Miss Naziim Mohamed1, Dr Charlotte Frise2, Dr Sheba Jarvis1,2
1Imperial College London, London, United Kingdom, 2Imperial College Healthcare Trust, London, United Kingdom
Biography:
Charlotte Frise is a consultant Obstetric Physician and is Lead Obstetric Physician for the NW London Maternal Medicine network. She is co-editor-in-chief of the journal Obstetric Medicine. She has authored two textbooks: Obstetric Medicine, in the Oxford Specialist Handbooks in Obstetrics and Gynaecology series, and Case Histories in Obstetric Medicine.
Abstract:
Background: Obesity is a major global health issue linked to non-communicable diseases such as type 2 diabetes mellitus, hyperlipidaemia and hypertension1. Obesity is defined as a body mass index (BMI) over 30 kg/m2 2 and extreme obesity as over 50 kg/m2 3. Obesity in pregnancy is associated with adverse risks such as gestational diabetes mellitus (GDM), preeclampsia and venous thromboembolism4. The aims of this paper are to explore the prevalence of extreme obesity in our Trust, explore the perinatal outcomes and compare the management of these women to guidelines.
Methods: The electronic patient record was searched for women with a BMI over 50kg/m2 who delivered between January 2019 and January 2024. 45 pregnancies were appropriate to include for analysis.
Results: 8 women (17.8%) were admitted to the maternal high dependency unit, with a mean stay of 8 days. 8 women (17.8%) developed preeclampsia. 26 (57.8%) women delivered by caesarean section.11 women developed GDM.
For antenatal VTE prophylaxis, adherence to local guidelines ranged from 80-87%. 21 patients were incorrectly classified at booking as low risk, in contrast to national and Trust guidelines; however, this was recognised later in their pregnancy and prophylactic anticoagulation started in the majority.
Conclusions: Women with extreme obesity had higher rates of GDM, preeclampsia, postpartum haemorrhage and labour intervention, consistent with other studies comparing extreme and moderate obesity. Very few women were assessed for vitamin B12 and folate levels, respiratory function and liver disease, despite increasing understanding of the association of obesity and sleep apnoea/obesity hypoventilation and metabolic dysfunction-associated steatotic liver disease.
A key finding was confusion about risk assessment for VTE, with local and national guidelines subtly different, leading to inter-clinician variability and an unintentionally inconsistent local approach, for which pathway review and education are required.
Keywords
Extreme Obesity, Pregnancy
References
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(2) Edward E. Mason M.D., Ph.D. a b, Cornelius Doherty M.D. a b, James W. Maher M.D. a b, David H. Scott a b, Evelyn M. Rodriguez a b, Thomas J. Blommers Ph.D a b. Super Obesity and Gastric Reduction Procedures – ScienceDirect. Gastroenterology Clinics of North America. 1987; 16 (3): 495-502. https://www.sciencedirect.com/science/article/abs/pii/S0889855321003125.
(3) Catalano PM. Management of Obesity in Pregnancy. Obstetrics & Gynecology. 2007; 109 (2 Part 1): 419. 10.1097/01.AOG.0000253311.44696.85.