1. The Health Roundtable Pregnancy Weight Matters Presenter: Glyn Teale Hospital Code Name: Wombat Innovation Poster Session HRT1104b – Maternity March 10-11 2011

2. The Health Roundtable KEY PROBLEM  63% of our pregnant women have a BMI over 25  >30% > BMI 30  Lack of standardisation of care for high risk group  Stopped routine weighing of antenatal women  Resistance to re-introduction of routine weighing  Clinical incidents  Late diagnosis of diabetes, failed epidurals, severe missed IUGR

3. The Health Roundtable AIM OF THIS INNOVATION  Establishing weight as an important issue in antenatal care  Risk management  Reduced incidents  Improved detection of diabetes  Improved detection of growth restriction  OH&S

4. The Health Roundtable Change management strategy… Commence working group Develop plans Develop guidelineDevelop handout Implement training to staff Implement program

5. Please ask your midwife or doctor for information about the importance to your baby of appropriate weight gain throughout your pregnancy and beyond A new program for pregnant women delivering at Goulburn Valley Health from 1st February 2010

6. BMI >35 BMI 18.5 - 35 BMI < 18.5 26 weeks – reassess weight – advise if outside target weight change 36 - 38 weeks – reassess weight – advise if outside target weight change Advise about weight management after pregnancy 35 weeks: US/S for growth 36 weeks: Specialist review 28 weeks: repeat OGTT Refer to dietitian Arrange early OGTT Refer to dietitian Booking - Calculate BMI / establish target weight gain range Increased surveillance 32 weeks – primip/high risk multip – PAC Post-natal - Advise about weight management after pregnancy

7. The Health Roundtable AIM OF THIS INNOVATION – Achieved?  Establishing weight as an important issue in antenatal care  Risk management  Reduced incidents  Improved detection of diabetes  8 ‘type II’ diabetics diagnosed < 20 weeks  Improved detection of growth restriction  OH&S

8. The Health Roundtable LESSONS LEARNT  Multidisciplinary team  Present the risks before suggesting change  Obesity risks > Smoking risk ----- brings home the message  Time involved in counselling can be an issue