Endocrine and Metabolic Disorders in Pregnancy Flashcards
How is obesity defined in pregnancy?
Obesity is defined as a body mass index (BMI) of 30 or higher at the first antenatal booking.
How is obesity classified based on BMI?
Class 1: BMI 30–34.9
Class 2: BMI 35–39.9
Class 3 (morbid obesity): BMI ≥ 40
Why is obesity in pregnancy significant?
It is increasingly common and is associated with increased maternal and fetal complications.
What are the maternal risks associated with obesity in pregnancy?
Gestational diabetes.
Hypertensive disorders (e.g., preeclampsia).
Miscarriage and stillbirth.
Difficulties in monitoring fetal growth and health.
Increased cesarean section rates and surgical complications.
Postpartum complications (e.g., infection, thrombosis).
What are the fetal risks associated with maternal obesity?
Macrosomia (large for gestational age).
Increased risk of birth injuries (e.g., shoulder dystocia).
Congenital anomalies (e.g., neural tube defects).
Prematurity.
Higher risk of obesity and metabolic syndrome later in life.
What advice should be given to women with obesity planning pregnancy?
Aim for weight loss before conception.
Encourage a balanced diet and regular exercise.
Consider folic acid supplementation: High-dose (5 mg/day).
Optimize management of comorbidities (e.g., diabetes, hypertension).
What are key aspects of antenatal care for women with obesity?
Early screening for gestational diabetes.
Regular ultrasound scans to monitor fetal growth.
Anesthetic review if BMI > 40.
Thromboprophylaxis with low molecular weight heparin (if indicated).
Monitor for hypertension and other complications.
Women with obesity in pregnancy should receive high-dose __________ supplementation to reduce the risk of neural tube defects.
Folic acid
What are the key considerations for intrapartum care in women with obesity?
Increased risk of cesarean section and prolonged labor.
Difficulty with epidural placement or general anesthesia.
Risk of postpartum hemorrhage (PPH).
Ensure availability of appropriate equipment (e.g., beds, operating tables).
What are the postpartum considerations for women with obesity?
Increased risk of thromboembolic events.
Higher risk of infection (e.g., wound infections).
Support with breastfeeding, as obesity may reduce milk production.
Encourage long-term weight loss and management of comorbidities.
True/False
Q: Obesity in pregnancy increases the risk of macrosomia and shoulder dystocia.
true.
A 32-year-old pregnant woman with a BMI of 35 attends her booking visit. What additional care should be provided?
Screen for gestational diabetes early (and repeat at 24–28 weeks if negative).
Recommend high-dose folic acid (5 mg/day).
Plan for regular growth scans in the third trimester.
Discuss risks of obesity and encourage healthy lifestyle changes.
Women with a BMI ≥ _________ should be referred for an anesthetic review during pregnancy.
40
What is Gestational Diabetes Mellitus (GDM)?
Chronic hyperglycemia and insulin resistance due to pregnancy.
What stimulates peripheral insulin resistance in normal pregnancy?
Local and placental hormones.
What is the purpose of peripheral insulin resistance?
- the purpose of this is to spare glucose for delivery to the developing foetus
What else increases free fatty acids and glucose levels?
lipolysis and gluconeogenesis
What happens to pancreatic beta-cells in GDM?
Hypertrophy and hyperplasia occur.
What is the purpose of hypertrophy and hyperplasia of pancreatic beta cells?
to protect maternal glucose homeostasis
What leads to Gestational Diabetes Mellitus (GDM)?
Beta-cell dysfunction + insulin resistance
What is a maternal complication of GDM?
Pre-eclampsia, T2DM, Increased risk of CVD
What is the increased risk of chronic type 2 diabetes after GDM?
0.6
Name some foetal complications of GDM?
Macrosomia, Neonatal hypoglycaemia, childhood obesity, increased risk of metabolic syndrome + associated complications in later life
What foetal complication is caused by macrosomia?
Shoulder dystocia
