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HUNT243 > Lecture 5: Maternal Weight Gain > Flashcards

Lecture 5: Maternal Weight Gain Flashcards

1
Q

How much does a baby weigh at birth generally?

A

3.5kg

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2
Q

What is ‘normal’
birthweight?

A

2.5-4kg

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3
Q

How much maternal fat stores does a mother have at birth?

A

Approx. 3.5kg

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4
Q

Why do mothers need fat stores?

A

Stored energy for healing and breastfeeding

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5
Q

What is the recommendation for weight gain during pregnancy if you are starting at a healthy weight (BMI=18.5-24.9)?

A

11.5-16kg

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6
Q

What is the recommendation for weight gain during pregnancy if you are starting as overweight (BMI=25-29.9)?

A

7-11.5kg

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7
Q

What is the recommendation for weight gain during pregnancy if you are starting as underweight (BMI= <18.5)?

A

12.5-18kg

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8
Q

Why do pregnant women need to maintain healthy weight gain?

A

Ensure babies are born within the normal range

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9
Q

Weight gain increases as…

A

Pregnancy goes on (mostly in 2nd and 3rd trimester)

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10
Q

What is the mean weekly weight gain for women of healthy BMI in 2nd and 3rd trimesters?

A

0.42 (0.35-0.5) kg/week

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11
Q

When should pregnant womens BMI be measured?

A

From a pre-pregnancy weight or an early pregnancy weight (ideally <10 weeks gestation)

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12
Q

What is the recommendation for weight gain during pregnancy if you are starting at a healthy weight (BMI=18.5-24.9) for TWINS?

A

17-25kg

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13
Q

What is the recommendation for weight gain during pregnancy if you are starting as overweight (BMI=25-29.9) for TWINS?

A

14-23kg

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14
Q

What is GWG?

A

Gestational weight gain

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15
Q

What is gestational weight gain made up of?

A
  • Fetus
  • Water
  • Fat mass
  • Fat-free mass
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16
Q

How much of GWG is water?

A

62%

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17
Q

How much of GWG is fat mass?

A

30%

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18
Q

How much of GWG is fat-free mass?

A

8%

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19
Q

How much of GWG is the fetus?

A

25%

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20
Q

How much of fetal growth occurs in the second half of pregnancy?

A

90%

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21
Q

What does fetal weight gain look like over the pregnancy?

A

Starts around 12 weeks, grows more in the 2nd and 3rd trimester

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22
Q

What does mothers weight gain look like over the pregnancy?

A

Starts around 8 weeks, mothers gain is a steeper slope compared to fetus

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23
Q

How much of GWG occurs in 2nd trimester?

A

1/3

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24
Q

How much of GWG occurs in 3rd trimester?

A

2/3

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25
Q

What weeks are maternal fat stores gained predominantly between?

A

10th-30th week

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26
Q

What does 1st and 2nd trimester weight gain reflect?

A

Deposition and expansion of maternal tissue

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27
Q

What does late 2nd trimester onwards weight gain reflect?

A

Primarily fetal, placental and accumulation of amniotic fluid

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28
Q

What are the NZ guidelines for pre-pregnancy weight gain?

A

Focus on obese women - We really want the mother to start their pregnancy at a healthy weight

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29
Q

What is higher BMI and lower education associated with during pregnancy?

A

Greater GWG

30
Q

Overweight and obese women are more likely to…

A

Overestimate appropriate weight gain

31
Q

What is the PA guidelines for pregnant women?

A

30 mins moderate intensity physical activity atleast 5 times a week

32
Q

What does postpartum weight retention look like?

A

A lot of GWG is retained, meaning preconception BMI will be increased

33
Q

What does retained GWG look like in later life?

A

Increased BMI, fat mass and visceral fat

34
Q

What percent of adults in the world carry excess weight?

A

39%

35
Q

Obese women vs lean women; risk of miscarriage and stillbirths

A

Obese women have a 25-37% higher risk

36
Q

What is PIH?

A

Pregnancy-induced hypertension; also known as toxemia or pre-ecampsia (high BP developing after 20 wks gestation)

37
Q

What is venous thromboembolism?

A

Blood clot within vein (thrombosis); if transported, embolism travels to right side of heart and into lungs (pulmonary embolism) - can be fatal

38
Q

What are examples of delivery complications?

A

Labour induction and caesarean delivery

39
Q

What is GDM?

A

Gestational diabetes mellitus

40
Q

What are the implications of obesity for pregnant women?

A
  • Miscarriage/stillbirths
  • Pregnancy-induced hypertension (PIH)
  • Venous thromboembolism
  • Delivery complications
  • Gestational diabetes mellitus (GDM)
41
Q

What are the odds of cesarean delivery in women above recommended weight gain?

A

1.3 times greater

42
Q

What is Gestational Diabetes Mellitus (GDM)?

A

A condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy - generally very few symptoms

43
Q

How many pregnancies does GDM affect?

A

3-10% of pregnancies

44
Q

How many cases of diabetes in pregnancy are GDM?

A

90% of cases

45
Q

How many NZ women are diagnosed with gestational diabetes per year?

A

3000-4000

46
Q

What does the prevalence of GDM look like over time?

A

Prevalence is increasing 8-9% per year, relative to the increasing rates of obesity

47
Q

What does the prevalence of GDM look for different ethnicities in NZ?

A
  • Maori (5-10%)
  • Pacific peoples (4-8%)
  • Asian Indians (4%)
  • NZ Europeans (3%)
48
Q

How does GDM happen?

A

Unknown - believed that hormonal changes interfere with the action of insulin as it binds to the receptor resulting in increased insulin resistance

49
Q

Is GDM reversible?

A

Yes with adequate control of blood glucose

50
Q

What are the risk factors for GDM?

A
  • Overweight (2.1x), Obese (3.6x) and Severely Obese (8.6x)
  • Previous diagnosis of diabetes related illnesses
  • Family history
  • Age (esp. over 35)
  • Previous child with high birth weight
51
Q

What are the complications for the baby caused by GDM?

A

High maternal blood glucose exposes the fetus to higher glucose levels; leads to increased fetal levels of insulin

52
Q

What are the effects of high fetal insulin levels?

A

Growth stimulating effects of insulin can lead to excessive growth and macrosomia (fetal overgrowth) = high risk of developing T2D later in life

53
Q

What are the complications for the mother caused by GDM?

A
  • Higher risk of developing GDM again
  • Increased risk of T2D
  • Caesarean section
  • Induction of labour
54
Q

What is the recommendation for NZ to screen for GDM?

A

All non-diabetic women offered/recommended screening for GDM

55
Q

How is GDM screened for?

A
  • Blood test before 20 weeks
  • Oral glucose tolerance test (OGTT) recommended at 24-28 weeks
56
Q

What are implications of maternal obesity for the baby?

A

Increased risk of congenital abnormalities

57
Q

What are congenital abnormalities?

A

structural or functional defects that occur during intrauterine development - present from birth

58
Q

What kind of congenital abnormalities does maternal obesity cause in babies?

A

CNS and heard including:
- CV defects
- Orofacial clefts
- Hydrocephalus
- Limb reductions

59
Q

For every incremental unit increase in BMI (of mother) the risk of birth defects increases by….

A

7%

60
Q

What are the odds of NTD to babies born to obese mothers?

A

1.6 greater odds

61
Q

What is SGA?

A

Small for gestational age

62
Q

What is the cut off for SGA?

A

Birth weight below the 10th percentile for age

63
Q

What is LGA?

A

Large for gestational age

64
Q

What is the cut off for LGA?

A

Birth weight above the 90th percentile, for age

65
Q

What is macrosomia?

A

growth beyond a specific threshold, regardless of gestational age

66
Q

What is macrosomia in pregnancy?

A

> 4000g

67
Q

What does the delivery of infants with birth weight more than 4000g increase risk of?

A
  • Caesarean delivery
  • Fetal hypoglycaemia
  • Shoulder dystocia
68
Q

What is a neonate?

A

New baby

69
Q

What is the risk of death 18 months post birth for pre-term infants born to obese mothers?

A

4 times greater than for lean mothers

70
Q

What is the recommendation for weight loss during pregnancy?

A

Not recommended

HUNT243 (11 decks)

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