NJPA August 2014 Newsletter
In this newsletter…
- Maternal obesity and adverse obstetric outcomes
- New Jersey Top Hospitals for High Risk Pregnancy
- Meet our perinatologist
Maternal Obesity and Adverse Obstetric Outcomes
In the United States, the prevalence of obesity has increased tremendously over the last few decades. Among pregnant women, obesity is also a growing health concern that is associated with numerous pregnancy-related complications. These include gestational diabetes mellitus, pre pregnancy hypertension, gestational hypertension, venous thromboembolism and preeclampsia.
Maternal obesity is a known risk factor for stillbirth and this has been suggested in large epidemiologic studies. The reported risk of stillbirth is 2.5 times higher in obese, compared with normal-weight women. This association persists even when medical complications such as overt hypertension and diabetes are excluded from analyses. While the mechanism remains unclear, it has been suggested that subclinical hypertension and hyperglycemia may be the etiology. Other possible mechanisms include the increased difficulty in monitoring fetuses among morbidly obese women and the decreased maternal perception of fetal movement.
To date, we have no data about the utility of fetal surveillance in reducing the risk of stillbirth in obese women; however, extrapolating from other groups at increased risk of stillbirth, it may be reasonable to undertake these measures. Many authors suggest that these patients merit antepartum monitoring. The most beneficial and cost-effective regimen has not been established.
Management Recommendations for Maternal Obesity (BMI ≥ 40)
- Early screening for gestational diabetes
- Weekly antepartum fetal testing beginning at 36 weeks gestation
- Delivery should be considered by 41 weeks gestation
- In patients with BMI ≥ 50, delivery should be considered at 39 weeks gestation
New Jersey Top Hospitals for High Risk Pregnancy
- Saint Barnabas Medical Center – #1
- Overlook Medical Center – #4
- Holy Name Medical Center – #7
Meet Our Perinatologist
Jonathan E. O’Brien, MD
Dr. O’Brien graduated from the Saint George’s University School of Medicine and completed his residency in obstetrics and gynecology at Saint Barnabas Medical Center in Livingston, New Jersey. He completed his fellowship training in maternal fetal medicine at the Mayo Clinic College of Medicine in Rochester, Minnesota.
Dr. O’Brien maintains a strong research interest in prenatal diagnosis and preeclampsia.
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