Addressing the influence of obesity on pregnancy to improve the health of women and their offspring

Obesity is associated with a large number of serious pregnancy complications. Changes to pre-pregnancy and early pregnancy care can reduce risk and improve life expectancy of offspring.

Across Australia 46% of pregnancies are complicated by overweight or obesity; in the Western suburbs the figure is over 55% and over 7% are Class 3 obese (BMI>40). Obesity, at all levels, imparts powerful effects on pregnancy including risk of diabetes, hypertensive disease, caesarean section, neonatal intensive care admission as well as a dramatic rise in stillbirth risk.

Guidelines advocate for increased surveillance, weight gain minimisation, aspirin and calcium supplementation and carefully timed delivery. Many of the recommended measures need to be considered pre-pregnancy or in the first trimester. In the current model, most women don’t get seen in the antenatal clinic until well into the second trimester which is too late to make a difference.

A coordinated and consistent approach pre-pregnancy, in early pregnancy and postnatally is likely to support increased adherence to risk mitigation strategies. Many of the interventions are simple and low risk and just require an understanding of the difference that can be made to outcomes. Recent research is highlighting that some interventions positively alter the offspring genome; these trials should encourage all of us to look at ways of adjusting our approach to pregnant, or soon to be pregnant, women living with obesity.

SPEAKER:
Glyn Teale is the Clinical Services Director for Women’s and Children’s Services at The Joan Kirner Women’s and Children’s at Sunshine Hospital, Western Health and Clinical Associate Professor, University of Melbourne. He is a clinically active obstetrician and gynaecologist with research interests in reducing stillbirths and the management of obesity in pregnancy.
Glyn is a member of The Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) and two of its subcommittees; The Neonatal Death subcommittee and The Maternal Mortality & Morbidity subcommittee. He was formally the Chair of the Safety and Quality Committee and the Clinical Lead for the Maternity and Newborn Clinical Network Maternity and Newborn Program, Department of Health and Human Service in Victoria.
In response to the increasing percentage of women with extreme obesity seeking antenatal care at Western Health, Glyn established the DIAMOND Antenatal clinic in 2016. This dedicated multidisciplinary clinic supports women with BMI over 50 to achieve safe pregnancy outcomes and was awarded the Person-Centred Care award in 2017.

Learning outcomes:

By the end of this session you will be able to:

• Describe the complications that women living with obesity face in pregnancy
• Provide care and advice to women who are obese pre-pregnancy or in early pregnancy as per guidelines
• Incorporate routine discussion of pregnancy risk with obese women as a routine part of care and offer advice on risk mitigation