Obesity and Pregnancy

1
Obesity and Pregnancy

• Professor Julie Quinlivan
• Dean
• School of Medicine Sydney
• The University of Notre Dame Australia

2
How to manage obese women in pregnancy

• Absence of randomised trials in the research
  literature
• What does the general literature advise for
  management of obese women who are not pregnant?

3
Management of overweight women

• The general literature informs us that
• Multidisciplinary approach
• Dietary focus on education
• Address psychological symptomatology contributing
  to obesity
• Address obstetric risks
• Aim to reduce pregnancy weight gain

4
Designing an intervention

• Multidisciplinary clinic
• Obstetrician
• Dietary advisor
• Clinical psychologist (alternating weeks)
• Access to a pregnancy exercise group on Tuesdays

5
Intervention Protocol

• Saw Obstetrician and dietary advisor at each
  visit
• Saw Clinical psychologist and individualised plan
  made for either no more visits, or frequent
  visits
• Encourage breastfeeding, treated depression and
  emotional issues, careful dietary planning and
  information on food labels, sample recipes.

6
RCT Trial Outcomes

• Primary outcome Sample size of 80 per arm could
  detect reduction in gestational diabetes from
  17 to 8.
• Secondary outcomes
• Pooled obstetric and neonatal morbidity
• Weight gain in pregnancy

7
Results
8
(No Transcript)
9
Key outcomes

• Primary outcome gestational diabetes
• Intervention 3.6 (3/83)
• Control 12.3 (10/81)
• P0.039

10
Weight gain

• Intervention 5kg
• Control 14kg
• Plt0.0001

11
Adverse effects on mother and baby pooled

• No significant differences detected