

What are the BMI classifications?

Answer 14

<18.5 Underweight
18.5-25 Normal
25-30 Preobese
30-35 Obese class 1
35-40 Obese class 2
≥40 Obese class 3

Question 15

What proportion of the antenatal population are a) of normal BMI, b) obese?

Answer 15

a) 47%
b) 21%

Question 16

What maternal risks are increased with obesity in pregnancy?

Answer 16

1. Miscarriage
2. Gestational diabetes
3. Pre-eclampsia
4. VTE
5. IOL
6. Dysfunctional or prolonged labour
7. CS
8. Anaesthetic complications
9. PPH
10. Wound infections
11. Mortality

Question 17

What fetal risks are associated with obesity in pregnancy?

Answer 17

1. Congenital anomalies
2. Stillbirth
3. Prematurity
4. Macrosomia
5. Shoulder dystocia
6. NICU admission
7. Neonatal death
8. Childhood obesity & metabolic disorder

Question 18

What weight loss drugs are available, with what mechanisms of action?

Answer 18

1. Orlistat: lipase inhibitor
2. Phentermine/topiramate: reduce appetite
3. Lorcaserin: 5-HT2c agonist, promotes feeling of satiety

Question 19

Which fetal structural anomalies are more common in obesity?

Answer 19

1. Neural tube defects
2. Cardiovascular anomalies
3. Cleft lip & palate
4. Anorectal atresia
5. Hydrocephaly
6. Limb reduction anomalies