Obesity and Pregnancy Outcome.

Question 1

What does obesity in pregnancy increase the risk of for the child?

Answer 1

Preterm labour.
Still birth.
Cogenital defects - cleft palate, spinal bifida etc.
Shoulder dystocia (shoulder too large)
Macrosomina (baby too big)

Question 2

What does obesity in pregnancy increase the risk of for the mother?

Answer 2

Maternal  mortality.
Gestational diabetes.
Pre-eclampsia.
Thromboembolism.
Failed intubation.
Post-partum haemorrhage.
Can't get a good scan - therefore miss defects that may have led to a termination - increased incidence of defects.
Increase healthcare costs - ~4 days longer in hospital.
Multiple attempts at epidural.
Genital infection.
Urinary tract infection.
Wound infection.

Question 3

Current practice for obese pregnancies?

Answer 3

Weight loss pre-conception.
Plan delivery and post-natal care.
Lifestyle changes.
Bariatric (gastric bypass)
Medical management.

Question 4

Explain the medical management of obese pregnancies.

Answer 4

Folate supplementation.
Weight mothers?
Screen for diabetes?
Low dose aspirin - prevent pre-eclampsia/ thromboprophylaxis.
Anasthetic review.
Equipment - tables etc.

Question 5

How can we improve pregnancy outcome?

Answer 5

Diet and physical activity - individual goal setting.
Primary outcomes - pregnancy weight gain, combined adverse outcomes, large for gestational age delivery, glucose homoeostasis and gestatiomal diabetes mellitus.

Question 6

Do the UK weigh mothers?

Answer 6

No - the range of weights to put on each semester is too large (IoM).
Many components of weight gain - baby, placenta, fluid, fat.

Question 7

Implications of maternal insulin resistance?

Answer 7

Gestational diabetes
Macrosomia - increase glucose across placenta, increase insulin, stimulates foetus growth.
Also associated with pre-eclampsia.

Question 8

UPBEAT?

Answer 8

UK Pregnancy better eating and activity trials.
Multicentre
Pilot
Goal setting - low glycemic index diet (glucose release slowly).
Primary outcome - maternal - insulin resistance.
Neonatal - macrosomia.

Question 9

Explain the transgenerational acceleration of obesity.

Answer 9

Maternal obesity = increae glucose, insulin, leptin, lipids, inflammatory response = fetal.post natal plasticity = increase appetite = childhood and adulthood obesity.

Question 10

What causes childhood obesity?

Answer 10

Maternal obesity.
High birthweight.
Maternal smoking.
infancy breastfeeding - sleep duration and rapid growth.
Diet and PS.
Obesity genes.
Community, demographic factors.

Question 11

In rats, what does maternal obesity cause?

Answer 11

Increase adiposity, hyperphagia, insulin resistance, hypertension, endothelial dysfunction, fatty liver, fatty pancreas.

Question 12

Leptin in rats?

Answer 12

Switches off appetite.
But high post natal leptin = turn off hypothalamus - neuronal connections no made - no leptin/leptin insensitvity = FAT RATS!

Question 13

Leptin and BP?

Answer 13

Leptin increase sympathetic output to the kidenys via renal nerve. Integrated response in hypothalamus and brain stem.

Selective leptin resistance

• decrease sensitvity to food intake
• maintained/enhanced sensitivity to BP

BP = excessive response to leptin.

Question 14

Explain maternal obesity and its effects on leptin.

Answer 14

Maternal obesity = central leptin sensitivity increase (symp efferent activity).
Maternal obesity = increase neonatal leptin, central leptin resistance, increase appeite.

= fat hypertensive rat!!

Question 15

Neonatal leptin treatment leads to?

Answer 15

increased leptin resistance
Increase BP before obesity.
Cardiac dysfunction at 1 month.