Obesity in pregnancy

1. OBESITY IN
PREGNANCY
Juanda Raynaldi, MD
Universitas Syiah Kuala

2. Introduction
01

3. Obesitas memiliki resiko tinggi
dapat menyebabkan gangguan
peny. Jantung, diabetes, hipertensi,
stroke, dan komplikasi lain
terutama resikok mortalitas.
Pada wanita dengan obesitas
dikatakan bahwa pemeriksaan USG
serial harus dilakukan untuk
menilai perkembangan janin mulai
dari usia 28 – 32 minggu.
Upaya menurunkan berat badan
dengan diet, olahraga dan
modifikasi gaya hidup sangat
diperlukan pada saat prekonsepsi
Obesitas dikaitkan dengan
gangguan kesuburan, abortus, dan
kelainan kongenital pada janin,
makrosomia, preeklampsia,
diabetes gestasional

4. Definisi Dan Klasifikasi
Obesitas adalah berat badan yang memiliki Body Mass Index
( BMI) ≥30 kg/m2.

5. Prevalensi
• WHO mengatakan bahwa obesitas merupakan permasalahan yang paling mudah terlihat
namun tetap terlantar.
• WHO memperkirakan 1.9 Miliar orang dewasa overwight, dan 600 juta diantaranya
obesitas. Di proyeksi pada tahun 2030, lebih dari 2.16 miliar orang overweight dan 1.12
miliar diataranya obesitas
• WHO memperkirakan 1.9 Miliar orang dewasa overwight, dan 600 juta diantaranya
obesitas. Di proyeksi pada tahun 2030, lebih dari 2.16 miliar orang overweight dan 1.12
miliar diataranya obesitas

6. Obesity in
Pregnancy
02

7. Post term pregnancy
Multi fetal pregnancy
Preterm labor
1
2
3
4
5
6
Early pregnancy loss
Diabetes pregestasional
dan gestasional
Preekalmpsia Berat
Antepartum

8. Antepartum
1. Early pregnancy loss
2. Occult type 2 diabetes
3. Gestational diabetes
4. Pregnancy associated hypertension
5. Indicated and spontaneous preterm birth
6. Post-term pregnancy
7. Multifetal pregnancy
8. Obstructive sleep apnea

9. Induction
Progress of labor
Cesarean delivery
Difficulties with anesthesia
Intrapartum

10. Venous thromboembolism
Infection
Postpartum depression
Postpartum

12. 1.Maternal weight and body mass index (BMI).
2.Blood pressure using an appropriately sized cuff
3.Early ultrasound  gestational age a multifetal
gestation
4.Medication review, oral anti-hyperglycemic drugs,
which are often discontinued in favor of insulin therapy.
5.Diabetes screening
6.Consider quantitative urine protein, KFT, platelet count,
and liver function tests  (Baseline values evaluation
for preeclampsia. Obesity is a known risk factor for
nonalcoholic fatty liver disease (NASH). )
7.Bariatric surgery  evaluate for and treat nutritional
deficiencies
Management
1st trimester

14. Excercise
Pregnant women can initiate an exercise
program or continue most prepregnancy
exercise programs, which can help control
gestational weight gain

15. 04
Fetal aneuploidy
screening
1.Cell-free fetal DNA screening is more likely to result in test failure.
2.Serum-based screening tests are adjusted for maternal weight; thus, obesity does not affect
test performance
3.Accurate nuchal translucency measurement may be more difficult to obtain  (transvaginal
probe)
4.Diagnostic procedures (amniocentesis, chorionic villus sampling) are more challenging
technically  (a low-frequency transducer vaginal probe in the umbilicus)
The same as that for the general
Obese women are not at increased risk for fetal aneuploidy
Obesity can affect screening test performance:

16. BMI ≥30 kg/m2, →moderate risk factor for
preeclampsia
Obese women with additional risk factors for
development of preeclampsia may benefit from treatment
with low dose aspirin (81 mg)
Management
2nd trimester
1.nulliparity,
2.family history of preeclampsia (mother or sister)
3.sociodemographic characteristics (African American race, low
socioeconomic status)
4.maternal age ≥35
5.personal factors (eg, low birth weight or small for gestational age,
previous adverse pregnancy outcome, >10-year pregnancy
interval)
Other Moderate risk factors:

17. Fetal ultrasound survey: Management
2nd trimesterA detailed fetal anatomic survey is performed at 18 to 24 weeks
Due to the limitations of ultrasound with increasing degrees of
obesity→concomitant use of maternal serum alpha fetoprotein to
screen for neural tube and other relevant congenital defects
maternal obesity as not an indication for fetal echocardiography
→ unless the detailed obstetric ultrasound assessment of the heart
was not optimal.
Fetal ultrasound survey: Is recommended at 24 to 28 weeks of gestation

18. Assessment of fetal well-being Management
3rd trimesterAlthough the frequency of fetal demise appears to be increased in
pregnancies of obese women, the value of antenatal fetal
surveillance with nonstress tests or biophysical profile scoring in
this setting has not been studied
External cephalic version
Obesity is not a contraindication to ECV, A
successful ECV is particularly beneficial in obese
women, given the significant surgical risks of
cesarean delivery in these patients.

19. Labor and delivery
Equipment and instruments
Ensure that the labor and delivery unit has
appropriate physical resources (eg, gowns,
beds, operating room table) for caring for
severely obese women.
Anesthesia consultation
Evaluation by an anesthesiologist prior to labor or in early labor is
recommended for all obese parturients because of their higher risk of
anesthetic complications. For patients planning a vaginal birth, early
placement of an epidural or intrathecal catheter may obviate the need
for general anesthesia if emergency cesarean is needed
Delivery by the estimated due date has been recommended to reduce the risk of
stillbirth and complications from continued fetal growth.
Timing and route of delivery

20. Thromboprophylaxis :
Use of pneumatic compression devices at the time of
cesarean delivery
For obese women with additional risk factors for venous
thromboembolism, we suggest use of both pharmacologic
and mechanical thromboprophylaxis (Grade 2C). ~ACOG

21. Incision technique:
For women who weigh under 170 kg,
we suggest a Pfannenstiel incision if
the pannus can be adequately
retracted cephalad (Grade 2C). For
women who weigh over 170 kg , we
suggest a transverse supraumbilical
incision with the pannus displaced
caudally (Grade 2C)
Type of incision:
When making the skin incision, attention to the
distorted landmarks in obese women is very
important. The umbilicus is often anatomically
directly over the lower uterine segment because
the large pannus draws it caudally; however, the
position of the symphysis pubis is reliable

22. Subcutaneous closure
The fascia can be closed using a
Smead-Jones or comparable
interrupted technique or mass
continuous closure with
nonabsorbable or slowly absorbable
suture. This is especially important
for supraumbilical incisions. Both
approaches are equally effective for
reducing the risk of dehiscence or
hernia formation.
Fascial closure:
We recommend closure of subcutaneous tissue
greater than 2 cm thick (Grade 1A). We also
recommend avoiding placement of
subcutaneous drains (Grade 1A).
We suggest skin closure with staples rather than
stitches (Grade 2C).
Skin closure

23. • If cesarean was performed, postcesarean care should be modified to reduce the risk
of obesity-associated postsurgical complications.
• Encourage breastfeeding and provide additional support. since obese women are
prone to difficulty with lactation
• Intrauterine contraception is safe and effective, and may be safer and more effective in
this population than estrogen-progestin contraceptives, although the latter are also an
acceptable choice
• Women with a gestational diabetes should be screened for glucose intolerance 6 to 12
weeks after delivery.
Postpartum:

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