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Obesity During Pregnancy: A Teachable Moment

A Prezi Presentation adapted from a recent article by Suzanne Phelan, PhD which details current strategies for addressing obese women during pregnancy
by

Chukwuma Onyeije

on 10 September 2010

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Transcript of Obesity During Pregnancy: A Teachable Moment

Obesity is major health problem in
the United States.
65.1% of Americans are
considered overweight
or obese
The prevalence of obesity
has increased by 50%
(from 14.5 to 33.6%) over
the past 2 decades.
The known risks of obesity include
hypertension
cardiovascular disease
diabetes mellitus
cancer An important contributing factor to weight gain among young adult women is sustained weight retention after pregnancy.
In 2 large prospective studies, weight gain during the pregnancy and weight changes during the year after delivery were both independently related to the development of obesity and weight gain at greater than 10 years follow-up.
oBESITY DURING PREGNANCY A Teachable Moment The Depressing Statistics HYPERTENSION CARDIOVASCULAR
DISEASE DIABETES CANCER Currently, two-thirds of women are overweight,
of which a third are obese. Having 1 child doubles the incidence of obesity in 5 - 10 years compared with women who have never given birth Childbearing contributes to the long-term development of obesity in women.

Prepregnancy, pregnancy, and postpartum periods are critical to the obesity problem. Perinatal Factors Related to Obesity:
Prepregnancy weight
Excessive pregnancy weight gain
Postpartum weight retention
High parity Women who are overweight at the beginning
of pregnancy are significantly heavier after pregnancy. Women who are obese prepregnancy are more likely than the normal prepregnancy weight women to have adverse pregnancy-related outcomes. ADVERSE PREGNANCY RELATED OUTCOMES
SEEN IN OBESE MOTHERS:
gestational diabetes,
pregnancy-induced hypertension
maternal infections
operative delivery
neonatal hypoglycemia Historical recommendations for appropriate pregnancy weight gain have varied
substantially eARLY 1900S:
restricted weight gain to prevent macrosomia 1960S - 1990
INCREASED weight gain emphasized to avoid low birth weight and abnormal outcome The current IOM pregnancy weight gain recommendations are intended to reduce infant mortality by increasing maternal pregnancy weight
Recent research shows that the range of pregnancy weight gain recommended by the IOM continues to be associated with the optimal birth size The IOM-recommended ranges DECREASE the risk of
Low birth weight (<2500 grams)
Macrosomia (>4000 g)
Small for gestational age (SGA)
Large for gestational age (LGA) What Happens when patients EXCEED IOM? And, does it matter? IMPORTANT POINT:
Provider advice about recommended weight gain correlates strongly with actual pregnancy weight gain. Unfortunately, more than half of pregnant patients DO NOT get information regarding weight gain. Gestational diabetes is also related to number of adverse infant
outcomes and obese women are 6 times more likely to have gesational diabetes than normal weight women. MATERNAL AND INFANT OUTCOMES RELATED TO MATERNAL OBESITY Gestational diabete
Hypertensive disorders
Abnromal Infant outcomes Pregnancy-induced hypertension
causes significant morbidity, and
increases the risk of developing essential hypertension long term. Obese women and those who exceed IOM guidelines have a greater incidence of adverse infant outcomes EXAMPLES:
Head trauma,
fractured clavicles
brachial plexus lesions
shoulder dystocia,
Intrauterine fetal death,
Infant mortality

Excessive weight gain during pregnancy is an independent risk factor for macrosomia. Timing of maternal weight gain
First Trimester: Most important
Third Trimester: Least important Obese women have infant death risk of 2.0 to
4.3 times that of normal weight mothers. special high risk
populations Women at high risk for excessive gestational weight gain and postpartum weight retention. Adolescents
Women of low socioeconomic status,
African-American women
Women who have undergone bariatric surgery Common practice has been to recommend that
adolescents and African Americans gain at the upper end of the pregnancy weight gain ranges to prevent low infant birth weight. HOWEVER African American and poor women have greater prepregnancy weight, parity, postpartum weight retention, and calorie intake, as well as decreased physical activity in the postpartum period What can be done 5 clinical intervention studies have aimed to promote healthy weight gain during pregnancy These 5 studies varied in intensity
from newsletters and health booklets to counseling sessions with dieticians,
aqua aerobic classes, or weight monitoring by health providers. The available studies indicate
that excessive weight gain
during pregnancy can be reduced
by 40% Clinical interventions that focus on restricting maternal weight during pregnancy are
controversial Four recent clinical intervention studies have focused on efforts to reduce postpartum weight retention All 4 studies showed more weight reduction postpartum in the treatment groups

BUT

Self-monitoring appeared to be MORE effective in helping women lose weight postpartum. Pregnancy as a “teachable moment” A teachable moment is:
a naturally occurring life transition
or health event that can motivate individuals to spontaneously adopt risk-reducing health behaviors By monitoring and giving
appropriate advice about gestational
weight gain, health care providers have
the potential to influence weight gain
during pregnancy and reduce the incidence
of overweight and obesity in
women and children.
Full transcript