Obesity or failure to gain weight in Pregnancy




Although evidence exists to refuse strongly the value of routine weighting of pregnant women in predicting various perinatal outcomes,surprisingly little is known about optimally weight gain in pregnancy.However,it is becoming increasingly clear that women who have a poor diet and their fetuses are greater risk than well nourished women.Weight is no more than a very crude indicator of a women's health status in pregnancy.However,the midwife observation of a very obese women,or a very thin one,should alert her to some of the risks such women may face during pregnancy and the longer term risks to both women and their children.
A women who starts pregnancy while obese,or puts on an excessive amount of weight during pregnancy,appears to be at greater risk of hypertensive disturbance,including pregnancy-induced hypertension.She is also at greater risk of gestational diabetes and both of these condition make her more likely to be delivered by cesarean section.She is also at increased risk of urinary tract infection,uncertain fetal position,postpartum hemorrhage and thrombotic.She is more likely to give birth to a baby who is either smaller large for gestational age,although if her pregnancy has been otherwise uncomplicated she is not statistically at greater risk of shoulder dystopia.There does not appear to be an association between maternal obesity and perinatal mortality.The women is also more prone to wound infection following operative delivery.Obesity may also be associated with malnourished from essential nutrient deficiency.
As well as excessive weight increase during pregnancy being a greater risk factor for the onset of hypertensive disorders,its sudden onset may signal occult edema.If such weight gain is noticed by the women or the midwife it is prudent to take the women's blood pressure and test her urine for protein.Once edema has been excluded,the midwife should make tactful attempts to discuss the women's diet with her,when it becomes apparent that her weight may raise her risk of complications.It is debatable at what point the midwife should intervene with such a discussion.Ideally all women should be given the opportunity to discuss diet,as well as other general lifestyle factors,from as early on in their pregnancy as possible ,or even before,and at the regular intervals thereafter.Overweight women will often themselves express concerns to a friendly and generally supportive midwife and the midwife should be able to take such opportunities to discuss diet,nutrition,exercise and the reasons why excessive weight gain in pregnancy is undesirable.There is no advantage to dieting during pregnancy.So sensible eating should be advocated.Referral to a dietitian may be helpful.
Blood pressure measurements should always be taken accurately with a correctly sized cuff,and gestational diabetes and urinary infection screened for.Routing weight is rarely of any practical benefit and may only reduce a women's self-esteem and make her dread her antenatal appointments.The midwife should also bear in mind that obesity can be a symptom of another disease,such as hypothyroidism, poly cystic ovarian syndrome or cushing's diseases,and in such cases diet will have only a minimal effect on weight.Conversely,the midwife may observe that a women appears to be thin during her pregnancy and not laying down healthy fat stores.Detailed discussions should attempt to elicit the quality and quantity of the woman's diet and her weight pattern over previous years.Some woman's are naturally very slim and remain so because of genetic factors and a high metabolic rate,going on to produce a healthy sized infant.Of the rest,a medical disorder such as a absorption condition may be present,or starvation,if the woman has been living until recently in a country struck by famine.
The midwife needs to be aware that pregnant women can be afflicted by anorexia nervous or bulimia or both,often chronic conditions that may have been previously undetected despite their obsessive nature,or labelled dieting.Where a woman is suffering from nutritional deprivation she is at greater risk of anemia,preterm birth and intrauterine growth restriction and its sequelae,including birth asphyxia and perinatal death.Bulimia may be wrongly diagnosed as hyperemic gravid arum.The midwife's role in the care of such women will depend on the cause.She should always involve the medical practitioner because of the risk of intrauterine growth restriction,and in case with a medical cause.


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