Obesity and Pregnancy Flashcards
Define obesity.
Obesity is a BMI >30
What are the classes of Obesity?
Class 1 = 30-34.9
Class 2 = 35-39.9
Class 3 MORBID = BMI 40+
A lady walks into clinic and her BMI is 37.2 what does this mean.
She is class 2 obese
A lady walks into clinic and her BMI is 27.2
She is overweight but not obese.
What risks does obesity in pregnancy pose to the mother? (6 marks)
Exacerbate pre-existing conditions e.g. T2 DM and heart disease. Gestational Diabetes Mellitus Preeclampsia Thromboembolism PPH Wound infections
What risks does obesity in pregnancy pose to the foetus? (6marks)
Increased risk of: Miscarriage/still birth Congenital abnormalities Premature Macrosomia- shoulder dystocia, brachial plexus injury RDS Hypoglycemia Neural tube defects
What is the Pedersons hypothesis?
Increased maternal glucose Increased foetal glucose Increased foetal insulin production Increased fat deposition in foetus Macrosomic foetus
What is the periferal and hepatic insulin resistance hypothesis?
Increase in fuels Inflammatory state Altered adipocyte function and size Increased mRNA expression in adipocyte genes in the foetus Macrosomic offspring
Give the three possible mechanisms for macrosomia.
1) Epigenetic hypothesis
2) Peripheral and hepatic insulin resistance
3) Pederson’s hypothesis
An obese woman presents to your clinic as she is intending on becoming pregnant what advice do you give her?
Decrease weight 5-10%
Take folic acid (high dose 5mg) for at least 1 month prior.
An obese woman presents to your clinic as she has found out she is pregnant what advice do you give her?
High dose folic acid (5mg)
Do not diet in pregnancy
Foetal monitoring
Screen for GDM and VTE risk
What are the risks at birth of a macrosomic foetus?
Shoulder dystocia
Brachial plexus injury - erbs palsy.
An obese woman has just given birth what are you concerned about?
DVT ( greatest risk is few wks post partum).
PPH
Wound infections.
A 34 yr old woman G4 P4, BMI 38 is readmitted to the postnatal ward 10 days after C-section with a dull ache in her left calf. It is exacerbated by walking, her left calf is 22 cm and her right calf is 19 cm.
Diagnosis and treatment plan.
DVT
LMWH until 6 weeks post delivery.
