Obesity in pregnancy: Brocato

Question 1

How do we identify weight class?

Answer 1

BMI

Question 2

What are BMI classifications?

Answer 2

40 class III extreme obesity

Question 3

What is notable about obesity and fertility?

Answer 3

Lower Fertility:

Anovulation (PCOS)
Leptin impairs fertilization
Low fertilization potential of ova
Risk of spontaneous abortion
Success rates of ART impacted negatively
Infrequent interourse

Question 4

What reproductive cancers are associated with obesity?

Answer 4

ENDOMETRIAL: have to know: fat has higher estrogen production, causes endometrial cancer

Breast: same reason

Question 5

What are steps of motivational interviewing?

Answer 5

Feedback- identify behavior and results
Responsibility- stress who will suffer
Advice-   teach, give ideas
Menu- identify difficult situations
Empathy - understading and involved
Self-efficacy - learn from mistakes

Question 6

What are two aspects of counseling for obesity?

Answer 6

Motivation: identify natural consequences that are important to your patient

Ability: 
    track calories
   encourage support groups
   exercise: minimal goals, taking stairs
   track weight loss

Question 7

Book: Change anything: how was it helpful?

Answer 7

Help in counseling and leadership as doctor

What motivates parents is their kids

Question 8

Preconception counseling should do what in terms of obesity?

Answer 8

Name obesity as health condition: use classification system

Counsel on risk
Encourage lifestyle change
Refer to specialist if needed

Question 9

Who are candidates for bariatric surgery?

Answer 9

BMI over 40
Motivated
Acceptible surgical risk
Failed nonsurgical

BMI over 35 with complications:
sleep apnea
severe diabetes
joint disease

Question 10

What are the types of bariatric surgery?

Answer 10

Restrictive: adjustable band banding
Malabsorptive: shunt around stomach (cut out duodenum)

Question 11

What are the effects of gastric bypass on pregnancy?

Answer 11

Lower: 
   Preeclampsia
   Gestational diabetes
   macrosomia
   congenital anomalies
   average weight gain during pregnancy

Higher risk:
C section
PPROM: water breaks early

Question 12

What risks are increased in gastric bypass?

Answer 12

Higher:
Low fat soluble vitamins
C section
PPROM

Question 13

What are risks of bypass during pregnancy?

Answer 13

Nutritional deficiency
Rapid dumping syndrome
Surgical complication: anasthemosis, bowel obst.
Medication dosing: avoid extended release meds

Question 14

Is labor shorter or longer in obesity?

Answer 14

Longer

Question 15

How does obesity increase blood clot risk?

Answer 15

Estrogen! Like birth control.

Causes increase in clotting factors in the liver.

Question 16

Should we give prophylactic anticoagulation to obese patients?

Answer 16

Not on BMI alone, but heparin if at risk. Basically no. It depends on pt.