Case Study Kelly

Risk Factors- The risk for an infant being born to a diabetic mother is maternal diabetes.

Obesity in the United States continues growing alarmingly. Approximately 66 % of adults and 33 % of children and teenagers in the US are overweight. Obesity is the result of fat accumulated over time due to the lack of a balanced diet and exercise. An adult with a BMI (body mass index) higher than thirty percent is considered obese (Whitney & Rolfes, 2011, pg. 271).

In our time period, there is a significant increase in the average body index in all age groups and most commonly with the women who are entering their reproduction age. According to the article, “Weight Gain During Pregnancy”, a normal weighted gravida, or pregnant woman, has BMI of 18.5–24.9 Kg/m2, over-weight gravida has BMI of 25–29.9 Kg/m2, and obese gravida has BMI of 30 and greater Kg/m2. Obese pregnant women face many critical health risks compare to normal weight pregnant women. In the study “Maternal Obesity a Global Health Problem and Its Implications on Maternal and Fetal Health”, by Hashmi and his colleagues, they aimed to find out if obese women were at greater risk of having adverse reproductive outcomes compared to women with a normal BMI. By using

Multiple antenatal, antepartum, and postpartum challenges are incurred with a BMI of > 45. Miscarriage is at an increased risk among women with elevated BMI as well as prevalence of GDM and preexisting diabetes. First trimester screening for previously unrecognized diabetes with an early glucose screening is recommended. Obese women have an increased risk for hypertensive disorders as well as preeclampsia. It is not clear whether low-dose aspirin therapy is effective in reducing the likelihood of developing preeclampsia among women with an elevated BMI; however, low-dose aspirin is low-risk and therefore, can help decrease the risk for preeclampsia among women with moderate to high risk of developing the disease. Obstructive sleep apnea may be precipitated or exacerbated during pregnancy and may increase the risk of preeclampsia and GDM. Women who are obese have an increased risk for preterm birth. Maternal obesity is also associated with an increase in absolute rate of congenital anomalies. In addition, congenital anomalies are often more difficult to detect by prenatal ultrasound given acoustic limitations. (Detection decreases by 20%) Finally, there is an increased risk of dysfunctional labor in addition to complications that are incurred should an operative delivery be required. Weight gain goals recommended in obesity are 10-15 lb. Unfortunately, weight loss during pregnancy is not recommended. Serial surveillance

When thinking of public health in regards specifically to obesity, a study into maternal obesity and the long-term health of the offspring, found that ‘maternal obesity has been associated with a number of long-term adverse health outcomes in the offspring, including lifelong risk of obesity and metabolic dysregulation with increased insulin resistance, hypertension and dyslipidaemia, as well as behavioural problems and risk of asthma’ (O’Reilly et al, 2012:1), this highlights to us the implications not just to mother, but the long term effects to her child.

First, because American mothers and fathers were misled or failed to deliver healthy children to the best of their abilities, generations have inherited and still are inheriting genes that have triggered obesity. Early-life impacts, starting with the intrauterine environment, have shaped the path of weight gain and body fatness throughout a child’s life course. Shari Roan, a journalist at the Los Angeles Times newspaper, says obesity rates in American children may have risen because of pregnant mothers’ misconceptions and irresponsible decisions related to the care of their unborn children. She continues that Melinda Sothern, a leading fitness and nutrition expert at Louisiana State

The main purpose of this assessment is to guarantee a healthy baby, with low risk to Angie’s health. At present Angie weigh’s 177.5 lbs. and her height is 5’5”, this puts her BMI at 30 she is classified as being obese (Grosvenor & Smolin, 2015, p. 292). She is currently experiencing some complications at this stage in her pregnancy. Additionally she desires to keep her weight in line with the recommended weight gain guidelines for pregnant women which are about 11-20 lbs., during her entire nine months of pregnancy (Grosvenor & Smolin, 2015, p. 369).

Obesity is described by the World Health Organisation (WHO) as unusual or extreme fat growth that presents a risk to a person’s health. Obesity is a complex disease with multiple drivers such as

CTVNews released an article on September 7, 2016 regarding the findings in a study published in Jama Pediatrics. The study was conducted in the United States linking babies born by caesarean section (C-section) to an increased likelihood of becoming obese.1 C-section is a procedure used during high-risk pregnancies. This method of delivery is an option; however, it may be associated with negative health outcomes. The news story sheds light on the findings and illustrates a 15% increased likelihood of a child becoming obese when born by C-section instead of vaginal delivery.1 The heightened risk was primarily significant amongst siblings. The findings depict a 64% increased likelihood of becoming obese when born by C-section as opposed to siblings who are delivered vaginally.1 In addition, the news story details that vaginal births after previous C-section deliveries has a 31% less likelihood of the child becoming.1

Gestational diabetes, which is much less common, only occurs during pregnancy and is caused by a resistance to the actions of insulin brought on by the hormones a woman’s body releases during pregnancy (WHO 2011, p. 2). Once diagnosed with gestational diabetes mellitus you are at a greater risk of developing type 2 diabetes later in life (Zimmet & Magliano 2011). For this reason it is particularly important to use preventative measures and consistent health checks.

Gestational diabetes, affecting approximately 3-10% of pregnancies, is diagnosed by hyperglycemia during pregnancy in women without a history of diabetes. The underlying cause of gestational diabetes remains unknown, although the interference of pregnancy hormones, such as human placental lactogen, with susceptible insulin receptors, has been considered. The patients usually have few symptoms, and they are often diagnosed by screening during routine pregnancy check-up. For the mother, glucose intolerance typically disappears after the baby is born. However, gestational diabetes often places the body at risk. Babies born to mothers with poor hyperglycemia control are often at increased risk of series problems including macrosomia, which associates with a high chance of C-section, shoulder dystocia, hypoglycemia after birth, polycythemia as well as multiple chemical disorders.

When mums become over weight (if you are not already over weight before pregnancy) in their pregnancy this can cause a lot of issues with the birth of the baby. If mums weight increases, risk of baby being born too large increases this can lead to obesity in child, this can also trigger delivery complications and can lead to caesarian section and this can prolong the recovery after giving birth.

Methods: The methods used in this article was a double-blind, placebo-controlled trial. From a group of 450 pregnant women without diabetes and with a BMI greater than 35, half of the group was randomly given a dose of 3.0 g of metformin per day, and the other half was randomly given a placebo per day. The metformin and placebo were given from 12 to 18 weeks gestation with a singleton fetus until the delivery. At the start of the study at 12 or 18 weeks of gestation, the BMI of each participant was measured by dividing the weight in kilograms by the square of the height in meters, BMI = weight (kg)/ height2 (m2). Randomization was achieved by using a computer to generate random numbers.

Of the 102 participants fifty (49%) were classified as non-obese and fifty-two (51%) as obese at the conception of the pregnancies. The mean PPBMI for the non-obese group was 25.5 ± 2.3 kg/m2 compared to 37.9 ± 5.9 kg/m2 in the obese group (Stone et al., 2011). The obese group of women gained less weight during the pregnancy than the non-obese group. Preterm delivery occurrences at less than 37 weeks were similar between both groups at 32.0% for the non-obese and 28.8% in the obese group. Little difference was noted between the groups in the gestational ages at delivery and infant birth weights. Additionally, no clinically significant differences in the development of GDM, NICU or nursery admissions were noted. However the maternal obesity group had clinically significant differences in the cesarean delivery rate (63.5% vs. 36.0%, p = 0.010) and the development of PRH (36.5% vs. 8%, p = 0.010) in comparison to the non-obese group, these were statistically significant findings (Stone et al., 2011).

Between 5.5 and 8.8% of pregnant women develop GDM in Australia. Risk factors for GDM include a family history of diabetes, increasing maternal age, obesity and being a member of a community or ethnic group with a high risk of developing type 2 diabetes. While the carbohydrate intolerance usually returns to normal after the birth, the mother has a significant risk of developing permanent diabetes while the baby is more likely to develop obesity and impaired glucose tolerance and/or diabetes later in life. Self-care and dietary changes are essential in treatment.