Care of Women with Obesity in Pregnancy

Management of Breech Presentation: Green-top Guideline No. 20b.

Maternal obesity during pregnancy as a risk for early-life asthma

In December 2020, the National Institute for Health and Care Excellence (NICE) reviewed the evidence and updated their recommendations on intermittently scanned (commonly known as Flash) and Continuous Glucose Monitoring (CGM) during pregnancy for women with type 1 diabetes (1). The NICE guidelines now recommend offering CGM to all pregnant women with type 1 diabetes to help them meet their pregnancy glucose targets and improve neonatal outcomes. Their evidence review, based on the CONCEPTT randomised trial (2) and a Swedish observational study (3) found that, compared to capillary glucose monitoring, CGM resulted in more women achieving their blood glucose targets, fewer caesarean sections and fewer neonatal intensive care admissions.

BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn.

Tackling childhood obesity at its maternal roots

BackgroundMaternal obesity is associated with increased risks of adverse pregnancy-related complications and outcomes for both mothers and infants. Overweight and obese women have an increased risk of pregnancy-induced hypertension, preeclampsia and gestational diabetes mellitus (GDM). Infant Body Mass index (BMI) and the risk of obesity in adulthood are related to maternal gestational weight gain (GWG). Preventive lifestyle and dietary interventions are time-consuming and do not always reduce GWG or the risk of maternal pregnancy complications. Recent research has indicated that the gut microbiota may play a significant role in the development of obesity. Some studies have indicated that the daily consumption of probiotics may reduce the risk of preeclampsia, maintain serum insulin levels and reduce the frequency of GDM in pregnant women. The aims of this study are to investigate whether daily probiotic supplements in obese women during pregnancy can limit gestational weight gain, improve glucose homeostasis and thereby improve maternal, fetal and infant health outcomes.MethodsA pilot study including 50 obese pregnant nulliparous women with a prepregnancy BMI of between 30 and 35 kg/m2 will be randomized to receive daily probiotics (four capsules of Vivomixx®; total of 450 billion CFU/day, including eight probiotic bacterial strains) or placebo from gestational age 14–20 weeks until delivery. The infants will be followed until 9 months of age. The women will be monitored by weight, blood, fecal, vaginal and urine samples, diet questionnaires and hospital record review. Primary outcomes are: maternal weight gain, glycated hemoglobin (HbA1c) level and changes in glucose concentration measured during an oral glucose tolerance test. Secondary outcomes are: microbiota and inflammatory markers in mother and child, pregnancy complications, pregnancy outcomes, physical activity and the body composition of the neonate.DiscussionWe expect to find alterations in the metabolic profiles, microbiota and possibly pregnancy outcomes. From a clinical point of view the effects of Vivomixx® could control weight gain and reduce complications during pregnancy by inducing changes in the gut microbiota. Furthermore, this intervention during pregnancy could influence the infant’s microbiota, which could have important implications for infant development and health.Trial registrationClincalTrials.gov Identifier: NCT02508844, registered on 11 May 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1617-5) contains supplementary material, which is available to authorized users.

Thromboprophylaxis in pregnant women: For whom and which LMWH dosage?

Background and aims EOS is a major cause of neonatal morbidity and mortality that can progress rapidly with minimal clinical and laboratory signs. Early identification of at risk newborns and prompt antibiotic treatment is therefore crucial. In 2012, National Institute for Health and Care Excellence (NICE) guidelines for EOS were published. Our local guideline includes fetal distress (abnormal cardiotocography) and meconium stained liquor as risk factors. We compare the outcomes with NICE and local guidelines. Methods Retrospective analysis of infants ≥35 weeks gestation admitted to a level-3 NICU over 4 months with suspected sepsis classified to have presumed (PS) or confirmed sepsis (CS). Results Of 81 cases identified, 44(54.3%) had PS and 37(45.7%) CS. 23(28.4%) babies in poor condition at birth received antibiotics on clinical grounds. Of remaining 58 cases, 36(62.1%) had PS and 22(37.9%) CS. Using local guideline in PS, 9(25%) required antibiotics, 13(36.1%) observed and 14(38.9%) were low risk. With NICE guideline, 5(13.9%) received antibiotics, 8(22.2%) observed and 23(63.9%) low risk. Using local guideline in CS, 10(45.5%) required antibiotics, 4(18.2%) observed and 8(36.3%) low risk but with NICE guideline, 3(13.6%) received antibiotics, 8(36.3%) observed and 11(50%) low risk did not require antibiotics or observations. Meconium was more common in CS (12/37; 32.4%) versus PS (6/44; 13.6%). Abnormal cardiotocography was noted in 40.5% CS cases versus 25% in PS. Conclusions Local guidelines with fetal distress as a risk factor may enable earlier identification of EOS risk. Larger study may enable better evaluation of our antibiotic therapy and resource implications.

AimsThe aim of this audit was to review the prescriptions in one community Child and Adolescent Mental Health Service (CAMHS) and to see whether these prescriptions were licenced for the prescribed indication and if the prescription was supported by national guidelines.MethodsI reviewed the treatment of 77 patients who were assessed by the consultant psychiatrist in one CAMHS team between January 2020 and August 2022.For each prescription I gatheredThe name of the medicationThe IndicationChild or young person's comorbiditiesI then compared this with the licenced use on the Summary Product Characteristics (SPC), as well as the guidance available from (National Institute for Health and Care Excellence (NICE), British Association of Psychopharmacology (BAP) and British National Formulary for Children (BNFc)).ResultsIn total there were 177 prescriptions for a variety of medication including antidepressants, antipsychotics, sedatives, and medication to treat ADHD.It was found that 25% of all prescriptions were prescribed according to the medication's licensed use, with 42%, 62% and 67% compatible with NICE guidelines, BAP guidelines and BNFc respectively. However, 12% deviated entirely from these guidelines, including prescriptions for mirtazapine (1), melatonin (9), quetiapine (6), risperidone (1) and olanzapine (4). These prescriptions were also associated with increased comorbidity with each child having at least one comorbid mental health problem.There was an 81% agreement between NICE and BAP guidelines, a 75% agreement between NICE and BNFc and 66% agreement between BAP guidelines and BNFc.ConclusionThis audit demonstrated that only a quarter of prescriptions were prescribed according to a licenced use, with the vast majority falling outside the product licence. This is important because the Joint Standing Committee on Medicines preference “an appropriate licenced preparation” over unlicenced prescribing.Furthermore, the defensibility of unlicenced prescriptions is increased when they are supported by published clinical guidelines which was the case in 88% of prescriptions that were reviewed. This leaves 12% of prescriptions that were not supported by either licencing or BAP, NICE or BNFc guidelines. There may be multiple causes for this, but it is likely that the high number is aggravated by the lack of NICE guidelines for common conditions such as anxiety as well as high levels of comorbidity in this population group which is not always reflected in clinical trials and guidelines.

A multifactorial relationship exists between total circulating cell‐free DNA levels and maternal BMI

IntroductionIncreasing evidence suggests obesity has its origins prior to birth. There is clear correlation between maternal obesity, high birthweight and offspring risk of obesity in later life. It is also...

IntroductionObesity is the greatest threat to the childbearing population of UK. According to the 2003–2005 CEMACH report, half of those who died were obese, 15% extremely obese.Materials and methodsWe performed...

Previous research has shown attachment avoidance in adulthood to be a strongnegative predictor of desire to have children, bonding in pregnancy, and abilityto relate to children after birth (Rholes, Simpson, & Blakely, 1995; Rholes,Simpson, Blakely, Lanigan, & Allen, 1997). Other research has shown that relationships between adult attachment and prenatal bonding and parenting style are sometimes mediated by caregiving style (Walsh et al., 2011; Millings, Walsh, & O’Brien, 2008). The two studies presented here explore the roles of attachment and caregiving in how individuals without children think about their intentions to become a parent and their expectations of what future parenting will be like. Study 1 demonstrated that, in accordance with other literature, attachment avoidance was a good negative predictor of desire to have children, but that caregiving style did not mediate this relationship. There appeared to be different predictors for young men and young women such that attachment avoidance predicted desire to have children for women, but caregiving responsiveness to partner predicted desire to have children for men. The second study sought to replicate and extend these results by examining attachment, caregiving, and relationship influences on expectations of future parenting. This research adds to our understanding of the correlates and predictors of parenting intentions and expectations, and the relative importance of relationship and individual processes.

IntroductionEvidence suggests that delivery by caesarean section in obese women (body mass index (BMI) ≥ 30kg/m2) carries a higher risk of postoperative complications.AimThis study tested the hypothesis that overweight (BMI...

Diagnosis and Management of Ectopic Pregnancy: Green-top Guideline No. 21.