Obesity in Pregnancy Flashcards
What are the BMI thresholds for underweight, normal, overweight, obese class I, obese class II, obese class III
Underweight: <18.5
Normal: 18.5-24.99
Overweight: >25
Obese class I: 30-34.99
Obese class II: 35-39.99
Obese class III: >40
What are the maternal risks of obesity in pregnancy
Gestational diabetes
Pre-eclampsia
VTE
Mental health problems
Miscarriage and stillbirth
Caesarean birth
PPH
Wound infections
Mortality
Issues with breastfeeding
What are the foetal risks of obesity in pregnancy
Congenital anomalies
Neural tube defects
Stillbirth
Prematurity
Macrosomia
Neonatal death
Increased risk of developing obesity and metabolic disorders in childhood
What is the pre-pregnancy advice for obesity
Weight and lifestyle advice
Encouragement to lose weight
High dose folic acid supplementation (5mg) at least 1 month before conception
Consider vitamin D supplements
Waiting period (12-18 months) if they have had bariatric surgery
What is the antenatal care for a pregnant woman who is obese
- Weight, height, and BMI should be measured at the antenatal booking visit, and a re-weigh during the third trimester to allow for appropriate plans for equipment and personnel
- Environmental risk assessment regarding availability of facilities
- Aspirin 150mg daily from 12 weeks (BMI >35)
- Screen for GDM at 24-28 weeks for GDM
- Routine measurement of peak ani-Xa activity for women >90kg on therapeutic doses of LMWH
What are the considerations for labour for obese pregnant women
Should have an informed discussion with the obstetrician and anaesthetist about a plan for labour and birth
Multiparous and low risk → can choose a midwifery-led unit (MLU) with clear referral pathways
Active management of the third stage to reduce risk of PPH
Elective induction of labour may reduce the chance of a caesarean birth without increasing risk of adverse outcomes
Macrosomia → consider induction of labour
