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Maternal Obesity: A Continuum of Risk November 22, 2013
Anne M. Jorgensen NNP Assistant Professor of Pediatrics
New York Medical College
“Globesity” Global Epidemic of Overweight and Obesity
Obesity Prevalence Worldwide § An es:mated 500 million adults worldwide are obese and
1.5 billion are overweight or obese.
§ If recent trends con:nue unabated, nearly 60 percent of the world’s popula:on—3.3 billion people—could be overweight (2.2 billion) or obese (1.1 billion) by 2030.
Defining Overweight & Obesity ~ Body Mass Index ~
Obesity: Condi:on characterized by excess body fat and frequently resul:ng in significant impairment of health and longevity
BMI : Reliable indicator of body fatness
BMI Calcula:on BMI = Weight (lbs.) / [height (in.)] 2 x 703 Example: Weight = 150 lbs, Height = 5’5” (65”) [150 ÷ (65)2] x 703 = X
(150 ÷ 4225) x 703 = X .0355029585 x 703 = X 24.96 = X 25 = BMI
Obesity: Defined by BMI Weight classification by Body Mass Index (BMI)
Standard Weight Categories for Adults
WEIGHT STATUS "
BMI (Kg/M2)"
Underweight "" < 18.5"
Normal" 18.5 - 24.9"Overweight "" 25.0 - 29.9 "
Obese "" > 30.00"Class 1"Class 2 "Class 3 "
30.00 – 34.99"34.99 – 39.99 "> 40"" WHO, CDC, 2012
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Obesity Trends* Among U.S. Adults BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data
1
Obesity Trends Among U.S. Adults BRFSS, 1991
No Data
1
Obesity Trends Among U.S. Adults BRFSS, 1997
No Data
1
Obesity Trends Among U.S. Adults BRFSS, 2004
No Data
1
Obesity Trends Among U.S. Adults BRFSS, 2010
No Data 30 • Waist Circumference
What is Morbid Obesity?
§ Obesity becomes "morbid" when it reaches the point of significantly increasing the risk of one or more obesity related health condi:ons or serious diseases (comorbidi:es).
§ Morbid obesity is considered a chronic condi:on
§ Obesity related comorbidi:es may result in significant physical disability or even death.
§ Morbid obesity is typically defined as being 100 lbs. or more over ideal body weight or having a BMI of 40 or higher.
1
What Causes Obesity? ~ Multifactorial & Complex Etiologies ~
Energy Imbalance: Energy expenditure is less than food intake, energy, in the form of triglycerides are stored in adipose :ssue. Cultural Influences: Food volume; food availability; fast foods & soda consump:on; media & marke:ng influences on food choices; exercise habits; lifestyle habits Environmental Influences: work schedule, weather, safety Socioeconomic Factors: Food scarcity Biologic Factors: Brain & diges:ve organs; chemical & hormonal influences on appe:te regula:on; lep:n levels
What Causes Obesity? ~ Multifactorial & Complex Etiologies ~
Gene:c Factors: § Gene:cally Low Lep:n levels § Human obesity gene map (2005) links more than 600
genes, markers and chromosomal regions to obesity § Rare Gene:c Syndromes: Prader-‐Willi, Cohen Alstrom;
Bardet-‐Biedl Medica:ons
§ Steroids, Some An:depressants § Insulin & Insulin S:mula:ng Drugs
Medical Causes § Underac:ve Thyroid § Cushing’s Disease; Polycys:c Ovary Syndrome
Obesity: An Energy Imbalance
Energy (Kcal) IN > Energy (Kcal) OUT What Causes Obesity?
1
What Does Obesity Cause?
“Sitting is the Smoking of Our Generation”
Nilofer Merchant, Healthcare Blog
Maternal Obesity Pre-‐Pregnancy Obesity
Improved Awareness -‐ Correct PercepAon
Maternal Obesity Prevalence ★Pre-‐ Pregnancy Obesity
§ 57% women ages 18-‐42 – overweight or pre-‐obese § Nearly 60% women begin pregnancy overweight or obese
§ 8% reproduc:ve-‐aged women are extremely obese
§ Obesity is most common in Non-‐ Hispanic Black women (50% prevalence); Mexican American (45%); and White (33%)
§ Lack of educa:on increases risk for obesity § Less than high school educa:on doubles risk, compared to women with high school educa:on
§ Inversely related to socioeconomic status
Pregnancy Risk Assessment Monitoring System Pre-‐pregnancy Obesity Prevalence in the US: 2004 -‐ 2005
n = 75,403 women, participating in the PRAMS, from 26
states and New York City "§ One in five women who delivered were obese"§ State-specific prevalence varied widely and ranged from
13.9 to 25.1%. "§ Black women had an obesity prevalence about 70%
higher than white and Hispanic women (black: 29.1%; white: 17.4%; Hispanic: 17.4%); however, these race-specific rates varied notably by location "
§ Obesity prevalence was 50% higher among women whose delivery was paid for by Medicaid than by other means (e.g., private insurance, cash, HMO)"
[Chu, Kim & Bish, 2009 Journal of Maternal and Child Health, 13(5)] "
Obesity is a Well Recognized Risk Factor Adverse Pregnancy Outcome
§ More than 50 years ago, obesity associated with pregnancy complica:ons
1
Maternal Obesity: A Continuum of Risk Infertility & Miscarriage
Infer:lity § Related to mul:ple endocrine pathophysiologic mechanisms:
§ Abdominal obesity associated with increased circula:ng insulin levels, results in increased androgen levels – hyperandrogenism clinically manifested in part by anovula:on & amenorrhea
§ Morbid obesity increases risk for polycys:c ovary syndrome
Increased Need for ART
Early Miscarriage [Krishnamoorthy et al. 2006; Sarwer et al., 2006]
Maternal Obesity: A Continuum of Risk Chronic Health Disorders
Diabetes § Overweight or obesity is the single most important predictor of DM
Chronic Hypertension Cardiovascular Disease
§ Waist circumference of 88cm + Increases risk of CVD related death
Musculoskeletal Pain
Knee Osteoarthri:s
Mental Health Disease & Depression
Maternal Obesity: A Continuum of Risk Gestational Health Disorders
Gesta:onal Diabetes § 17% obese vs. 1-‐3% in non-‐obese mothers
[Linne et al. 2002]
§ 24.5 % in morbid obese vs. 2.2% in non-‐obese [Kumari, 2001]
Hypertensive Disorders of Pregnancy § Preeclampsia : 2.9% in non obese vs. 29.8% in morbidly obese mothers [Kumari, 2001]
Sleep Apnea [Sohota et al. 2003] § Increased rates reported in pregnant obese women § Results in inadequate O2 delivery to fetus
Maternal Obesity: A Continuum of Risk Preterm Birth
§ Preterm delivery is a significant concern for obese women, especially those mothers with BMI>35
§ Obese women are less likely to have spontaneous preterm labor [Salihu, Lynch, Alio, & Liu, 2008; Smith, Shah, Pell, & Crossley, & Dobbie, 2007]
§ The higher preterm birth rates in obese women are related to a higher incidence of obstetrical complica:ons [Smith, Shah, Pell, Crossley, & Dobbie, 2007]
§ Obese pa:ents are more likely to be admited earlier in labor, need labor induc:on, require more oxytocin, and have longer labor [VahraYan, Zhang, Troendle, Savitz, & Siega-‐Riz, 2004]
§ History of preterm birth is the most significant risk factor for preterm birth!
Obesity Trends Among U.S. Adults BRFSS, 2010
No Data
1
WHAT STATE DO YOU LIVE IN? STATE-‐BY-‐STATE ADULT OBESITY RATES
1. Louisiana (34.7%) 2. Mississippi (34.6%) 3. West Virginia (32.4%) 4. Alabama (32.0%) 5. Michigan (31.3%); 6. Oklahoma (31.1%); 7. Arkansas (30.9%); 8. (:e) Indiana (30.8%); and South Carolina (30.8%); 10. (Ae) Kentucky (30.4%); and Texas (30.4%); 12. Missouri (30.3%); 13. (:e) Kansas (29.6%); and Ohio (29.6%); 15. (Ae) Tennessee (29.2%); and Virginia (29.2%); 17. North Carolina (29.1%); 18. Iowa (29.0%); 19. Delaware (28.8%); 20. Pennsylvania (28.6%); 21. Nebraska (28.4%); 22. Maryland (28.3%); 23. South Dakota (28.1%); 24. Georgia (28.0%); 25. (:e) Maine (27.8%); and North Dakota (27.8%); 27. Wisconsin (27.7%); 28. Alaska (27.4%): 29. Illinois (27.1%); 30. Idaho (27.0%); 31. Oregon (26.7%); 32. Florida (26.6%); 33. Washington (26.5%); 34. New Mexico (26.3%); 35. New Hampshire (26.2%); 36. Minnesota (25.7%); 37. (:e) Rhode Island (25.4%); and Vermont (25.4%); 39. Wyoming (25.0%); 40. Arizona (24.7%); 41. Montana (24.6%); 42. (:e) Connec:cut (24.5%); Nevada (24.5%); and New York (24.5%); 45. Utah (24.4%); 46. California (23.8%); 47. (:e) District of Columbia (23.7%) and New Jersey (23.7%); 49. Massachusets (22.7%); 50. Hawaii (21.8%); 51. Colorado (20.5%).
March of Dimes 2013 Premature Birth Report Card
© 2013 March of Dimes Foundation
Grade for Preterm Birth Rate*
A
B
C
D
F
Grade for National Preterm Birth Rate
C
* Percent of babies born preterm is shown in parentheses ( ).
(11.5)
Preterm birth is less than 37 completed weeks of gestation.
Source: National Center for Health Statistics, 2012 preliminary natality data. Report card grades calculated by March of Dimes Perinatal Data Center, September 2013.See Technical Notes for more information.
(11.6)
(9.6) (10.4)
(10.3)
(11.0)
(11.2)
(11.1)(13.0)
(11.5)
(9.9)(9.1)
(10.7)
(10.2)
(9.9)
(10.8)
(13.3)
(11.5)
(15.3)
(10.2)
(11.7)
(13.0)
(12.4)
(10.5)
(12.0)(10.9)
(11.8)
(9.2)
(12.2)
(16.9)
(14.6)
(13.7)
(12.7)
(12.7)
(17.1)
(12.0)
(12.1)
(13.7)
(12.5)
(12.4)
(10.8)
(11.3)
(9.2)
(10.7)
(12.8)
(9.7)
(12.3)
(12.2)
(10.0)
(9.3)
(11.2)
(11.0)
(8.7)
Visit marchofdimes.com/reportcard for an interactive version of this map.
Maternal Obesity: A Continuum of Risk Intrapartum Risk
Increased Use of Induc:on [Sohota et al. 2003] § InducYon Rates: 28% in nl wt woman; 34% in woman with BMI>40
Increased Risk of Failed Induc:on [Wolfe, Rossi, & Warshak, 2005] § 13% in nl wt woman; 29% in woman with BMI>40 § Previous C-‐S + Macrosomic fetus – highest risk for failure (80% failure rates)
Prolonged Labor
§ Prolonged 1st stage § Prolonged 2nd stage § Maternal Age – important cofounder
Maternal Obesity: A Continuum of Risk Cesarean Delivery
Cesarean Delivery Risk
§ Increased by 50% in overweight women and is more than double for obese women, compared to women with normal BMI [Poobolan et al. 2009]
§ Late Preterm infants born via elecYve C/SecYon to obese mothers incur serious risk for acute respiratory morbidity & neonatal mortality [Gnanaratnem & Finer, 2000; Kasap et al. 2008]
Maternal Obesity: A Continuum of Risk Anesthesia & Intubation
Epidural placement [Dresner et al. 2006] § More difficult & more likely to fail
Spinal Anesthesia [von Ungern-‐Sternberg, 2004] § Obesity can significantly impair respiratory func:on in women receiving spinal anesthesia as height of block is posi:vely correlated to BMI
Intuba:on § 10X higher rate in OB popula:on § Much more difficult [ D’Angelo & Dewan, 2004]
General Anesthesia § More likely to require general anesthesia
Maternal Obesity: A Continuum of Risk Stillbirth
S:llbirth: [Salihu et al., 2007] § 5.5/1000 for non obese; 8/1000 BMI 30-‐39; 11/1000 BMI ≥ 40
§ Obesity shown to be an independent risk factor § 40% more likely, compared to normal weight women § Greatest risk – Black women with BMI > 40 (2X more likely)
§ Some evidence shows obesity related s:llbirth risk increases with gesta:onal age [Chu et al., 2007]
§ 28 – 36 weeks -‐ Hazard ra:o 2.1 § 40 weeks – Hazard ra:o 4.0
1
Maternal Obesity: A Continuum of Risk Hemorrhage
Post Partum Hemorrhage [Sebire et al. 2001] § 44% risk with BMI > 30 [5X more likely compared to non-‐obese
§ 70% more frequent in obese women with BMI > 40, compared to normal weight mother
Maternal Obesity: A Continuum of Risk Thromboembolism
Thromboembolism § Leading cause of maternal mortality in US & UK [CDC, 2010; Lancet, 2010]
§ Greatest risk at term with C/Sec:on
§ Pregnancy is a hypercoagulable state, obesity furthers the risk of thrombosis by promo:ng venous stasis, increasing blood viscosity and promo:ng ac:va:on of the coagula:on cascade.
40% of Maternal Deaths Worldwide Occur in Obese Women
Maternal Obesity: A Continuum of Risk Post Partum Complications
§ Higher rates of PP complica:ons result in significantly higher incidence of LOS > 4 days
§ Immediate Complica:ons: § Wound Infec:on [Wall, Deucy, Glantz, & Pressman, 2003]
§ All obese women delivering via C-‐S should be given prophylaxis an:bio:cs [ACOG, 2005]
§ Urinary Tract Infec:on [Bamgbade, Ruher, Nafiu, & Dorje, 2006] § Longer term complica:ons
§ Stress Incon:nence § Post Partum Depression
Maternal Obesity: A Continuum of Risk Breast, Endometrial, Ovarian, & Cervical Cancers
§ Breast Cancer § Several meta-‐analyses, systema:c reviews, and large cohort studies have shown obesity worsens breast cancer mortality. May be related to: § Less likely to report mammogram, Late detec:on & Obesity promotes rapid growth of metasta:c disease
§ Endometrial Cancer § Obesity associated with 2-‐3 fold risk
§ Ovarian Cancer
§ Cervical Cancer § Related to increased estrogenic hormones § May be related to decreased screening compliance § Recommenda:on – PAP Smears at same intervals as normal weight women
"
Maternal Glucose Load
Glucose Crosses Placenta
Fetus Responds High Glucose Load Results In Fetal Hyperinsulinemia
Drives Catabolism of the Oversupply of Fuel Uses Energy & Depletes O2 Stores
Fetal Hypertension Cardiac Remodeling & Hypertrophy
Episodic Fetal Hypoxia ↑ Release of Fetal Catecholamines
S:mulates Erythropoie:n
Fetal RBC Hyperplasia & ↑ Hemoglobin & Hct Poor Circula:on & Postnatal Hyperbilirubinemia
©Neostar USA Inc. 2012
1
Maternal Obesity: A Continuum of Risk Fetal Risk
§ Infants conceived with ART have increased risk for congenital anomalies: [Reefhuis, 2008] § 2x the risk of Atrial Septal Cardiac Defects § > 2X the risk of clez lip with or without clez palate
§ > 4 X the risk esophageal and anal atresia compared with babies conceived without fer:lity treatments "
Fetal Risk Increased Risk of Congenital Anomalies
§ Neural tube defects, Cardiac Anomalies, Oral -‐ facial clezs,
even azer controlling for diabetes [King, 2006; Rasmussen, Chu, Kim, Schmid, & Lau, 2008]
§ The risk of neural tube defects among obese women is double that among women of normal weight [Shaw, Velie, & Schaffer, 1996; Waller et al., 1994 Werler, Louick, Shapiro, & Mitchell, 1996]
§ Hydrocephaly, anorectal atresia, and limb reduc:ons [Stothard, Tennant, Bell, & Rankin, 2009]
§ Diaphragma:c hernia, anorectal atresia, hypospadias, and omphalocele among obese women with BMI >30, compared with women with normal BMI [Waller et al. 2007]
Fetal Risk Abnormal Fetal Growth
Bigger is Not Always Better
Fetal Risk Abnormal Fetal Growth – LGA
§ A large body of evidence shows that pre-‐pregnancy obesity as well as excessive weight gain during pregnancy are associated with macrosomia and large for gesta:onal age (LGA) infants [Cedergren, 2004; Rode, Nilas, Wojdemann, & Tabor, 2005; Watkins, Rasmussen, Honein, Boho, & Moore, 2003]
§ Both fetal macrosomia and LGA associated with a higher risk for delivery complica:ons and birth trauma
"
"
Fetal Risk Potential for Inaccurate
Fetal Surveillance
§ Anthropomorphic measurements less accurate § Unreliable da:ng, especially in 3rd trimester § Difficulty in detec:ng fetal anomalies When BMI >90th
§ Subop:mal in diagnosing heart, spine, and abdominal wall anomalies
"Hendler et al., 2005
Neonatal Risk Need for Neonatal Resuscitation & NICU Admission
§ Increased risk for delivery room resuscita:on requiring posi:ve pressure ven:la:on with bag and mask or intuba:on Johnson, Longmate, & Frentzen,1992
§ Infants of obese mothers were 3.5 :mes more likely to be admited the NICU Pathi, Esen, and Hildreth, 2006
§ Infants born to morbidly obese mothers are nearly five :mes more likely to be transferred to the NICU Kumari, 2001
§ Aside from the health risks and the poten:al for poor neonatal outcome, admission to the NICU is associated with disrupted maternal-‐infant atachment and increased hospital costs Ramachendran, Bradford, & Mclean, 2008
1
Neonatal Risk Delayed Fetal Lung Maturity – Respiratory Distress Syndrome
§ Male Preponderance"
§ Maternal Diabetes"
§ Maternal Obesity "
§ Antepartum Hemorrhage" "
Neonatal Risk Infants of Obese Mothers Born
Before 39 Weeks Gestation via C/S with No Labor Incur Serious Risk for Retained Fetal Lung Fluid &
Respiratory Distress
Neonatal Risk Infant of Obese Mother
Severe Respiratory Morbidity
Neonatal Risk Instrument Assisted Delivery
§ Caput Seccundem
§ Cephalhematoma
§ Subgaleal Hemorrhage
§ Neonatal Anemia
§ Hyperbilirubinemia
Neonatal Risk Brachial Plexus Injuries
Neonatal Risk Hypoglycemia
§ Increasing maternal glucose concentra:on less severe than diabetes is associated with fetal overgrowth, specifically adiposity & LGA
§ Con:nuous rela:onships of maternal glucose levels below those diagnos:c of diabetes were strongly associated birth weight > 90th percen:le, fetal hyperinsulinemia, cesarean delivery and clinical neonatal hypoglycemia
Metzger et al., 2008
1
Neonatal Risk Polycythemia & Hyperbilirubinemia
Neonatal Risk Breast Feeding Failure Risk
§ Related to multiple factors - chronic and gestational health disorders, prolonged labor, the need for general anesthesia, cesarean section delivery, wound infections, postpartum complications, delayed lactogenesis, and difficulties related to large breasts and proper infant positioning
§ Maternal obesity associated with increased risk of failure to initiate lactation and decreased duration of breast-feeding Donath & Amir 2000; Li, Ogden, Ballew, Gillespie, & Grummer-Strawn, 2002; Sebire et al., 2001
§ BF failure may resulting in dehydration, hypoglycemia, and extreme levels of unconjugated hyperbilirubinemia and kernicterus Bhutani, 2006
Neonatal Risk Neonatal & Infant Mortality
§ At all gesta:onal ages, the risk of neonatal mortality has been shown to increase for both overweight (BMI 25 -‐ 30) and obese women (BMI > 30) Cedergren, 2004
§ Infants of obese women nearly twice as likely to die in the first year of life, compared to those born to normal weight women Baeten, Bukusi, & Lambe, 2001; Sebire, Jolly, & Harris, 200
§ Obese women were more likely to experience fetal death and s:llbirth, and this risk increased with advancing gesta:on from an RR of 1.9 at 20–27 weeks gesta:on, to 3.5 at 28–36 weeks, and 4.6 at term Nohr et al., 2005
Child Health Morbidity Risk Childhood Obesity
Child Health Morbidity Risk Infant of Obese Mother
Risk for Autism Normal Weight Mothers & Au:sm
§ Prevalence: 1 in 88 § 3: 1 Male to female Preponderance
Maternal Obesity & Au:sm CHARGE Study – Children aged 2-‐5, popula:on based study, CA § Obesity is associated with increased risk for having an au:s:c
child to (1 in 53). § Doubles the risk for having a child with a developmental delay
Krakowiak, Walker, Bremmer, et al (2012). Maternal Metabolic Condi:ons and Risk for Au:sm and Other Neurodevelopmental Disorders, Pediatrics, 129(5)
Life Course Risk Fetal Origins of Disease
1
Thank you
Presentation Handouts: * Maternal Obesity: A Continuum of Risk
* Infant of Obese Mother
Anne M. Jorgensen NNP Email: AMJ@NeostarUSA.com
T 845-‐553-‐5657 ©Neostar USA Inc. 2013
"
Maternal Glucose Load
Glucose Crosses Placenta
Fetus Responds High Glucose Load Results In Fetal Hyperinsulinemia
Drives Catabolism of the Oversupply of Fuel Uses Energy & Depletes O2 Stores
Fetal Hypertension Cardiac Remodeling & Hypertrophy
Episodic Fetal Hypoxia ↑ Release of Fetal Catecholamines
SOmulates ErythropoieOn
Fetal RBC Hyperplasia & ↑ Hemoglobin & Hct Poor CirculaOon & Postnatal Hyperbilirubinemia
©Neostar USA Inc. 2012
Transla'ng Evidence Into Best Prac'ce Hyperglycemia Adverse Pregnancy Outcome
The “HAPO Study” Metzger et al. (2008). NEJM, 358, 19
Research Findings Implica'ons for Prac'ce Best Prac'ce (Ac'on Step)
Obese women without history of elevated glucose tolerance test or gestaOonal diabetes are at increased risk for delivering a macrosomic and LGA infant
Macrosomia and LGA are associated with cesarean secOon, shoulder dystocia, and birth trauma, and increased need for NICU
The NICU should be noOfied when obese mothers are admi]ed to labor and delivery and when birth is expected
Infants of obese women are at increased risk for fetal hyperinsulinemia
Fetal hyperinsulinemia has a well-‐known associaOon with delayed surfactant synthesis and excreOon, which may result in respiratory distress syndrome
Infants of obese mothers, especially late preterm infants (born 34-‐36 6/7 weeks gestaOon), should be carefully monitored for signs and symptoms of respiratory distress syndrome
Infants of obese women are at increased risk for neonatal hypoglycemia
Fetal hyperinsulinemia is well-‐known to result in neonatal hypoglycemia
Infants of obese mothers should be closely monitored for hypoglycemia, beginning at 1-‐2 hours acer birth
Maternal hyperglycemia is associated with hyperbilirubinemia
Fetal hyperinsulinemia drives catabolism of the oversupply of fuel, uses energy & depletes O2 stores, resulOng in fetal RBC hyperplasia and increased hematocrit
Infants of obese mothers should have bilirubin screening and conOnued monitoring if warranted
Maternal Obesity and Congenital Anomalies Neonatal Assessment – Best Prac'ce
Research Study Research Findings Best Prac'ce
Stothard, Tenant, Bell, & Rankin, 2009 Maternal obesity is associated oral-‐facial clecs In infants born to obese women, physicians and nurses should have higher index of suspicion for congenital anomalies, even if prenatal ultrasound reports normal fetal anatomy
Stothard, Tenant, Bell, & Rankin, 2009 Sarwer et al., 2006
Maternal obesity is associated with congenital heart defects
Waller et al., 2007 Maternal obesity associated with diaphragmaOc hernia and omphalocele
Waller et al., 2007 Maternal obesity is associated with hypospadius
Stothard, Tenant, Bell, & Rankin, 2009 Rasmussen, Chu, Kim, Schmid, & Lau, 2008; Shaw, Vellie, & Schafer, 1996
Maternal obesity is associated with neural tube defects
Stothard, Tenant, Bell, & Rankin, 2009 Waller et al., 2007
Maternal obesity is associated with anorectal atresia
Stothard, Tenant, Bell, & Rankin, 2009 Maternal obesity is associated with limb reducOons
Hendler et al., 2004 VisualizaOon of fetal anomalies, especially cardiac structures, is more difficult in obese women, compared to non-‐obese women. Prenatal diagnosis of cardiac anomalies may be missed
©Neostar USA Inc. 2012
Transla'ng Evidence Into Best Prac'ce Maternal Obesity and BreasKeeding
Research Study Research Findings Best PracOce
Donath & Amir, 2000 Li, Jewel, & Grummer-‐Strawn, 2003
Fewer obese women iniOated breast feeding, compared to normal weight women
Obese women need educaOonal efforts aimed at promoOng breast feeding
Oddy et al., 2006 Li, Jewel, & Grummer-‐Strawn, 2003
Obese women breasjed their infants for less Ome (weeks and months), compared to normal weight women
Early and on-‐going lactaOon support should be provided for all obese mothers
Hilson, Rasmussen, & Kjolhede, 2004
Obese women are more likley to expreience delayed onset of lactogenesis (defined as milk coming in > 72 hours acer birth) compared to non-‐obese women
Because delayed Iactogenesis may pose a significant risk for dehydraOon, thermal instability, hypoglycemia, and extreme hyperbilirubinemia, exclusively breast fed infants of obese mothers, especially those infants born late preterm, should have: • Glucose screening at 1-‐2 hours of life and conOnued monitoring if warranted • Bilirubin screening at 48 hours of life and conOnued monitoring if warranted Infants of obese mothers may require supplemental formula feeding unOl the Mother’s breast milk is enough to meet the infant’s nutriOonal requirements
©Neostar USA Inc. 2012
Maternal Obesity - A Continuum of Risk.pdfIntrapartum ImplicationsAssisting the Obese Breastfeeding MotherTranslating Evidence into Practice
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