1. Weight gain during pregnancy & pathological associations Supervisor: Dr.Claudiu Mărginean MD, PhD Author: Maria Edwards (Ardelean) University of Medicine and Pharmacy of Târgu Mureş Faculty of Medicine, Specialisation: Midwifery

2. Reasons & Objectives of My Project I chose this subject because I consider that the area concerning obesity is important in today’s society, especially due to the increasing rate in obesity in the general population. Obesity is not only a medical problem but also a psychological one which continues to grow and affects not only the pregnant women but all the population. It is known that obese women have a higher risk of developing intra-partum and post-partum complications, which may then also affect the outcome of the newborn, e.g. weight of the newborn, etc.

3. Reasons & Objectives of My Project continued… The main objective of my study is to establish possible connections between the pregnant woman’s weight at the beginning of the pregnancy and pathological associations which occur during pregnancy and post-partum. I have also tried to establish the following: Whether the weight of the pregnant woman at the beginning of pregnancy affects the newborns weight Whether women who weigh >=70 kg at the beginning of the pregnancy and those who add >=15 kg during their pregnancy: –have a higher risk of giving birth prematurely –have a higher risk of developing high blood pressure, gestational diabetes, varicose veins, hemorrhoids, nipple fissure, preeclampsia –have a higher risk of requiring a Caesarian section, episiotomy or other interventions;

4. Data Collection & Statistics My study is a retrospective one, consisting of 322 women of various ages and weights (which I have called “Group A”), who were admitted to Targu Mures Clinical County Hospital between 1 st January 2012 & 1 January 2013. Group A has been further divided into three groups: Group B represents women in the study who weighed >=70kg at the beginning of pregnancy (85 pregnant women) Group C represents women in the study who weighed <70 kg at the beginning of pregnancy (237 pregnant women) Group D represents women in the study who added >=15 kg during their pregnancy (121 pregnant women)

5. Data Collection & Statistics continued… The data for the study was taken from patient’s personal observation sheet from the Targu Mures County Clinical Hospital archive.

6. Newborns Weight The average weight of newborns belonging to mothers in Group A was 3174.2 grams. The average weight of newborns belonging to mothers in Group B (women who weighed >=70kg) was 3387.8 grams In comparison, the average weight of newborns belonging to mothers in Group C (women who weighed <70kg.) whose newborns weight media was 3097.6 grams. The average weight of newborns belonging to mothers in Group D was 3370 grams.

9. Conclusions Although my conclusions came from a small study (due to the limited number of pregnant women in the study), my results still confirm many of the things that are already known, e.g. excess weight increases the risk for both mother and child during both pregnancy and labour. The main conclusions are:

10. Conclusions continued… Women who start their pregnancy weighing >=70 kg have a higher risk of gaining >=15kg during pregnancy Women who started their pregnancy weighing >=70kg had a higher risk of adding >=15kg during their pregnancy (44.7% of women studied), compared with those who started their pregnancy weighing <70kg (35% of women studied). Women who start their pregnancy weighing <70 kg have a higher risk of premature birth. Women who started their pregnancy weighing >=70kg did not have a higher risk of premature birth (9.1% of women studied), compared with those who started their pregancy weighing <70kg,(16.9% of women studied).

11. Conclusions Continued… Women who start their pregnancy weighing >=70 kg have a higher risk of having a Caesarian Section. Women who started their pregnancy weighing >=70kg had a higher risk of having a C-section (40% of women studied), compared with those who started their pregnancy weighing <70kg (32.06% of women studied). However, those who gained 15kg during pregnancy (regardless of their pre-pregnancy weight) had a higher risk of needing a C-section (36.4% of women studied). Women who start their pregnancy weighing >=70 kg have a higher risk of needing Oxytocin. Women who started their pregnancy weighing >=70kg had a slightly higher risk of needing Oxytocin (23.5% of women studied), compared with patients who started their pregnancy weighing =15kg during pregnancy (regardless of their pre-pregnancy weight) had a slightly lower risk of needing Oxytocin (21.5% of women studied)

12. Conclusions Continued… Women who start their pregnancy weighing <70 kg have a higher risk of needing an episiotomy. Women who started their pregnancy weighing >=70kg did not have a higher risk of needing an episiotomy (43.5% of women studied), compared with women who started their pregnancy weighing =15kg during pregnancy (regardless of their pre-pregnancy weight) had a greater risk of needing an episiotomy (49.6% of women studied). Women who start their pregnancy weighing >=70 kg have a higher risk of developing high blood pressure. The risk of developing high blood pressure during pregnancy was higher for women who started their pregnancy weighing >=70kg (14.1% of women studied) compared with those who started their pregancy weighing =15kg during pregnancy (regardless of their pre-pregnancy weight) had a high risk of developing high blood pressure (8.3% of women studied).

13. Conclusions Continued… Women who start their pregnancy weighing >=70 kg have a higher risk of developing gestational diabetes. Women who started their pregnancy weighing >=70kg had a higher risk of developing gestational diabetes (5.9% of women studied), compared with those who started their pregnancy weighing =15kg during pregnancy (regardless of their pre-pregnancy weight) had a slightly high risk of developing gestational diabetes (3.3% of women studied). There is a greater risk of developing preeclampsia for women who weigh >=70kg than for women who gain >=15kg during pregancy or for women who weigh <70kg. Out of the pregnant women who started their pregnancy weighing >=70 kg, from 85 women, 4 developed preeclampsia, 2 of whom added >=15 kg during pregnancy. The risk of developing preeclampsia for women in Group B (who weighed >=70kg) was 4.7% and for women in Group D (who added >=15 kg during pregnancy) the risk of developing preeclampsia was 1.7%. No women from Group C (who weighed <70kg) developed preeclampsia.

14. Conclusions Continued… Women who start their pregnancy weighing >=70 kg have a higher risk of developing varicose veins. The risk of developing varicose veins was higher for women who started their pregnancy weighing >=70kg (4.7% of women studied) compared with those who gained >=15kg during pregnancy (regardless of their pre- pregnancy weight), (1.7% of women studied). Women who start their pregnancy weighing >=70kg have babies who have a greater weight than those who start their pregnancy weighing <70kg. The average newborn weight was slightly higher (on average 350g more) for babies born to women who started their pregnancy weighing >=70kg compared with the babies born to women who started their pregnancy weighing <70kg

15. Conclusions Continued… Women who start their pregnancy weighing >=70 kg have a higher risk of developing postpartum anemia. There was a greater risk of developing postpartum anemia in women who started their pregnancy weighing >=70kg (21.2% of women studied), and among those who gained >=15kg during pregnancy (regardless of their pre-pregnancy weight) (19.8% of women studied), compared with those who started their pregnancy weighing <70kg (15.6% of women studied). Women who start their pregnancy weighing >=70 kg have a higher risk of developing hemorroids post-partum. The risk of developing hemorroids post-partum was higher for women who started their pregnancy weighing >=70kg (7.1% of women studied), compared with those who started their pregnancy weighing =15kg during pregnancy (regardless of their pre-pregnancy weight) had a similar risk of developing hemorroids, (3.3% of women studied).

16. Conclusions Continued… Women who start their pregnancy weighing >=70 kg have a higher risk of developing nipple fissure. Women who started their pregnancy weighing >=70kg and those who gained >=15kg during pregnancy (regardless of their pre-pregnancy weight) had a higher risk of developing nipple fissure post-partum (21.2% and 15.6% of women studied respectively), compared with those who started their pregnancy weighing <70kg (9.1% of women studied). The patients who started their pregnancy weighing >=70 kg have a higher risk of developing gestational oedema. Women who started their pregnancy weighing >=70kg had a higher risk of developing gestational oedema (12.9% of women studied). Women who started their pregnancy weighing =15kg during pregnancy (regardless of their pre-pregnancy weight) had a similar risk of developing gestational oedema (8% of women studied).

17. thANK YOU VERY MUCH FOR YOUR ATTENTION!!!