Obesity and pregnancy

Question 1

Define obesity in pregnancy

Answer 1

BMI >30kg/m2 at first antenatal consultation

Question 2

What are the classes of obesity

Answer 2

30-34.9 Class I
35-39.9 Class II
40+ Class III, morbidly obese

Question 3

What are the general risk of obesity

Answer 3

Type 2 diabetes, insulin resistance, hypertension, dyslipidaemia, sleep apnoea, gall bladder disease, coronary heart disease, osteoarthritis, cancer, PCOS, pregnancy related complications, anaesthetic risks

Question 4

What are the causes of obesity

Answer 4

Biology- genetic conditions rate. Underactive thyroid gland, prader-willi syndrome, medication eg. corticosteroids
Lack of physical activity- main factor. Recommended 150 minutes of moderate aerobic activity every week
Calories
Poor diet
Societal influences
Individual psychology

Question 5

What are the risks of obesity during pregnancy

Answer 5

Gestational diabetes, preeclampsia, thromboembolism, higher caesarean rates, higher risk of postpartum haemorrhage, wound infections, longer hospital stays, lower breastfeeding rate
Possible risk factor for maternal death

Question 6

What are the long term risks of obesity during pregnancy

Answer 6

Women with preeclampsia have heightened risk of cardiovascular disease
Women with gestational diabetes have higher risk of developing type 2 diabetes

Question 7

What are the risks of maternal obesity during pregnancy to the fetus

Answer 7

Miscarriage

Congenital anomalies

Question 8

Why is folic acid supplementation important

Answer 8

Deficiency can cause neural tube defects which can cause stillbirth, neonatal death, prematurity, macrosomia, LGA, hypoglycaemia, hyperbilirubinaemia, respiratory distress syndrome

Question 9

What are the long term effects of maternal obesity to the child

Answer 9

Higher BMI + obesity in childhood
Cardiovasculart dysfunction, high blood pressure
Increased risk of diabetes
Cognitive and behavioural eg ADHD, eating disorders, psychotic disorders

Question 10

What is the mechanism for maternal obesity affecting fetus

Answer 10

Obesity is associated with peripheral + hepatic insulin resistance, increase in metabolic fuels, inflammatory state, altered adipocyte size, increased mRNA expression of genes involved in adipocyte differentiation
Long term modification of specific fetal genes and persistently altered gene expression + altered gene function

Question 11

How is obesity managed before pregnancy

Answer 11

If BMI >30:
Provide information about benefits of losing weight and risks of obesity during pregnancy and childbirth
Help to lose 5-10% weight before pregnancy
Offer weight loss programme with diet and physical activity
Preconception vitamins

Question 12

How is obesity managed during pregnancy

Answer 12

Dieting is not recommended as may harm health of fetus
Prevent excessive weight gain
Screen for gestational diabetes if BMI >30
Advise healthy diet and physical activity
Vitamin D supplementation (10mcg)
Antenatal and post delivery thromboprophylaxis should be considered

Question 13

How is obesity managed antenatally

Answer 13

All women with BMI >30 offered postnatal thromboprophylaxis regardless of mode of delivery, antenatal consultation with obstetric anaesthatist
Anaesthetic management plan for labour and delivery documented in medical records
BMI >30 assessed for risk of thromboembolism, encouraged to mobilise
BMI >35 surveillance for preeclampsia

Question 14

How is obesity managed in labour

Answer 14

BMI >35 give birth in consultant led obstetric unit
Home birth bot an option
Active management of third stage

Question 15

How is obesity managed intra-partum

Answer 15

Continuout electronic fetal monitoring
IV access
Oral fluids
Ranitidine

Question 16

How is obesity managed postnatally

Answer 16

BMI 35-39.9 thromboprophylaxis at 6 weeks
BMI >40 antibiotic cover for 5 days after caesarean, thromboprophylaxis at 6 weeks
Encourage breastfeeding

Question 17

What are the strategies for weight management in non-pregnancy women of reproductive age

Answer 17

Education
Lifestyle intervention
Referral to multidisciplinary clinic
Orlistat- pancreatic lipase inhibitor, prescribed with contraceptive advice (fetal malformations)
Bariatric surgery