High BMI In Pregnancy Flashcards
Obesity definition
Abnormal or excessive fat accumulation that presents a a risk to health
What is bmi
Measure of body fate based on height and weight
Cannot tell difeeernece between muscle and fat
What does obesity increase
Increases likelihood of developing various heart problems, including heart disease, type 2 diabetes, certain cancers and musculoskeletal disorders
How does it support babys growth and development
proper nutrition provides essential nutrient like folic acids and calcium, iron and protein which are vital for the development of the babys brain, bones ad overall bone structure
How does it reduce birth defects
Folate reduces neural tube defects like spinal bifida
Adequate iodine intake is also critical for healthy brain development
How does it maintain maternal health
Heathy diet can reduce pregnancy related complications such as anaemia, high blood pressure and estational diabetes
Also helps mum recover faster after childbirth
How does it promote healthy weight gain
Balance nutrition helps the mother gain the right amount of weight which is essential for the baby’s healthy birth weight whil reducing the risk of delivery complications
How does it boos energy levels
Pregnancy can b physically taxing
A well rounded diet provides the energy and nutrient needed to support bods increases demands
How does it support immune function
Vitamins and minerals from a nutritious diet. Help strengthen both the mothers and babys immune system reducing te risk of infection
How does it have one term benefits for the babay
Good parental neutrino can influence the babys health throughout the life potentially reducing the risk of chronic conditions such as obesity, diabetes and heart disease
Folic acid supplementaon
All women from when they begin trying to conceive until 12 weeks should take folic acid (400 μg daily)
Women who have had. Fetus diagnosed as affected by a neural tube defects like or have given birth to a baby with a neural tube defects like or should be offered high dose supplementation 5mg daily
Antenatal care pathway 14-16weeks
Weight
BMI
Health eating and safe exercise inn pregnancy discsssed
Healthy weight gain in pregnancy discussed (5-9kg)
- referral to wight management programme
Raised BMi risk factors discussed - HTN,GDM,VTE
- folic acid recommend 5mg daily to 12/14 weeks
Vit D recommended 100mvg booking to delivery and PN if breastfeeding
- aspirin 150mg prophylaxis 12 to 36 weeks
Gtt - 26-28 weeks ( +16-18 weeks if BMI 45 or above and repeat at 26-28 weeks
BP monitoring recommended every 2 weeks from 28 weeks and weekly from 36 weeks
Vaccination - recommend Covid 19 , influenza, RSV, whooping ough
VTE score
PLAN
If VTE score >3 H&W virtual ANC at 28 weeks to review VTE score +/- commence
Anaesthetic review
Serial growth scans asp per UHL policy
Obstretric review at 36-37 weeks and bariatric assssment if BMI >50 or weight >140kg
Aspirin in pregnancy
Women with one of theses risk factors hypertension in prev pregnancy requiring medication, type 1 or 2 diabetes or auto immune system or chronic hypertension should be advised to take aspirin 150mgs daily from 12 weeks until 36 weeks ‘
Women with more than one of theses risk factors for pre eclampsia should advise to take 150mgs of aspirin daily from 12 weeks until 36
- first ongoing pregnancy
Aged over 40 or over at booking
Pregnancy interva of 10 years or more
Body mass index equal o greater than 35
Family history of pre eclampsia
Multiple pregnancy
Women with the following ris should be Alamo commence aspirin 150mg daily until 36 weeks -
Previous fetal death econdru top placental mediated restriction
Previous infant who birthweight was less than 10th cetntile on a customised flow chart
PAPP- A <0.41 moms
Weight management programme for county areas
Healthy lifestyle in pregnancy service
Service for women who are pregnancy supporting them to achieve a healthy lifestyle
Emphasis on deity quality not weight loss
Women supported by qualified pubic health nutritionist who will provide 12 weeks of one to one support focusing on different topics such as Eatwell guide, portion sizing, benefits of physical activity, reading food labels and howto reduce fat and sugar intake
As a pilot women will. Get 4 veneer food boxes full of fresh fruit sand beg and other nutrional products deleivered to their doos to promote eating 5 a day
Need to be referred by midwife
Criteria
- 18 or over at booking
- resident of Leicestershire
- bmi of 30 or over - 27.5 BAME - due to higher risk of conditions such as gdm and type 2 diabetes and CVD
- if they have health issue such as gdm the condition should be well manages
28 week plan
VTE score review
Check if had vaccines
PLAN
Commence AN ennoxapiarin
Recommend postnatal enoxaparin
Ensure appropriate hydration at least 2l of fluids
Try to give the same time every day
Incensed to be given abdominallybut if relecuctant to give this way top of thigh acceptable
If SROM or contractions do not adminster enoxoparin
Stop 24hrs prior to ELCS or IOL
36-37 weeks
Weight
BMI
Reviewed USS - normal growth and Doppler
Discussed obstretric and neonatal risks associated with raised BMI from UHL data
Increased risk of stillbirth ( 5 fold increase if BMI>50)
MOD
- SVD - 40%
- IVD_5%
-C section rate 55%
- EMCS - >50% if BMI >50
- ELCS 30%
Increased risk of PPH
- bmi>40 = or >1.4
BMI >45+ 2-4 fold increase
HDY/ICU admission risk increases with increased bmi
NICU admission risk increase with increased bmi
>20% re admission with wound infection ( 85% had CS, ELCS>EMCS)
30% returned <12/12 with subsequent pregnancy
Delivery plans for SVD
Discuss
For SVd
- continous CTG in labour
Early venous access
Scan on admission in labour if concerned on presentation
Inform anaesthetic team upon arrival
Early consideration for antacid prophylaxis
Early consideration for regional analgesia
Activ management of third stage
For IVD or CS
Alert theatre. Staff regarding any women whose wight >140kg requires operative ntervention in theatre
Incision site
Antibiotic prophalyxis - consider route and dosage
Wound care
Considerations for special bariatric equipment
Bariatric ted stoking
Hover mattress
Oxford pill
Long spina epidural needles
Alexis-o retractor
TRAXI for women bmi > 50
PN care
Enoxaparin 7 days/6 weeks
Recommended vit k
Recommend breastfeeding - vit d recommended
Discussed appropriate pregnancy spacing
Discussed contraception
Discuss increase risk of endometrial CA with raised bmi
Barriers to women and engaging with restyle and public earth changes
Embarrassment
Fear on contraction
Spoiling an already positive relationship
Own beliefs
Previous experience
Feeling that you can’t influence change anyway
Bariatric surgery
Becoming increasingly performed prior o pregnancy for women with raised bmi
Many unplanned pregnancies due to rapid return to fertility with initial weight loss
In uk >20000 bariatric surgical procedure were preformed in 2012-16
Eligibility of undergoing surgery included them with bmi >40 or bmi >30 who have co morbidities such as diabetes or hypertension
Bariatric a tie nest need specialised care throughout pregnancy, Intrapartum and the postnatal period to manageable increased risk of endometrial benefits of the surgery included them with a reduced risk os gestational diabetes and hypertension and also reduction in risk of preterm birth
Addition risk factors in pregancy following bariatric surgery
Increased risk of maternal micronutrient defiency, iron or B12 defiency anaemia, complex psychological issues, surgical complications
Increased risk of of fetal anaomlaies especially ntd
Increased risk of SGA
Increased risk of preterm birth
Increased risk of perinatal mortality
Recommendations to avoid pregnancy for 12-24 months following any batriatric surgical procedure
Women are advised to use long acting reversible contraception such as coil r implant oral contraceptives are less effective due to malabsorption
Additional booking blood test Bly if undergone bariatric surgery — haematinics ( ferritin, folate, vit B12)
LFTS,U&Es, vit A,B,D each trimester
