Obesity and obstetrics
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Obesity and obstetrics

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Obesity and obstetrics Obesity and obstetrics Presentation Transcript

  • Obesity and Obstetrics Chris Griffin Consultant Obstetrician KEMH
  • The baby is the fruit of the love between me and my future husband who is slimmer, weighing just 70 kilograms
  • 266 kgs and triplets worse than octomom?
  • Questions • Risk to Baby • How much weight gain in pregnancy • What are the other high risk factors • How to lose weight or not gain weight in pregnancy • Effects of weight loss surgery • What extra surveillance is needed • Link between obesity and pre eclampsia – not known may be inflamatory • Management of insulin resistance – metformin but testicular size? • Ultrasound imaging • Who to refer to in pregnancy • What causes increased risks with obesity • Bariatric surgery
  • Risk to Fetus • ACOG statement • Autism – 50% increase • Developmental delays 150% increase • NTD, cleft lip and palate and cardiac
  • Dietary restriction in Pregnancy • BMJ May2012 Metanalysis • 4 kgs loss with calorie restricted diet • < 1 kgs on exercise alone • 1 kgs on exercise and diet • Diet restriction appeared to be associated with a reduction in pregnancy complications but too much heterogeneity to offer advice to women • Bottom line is that it appears safe to maintain pre pregnancy weight or lose weight in pregnancy but with a healthy dietary approach and not one of starvation as increased risk for NTD and Cl Palate as well as a lower birth weight and intrauterine fetal stress
  • Target weight management chart
  • What can the GP offer • Target weight management • Exercise plans • Dietary • Online programs • Psychological support • Referral to appropriate personnel • 25% of maternity staff do not feel they have the capa • Probiotics
  • Probiotics • lactobacillus • Double blind placebo controlled study • 256 first trimester randomisation • Diet and probiotics had a third the incidence of GDM in the probiotic group
  • Human studies • Two groups of beneficial bacteria are dominant in the human gut, the Bacteroidetes and the Firmicutes. • The relative proportion of Bacteroidetes is decreased in obese people by comparison with lean people, and that this proportion increases with weight loss on two types of low-calorie diet. • Our findings indicate that obesity has a microbial component, which might have potential therapeutic implications.
  • Bariatrics • No RCT studies as yet in pregnancy for manag • Pregnancy does not have a long term negative
  • Cocchrane RCT List • Computerised weight loss programs • Psychological support • Interventions to change GP management • Gastric Band Management • Surgery non pregnant