4. Questions
• Risk to Baby
• How much weight gain in pregnancy
• What are the other high risk factors
• How to lose weight or not gain weight in pregnancy
• Effects of weight loss surgery
• What extra surveillance is needed
• Link between obesity and pre eclampsia – not known may be
inflamatory
• Management of insulin resistance – metformin but testicular size?
• Ultrasound imaging
• Who to refer to in pregnancy
• What causes increased risks with obesity
• Bariatric surgery
5. Risk to Fetus
• ACOG statement
• Autism – 50% increase
• Developmental delays 150% increase
• NTD, cleft lip and palate and cardiac
6. Dietary restriction in Pregnancy
• BMJ May2012 Metanalysis
• 4 kgs loss with calorie restricted diet
• < 1 kgs on exercise alone
• 1 kgs on exercise and diet
• Diet restriction appeared to be associated with a reduction in
pregnancy complications but too much heterogeneity to offer
advice to women
• Bottom line is that it appears safe to maintain pre pregnancy
weight or lose weight in pregnancy but with a healthy dietary
approach and not one of starvation as increased risk for NTD
and Cl Palate as well as a lower birth weight and intrauterine
fetal stress
10. What can the GP offer
• Target weight management
• Exercise plans
• Dietary
• Online programs
• Psychological support
• Referral to appropriate personnel
• 25% of maternity staff do not feel they have the capa
• Probiotics
11. Probiotics
• lactobacillus
• Double blind placebo controlled study
• 256 first trimester randomisation
• Diet and probiotics had a third the
incidence of GDM in the probiotic group
12. Human studies
• Two groups of beneficial bacteria are dominant
in the human gut, the Bacteroidetes and the
Firmicutes.
• The relative proportion of Bacteroidetes is
decreased in obese people by comparison with
lean people, and that this proportion increases
with weight loss on two types of low-calorie diet.
• Our findings indicate that obesity has a microbial
component, which might have potential
therapeutic implications.
13. Bariatrics
• No RCT studies as yet in pregnancy for manag
• Pregnancy does not have a long term negative
14. Cocchrane RCT List
• Computerised weight loss programs
• Psychological support
• Interventions to change GP management
• Gastric Band Management
• Surgery non pregnant
