الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Obesity is a common condition affecting women and causing a considerable impact on their life and pregnancy events.
It was to determine the impact of weight pregnancy event of mother and fetus, also the study aimed to assess the knowledge about obesity among pregnant females attending in Minia maternity university hospital, Minia governorate, Egypt.
This was a prospective observational study carried out at Minia maternity university hospital city, Minia governorate, Egypt. Approval was taken from the ethical committee of Minia Faculty of Medicine and also from hospital administration. All pregnant females who is overweight or obese subjected to full medical history taking and local examination and different investigations to assess the degree of obesity and its complications.
Assessment of the impact of increased maternal weight on pregnancy events and labour and fetal complications was carried out using self-reported questionnaire.
This study was carried out on 120 pregnant females in their last trimester or on delivery, The age ranged from 20 to 34 years old, with a mean ±SD of 26.6±4.2, The weight of the selected sample were between (52 and 140 kg) with mean ±SD 77.6±21.2.
According to BMI, women have been grouped into control group with range (20.6-24.9) and subject group with range of (25.2-53.2).
Aim of work:
1. Measure BMI of pregnant women.
2. Find if the increased maternal body mass index is a risk factor of GDM, HDP and thromboembolic state during pregnancy.
3. Find the relationship between increase maternal body mass index and mode of delivery among women enrolled in this study
4. Find the relationship between increase maternal body mass index and postpartum hemorrhage, depression and wound infection as a maternal outcome.
5. Find the relationship between increase maternal body mass index and fetal outcomes as fetal macrosomia, shoulder dystocia, NTD and need for NICU admission.
Subjects and Methods
After approval of the university ethical, this study was conducted in Minia maternity University hospital to May 2020. It was conducted on120 pregnant females in their last trimester 60 overwight women and 60 normal weight as control. All the study subjects were submitted to A detailed questionnaire was taken from all subjects contributed in this study including
A. Socio_demographic data assessed is :
• Name
• Age
• Level of education
• Income level
• Parity
B. Obstetric history:
• Gestational age is “assessed by the last menstrual period or by ultrasonography in unreliable dates”
• Estimated date of delivery
• History of previous pregnancies
• History of previous cesarean sections
• Symptoms of current pregnancy including those of medical disorder as GDM , pregnancy induced hypertension or DVT
C. Gynecological history:
• Last menstrual period
• Regularity of cycles
• Primary or secondary infertility
• Any gynecological operations
Examination Then all subjects were examined:
A. Generally:
• Blood pressure, pulse, thyroid region and lower limb oedema to detect any medical disorder
• Height and weight to assess BMI.
B. Abdominally:
• For assessment of fetal lie and presentation
C. vaginal examination:
• To detect phase of Labour either latent phase or active phase by detection of degree of cervical dilatation and effacement
• To recognise the presentation part
• To detect the station by detection of the degree of the descend of the presenting part
Investigations
• All investigation is assessed from the medical record of the patient.
1. Laboratory
• OGTT
• Urine analysis to detect proteinuria
• Liver function test and complete blood count to detect HELLP syndrome.
2. Ultrasonography
• To detect gestational age Full term preterm and post term
• Gestational age and estimated date of delivery were calculated from a certain Last menstrual period date by ultrasound scan.
• Preterm birth was defined as any birth before 37 completed weeks (259 days) of gestation. Term delivery was defined as reaching (37_42)-weeks (259_294 days), while prolonged pregnancy find delivery on or after to win 294 days (>42 w) of gestation
• To ensure viability of the baby IUFD
• The Singleton or multiple pregnancy
• To detect fetal congenital anomalies
• To confirm the fetal lie, presentation and placental site “exclude malposition, mal-presentation, causes of antepartum hemorrhage”
• To detect amount of liquor “excluding oligohydramnios or polyhydramnios
• Ultrasound venography are done to confirm cases of DVT.
Results:
As regard mode of delivery.
• Our study found that maternal obesity is associated with increased frequency of Cesarean section delivery and decreased frequency of vaginal delivery.
As regard regression analysis
• All variables (GDM, hypertension, DVT, CS delivery, postpartum hemorrhage, postpartum wound infection, postpartum depression, delayed breast feeding, macrosomia, shoulder dystocia and neonatal ICU) is statistically significant in relation to maternal BMI except DVT, shoulder dystocia and neonatal ICU. The highest OR was 1.183 (1.106-1.256) for CS delivery. The lowest OR was 1.54(0.93-1.194) for shoulder dystocia.
As regard Cutoff value for BMI on different side effects
• The cutoff value for BMI on GDM was 29.9
• The cutoff value for BMI on HTN was 31
• The cutoff value for BMI on DVT was 29.1
• The cutoff value for BMI on CS delivery was 29.1
• The cutoff value for BMI on postpartum hemorrhage was 30.4
• The cutoff value for BMI on postpartum wound infection was 29.9
• The cutoff value for BMI on postpartum depression was 30.4
• The cutoff value for BMI on Delayed breast feeding was 29.9
• The cutoff value for BMI on macrosomia was 30.4
• The cutoff value for BMI on shoulder dystocia was 30.4
• The cutoff value for BMI on neonatal ICU admission was 30.4
Conclusion:
• Increased maternal weight is a common problem and has an obvious impact on maternal and fetal life among females attending to Minia maternity university hospital, Minia city, Egypt.
• Maternal overweight and obesity are modifiable risk factor for irregularity of menstrual cycle, infertility, GDM, HDP, DVT, and increased rate of cesarean delivery, potpartum hemorrhage, wound infection, depression symptoms and fetal macrosomia with a positive relationship.
• On the other, maternal obesity isn’t significantly associated with shoulder dystocia, NTD and need for NICU admission.
Implications:
• The study findings identified the magnitude of the problem of increased maternal weight, in the form of its high impact on maternal and fetal life that reach mortality in some cases.
• These findings have significant implications to rectify doctors’ attitudes for proper management of obesity, obesity is a multidisciplinary risk factor that need a cooperation of family physician, gynecologist dietitian and even endocrinologist.
• Giving attention to the lethal effect and organizing health education programs targeting this special age group.
Recommendations:
• Health education organized programs for educating the importance of proper weight gain during pregnancy to avoid complications and negative impact on mother and infant.
• Proper management of maternal overweight with taking in consideration its impact on mode of delivery.
• More studies are recommended to follow up the treatment effect on both mother and fetus.
• A study on the degree of knowledge about the disease after distribution of the knowledge brochure is recommended on a large scale of pregnant women or even the females in childbearing period.