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Prenatal Care in Obesity


Pregnancy
Damar Prasmusinto
Fetomaternal Division, Department of Obstetrics and
Gynecology
Faculty of Medicine, University of Indonesia

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Everything is Goreng

Indonesia

2010 total populaDon: 239 870 937


Income group: Lower middle

WHO Noncommunicable Diseases Country Profiles 2011!

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Indonesia

2010 total populaDon: 239 870 937


Income group: Lower middle

WHO Noncommunicable Diseases Country Profiles 2011!

Obesity

a risk factor in pregnancy

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Obesity

a risk factor
for
osprings
lifelong
metabolic
complicaDon
s
a risk factor
for
congenital
anomalies

How to dene

Body mass index (BMI) is currently the most widely used


measure

Measurements of skin-fold thickness and waist


circumference

CalculaDon of waist-to-hip circumference raDos

Imaging techniques such as ultrasound, computed


tomography, and magneDc resonance imaging

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Body Mass Index and Obesity


Definition!

Body mass index, kg/m2!

Underweight!

<18.5!

Normal!

18.5-24.9!

Overweight!

25.0-29.9!

Obesity class!

30.0-34.9!

I!

35.0-39.9!

II!

>40!

III!

Obese!
Extremely obese!

Pi-Sunyer FX, Becker DM, Bouchard C, et al. 1998!

Body Mass Index

BMI = weight/height2

correlated at extremes of the distribuDon

=
!

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Antenatal Management
First trimester
What can I palpate?

Antenatal Management
First trimester

Using ultrasound to conrm pregnancy viability


and assign esDmate gestaDonal age
Be careful of twin gestaDon
Screening or diagnosDc tesDng, if desired,
should not be deferred because of obesity

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Antenatal Management
First trimester
A thorough history and complete physical
examinaDon should be undertaken
Baseline laboratory tests

complete blood count, liver funcDons, kidney


funcDons, blood sugar, thyroids, lipid prole, 24
hours urinalysis

Antenatal Management
First trimester
Echocardiography
Sleep disorder evaluaDon
Counselling about the risks of adverse
pregnancy outcome

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GestaDonal weight
recommendaDons
Obese paDents should receive dietary
counselling with specic weight gain goals
PaDents should be advised that limited
weight gain, rather than weight loss, is a
primary goal during pregnancy

GestaDonal weight
recommendaDons

6.8 kg!

1990 IOM
guidelines!

2009 IOM/NRC !
guidelines!
4.9-9.0 kg!

0.2 kg!

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Antenatal Management
Second trimester
Medical opDmisaDon
Prenatal diagnosis of congenital anomalies
The sonographic evaluaDon of fetal
anatomy in is compromised by the inability
to achieve adequate ultrasound
visualisaDon of fetal structures because of
an obese body habitus

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Antenatal Management
Second trimester

Second laboratory tests

complete blood, OGTT, ferriDn, total


protein~albumin, urinalysis
CRP, HBsAg, HIV

Antenatal Management
Second trimester

Ongoing counselling for

appropriate weight gain


dietary recommendaDons
improvement of coexisDng medical disorders
obtaining appropriate medical consultaDve
referrals

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Antenatal Management
Third trimester

A criDcal period

Appearance of gestaDonal hypertensive


disorders
A higher risk of preterm delivery

More frequent antenatal visits

Antenatal Management
Third trimester

Ultrasound evaluaDon of fetal growth


serially should be considered

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Summary
The obese pregnant woman and her fetus
are at considerable risk for adverse
perinatal outcomes
The treatment of these paDents is
challenging, mulDfaceted, and oben
mulDdisciplinary

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