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 tripletsworse 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

capacity or understanding to help!

• 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 management

• Pregnancy does not have a long term negative impact upon weight loss in these patients

Cocchrane RCT List

• Computerised weight loss programs

• Psychological support

• Interventions to change GP management

• Gastric Band Management

• Surgery non pregnant