Pocket ObGyn – Obesity
See Abbreviations
Definitions
| Definitions for obesity | |
| CDC wt category | BMI for adults (>21 yo) |
| Underweight | <18.5 |
| Nml wt | 18.5–24.9 |
| Overweight | 25–29.9 |
| Obese | ³30 |
| Additional categories used by researchers | |
| Class 1 obesity | 30–34.9 |
| Class 2 obesity | 35–39.9 |
| Class 3 obesity | ³40 |
| • BMI = [Wt in lb/(ht in inches)2] ´ 709 = [Wt in kg/(ht in inches)2] | |
Epidemiology (CDC NHANES, 2009–2010)
- 7% of all US adults are obese, a dramatic in the past 20 y; affects 1 in 5 pregnant women.
- 17% of all US children & adols are obese ® leading to increased rate of heart dz, diabetes, & metabolic
Obesity and Gynecology
- Infertility: Oligo-ovulation & anovulation, ↓ gonadotropin resp, primary rx is wt
- Contraception: ¯ effectiveness of patch, combined OCPs, & implants. No difference in efficacy for Depo-Provera, few studies on other Metabolic changes ® altered half-life or storage in adipose tissue.
- Anesthesia/surgical risk: difficulty w/ spinal/epidural anesthesia, intubation risk w/ higher Mallampati score, consider preoperative anesthesia consult, wound breakdown w/ DVT risk, consider prophylaxis, ambulation, SCDs, compression stockings.
- Endometrial cancer risk: Unopposed estrogen (androstenedione ® estrogen by adipose tissue aromatase) ® endometrial
Obesity and Obstetrics (Obstet Gynecol 2013;121:213)
- Fetal anomalies: anomalies such as cleft lip/palate, neural tube, cardiac defects,
macrosomia, miscarriage, 2–4´ stillbirth.
- Antepartum complications: Obese services & testing w/ Preg 2/2 difficulty measuring fundal ht, 57% of time wt gain is higher than recommended (11–20 lb for obese). large for gestational age infants. gestational diabetes, gestational HTN, preeclampsia, & fetal
- Labor & deliv: Difficult to follow fetal HR w/ tocodynamometer ® interventions such as fetal scalp electrode Protracted labor curve & labor dystocia ® cesarean deliv. ¯ VBAC success rate. shoulder dystocia.
Treatment
- Nonsurgical: Nutrition & exercise programs, goal setting w/ provider, close f/u appointments, some limited pharmacotherapy; goal BMI <
Surgical: Bariatric Surg for BMI >40 or >35 w/ other comorbidities w/ gastric banding, sleeve gastrectomy, or gastric bypass. Attention to contraception should be paid to women who get bariatric Surg as their fertility may .