Obesity in pregnancy

Question 1

Definition

Answer 1

BMI >30 at first antenatal visit

Question 2

Maternal risks

Answer 2

Conception difficulties
Recurrent miscarriage
Increased rate of instrumental and C-section births
Increased rates of GDM, pre-eclampsia, PIH, TIIDM, maternal mortality

Question 3

Foetal risks

Answer 3

Neural tube defects
Macrosomia (=> birth trauma, dystocia)
Preterm delivery
Intrauterine death
Neonatal death
Reduction in breast feeding
Childhood obesity
TIIDM

Question 4

Any point in losing weight?

Answer 4

YES
Risks increase with increasing BMI
Losing weight prior to conception reduces all risks
Losing 4.5kg before 2nd pregnancy decreases risk of GDM by 40%

Question 5

Pre-pregnancy care

Answer 5

Give opportunity to optimise weight before pregnancy
Advice on weight and lifestyle at family planning consultations
Women BMI >30 given information and advice about risks and support to lose

Question 6

Pregnancy care

Answer 6

Vit D 10micrograms daily
Folic acid 5mg daily
Consider aspirin
US for foetal growth
Anaesthetic involvement
Monitoring in labour
VTE assessment