obesity and pregnancy

Question 1

what is the definition of obesity?

Answer 1

body mass index >30 lg/m2

Question 2

how is BMI calculated?

Answer 2

weight (kg) / square of their height (m2)

Question 3

what is the classification of BMI?

Answer 3

underweight = <18.5 
normal range = 18.5 - 24.9 
overweight = >25 
obese = >30 
morbidly obese = >40

Question 4

what are the classes of obesity?

Answer 4

1 = 30-34.9
2 = 35 - 39.9
3 = >40

Question 5

what are the risks of obesity?

Answer 5

T2DM 
insulin resistance 
HTN 
dyslipidaemia 
sleep apnoea 
gall bladder disease 
coronary heart disease 
osteoarthritis 
cancer - colon, breast, endometrium 
PCOS 
pregnancy related complications 
anaesthetic risk

Question 6

what is the trend in obesity in UK in women?

Answer 6

increased BMI at least 30 amongst childbearing women (16-44) from 12% - 20%

Question 7

what is the prevalence of obesity during pregnancy?

Answer 7

rising from 9% -> 19% in 2000s

21% of antenatal populations are obese

Question 8

what are the causes of obesity?

Answer 8

energy intake greater than energy expenditure, resulting I accumulation of excess body fat
lack of physical exercise
impact of society - media and peer pressure
psychological drive for particular foods
influence of genetics and ill health

Question 9

what does the department of health recommend for physical activity?

Answer 9

150 minutes of moderate-intensity aerobic activity every week (cycling, fast walking)

Question 10

what is the average calories needed daily for men and women?

Answer 10

men - 2500

women - 2000

Question 11

what is a poor diet?

Answer 11

eating large amount of processed food 
drinking too much alcohol 
eating out a lot 
eating larger portions than you need 
drinking sugary drinks 
comfort eating

Question 12

what are some medical reasons for obesity?

Answer 12

under active thyroid
cushings syndrome
corticosteroids
antidepressants

Question 13

what are some maternal risks of obesity?

Answer 13

GDM
pre-elcampsia 
thromoembolism 
dysfunctional labour 
higher Caesarean section rates
higher risk of PPH 
wound infections 
stay in hospital longer 
lower breast feeding rates

Question 14

what are the long term risks of obesity?

Answer 14

pre-eclampsia can lead to heightened risk of cardiovascular disease
GDM means 7x risk of developing T2DM

Question 15

what are some risks to the fetus of maternal obesity?

Answer 15

miscarriage
congential abnormalities 
still birth 
neonatal death 
prematurity 
macrosomia - LGA = shoulder dystocia, brachial plexus injury 
hypoglycaemia, hyperbilirubinaemia, RDS 
neural tube defects

Question 16

what are some risks for the child of maternal obesity?

Answer 16

obesity
cardiovascular dysfunction = higher risk of high blood pressure
increased risk of DM
cognitive and behavioural disorders = ADHD, eating disorders, psychotic disorders

Question 17

what is the plausible mechanism for maternal obesity causing childhood obesity?

Answer 17

peripheral and hepatic insulin resistance -> increase metabolic fuels, glucose, lips, aa -> inflammatory status -> altered adipocyte function -> increased adiposity size -> increased mRNA expression of genes involved in adipocyte differentiation

Question 18

how does epigenetic affect the fetus?

Answer 18

maternal over-nutrition and obesity -> long term modifications of specific fetal genes and persistently altered gene expression and altered organ function

Question 19

what can be done before pregnancy t reduce risks from obesity?

Answer 19

women with BMI >30 should receive info andadvce about risks of obesity during pregnancy and child birth
info about losing weight
reduce weight by 10%
offer weight loss programme - diet and exercise plan
5mg folic acid daily 1 month before conception and continued during 1st trimester

Question 20

how is obesity managed in pregnancy?

Answer 20

dieting not recommended 
prevent excessive weight gain 
physically active for 30mins/day 
vit D 10mcg 
folic acid 5 mg

Question 21

what is the target weight gain in pregnancy?

Answer 21

depending on starting weight 
under weight = 28-40 lbs 
normal = 25-35 lbs 
overweight = 15-25lbs 
obese = 11-20 lbs

Question 22

what does the eat well plate consist of?

Answer 22

1/3 carbs
1/3 fruit and veg
1/3 meat/fish/protein and milk/dairy

Question 23

what should all obese pregnancy women be screened/assessed for?

Answer 23

gestational diabetes - GTT 28wks
thromboembolism risk
pre-eclampsia

Question 24

what antenatal care should pregnant women with BMI >40 receive

Answer 24

obstetric anaesthetist consltation - to identify potential difficulties with venous access, and regional/general anaesthetics
to discuss anaesthetic management plan for Labour

Question 25

what is the intra-partum management of women with BMI >35?

Answer 25

continuous CTG 
IV access, FBC G&S
oral fluids only - consider IV fluids 
ranitidine 150mgs 6 hourly 
active 3rd stage

Question 26

what is the post-natal mangement of BMI 35-40 and BMI 40?

Answer 26

35-40 = thrombophylaxis 6 wks 
>40 = antibiotic cover 5 days after c-section, thrombophylaxis 6 wks

Question 27

what strategies for weight loss in non-pregnancy woman?

Answer 27

education programme
lifestyle intervention
referral to MDT specialist nurse, physiology, dietician, psychologist
orlistat = pancreatic lipase inhibitor (teratogenic)
bariatric surgery
NHS weight loss plan = 12 week diet and exercise plan
change4 life