6.2.3 Maternal Obesity - Exam Flashcards
Antenatal care
- Healthy diet
- light exercise
- QUIT education/resources if a smoker
- growth scans
- Diabetic Nurse Educator if OGTT +
- LDA if fits hospital policy
Antenatal
- early OGTT 20 week repeat 28 weeks if negative
- growth scans
-hard to do fundal height
-Obstetrician care
What is the relevance of calculating BMI in pregnancy
Why is booking BMI calculated and why
- determine risk of pregnancy associated risks factors
- education re diet, excerise
- Monitor weight gain
- Ability for VBAC
- Location of hospital and midwifery care v obstetrics care
Women who have high BMI are consider for early diabetes screening explain why
- higher association with GDM due to insulin resistance
Why do women with obesity have early testing for diabetes in pregnancy and when is appropriate
- to assess for undiagnosed of existing diabetes
- higher risk of gestational diabetes
- earlier identification earlier treatment and management
- early testing can be done through HbA1c
- fasting glucose check
- random glucose from early pregnancy
- urine testing
- early testing can dependant on phx family hx
Why should women with obesity be formerly assessed for VTE?
Higher risk of DVT due to decreased mobility, high bmi
Why should women with a high BMI be offered dietary advice, appropriate weight gain in pregnancy and what is suggested weight gain
Overweight BMI > 25 tp 29.9 - 6.8 to 11.3 kilo weight gain
Obese BMI > 30 - 5 to 9 kilo weight gain
- High risker of complications
- Antenatal
- unable to measure fundal height
- growth scans difficult can not see through adipose tissue & uterus (can challenge decision making)
- miscarriage
- Diabetes
- pre eclampsia
- Fetal congenital abnormalities
- thromembolism
- preterm labour
Intrapartum
- GTC monitoring maybe difficult
- monitor contractions difficult
- Option fetal scalp clip to monitor fetal heart rate
- can use intra-uterine pressure oxymontior
- IOL
- instrumental birth
- CS
- shoulder dystocia
Postpartum
- breast feeding
- wound healing/infection
- fundal rub or postnatal fundus check
Consider timing of birth and postnatal care for ^bmi
What is the recommended weight gain for women with obesity in pregnancy
Overweight BMI > 25 to 29.9 - 6.8kg to 11.3kg kilo weight gain
Obese BMI > 30 - 5kg to 9kg kilo weight gain
- High risker of complications
How to calculate BMI
Body Mass Index is a simple calculation using a person’s height and weight. The formula is BMI = kg/m2 where kg is a person’s weight in kilograms and m2 is their height in metres squared
M2 is height x height ie
1.48 x 1.48 = 2.19
55/2.19 = 25.11
Management during pregnancy
-lifestyle changes are imperative
education re weight gain
- Healthy eating during pregnancy
- diet - high in fibre, fresh fruit and vegetable, complex carb & protein
- avoid junk food
- dietician referral early
- vitamins such as Vit b12 and (higher dose) Folate (nutrient deficiency)
- can be vit d deficiency
- vit d <29.9 600iu per day
- vit d >3O 1000iu per day
- Folic acid BMI <29.9 400ug
- Folic acid BMI >30 5000ug per day
- gentle exercises
- risk of Neural Tube Defects increase due to nutrient deficiency
Which multi-disciplinary team members may also be involved in the woman’s pregnancy, Intrapartum, and postpartum
A multi-disciplinary team would be involved:
- midwife
- OBGYN
- diabetic nurse educator
- dietician
- Lactation consultant - anaesthesia - re pain relief, spinal or epi etc
- Physiotherapy
- referral to a tertiary centre due to >BMI
- endocrinologist
Women with a bmi >30 should have a gestational weight gain of
5kg to 9.1 kg
The timing for delivery for women with BMI >40
38 - 39 Weeks
