obesity and pregnancy - finished cards Flashcards
what is the definition of obesity in pregnancy?
Obesity in pregnancy is usually defined as a Body Mass Index (BMI) of 30 kg/m2 or more at the first antenatal consultation.
how do you work out the BMI?
BMI: Dividing a person’s weight in kilograms by the square of their height in metres (kg/m2)
what are the classes of obesity?
BMI 30.0–34.9 (Class I);
BMI 35.0–39.9 (Class 2);
BMI 40 and over (Class 3 or morbid obesity)
what are the risks of obesity?
Type 2 Diabetes Insulin resistance Hypertension Dyslipidemia Sleep apnoea Gall bladder disease Coronary heart disease Osteoarthritis Cancer – colon, breast, endoemtrium PCOS Pregnancy related complications Anaesthetic risk
what are the trends of obesity in the UK between 1993-2010
Increase in the prevalence of obesity (BMI at least 30 kg/m2) amongst women of childbearing age (16 to 44 years).
is the prevalence of obesity rising in the UK?
Rising from 9–10% in the early 1990s to 16–19% in the 2000s (21% of antenatal population are obese) BMI ≥35 :4.99%. BMI ≥40 (morbid obesity): 2.01% BMI ≥50 (super-morbid obesity): 0.19%
What is the prevalence of obesity in the world?
International studies show a prevalence of maternal obesity ranging from 1.8% to 25.3% across countries (using the WHO definition of obesity of BMI of at least 30kg/m2)
300 million worldwide
(world population 7.5 Billion, UK – 66 million)
what is the cause of obesity?
Energy intake is greater than energy expenditure, resulting in the accumulation of excess body fat.
Simple equation…when you eat more than you use..it is stored in your body as “fat
Biology: the influence of genetics and ill health
Lack of physical activity
Societal influences: the impact of society, for example the influence of the media, peer pressure or culture;
Individual psychology: psychological drive for particular foods
what amount of exercise is reccomended per week?
The Department of Health recommends that adults do at least 150 minutes (two-and-a-half hours) of moderate-intensity aerobic activity, such as cycling or fast walking, every week.
how man calories should people eat?
The average physically active man needs about 2,500 calories a day to maintain a healthy weight,
Average physically active woman needs about 2,000 calories a day.
what can contribute to a poor diet?
eating large amounts of processed or fast food drinking too muchalcohol eating out a lot eating larger portions than you need drinking too many sugary drinks comfort eating
do genetics have involvement with obesity?
Some people claimthere’s no point trying to lose weight because “it runs in my family” or “it’s in my genes”.
While there are some rare genetic conditions that can cause obesity, such asPrader-Willi syndrome, there’s no reason why most people can’t lose weight.
medical reasons for gaining weight?
anunderactive thyroid gland
Cushing’s syndrome
corticosteroids,
Antidepressants and medicines forschizophrenia–can contribute to weight
what portions of food should be on your plate
1/3 fruit/veg
1/3 carbs
1/3 small amount of diet, protein, and a small amount of fats
what are the maternal risks of obesity?
GDM Preeclampsia Thromboembolism dysfunctional labour Higher caesarean section rates Higher risk of post partum haemorrhage wound infections Stay in hospital for more days lower breastfeeding rate
obesity may be a risk factor for maternal death
what are the long term risks of obesity for the health of the mother?
Women who develop pre-eclampsia – heightened risk of cardiovascular disease
Women who develop GDM – seven fold risk of developing type 2 diabetes
what risks does maternal obesity have on the fetus
miscarriage
congenital anomalies
stillbirth
neonatal death
Prematurity
Macrosomia, LGA : shoulder dystocia and brachial plexus injury
Hypoglycaemia, hyperbilirubinaemia and respiratory distress syndrome
what are the risks of maternal obesity for the child?
Obesity
Cardiovascular dysfunction : higher offspring blood pressure
Increased risk of diabetes
Cognitive and behaviour disorders : ADHD, eating disorders and psychotic disorders
is there a relationship between maternal and childhood obesity?
There is a significant relationship between maternal obesity, macrosomia, and the subsequent development of childhood and adult obesity in their offspring .
Maternal obesity and weight gain during pregnancy are related to higher BMI in childhood and subsequent obesity in adulthood.
what is obesity in pregnancy associated with?
Peripheral and hepatic insulin resistance
Increase in metabolic fuels, glucose, lipids, leptins and aminoacids
Inflammatory state
Altered adipocyte function
Increased adiposite size
Increased mRNA expression of genes involved in adipocyte differentiation.
what is the epigenetic mechanism of obesity in pregnancy?
Maternal over-nutririon and obesity leads to long term modification of specific fetal genes and persistently altered gene expression and altered organ function
what is pederson’s hypothesis
obese mum will have more glucose in the body, that glucose will go to the baby, so the baby produces for insulin from pancreas, which is stored in liver.
this leads to fetal growth
what should obese woman take before pregnancy?
5mg folic acid supplementation daily, starting at least one month before conception and continuing during the first trimester of pregnancy
what are the NICE guidelines for preparing for pregnancy:
woman with BMI 30 or more
Provide information about health benefits of losing weight
Help women with BMI 30 or more to reduce weight before becoming pregnant – at least 5- 10% of weight
Offer weight loss programme – diet and physical activity
Pre-cenception vitamins – folic acid
read these two guidelines!!!!!!!!!!!!!!!!
RCOG and CMACE joint guidelines on management of women with obesity in pregnancy
Weight management before, during and after pregnancy Public health guideline [PH27] Published date: July 2010
how should obesity be managed during pregnancy?
Dieting during pregnancy is not recommneded
Preventing excessive weight gain
Dietary advice LGI and high fibre diet with moderate exercise
Being physically active: 30 min /day of mod intensity exercise
Folic acid 5 mg to reduce the risk of neural tube defect
Vit D ( 10 mcg) supplementation
Healthy start vouchers
why is dieting in pregnancy not advised?
Dieting during pregnancy is not recommended as it may harm the health of the unborn child.
No evidence-based UK guidelines on recommended weight-gain ranges during pregnancy.
what advise would you give to obese pregnant woman?
Advise that a healthy diet and being physically active
Advise her to seek information and advice on diet and activity from a reputable source.
There is no need to ‘eat for two’ or to drink full-fat milk.
Advise that moderate-intensity physical activity will not harm her or her unborn child. At least 30 minutes per day of moderate intensity activity is recommended.
Recreational exercise such as swimming or brisk walking and strength conditioning exercise is safe and beneficial
The aim of recreational exercise is to stay fit, rather than to reach peak fitness
how much weight can people gain during pregnancy?
if they are underweight (<18.5 BMI) 28-40 Ilbs
normal weight (18.5-24.9 BMI) 25-35Ibs
overweight (25-29.9 BMI) 15-25 Ibs
obese (>30 BMI) 11-20 IBS)
What is in the eat well guid?
eat 5 A Day
basemeals on starchy foods like potatoes, bread, rice or pasta
have some dairy or dairy alternatives (such as soya drinks)
eat some beans, pulses, fish, eggs, meat and other protein
choose unsaturated oils and spreads, eaten in small amounts
Drink plenty of fluids
who is screened for gestational diabetes?
All pregnant women with a booking BMI 30 should be screened for gestational diabetes, as recommended by the NICE Clinical Guideline No. 63 (Diabetes in Pregnancy, July 2008)
what antenatal care to obese woman need in preparation for delivery?
Pregnant women with a booking BMI 40 should have an antenatal consultation with an obstetric anaesthetist, so that potential difficulties with venous access, regional or general anaesthesia can be identified.
An anaesthetic management plan for labour and delivery should be discussed and documented in the medical records.
what are problems with c-section in obese woman?
difficult venous access
difficult spinal
difficult surgery
what is done to prevent thromboembolism in obese pregnant woman?
Women with a booking BMI 30 should be assessed at their first antenatal visit and throughout pregnancy for the risk of thromboembolism.
Antenatal and post delivery thromboprophylaxis should be considered in accordance with the RCOG Clinical
Green Top Guideline No. 37.41
what is done for pre eclampsia in obese pregnant woman?
Women with a booking BMI 35 have an increased risk of pre-eclampsia and should have surveillance during pregnancy in accordance with the Pre-eclampsia Community
Guideline (PRECOG), 2004.44
protocol for management of woman with BMI >40
hospital booking 8-12 weeks
Routine booking investigations
Advise Vitamin D 10mcg daily until delivery (Adcal D3 one tablet daily)
Advise Folic acid 5mg daily until 14 weeks
Complete Anaesthetic referral form
Thromboprophylaxis Risk assessment
Document plan for on going antenatal care and provisional plan for delivery
Recommend hospital birth
protocol for management of woman with BMI >40
20-22 weeks and 28 weeks?
20 – 22 weeks
Fetal anomaly scan
28 weeks
75g GTT
protocol for management of woman with BMI >40
third trimester
Third trimester
Ultrasound assessment of fetal growth and amniotic fluid volume at 36 and 40 weeks
Review response to anaesthetic referral
Measure for TEDS
Inform matron for antenatal/postnatal wards of possible need for special equipment eg beds, chairs, commode and hoist to allow forward planning
If delivery will be by elective caesarean section, inform theatre staff
A management plan for delivery should be clearly documented
Hospital ANC appointment at term to review birth plan and proposed mode of delivery
management of obese woman in labour?
Mothers of BMI >35, should give birth in consultant led obstetric unit.
Home birth not an option
Active management of third stage
Intra-partum management of women with BMI >35?
Continuous electronic fetal monitoring IV access, FBC G&S Oral fluids only, consider IV fluids Ranitidine 150mgs 6 hrly Active 3rd stage
what is the postnatal management of obese woman?
BMI 35-39 Thromboprophylaxis 6 weeks BMI 40 or more Antibiotic cover for 5 days after a caesarean delivery Thromboprophylaxis 6 weeks
encourage breastfeeding
what support should the woman obese woman have after childbirth?
If pregnancy and delivery are uncomplicated, a mild exercise programme consisting of walking, pelvic floor exercises and stretching may begin immediately.
But women should not resume high-impact activity too soon after giving birth.
After complicated deliveries, or lower segment caesareans, a medical care-giver should be consulted before resuming pre-pregnancy levels of physical activity, usually after the first check-up at 6–8 weeks after giving birth.
Offer a structured weight-loss programme.
If more appropriate, offer a referral to a dietitian or an appropriately trained health professional. They will provide a personalised assessment, advice about diet and physical activity and advice on behaviour change strategies such as goal setting.
Women who are not yet ready to lose weight should be provided with information about where they can get support when they are ready.
Strategies for weight management in non pregnant women of reproductive age
Education programme
Lifestyle intervention
Referral to multidisciplinary clinic involving physician, bariatric surgeon, dietecian, specialist nurse, physiotherapist and psychologist
Orlistat pancreatic lipase inhibitor – should only be prescribed in non pregnant women with contraceptive advice
Bariatric surgery – gastric band, gastric sleeve resection and gastric bypass – Nutritional deficiencies – nutritional supplements during pregnancy, should wait for 18 months prior to conception
NHS weight loss plan?
Downloadthe NHS weight loss guide
free12-weekdiet and exercise plan.
