AOM Clinical Practice Guideline 12: Management of High or Low Body Mass Index during Pregnancy

Flashcards about Body Mass Index during Pregnancy

What is Body Mass Index (BMI)?

A numerical value that relates weight to height and is used as an indicator of adiposity.

How is BMI calculated?

BMI = (weight in kilograms) / (height in metres)2 or BMI = (weight in pounds x 703) / (height in inches)2

What are the WHO BMI categories?

Underweight: BMI < 18.5, Recommended weight: BMI 18.5-24.9, Overweight: BMI 25.0-29.9, Obese: BMI ≥ 30.0

How can poor pregnancy outcomes be prevented in clients with high or low BMI?

Optimize gestational weight gain, and address issues of poverty and marginalization by becoming familiar with community programs and agencies.

What eating disorders are associated with high or low BMI?

Anorexia nervosa, bulimia, and binge eating are often associated with high or low BMI and increase the risks of morbidity and mortality.

What are the risks associated with GWG below guidelines during pregnancy?

Small for gestational age (SGA) and preterm birth.

What are the risks associated with GWG above guidelines during pregnancy?

Large for gestational age (LGA), macrosomia, and caesarean delivery.

What IOM recommendations can help clients address excessive or inadequate GWG during pregnancy?

Calculating and documenting pre-pregnancy BMI on the first antenatal record.

What dietary interventions are recommended for clients during pregnancy?

Dietary interventions have demonstrated effectiveness in reducing excessive weight gain during pregnancy, and Canada's Food Guide offers general dietary advice.

What are the benefits of exercise during pregnancy?

Improved cardiovascular function and a reduction of the occurrence of excess weight gain

What are the cons of a sedentary lifestyle during pregnancy?

Loss of muscular and cardiovascular fitness, excessive GWG, higher risk of gestational diabetes or hypertensive disorders of pregnancy, varicose veins and deep vein thrombosis.

What complications are associated with high BMI (BMI ≥ 30 kg/m2) during pregnancy?

Miscarriage, antenatal anxiety/depression, caesarean section, preeclampsia, gestational diabetes.

What complications are associated with very high BMI (BMI ≥ 40 kg/m2) during pregnancy?

Induction of labor, preeclampsia, gestational diabetes.

What preventative measure can be taken for preeclampsia and hypertension?

Low-dose acetylsalicylic acid (ASA) may provide some preventive benefit for multiple adverse pregnancy outcomes, including preeclampsia and hypertension for those with high BMI and at least one other moderate risk factor for preeclampsia.

What should providers do when monitoring blood pressure for clients with a BMI ≥ 30 kg/m2?

Obtain and document a baseline blood pressure, using the appropriate cuff size.

What should providers discuss with clients with a BMI ≥ 30 kg/m2?

Discuss the higher risk of preeclampsia and GDM, along with the risks and benefits of GDM screening.

Besides preeclampsia and GDM, what other serious health risks is a high-BMI associated with during pregnancy?

Thromboembolism

What preventative measures can be taken for thromboembolism risks?

Evaluate each client’s need for thromboprophylaxis individually and consider suggesting an antepartum consultation with a physician for clients with a BMI ≥ 40 kg/m2, or for clients with a BMI ≥ 30 kg/m2 and other known risk factors for thromboembolism.

How does excessive abdominal adiposity affect fetal monitoring during pregnancy?

Suboptimal visualization during ultrasounds, abdominal palpation and symphysis-fundal measurements can be difficult to interpret.

What measures can be taken if ultrasounds indicate suboptimal visualization?

A repeat ultrasound if needed, and discuss the risks and benefits of a third-trimester ultrasound.

What should providers offer clients who plan to have an epidural?

Offer an antepartum anesthesiology consultation for clients who plan to have an epidural, or for those who wish to have a more detailed discussion about potential anesthesia complications related to BMI ≥ 30 kg/m2.

What postpartum complications are associated with high BMI (BMI ≥ 30 kg/m2)?

Postpartum depression, surgical or caesarean wound infection, postpartum venous thromboembolism, postpartum hemorrhage, and not initiating breast or chest feeding.

How can providers support lactation among mothers with a high BMI?

Encourage chest/breastfeeding by discussing the numerous benefits for both parent and newborn and by providing lactation support.

What fetal and neonatal complications are associated with high BMI (BMI ≥ 30 kg/m2)?

Preterm birth, congenital heart defects, orofacial clefts, infant death, stillbirth, neural tube defects, NICU admission, and large for gestational age.

What fetal and neonatal complications are associated with very high BMI (BMI ≥ 40 kg/m2)?

Congenital birth defects, preterm birth, stillbirth, and large for gestational age.

Clients with a BMI ≥ 30 kg/m2 would benefit from what type of informed choice discussions?

Benefit from informed choice discussions about the increased risk for fetal macrosomia and LGA, and the associated complications this may have during labor and birth.

What does the guideline recommend for clients with a BMI ≥ 30 kg/m2, regarding NTDs?

Discuss the benefits of a diet high in nutrient-dense, folate-containing foods before and during pregnancy to reduce the risk of NTDs, and if clients cannot maintain a high-folate diet, discuss the risks and benefits of administering a supplement with 0.4 mg to 5 mg of folic acid.

In terms of establishing IV access, what does the guideline recommend for midwives?

Ensure that they feel competent to perform venipuncture and gain IV access in clients with a BMI ≥ 30 kg/m2, and they may consider establishing IV access during labor in clients who choose home birth.

BMI ≥ 30 kg/m2 (alone/does not matter) is an indicator for hospital birth.

Alone is not an indicator for hospital birth.

Name the key considerations for fertility in patients with Low BMI.

Fertility problems can increase the difficulty of calculating an estimated due date by menstrual history alone, and can increase the risk for miscarriage compare with recommended-BMI clients

Clients with a BMI < 18.5 kg/m2 are at a higher risk of what?

At higher risk of IUGR, SGA and LBW; offer third-trimester ultrasound or serial growth studies as necessary to rule out IUGR.