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1!
3/16/14!
Everything is Goreng
Indonesia
2!
3/16/14!
Indonesia
Obesity
3!
3/16/14!
Obesity
a
risk
factor
for
osprings
lifelong
metabolic
complicaDon
s
a
risk
factor
for
congenital
anomalies
How to dene
4!
3/16/14!
Underweight!
<18.5!
Normal!
18.5-24.9!
Overweight!
25.0-29.9!
Obesity class!
30.0-34.9!
I!
35.0-39.9!
II!
>40!
III!
Obese!
Extremely obese!
BMI = weight/height2
=
!
5!
3/16/14!
Antenatal
Management
First
trimester
What
can
I
palpate?
Antenatal
Management
First
trimester
6!
3/16/14!
Antenatal
Management
First
trimester
A
thorough
history
and
complete
physical
examinaDon
should
be
undertaken
Baseline
laboratory
tests
Antenatal
Management
First
trimester
Echocardiography
Sleep
disorder
evaluaDon
Counselling
about
the
risks
of
adverse
pregnancy
outcome
7!
3/16/14!
GestaDonal
weight
recommendaDons
Obese
paDents
should
receive
dietary
counselling
with
specic
weight
gain
goals
PaDents
should
be
advised
that
limited
weight
gain,
rather
than
weight
loss,
is
a
primary
goal
during
pregnancy
GestaDonal
weight
recommendaDons
6.8 kg!
1990 IOM
guidelines!
2009 IOM/NRC !
guidelines!
4.9-9.0 kg!
0.2 kg!
8!
3/16/14!
Antenatal
Management
Second
trimester
Medical
opDmisaDon
Prenatal
diagnosis
of
congenital
anomalies
The
sonographic
evaluaDon
of
fetal
anatomy
in
is
compromised
by
the
inability
to
achieve
adequate
ultrasound
visualisaDon
of
fetal
structures
because
of
an
obese
body
habitus
9!
3/16/14!
Antenatal
Management
Second
trimester
Antenatal
Management
Second
trimester
10!
3/16/14!
Antenatal
Management
Third
trimester
A criDcal period
Antenatal
Management
Third
trimester
11!
3/16/14!
12!
3/16/14!
Summary
The
obese
pregnant
woman
and
her
fetus
are
at
considerable
risk
for
adverse
perinatal
outcomes
The
treatment
of
these
paDents
is
challenging,
mulDfaceted,
and
oben
mulDdisciplinary
13!