Lecture 5

Question 1

(Twins) healthy weight (BMI 18.5 to 24.9)

Answer 1

Recommended weight gain =17kg- 25kg

Question 2

(Twins) overweight (BMI 25 to 29.9)

Answer 2

Recommended weight gain =14kg- 23kg

Question 3

(Twins) Obese (BMI 30 or more)

Answer 3

Recommended weight gain =11kg - 19kg

Question 4

Gestational weight gain (made up of several components)

Answer 4

• Water 62%
• Fat mass 30%
  -Fat-free mass 8%

Question 5

Fetal weight gain is about …. of ….

Answer 5

Fetal weight gain is about 25% of total weight gained

Question 6

How much percent of fetal growth occuring in the second half of pregnancy

Answer 6

90%

Question 7

The rate of gestational weight gain in the 1st trimester

Answer 7

Low

Question 8

The rate of gestational weight gain in the 2nd trimester

Answer 8

1/3

Question 9

The rate of gestational weight gain in the 3rd trimester

Answer 9

2/3rds

Question 10

Maternal fat stores are gained predominantly between

Answer 10

The 10th and 30th week of gestation

Question 11

1st and early 2nd trimester reflects

Answer 11

deposition and expansion of maternal tissue

Question 12

what are the two things that are gained in late in 2nd trimester to end of pregnancy

Answer 12

Fetal placental and accumulation of amniotic fluid

Question 13

NZ guidlines: Pre pregnancy

Answer 13

Focus on obese women

Higher BMI and lower education is associated with greater GWG

2/3rd women incorrectly identified appropriate weight gain

Overweight and obese women were more likely to overestimate appropriate weight gain vs normal weight women

Question 14

During pregnancy someone of a high BMI and lower education has higher

Answer 14

GWG

Question 15

Meta -analysis of GWG what percentage were above or below the recommended GWG

Answer 15

70%

Question 16

Midwives knowledge of GWG

Answer 16

midwives and obstetricians knowledge level of GWG is generally low

Question 17

GWG Bottom Line

Answer 17

awareness of weight monitoring and target weight guidlines

Improved training in communication skills and behaviour for health professionals

standardisation of registration of BMI and GWG in perinatal database

Future research studies on the effectiveness of preconception and during pregnancy health programs

Question 18

Higher GWG can lead to higher BMI for

Answer 18

adolescent life and you maintain the weight after the first pregnancy for your second pregnancy and so on

Question 19

Obesity is arguably the biggest challenge facing maternity services today. It is a challenge not only because of the magnitude of the problem… but also

Answer 19

because of the impact that obesity has on womens reproductive health and that of their babies

Question 20

Maternal obesity : pecentage in the world and is it higher for men or women

Answer 20

39% of adults in the world= excess weight

Rate is higher among women than men

Question 21

Problems with maternal obesity

Answer 21

• A metabolic and reproductive complication
• A technical problem affecting clinical issues such as ultrasound scanning “high risk” pregnancy

Question 22

with an obese mother it increases the risk of

Answer 22

miscarriage and stillbirths by 25-37%

Pregnancy induced hypertension

Venous throboembolism (Blood clot within vein

Delivery complications

Gestational diabetes mellitus

Question 23

Gestation diabetes

Answer 23

Gestational diabetes mellitus is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy few symptoms

Question 24

How common is gestational diabetes

Answer 24

affects 3-10% of pregnancies

Question 25

gestational diabetes accounts for ? percentage of cases of diabetes in pregnancy

Answer 25

90%

Question 26

In NZ how many women are diagnosed with gestational diabetes per year

Answer 26

3000-4000

Question 27

how much is gestational diabetes increasing per year

Answer 27

8-9%

Question 28

Prevoius diagnosis of gestational diabetes or prediabtes impaired

Answer 28

glucose tolerance, or impaired fasting glycaemia

Question 29

you are more at risk for GDM if

Answer 29

family history maternal age- a womens risk factor increases as she gets older (especially above the age of 35) Previous pregnancy which resulted in a child with a high birth weight

Question 30

Gestational diabetes: complications for the baby

Answer 30

High maternal blood glucose exposes the fetus to higher glucose

Question 31

Higher blood glucose for the baby leads to

Answer 31

Increased fetal levels of insulin (insulin itself cannot cross the placenta)

Question 32

The growth stimulating effects of insulin can lead to

Answer 32

excessive growth and macrosomia (fetal overgrowth)

Question 33

Having gestational diabetes will increase the risk of what latter in life

Answer 33

T2DM

Question 34

Gestational diabetes: Complications for the mother

Answer 34

- A high risk of developing gestational diabetes during a future pregnancy -Mother has increased risk of developing Type 2 diabetes -Caesarean section is more likely if the baby is large -Induction of labour if the baby is growing too big

Question 35

Screening and diagnosis

Answer 35

all non-diabetic women offered/recommended screening for GDM

Question 36

Implications of maternal obesity for the baby

Answer 36

Increased risk of congenital (present from birth) abnormalities -Orofacial cleft -Hydrocephalus

Question 37

For every incremental unit increase in BMI of the mother the risk of birth defects increased by

Answer 37

7%

Question 38

Small for gestational age

Answer 38

Birth weight below the 10th percentile for age

Question 39

Stillborn infants born to obese mother are smaller than those

Answer 39

born normal body weight mother

Question 40

Large for gestational age

Answer 40

fetal overgrowth Birth weight above the 90th percentile for age >400g

Question 41

Delivery of infant with birth weight more than 400g increases risk of

Answer 41

caesarean delivery, fetal hypoglycemia and shoulder dytocia

Question 42

Risk of death 18 months post birth was

Answer 42

4 times greater in infants born to obese mothers

Question 43

weight loss during pregnancy

Answer 43

dieting to lose weight is not recommended during pregnancy