Lecture 5 Flashcards
Maternal weight gain during pregnancy
(Twins) healthy weight (BMI 18.5 to 24.9)
Recommended weight gain =17kg- 25kg
(Twins) overweight (BMI 25 to 29.9)
Recommended weight gain =14kg- 23kg
(Twins) Obese (BMI 30 or more)
Recommended weight gain =11kg - 19kg
Gestational weight gain (made up of several components)
- Water 62%
- Fat mass 30%
-Fat-free mass 8%
Fetal weight gain is about …. of ….
Fetal weight gain is about 25% of total weight gained
How much percent of fetal growth occuring in the second half of pregnancy
90%
The rate of gestational weight gain in the 1st trimester
Low
The rate of gestational weight gain in the 2nd trimester
1/3
The rate of gestational weight gain in the 3rd trimester
2/3rds
Maternal fat stores are gained predominantly between
The 10th and 30th week of gestation
1st and early 2nd trimester reflects
deposition and expansion of maternal tissue
what are the two things that are gained in late in 2nd trimester to end of pregnancy
Fetal placental and accumulation of amniotic fluid
NZ guidlines: Pre pregnancy
Focus on obese women
Higher BMI and lower education is associated with greater GWG
2/3rd women incorrectly identified appropriate weight gain
Overweight and obese women were more likely to overestimate appropriate weight gain vs normal weight women
During pregnancy someone of a high BMI and lower education has higher
GWG
Meta -analysis of GWG what percentage were above or below the recommended GWG
70%
Midwives knowledge of GWG
midwives and obstetricians knowledge level of GWG is generally low
GWG Bottom Line
awareness of weight monitoring and target weight guidlines
Improved training in communication skills and behaviour for health professionals
standardisation of registration of BMI and GWG in perinatal database
Future research studies on the effectiveness of preconception and during pregnancy health programs
Higher GWG can lead to higher BMI for
adolescent life and you maintain the weight after the first pregnancy for your second pregnancy and so on
Obesity is arguably the biggest challenge facing maternity services today. It is a challenge not only because of the magnitude of the problem… but also
because of the impact that obesity has on womens reproductive health and that of their babies
Maternal obesity : pecentage in the world and is it higher for men or women
39% of adults in the world= excess weight
Rate is higher among women than men
Problems with maternal obesity
- A metabolic and reproductive complication
- A technical problem affecting clinical issues such as ultrasound scanning “high risk” pregnancy
with an obese mother it increases the risk of
miscarriage and stillbirths by 25-37%
Pregnancy induced hypertension
Venous throboembolism (Blood clot within vein
Delivery complications
Gestational diabetes mellitus
Gestation diabetes
Gestational diabetes mellitus is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy few symptoms
How common is gestational diabetes
affects 3-10% of pregnancies
gestational diabetes accounts for ? percentage of cases of diabetes in pregnancy
90%
In NZ how many women are diagnosed with gestational diabetes per year
3000-4000
how much is gestational diabetes increasing per year
8-9%
Prevoius diagnosis of gestational diabetes or prediabtes impaired
glucose tolerance, or impaired fasting glycaemia
you are more at risk for GDM if
family history
maternal age- a womens risk factor increases as she gets older (especially above the age of 35)
Previous pregnancy which resulted in a child with a high birth weight
Gestational diabetes: complications for the baby
High maternal blood glucose exposes the fetus to higher glucose
Higher blood glucose for the baby leads to
Increased fetal levels of insulin (insulin itself cannot cross the placenta)
The growth stimulating effects of insulin can lead to
excessive growth and macrosomia (fetal overgrowth)
Having gestational diabetes will increase the risk of what latter in life
T2DM
Gestational diabetes: Complications for the mother
- A high risk of developing gestational diabetes during a future pregnancy
-Mother has increased risk of developing Type 2 diabetes
-Caesarean section is more likely if the baby is large
-Induction of labour if the baby is growing too big
Screening and diagnosis
all non-diabetic women offered/recommended screening for GDM
Implications of maternal obesity for the baby
Increased risk of congenital (present from birth) abnormalities
-Orofacial cleft
-Hydrocephalus
For every incremental unit increase in BMI of the mother the risk of birth defects increased by
7%
Small for gestational age
Birth weight below the 10th percentile for age
Stillborn infants born to obese mother are smaller than those
born normal body weight mother
Large for gestational age
fetal overgrowth
Birth weight above the 90th percentile for age
> 400g
Delivery of infant with birth weight more than 400g increases risk of
caesarean delivery, fetal hypoglycemia and shoulder dytocia
Risk of death 18 months post birth was
4 times greater in infants born to obese mothers
weight loss during pregnancy
dieting to lose weight is not recommended during pregnancy
