TEMPLATE DESIGN © THE EFFECTS OF MATERNAL BODY MASS INDEX (BMI) ON THE PREGNANCY OUTCOME AMONG PRIMIGRAVIDA WHO DELIVERED AT HOSPITAL TENGKU AMPUAN AFZAN (HTAA), KUANTAN, PAHANG. Siti Anisah Adnan ¹, Hamizah Ismail², Razman Mohd Rus³, Zalina Nusee² Department of Obstetrics and Gynaecology, Hospital Tengku Ampuan Afzan¹ Department of Obstetrics and Gynaecology, Kulliyyah of Medicine, International Islamic University Malaysia² Department of Community Medicine, Kulliyyah of Medicine, International Islamic University Malaysia³ Objectives Results Conclusions References  To measure the prevalence of antenatal, intrapartum and postpartum complications in the mother and the fetus/newborn in relation to their BMI.  To determine the mean intrapregnancy weight gain for each BMI category. Methods A total of 102 women were included in the study. Of these, 29 (28.4%) were underweight, 36 (35.2%) had normal BMI, 14 (13.7%) were overweight, 19 (18.6%) were obese and 3 (2.9%) were morbidly obese.(chart 1 ) A comparison of the sociodemographic characteristic of the women in the five BMI categories is presented in table 1. OPTIONAL LOGO HERE This is a cross sectional study conducted between December 2011 and November The study includes all primigravida who booked before 14 weeks of gestation. Upon delivery women had their antenatal, intrapartum and postpartum events reviewed and then categorized into five BMI groups; underweight (≤ 19.9 kg/m 2 ), normal ( kg/m 2 ), overweight ( kg/m 2 ), obese ( kg/m 2 ) and morbidly obese (>35kg/m 2 ). Women were followed up until discharged and reviewed again at 6 weeks postpartum. All statistical analyses were performed with the use of SPSS for Windows, version 18.0 (SPSS) and P -value of less than 0.05 was taken to be statistically significant Table 1 : sociodemograhic characteristic of the women in five BMI groups The maternal risk increases as the BMI increases whereas the fetal risk increases with the extreme of BMI (underweight and morbidly obese). Inappropriate weight gain was observed in all groups but was significant in the morbidly obese. 1) The Impact of Maternal Obesity on Maternal and Fetal Health,Meaghan A Leddy.Michael L Power,PhD, and Jay Schulkin,PhD; Rev Obstet Gynecol.2008 Fall;1(4): ) Effect of Body Mass Index on Pregnancy outcomes in nulliparous women delivering singleton babies,Sohinee Bhattacharya, Doris M Campbell, William A Liston and Siladitya Bhattacharya; BMC Public Health 2007,7;168 3) The impact of obesity on fertility and pregnancy;Authors : Francis S Nuthalapathy.MD,Dwight J Rouse,MD,MSPH 4) The Effect Of Pre-Pregnancy Body Mass Index,Gestational Weight gain On Pregnancy Outcomes;The internet Journal Of Health,2005 volume 4 Number 2 5) Overweight and obesity in mothers and risk of preterm birth and low birth weight infants: systemic review and meta-analyses; Sarah D Mc Donald,associate profesor,Zhen Han,associate profesor,Sohail Mulla,student,and Joseph Beyene,associate profesor and senior scientist on behalf of the Knowledge Synthesis Group; BMJ 2010;341:c3428 6) The risk of adverse pregnancy outcomes in women who are overweight or obese ; Chaturica Athukorala,Alice R Rumbold,Kristyn J Wilson and Caroline A Crowther ;BMC Pregnancy childbirth 2010;10:56 Distribution of BMI n= 102 Variables Mean SD No % Age 26 4 Income intrapregnancy weight gain Education Primary Secondary Tertiary Marital status Unmarried 2 2 Married Race Malay Chinese Indian 2 2 others Maternal BMI Underweight Normal BMI Overweight Obese Morbidly obese The morbidly obese group was found to experience higher percentage of gestational diabetes mellitus (33%), pregnancy induced hypertension (100%), preterm delivery (33%), augmentation (100%) and instrumentation (33%). Risk of caesarean section was highest (64%) in the overweight group. Highest risk of shoulder dystocia (33%) and wound dehiscence (15.8%) were observed in the obese group.The underweight women had higher risk for preterm delivery (17%). Table 2 showed the incidence of complications of pregnancy, labour and delivery in women in the five BMI categories Characteristic Underweight Normal Overweight Obese Morbidly obese n=29 n=36 n-14 n =19 n=3 Gestational diabetes 4(13%) 4(11%) 4(28%) 3(15%) 1(33%) Mellitus Pregnancy induced 2(6%) 7(19%) 6(42%) 3(15%) 3(100%) hypertension Preterm delivery 5(17%) 5(13%) 2(14%) 0(0%) 1(33%) Augmentation 9(31%) 17(47.2%) 10(71.4%) 10(52.6%) 3(100% Instrumentation 3(10%) 6(16%) 1(7%) 1(5%) 1(33%) Caesarean section 8(27%) 12(33%) 9(64%) 9(47%) 0(0%) Shoulder dystocia 0(0%) 0(0%) 0(0%) 1(33%) 0(0%) Wound dehiscence 0(0%) 0(0%) 0(0%) 3(15.8%) 0(0%) Values expressed as number ( percent) The mean intrapregnancy weight gain for each BMI category were:12.2 ± 4.6kg (underweight), 13.6 ± 4.4kg (normal), 12.8 ± 5.5 kg (overweight), 12.4 ± 6.2kg (obese) and 0.8 ± 7.8kg (morbidly obese). Morbidly obese group had lower intrapregnancy weight gain compared to other groups (P = 0.004).