obesity and pregnancy Flashcards
what is the definition of obesity?
body mass index >30 lg/m2
how is BMI calculated?
weight (kg) / square of their height (m2)
what is the classification of BMI?
underweight = <18.5 normal range = 18.5 - 24.9 overweight = >25 obese = >30 morbidly obese = >40
what are the classes of obesity?
1 = 30-34.9 2 = 35 - 39.9 3 = >40
what are the risks of obesity?
T2DM insulin resistance HTN dyslipidaemia sleep apnoea gall bladder disease coronary heart disease osteoarthritis cancer - colon, breast, endometrium PCOS pregnancy related complications anaesthetic risk
what is the trend in obesity in UK in women?
increased BMI at least 30 amongst childbearing women (16-44) from 12% - 20%
what is the prevalence of obesity during pregnancy?
rising from 9% -> 19% in 2000s
21% of antenatal populations are obese
what are the causes of obesity?
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
what does the department of health recommend for physical activity?
150 minutes of moderate-intensity aerobic activity every week (cycling, fast walking)
what is the average calories needed daily for men and women?
men - 2500
women - 2000
what is a poor diet?
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
what are some medical reasons for obesity?
under active thyroid
cushings syndrome
corticosteroids
antidepressants
what are some maternal risks of obesity?
GDM pre-elcampsia thromoembolism dysfunctional labour higher Caesarean section rates higher risk of PPH wound infections stay in hospital longer lower breast feeding rates
what are the long term risks of obesity?
pre-eclampsia can lead to heightened risk of cardiovascular disease
GDM means 7x risk of developing T2DM
what are some risks to the fetus of maternal obesity?
miscarriage congential abnormalities still birth neonatal death prematurity macrosomia - LGA = shoulder dystocia, brachial plexus injury hypoglycaemia, hyperbilirubinaemia, RDS neural tube defects
what are some risks for the child of maternal obesity?
obesity
cardiovascular dysfunction = higher risk of high blood pressure
increased risk of DM
cognitive and behavioural disorders = ADHD, eating disorders, psychotic disorders
what is the plausible mechanism for maternal obesity causing childhood obesity?
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
how does epigenetic affect the fetus?
maternal over-nutrition and obesity -> long term modifications of specific fetal genes and persistently altered gene expression and altered organ function
what can be done before pregnancy t reduce risks from obesity?
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
how is obesity managed in pregnancy?
dieting not recommended prevent excessive weight gain physically active for 30mins/day vit D 10mcg folic acid 5 mg
what is the target weight gain in pregnancy?
depending on starting weight under weight = 28-40 lbs normal = 25-35 lbs overweight = 15-25lbs obese = 11-20 lbs
what does the eat well plate consist of?
1/3 carbs
1/3 fruit and veg
1/3 meat/fish/protein and milk/dairy
what should all obese pregnancy women be screened/assessed for?
gestational diabetes - GTT 28wks
thromboembolism risk
pre-eclampsia
what antenatal care should pregnant women with BMI >40 receive
obstetric anaesthetist consltation - to identify potential difficulties with venous access, and regional/general anaesthetics
to discuss anaesthetic management plan for Labour
what is the intra-partum management of women with BMI >35?
continuous CTG IV access, FBC G&S oral fluids only - consider IV fluids ranitidine 150mgs 6 hourly active 3rd stage
what is the post-natal mangement of BMI 35-40 and BMI 40?
35-40 = thrombophylaxis 6 wks >40 = antibiotic cover 5 days after c-section, thrombophylaxis 6 wks
what strategies for weight loss in non-pregnancy woman?
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
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