1 / 18

Paul de Cock AIRC2012

Underweight pregnant women in low risk populations: Does a low BMI (<18.5) predict adverse pregnancy outcomes?. Paul de Cock AIRC2012. Midwifery Academy Amsterdam Groningen (AVAG) VU University Medical Center. Echelon system in perinatal care.

luella
Download Presentation

Paul de Cock AIRC2012

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Underweight pregnant women in low risk populations: Does a low BMI (<18.5) predict adverse pregnancy outcomes? Paul de Cock AIRC2012

  2. Midwifery Academy Amsterdam Groningen (AVAG) • VU University Medical Center

  3. Echelon system in perinatal care The Netherlands: echelon system in perinatal care • 1st: community: monitored by independent midwife • 2nd: hospital: gynaecologist & clinical midwife • 3rd: academic referral centre: gynaecologist & clinical midwife http://www.knov.nl/docs/uploads/Midwifery_in_The__Netherlands__20120730__groot.pdf

  4. Midwifery care • App. 184000 births in Netherlands • A quarter of these are home births • Antenatal care by Midwife in 79.6% of pregnancies • Remaining pregnancies (20.4%) are under supervision of gynaecologist (hospital/secondary care) • Half of these are because of a medical indication.

  5. Risk selection in echelons • Women with health complications or known health risks are referred to secondary care setting • This means that there is a risk selection in primary care, which is effective. • For low BMI women this means that only those with no known additional health risks are under supervision of a primary care midwife.

  6. Reason for this research • University of applied science keeps strong links with the field – the field is actively invited to submit research questions to the college • Manager of a large midwifery practice asked about the risks attached to low BMI for pregnant women under supervision of a primary care midwife. • Women with medical indications have been referred. Is there a risk for the remaining healthy low BMI women with regard to pregnancy outcomes for mother and baby?

  7. Low BMI – risk • Increased risk of miscarriage (Maconochie et al., 2007) • Preterm birth (Han et al., 2011) • Low birth weight (Han et al., 2011) • Increased risk of anaemia (Sebire et al., 2007)

  8. Low BMI – lowered risk of… • Reduced risk of complications, such as: • Gestational diabetes mellitus • Pre-eclampsia • Obstetricintervention • Postpartum haemorrhage (Sebire et al., 2007 - BMI<20)

  9. Low BMI in low-risk population • Research question: • What are the pregnancy outcomes of low-risk underweight women in primary midwifery care?

  10. Method - sample • Retrospective case-control database study • 2 large midwifery practices • All underweight (< 18.5) women on record (past 5 years) • Controls matched on age, smoking, alcohol use, drug use • Only controls with normal BMI were included (18.5 – 24.99) • Zwangerschapsuitkomsten: • Zwangerschapsduur • Geboortegewicht

  11. Method - outcomes • Maternal • Hypertension • Hb (1st consult and at 30 weeks) • Suspected intrauterine growth retardation • Birth outcomes • Duration of pregnancy • Prematurity • Instrumental delivery • Bloodloss • Active management of placental delivery

  12. Method - outcomes • Neonatal • Weight • Weight percentile (<2.3; <5.0; <10) • APGAR <7 after 5 minutes • Consult with paediatrician

  13. Results – Pregnancy outcomes

  14. Results – Birth outcomes

  15. Results – Neonate outcomes

  16. Discussion • Women with low BMI at increased risk of anaemia. • Babys are smaller, but no raised levels of suspected IUGR, poor APGAR scores or consults with paediatrician. • No difference in prematurity found in this study

  17. Conclusion • On the basis of this study pregancy outcomes do not appear to differ much between women with low and normal BMI in primary care. • More research is being done in a large prospective cohort study (DELIVER) to assess a broader range of outcomes in a large national sample.

  18. Paul de Cock PhD ab, Willemijn Perdijk b, MA RM, Aresh Mohammadi BA RM b, Elise Neppelenbroekb, Ingrid Hollemab Thank you for listening • a Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands, p.decock@vumc.nl. • b Midwifery Academy Amsterdam Groningen, The Netherlands; T: +31 50- 3618886, F: + 31 50-3619930,

More Related