Lecture 5 - Maternal Weight Gain During Pregnancy

Question 1

what is the average birth weight of a baby

Answer 1

between 2.5-4kg, anything above or below this is considered to be a high or low birth weight

Question 2

why are fat stores important for a mother during pregnancy

Answer 2

stored energy is needed during pregnancy and after birth where the baby will be breast fed

Question 3

what is the recommended weight gain for someone with a BMI that is underweight (<18.5)

Answer 3

13-18 kg

Question 4

what is the recommended weight gain for someone with a BMI that is healthy (18.5-24.9)

Answer 4

11-16kg

Question 5

what is the recommended weight gain for someone with a BMI that is overweight (25-29.9)

Answer 5

7-11kg

Question 6

what is the recommended weight gain for someone with a BMI that is obese (>30)

Answer 6

5-9kg

Question 7

is weight loss recommended during pregnancy

Answer 7

weight loss is never recommended during pregnancy

Question 8

what are the weight gain recommendations like during pregnancy for a mother with twins

Answer 8

higher recommendation that if it is just a single pregnancy

Question 9

why is there no recommendation for a mother with twins for weight gain if her BMI is underweight pre pregnancy

Answer 9

no recommendation because they should just gain as much weight as possible

Question 10

twin pregnancy often have a lower …..

Answer 10

often have a lower gestation and the babies are often smaller at birth

Question 11

what are the weight gain recommendations for a mother with twins who has a healthy BMI weight before pregnancy

Answer 11

17-25kg

Question 12

what are the weight gain recommendations for a mother with twins who has a overweight BMI weight before pregnancy

Answer 12

14-23kg

Question 13

what are the weight gain recommendations for a mother with twins who has a obese BMI weight before pregnancy

Answer 13

11-19kg

Question 14

gestational weight gain is made up of several components, what are they

Answer 14

• water (62%)
• fat mass (30%)
• fat free mass (8%)

Question 15

fetal weight is around what % of the total weight gained

Answer 15

about 25% of total weight gained

Question 16

what % of fetal growth occurs in the second half of pregnancy

Answer 16

90% of fetal growth occurs in the second half of pregnancy

Question 17

1/3 of gestational weight gain happens in what trimester

Answer 17

2nd trimester

Question 18

2/3 of gestational weight gain occurs in what trimester

Answer 18

3rd trimester

Question 19

maternal fat stores are gained predominantly between what weeks gestation

Answer 19

10th and 30th week gestation

Question 20

global study finds what % of pregnant women dont have healthy weight gain in pregnancy

Answer 20

75%

Question 21

midwives and obstetricians knowledge level of GWG is generally ….

Answer 21

low

Question 22

what is the link between postpartum weight retention and health effects later in life

Answer 22

• women with greater gestational weight gain are more likely to retain this weight post
• this leads to a greater BMI going into their second pregnancy and then are more likely to retain more weight post birth
• this can then lead to complications further in life if the weight is retained

Question 23

during pregnancy, obesity is associated with increased risk of …… by 25-37% higher compared with lean women

Answer 23

increased risk of miscarriage and still births

Question 24

during pregnancy obesity is associated with : pregnancy induced …..

Answer 24

pregnancy induced hypertension

Question 25

during pregnancy, obesity is associated with higher risk of venous .....

Answer 25

higher risk of venous thromboembolism

Question 26

what is venous thromboembolism

Answer 26

blood clot within vien, if transported, embolism travels to right side of heart and into lungs ( can be fatal)

Question 27

delivery complications and gestational diabetes is associated with what in pregnancy

Answer 27

obesity

Question 28

what is gestational diabetes mellitus

Answer 28

a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy

Question 29

how many pregnancies are affected by gestational diabetes

Answer 29

3-10%, prevalence

Question 30

what is believed to be the cause of gestational diabetes

Answer 30

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

Question 31

what are risk factors for gestational diabetes

Answer 31

- being overweight - previous diagnosis of gestational diabetes or prediabetes - family history - maternal age - previous pregnancy which resulted in a child high birth weight

Question 32

what are the complications for the baby when the mother has gestational diabetes

Answer 32

- high maternal blood glucose exposes the fetus to higher glucose levels - this leads to increased fetal levels of insulin (insulin itself can not cross the placenta) - the growth stimulating effects of insulin can lead to excessive frowth and macrosomia - higher risk of developing T2DM later in life

Question 33

what are the complications for the mother if she has gestational diabetes during pregnancy

Answer 33

- higher 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

Question 34

what is the screening that happens for gestational diabetes during pregnancy in NZ

Answer 34

all non-diabetic women offered / recommended screening for GDM

Question 35

what is the test that happens in the first 20 weeks that can be a way of screening for gestational diabetes

Answer 35

HbA1z at antenatal blood tests - this would be an early indication of GDM

Question 36

what is the main screening method for GDM, at about 24-28 weeks

Answer 36

oral glucose tolerance test (OGTT)

Question 37

what does the oral glucose tolerance test involve

Answer 37

- fasted (overnight, 8-10 hours) - 75g oral glucose load - assessment of blood glucose after 2 hours via finger prick - GDM diagnosed if fasting blood glucose is >5.5mmol/L and or 2 hour post load >9.0 mmol/L

Question 38

women can choose to do a polycose test instead of the OGTT, but what must happen if this comes back positive

Answer 38

is polycose test is positive then they must go and do OGTT to confirm diagnosis

Question 39

maternal obesity increases risk for congenital (present from birth) abnormalities such as

Answer 39

CNS and heart including cardiovascular defects, orofacial clefts, hydrocephalus (fluid on the brain) and limb reductions

Question 40

what does small for gestational age refer to

Answer 40

birth weight below the 10th percentile, for age

Question 41

what does large for gestational age refer to and what is it often called

Answer 41

"fetal overgrowth" birth weight above the 90th percentile for age

Question 42

delivery of infant with birth weight more than 4000g increases risk for what

Answer 42

- caesarean delivery - fetal hypoglycemia - shoulder dystocia

Question 43

what is a neonate

Answer 43

new baby

Question 44

what happens to the mortality rate of a pre term baby birthed by an obese mother

Answer 44

the mortality rate will be higher than the same baby birthed by a mother that was not obese

Question 45

is weight loss advised during pregnancy

Answer 45

never

Question 46

obese mothers have what times greater odds of a C section compared to non obese mothers

Answer 46

1.3 greater odds

Question 47

what are implications for the mother if she is obese

Answer 47

obesity in pregnancy is associated with increased risk of : - venous thromboembolism - pregnancy induced hypertension - increased risk of miscarriage and still births (25-37%) - delivery complications - gestational diabetes