Obesity in Pregnancy Flashcards
Normal, High Risk & Abnormal Pregnancy
Risk factors for high risk pregnancies
- Age <15yo or >35yo
- Pre-pregnancy weight under 45kg or obese
- Height under 5 ft (1.5m)
- Incompetent cervix
- Uterine malformations
- Small pelvis
- Being single
- Smoker or alcohol
- Illicit drugs
- No access to early prenatal care
- Low socioeconomic status
- Previous obs hx for recurrent miscarriages
- Hypothyroid
- Hyperthyroid
o Any previous complicated pregnancies (biggest risk for another abnormal pregnancy)
If high-risk, refer for obstetrician-led care and…
o Continued surveillance for high risk patients – more frequent scans
o Offer high dose folate 5mg – also given to…
- Previous child with NTD
- Diabetes mellitus
- Woman on an anti-epileptic
- Obesity
- HIV positive taking co-trimoxazole
- Sickle cell disease
Offer low-dose aspirin (75mg, OD) as prophylaxis for pre-eclampsia
Obesity in Pregnant
Obesity = BMI >30kg/m2
Class I: 30-34.99 kg/m2
Class II: 35-39.99 kg/m2
Class II ≥ 40 kg/m2
· Aetiology
o Pre-existing obesity – poor diet, lack of exercise
o Fluid retention – polyhydramnios, heart, kidney, liver failure
· Epidemiology = 16% of women are obese at the start of pregnancy
Signs
obesity; associated conditions may be present:
- GDM
- Pre-eclampsia
- Infections
- High waist/hip circumference
- Symphysis fundal height significantly higher (> + 2cm of respective gestational week)
Investigation
BMI monitoring
SFH
o Bloods – FBC, LFT, UE, cholesterol, OGTT
o USS – liquor volume, foetal growth scans
Management
Antenatal/ Booking
Women need to take 5mg folic acid for 1 month prior to conception
NUTRITIONAL ADVICE
- more exercise, better diet, vitamin D supplementation
if the BMI >= 35 kg/m² women should give birth in a consultant-led obstetric unit
if the BMI >= 40 kg/m² should have an antenatal consultation with an obstetric anaesthetist and a plan made
Explain to women with a BMI of 30 or more at the booking appointment how this poses a risk, both to their health and the health of the unborn child. Explain that they should not try to reduce this risk by dieting while pregnant and that the risk will be managed by the health professionals caring for them during their pregnancy
First trimester
- Those with BMI ≥ 35kg/m2 should take 150mg aspirin from 12 weeks gestation until delivery as high risk of preeclampsia
- Some forms of chromosomal anomaly screening are less effective if have raised BMI
- Consider TVUSS in women who need nuchal translucency rather than transabdominal USS (as may be difficult)
Second trimester
- GDM screen
- Measure SFH at every antenatal appointment from 24 weeks- use USS to measure foetal size in those with BMI ≥ 35kg/m2
Third trimester
- Re-weigh mother
- Documented risk assessment in those with BMI ≥ 40 kg/m2
NOTE: There should be a moving and handling risk assessment done in those who find it unusually difficult to move
Plan delivery - elective induction of labour (this reduces rates of caesarean sections without increasing adverse outcomes)
Intrapartum
- Constant foetal monitoring whilst in labour
- Establish early venous access
- Consult anaesthetist
- Active management of 3rd stage to reduce risk of PPH
Post-partum
- Advise on weight loss
- T2DM testing
Complications
Complications
FOETAL
- Stillbirth
- Foetal macrosomia
MATERNAL
- Hypertensive complications e.g. pre-eclampsia
- GDM
- Higher risk of VTE in obese
- At higher risk of Vitamin D deficiency
- Labour difficulties
Prognosis
- almost 1/3 maternal deaths are in obese mothers
