national obstetrics registry (nor)acrm.org.my/nor/doc/universal_vs_population... · rancog, college...
TRANSCRIPT
-
National Obstetrics Registry (NOR)
-
Obesity – the epidemic
World Obesity Federation 2015
WHO Overweight and Obesity January 2015
National Obstetrics Registry (NOR)
-
Malaysian Scenario
National Obstetrics Registry (NOR)
-
Obesity Burden
3.4 million deaths, 3.9% of years lost & DALY
Health burdenBMJ OPEN 2014
Lancet 2014, Global Burden of Disease StudyNational Obstetrics Registry (NOR)
-
Obesity & Pregnancy
BMI risk stratification tool in Obstetrics
ACOG, Committee Opinion 549, January 2013CMACE/RCOG Joint Guideline 2010NICE, weight management public Health Guidance 27, July 2010RANCOG, College Statement C-Obs 49, March 2013
National Obstetrics Registry (NOR)
-
The Obstetrician
National Obstetrics Registry (NOR)
-
Definition of BMI
Centres for Disease Control and Prevention
•Gender
•Age
•Ethnicity BMI
National Obstetrics Registry (NOR)
-
Population specific BMI
Lancet 2004BMJ 2014IDFIFSO- Asia Pacific 2011
Population
specific
references
ASIAN
Specific
references
National Obstetrics Registry (NOR)
-
OBJECTIVES
•Maternal
•Fetal
BMI1)WHO
2) ASIAN
3) Malaysian
National Obstetrics Registry (NOR)
-
METHODS
Cross sectional retrospective cohort study
Dataset is from the National Obstetric Registry of Malaysia (14 major tertiary hospitals nationwide)
Three year study period from 1st January 2010 till 31st December 2012
National Obstetrics Registry (NOR)
-
DEFINITIONS
Inclusion criteria
Booking BMI < 16 weeks
WHO references
ASIAN references 2004
Malaysian references
GDM based on NICE guidelines 2014
Exclusion criteria
Booking >16 weeks of pregnancy
Missing/incomplete data
Multiple pregnancies
IVF pregnancies
National Obstetrics Registry (NOR)
-
The Malaysian BMI range
• 35.5
Obesity
Receiver operating
characteristics
(ROC) curve• 21.6-24.9
National Obstetrics Registry (NOR)
-
METHODS
Total Sample size 399,274 pregnant mothers
WHO MALAYSIAN
Included in study298,642 pregnant mothers
ASIAN
National Obstetrics Registry (NOR)
-
Primary outcomes
Pre-gestational hypertension
Pre-gestational diabetes
Secondary outcomes
Primary Post partum haemorrhage
Shoulder dystocia
Fetal macrosomia
Caesarean section
Outcome Variables
Adjusted for maternal age, parity & ethnicity
National Obstetrics Registry (NOR)
-
STATISTICAL ANALYSIS
Multivariate analysis using logistic regressions
Crude and adjusted odds ratio with respective 95% confidence interval
Paired sample t-test to compare the mean difference between odds ratio
National Obstetrics Registry (NOR)
-
RESULTSNational Obstetrics Registry (NOR)
-
Pre-gestational diabetes
(n = 2,722)
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Overweight Class 1 obesity Class 2 obesity Class 3 obesity
1.59
2.27
3.12
3.76
1.53
2.29
2.8
4.01
1.64
2.41
2.93
4.18WHO ASIAN MALAYSIAN
BMI
21.6
National Obstetrics Registry (NOR)
-
Pre-gestational Hypertension
(n=3,051)
0
2
4
6
8
10
12
14
Overweight Class 1 Obesity Class 2 obesity Class 3 obesity
2.15
3.96
6.32
11.09
1.83
3.54
6.34
10.78
2.53
5.24
8.01
12.99WHO ASIAN MALAYSIAN
BMI
21.6
National Obstetrics Registry (NOR)
-
Caesarean section
(n=95,085)
0
0.5
1
1.5
2
2.5
3
3.5
4
Overweight Class 1 obesity Class 2 obesity Class 3 obesity
1.34
1.84
2.59
3.57
1.26
1.68
2.35
3.4
1.33
1.93
2.58
3.68WHO ASIAN MALAYSIAN
National Obstetrics Registry (NOR)
-
Primary PPH
(n=2,091)
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
Overweight Class 1 obesity Class 2 obesity Class 3 obesity
1.19
1.53 1.52
1.84
1.25
1.481.62
1.8
1.21
1.44
1.6
1.87WHO ASIAN MALAYSIAN
National Obstetrics Registry (NOR)
-
Shoulder dystocia
(n=758)
0
0.5
1
1.5
2
2.5
3
Overweight Class 1 Obesity Class 2 Obesity Class 3 Obesity
1.7
2
2.54
1.781.7
2
2.54
1.71.83 1.88
2.612.44
WHO ASIAN MALAYSIAN
BMI
31.5
National Obstetrics Registry (NOR)
-
Fetal macrosomia
(n=5,331)
0
2
4
6
8
10
12
Overweight Class 1 obesity Class 2 obesity Class 3 obesity
2.28
4.46
8.16
9.93
1.94
4.12
7.85
11.64
1.83
4.1
6.03
9.68
WHO ASIAN MALAYSIAN
National Obstetrics Registry (NOR)
-
Conclusion &
Recommendations
Population specific range is a more sensitive measure
Range for Malaysians
35.5
National Obstetrics Registry (NOR)
-
Strength and limitations
Strength
Sample size
Limitations
Single registry
Retrospective
Underpowered for
anaesthetic complications
and thromboembolism
National Obstetrics Registry (NOR)
-
Acknowledgements
Director General of Health
NOR site co-ordinators
Dr Japaraj Robert Peter
Declaration of interest - NONE
National Obstetrics Registry (NOR)
-
REFERENCES
World Health Organization: Obesity. Preventing and Managing the Global Endemic. Geneva: WHO,
1998
World Health Organization expert consultation. Appropriate body-mass index for Asian populations and
its implications for policy and intervention strategies. Lancet. 2004;363:157–63.
Sebire NJ, Jolly M, Harris JP, Wadsworth J, Joffe M,Beard RW, et al. Maternal obesity and pregnancy
outcome: A study of 287,213 pregnancies in London. Int J Obesity 2001;25:1175-82.
Baeten JM, Bukusi EA, Lambe M. Pregnancy complications and outcomes among overweight and
obese nulliparous women. Am J Public Health 2001;91:436-40.
Steinfeld JD, Valentine S, Lerer T, Ingardia CJ, Was JR, Curry SL. Obesity-related complications of
pregnancy vary by race. J Matern Fetal Med 2000;9:238-41
National Obstetrics Registry (NOR)
-
THANK
YOUNational Obstetrics Registry (NOR)
-
Extra SlidesNational Obstetrics Registry (NOR)
-
Incidence
0.7%
8.1%
0.8%
0.5%
23.8%
3.8%
1.3%
0.2%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0%
Pre-existing Diabetes Mellitus (n=2722)
Gestational Diabetes Mellitus (n= 32328)
Pre-existing Hypertension (n= 3051)
Primary Postpartum Haemorrhage (n=2019)
Caesarean section (n=95085)
Instrumental delivery (n=15320)
Fetal macrosomia (n=5331)
Shoulder Dystocia (n=758) Adjusted for maternal age, parity & ethnicity
National Obstetrics Registry (NOR)
-
ROC curve
National Obstetrics Registry (NOR)
-
BMI as a risk stratification
tool in Obstetrics
strong
• Pre-gestational hypertension
• Fetal macrosomia
Moderate
• Pre-gestational Diabetes
• Shoulder dystocia
• Caesarean section
• Primary PPH
Weak• Stillbirth
• Assisted conception
National Obstetrics Registry (NOR)