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obesity and pregnancy

Dr. Osama Yahia

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obesity and pregnancy

  1. 1. OBESITY AND PREGNANCY Dr. Osama Yahia OB/GYNE Specialist Afif General Hospital
  2. 2. DEFINITION • Overweight is defined as a body mass index (BMI) of 25-29.9 • Obesity is defined as a BMI of 30 or greater • There are 3 levels or classes within the general category of obesity reflect the increasing health risk. • Lower risk (Class I) is a BMI of 30-34.4 • Medium risk (Class II) is a BMI of 35-39- .9 • Highest risk (Class III or morbid obesity)- is a BMI of 40 or greater.
  3. 3. BODY MASS INDEX • Is a simple index of weight-for-height and is calculated by dividing a person’s weight in kilograms by the square of their height in meters (kg/m2).
  4. 4. • The prevalence of obesity in pregnancy has been increased from 9-10% in the early 1990s to 16-19% in the 2000s. (UK) • 2/3 of US women of child bearing age are obese or overweight.
  5. 5. RISK OF OBESITY DURING PREGNANCY • Depression and Anxiety • Gestational Diabetes • D.M in the future • D.M of their children. Obese women are screened for Gestational Diabetes and screened later in pregnancy as well. • Pre-eclampsia and Eclampsia: the baby may need to delivered early.
  6. 6. • Stroke in rare cases • Prolonged pregnancy • Sleep apnea which can cause fatigue, high blood pressure, pre-eclampsia, eclampsia and heart and lung disorders. • Thromboembolism • Lower breastfeeding rate • Induced labor • Higher cesarean section rate • Anaesthetic complications • Dysfunctional labor • Post partum hemorrhage • Wound infection • Maternal death
  7. 7. BABY RISK • Miscarriage • Fetal Congenital Anomaly such as heart defects and neural tube defects • Problems with diagnostic tests. The too much body fat can make it difficult to see certain problems with the baby’s anatomy on an ultrasound exam. Checking the baby’s heart rate during pregnancy may be difficult. • Macrosomia with increase risk of injury of the baby e.g. shoulder dystocia. • Increased cesarean delivery • Obesity of infants later in life, DM & heart diseases
  8. 8. BABY RISK • Preterm birth (2 folds increase) due to problem associated with obesity such as pre-eclampsia. Baby have an increased risk of short-term and long- term health problems. • Stillbirth (2 folds risk) the higher the BMI the greater the risk of still birth.
  9. 9. PRE PREGNANCY CARE • Primary Care services should ensure that all women of childbearing age have the opportunity to optimize their weight before pregnancy. • Women of childbearing age with a BMI ≥ 30 should receive information and advice about the risks of obesity during pregnancy and childbirth, and be supported to lose weight before conception.
  10. 10. • Losing weight before pregnancy is the best way to decrease the risk of problems. • Losing a small amount of weight (5- 7% of weight or about 10-20 pounds) can improve the overall health and pave the way for healthier pregnancy. • To lose weight more calories are used than take in. This can be done by eating healthy foods and exercise.
  11. 11. • Women will achieve & maintain a healthy weight before, during and after pregnancy if they:  base meals on starchy foods such as potatoes, bread, rice and pasta.  Eat fibre-rich foods such as oats, beans, peas, lentils, grain seeds, fruit and vegetables, as well as wholegrain bread and brown rice and pasta.  Eat low fat diet and avoid increasing their fat and/ or calorie intake.  Eat at least five portions of variety of fruits and vegetables each day, in place of foods higher in fat and calories.  Eat as little as possible of fried food, drinks and confectionery high in added sugars such as cakes, pastries and frizzy drinks; and other food high in fat and sugar such as some take-away and fast foods.  Eat breakfast  Watch the portion size of meals and snacks, and how often they are eating.
  12. 12. • Make activities such as walking, cycling, swimming, aerobics and gardening part of everyday life and build activity into daily life for example by taking the stairs instead of the lift or taking a walk at lunchtime. • The aim is to be moderately active ( for example biking, brisk walking and general gardening)for 60 minutes, or vigorously active (jogging, swimming laps) for 30 minutes on most days of the week. It does not have to do this amount at once. For instance, exercise 20 minutes 3 times a day.
  13. 13. • Minimize sedentary activities, such as sitting for long periods watching television, at a computer or playing videogames. • Walk, cycle or use another mode of transport involving physical activities. • If trial to lose weight through diet change or exercise and still BMI of 30 or greater or a BMI of at least 27 with certain medical conditions, such as diabetes or heart disease, weight-loss medications may be suggested. • Those medications should not be taken if the obese woman is trying to become pregnant or is already pregnant.
  14. 14. • Bariatric Surgery may be an option for people who are very obese or who have major health problems caused by obesity. If weight loss surgery has done, pregnancy should be delayed for 12-24 months after surgery. • If there are fertility problems they may resolve on their own with rapidly lose the excess weight. It is important to be aware of this because the increase in fertility can lead to unplanned pregnancy. • Some types of Bariatric Surgery may affect how the body absorbs medications taken by mouth, including birth control pills, switch to another form of birth control may be needed.
  15. 15. • Despite the risk, obese woman can have a healthy pregnancy. She takes careful management of weight, attention to diet and exercise, regular prenatal care to monitor for complications, and special considerations for labor and delivery. • Women with a BMI ≥30 wishing to become pregnant should be advised to take 5mg folic acid supplementation daily, starting at least one month before conception and continuing during the first trimester of pregnancy.
  16. 16. PREGNANCY CARE • All pregnant women should have their weight and height measured, and their body mass index calculated at the antenatal booking visit. • All pregnant women with a booking BMI ≥30 should be provided with accurate and accessible information about the risks associated with obesity in pregnancy and how they may be minimized.
  17. 17. • Pregnant women with booking BMI ≥40 should have an antenatal consultation with an obstetric anaesthetist, so that potential difficulties with venous access, regional or general anethesia can be identified. • Women with booking BMI≥30 should be assessed at their first antenatal visit and through pregnancy for the risk of thromboembolism. Antenatal and post delivery thromboprophylaxis should be considered. • Women with booking BMI ≥35 have an increased risk of pre-eclampsia and should have surveillance during pregnancy.
  18. 18. • All pregnant women with a booking BMI ≥30 should be screened for gestational diabetes • Women with booking BMI ≥30 are advised to take 10 micrograms Vitamin D supplementation daily during pregnancy and while breastfeeding. • Finding a balance between eating healthy foods and staying at a healthy weight is important. In the 2nd and 3rd trimester, a pregnant woman needs an average of 300 extra calories a day.
  19. 19. • Dieting during pregnancy is not recommended as it may harm the health of unborn child. • Exercise during pregnancy: pregnant women begins with 5 minutes of exercise a day and add 5 minutes each week. The goal is to stay active for 30 minutes on most –preferably all-days of the week. Walking is a good choice if she is new to exercise. Swimming is another good exercise for pregnant women. The water supports their weight and can avoid injury and muscle strain.
  20. 20. • Weight will be tracked at each prenatal visit. The growth of their babies will be checked. • If they are gaining less than the recommended guidelines, and if their babies are growing well, they do not have to increase their weight gain. If their babies are not growing well, change may need to be made to their diet & exercise plan.
  21. 21. DELIVERY CARE • Overweight and obese women have longer labors than women of normal weight. It can be harder to monitor the baby during labor. For these reasons, obesity during pregnancy increase the likelihood of having a cesarean delivery. If a caesarean delivery is needed, the risk of infection , bleeding and other complications are greater for an obese woman than for a woman of normal weight. • Women with booking BMI ≥30 should have individualized decision for VBAC. • Women with BMI ≥ 35 should give birth in a consultant-led obstetric unit with appropriate neonatal services. • In the absence of other obstetric or medical indication obesity alone is not and indication for induction of labor and a normal birth should be encouraged.
  22. 22. • The duty Anesthetist covering labor ward should be informed when a woman with a BMI ≥40 is admitted to the labor if delivery or operative intervention is anticipated. • All women with BMI ≥30 should be recommended to have active management of the 3rd stage of labor. • Women with a BMI ≥30 having cesarean section have increased risk wound infection and should receive prophylactic antibiotics at the time of surgery.
  23. 23. CARE AFTER DELIVERY • Stick to healthy eating and exercise habits to reach a normal weight. • Breastfeeding is recommended for the first year of a baby’s life, not only is breastfeeding the best way to feed the baby, it also may help with post partum weight loss. Women who breastfeed their babies for at least a few months tend to lose pregnancy weight faster than women who do not breastfeed. • All women with BMI ≥30 who have been diagnosed with gestational diabetes should have a test of glucose tolerance approximately 6 weeks after birth.
  24. 24. POST NATAL CONTRACEPTION • IUDs and contraceptive implants are the most effective contraceptives for obese women. Contraceptive pills, patches and vaginal rings are effective options; however obese women should be made aware of a potential increased risk of venous thromboembolism. • Vasectomy & hysteroscopic sterilization carry the least surgical risk for obese women.