Obesity

Question 1

Describe the recommended weight gain for women with obesity in pregnancy

Answer 1

Women with a BMI of 25-30
- 6.8-11.3
- rate of 0.28/week in 2nd and 3rd tri

Women with a BMI >30
- 5-9.1
- rate of 0.22/week in 2nd and 3rd tri

Question 2

Describe the other associated risk factors for women with obesity

Answer 2

• PE
• preterm birth
• stillbirth
• fetal abnormalities
• Diabetes
• Failed IOL
• Infection
• prolonged pregnancy
• Operative birth
• multiples

Question 3

describe the recommendations and midwifery role for the care of obese women across the continuum

Answer 3

Pregnancy
- accurate recording of weight and height
- education on diet and exercise, referral if required
- maternal monitoring of diet and weight
- low dose aspirin from 12 weeks gestation - preventative for PE
- discussion of risks
- at least shared care
- anaesthetic review
- increased scans - SFH and abdo palp not the most accurate
- SFH every week from 34 weeks - US if abnormal
- Folic acid - increased risk of abnormalities

Birth
- Fetal monitoring - consider fetal scalp electrode
- active management
- obs and anaesthetics aware
- correct size equipment
-BMI <50 optimal timing 38-39 weeks to prevent risk of lateterm stillbirth
- prepare blood products for increased risk of PPH
- be aware higher risk of shoulder dystocia

Postpartum
- increased risk of PPH
- support with breastfeeding
- DVT management

Question 4

Describe the benefits of exercise in pregnancy

Answer 4

• increased energy
• improved fitness
• reduced back and pelvic pain
• decreased risk of pregnancy complications such as pre-eclampsia and pregnancy-induced hypertension
• preparation for the physical demands of labour
• fewer complications in delivery
• faster recuperation after labour