1. TEMPLATE DESIGN © 2008 www.PosterPresentations.com Gestational Weight Gain and Pregnancy Outcomes in Women Who Came for Delivery in a District Hospital Hateeza Z, Noorazmi MA, Rahmah S, Balanathan K, Matthew S, Sharmini D, Yuzainov A. University of Malaya Medical Centre (UMMC) & Seberang Jaya Hospital Introduction Excessive gestational weight gain and obesity has long been regarded as a pregnancy risk factor 1-7 The upward trend in the prevalence of obesity is increasing despite its well-publicised adverse effects on health 8,9,10 Study has shown that postpartum retention of weight is proportional to weight gain during pregnancy 10-13 Maternal antepartum medical complications, such as hypertension and diabetes mellitus, are significantly increased in obese mother 1,3,5,7,8 Obese patient also do poorly during the intrapartum period. Deliveries by obese women tend to have higher rates of induction of labour, caesarean section and dystocia from macrosomic babies 14-17 OBJECTIVE To determine the value of total gestational weight gain, describe the association of gestational weight gain with sociodemographic background and to evaluate whether gestational weight gain has a role in predicting the pregnancy outcomes amongst the obstetrics population in Seberang Jaya Hospital in 3 months duration METHODOLOGY A cross-sectional cohort study A total of 674 pregnant women with singleton pregnancy who came to deliver vaginally in Seberang Jaya Hospital from 17 th February 2010 until 17 th May 2010 and were booked at their respective health clinic at ≤ 12 weeks period of amenorrhoea were successfully recruited Their maternal antepartum, intrapartum and postpartum event as well as neonatal outcomes were documented The data was analysed using Statistical Package for Social Science version 18 RESULTS Total deliveries in Seberang Jaya Hospital during the 3 months study period were 1865 deliveries The number of recruited patients was 674, therefore at least 36% of obstetric population of Seberang Jaya were booked at ≤ 12 weeks period of amenorrhoea Majority of the mothers were Malay (81.6%), primigravida (29.9%) and were less than 35 years old (81.5%) The mean of total gestational weight gain in the recruited sample was 10.3 ± 4.95 kg Gestational weight gain is observed to be higher in the younger age group and in women who came to deliver at more advanced period of gestation Less weight gain is observed in women with higher gravidity, parity and higher pre-pregnancy body mass index Conclusions References Women of younger age and lower parity were associated with more gestational weight gain compared to older and higher parity women. Although there is no optimum or normal amount of weight to be gained during pregnancy, this study showed significant correlations between total pregnancy weight gain to maternal and fetal complications. The results of this study emphasized the importance of educating women to know their pre-pregnancy weight and not to put on excessive weight during their pregnancy OPTIONAL LOGO HERE Gestational weight gain does not show any association with race, history of previous LSCS and miscarriage Patients with higher gestational weight gain had a longer duration of labour, higher degree of perineal tear and higher neonatal birthweight. Weight gain also shows association with different group of gestational diabetes mellitus, analgesia usage in labour, postpartum haemorrhage, Apgar score at 1 minute, shoulder dystocia and wound complications. On the other hand, it does not shows any role in predicting hypertension in pregnancy, the mode of delivery, the need for induction of labour, duration of emergency caesarean section, Apgar score at 5 minute, infection status and duration of hospital stay. Total gestational weight gain (n=674 ) Mean (sd)Median (IQR)MinMax Pre pregnancy weight (kg) 58.77 (13.03) 56.50 (16.60)34.00109.00 Height (m) 1.56 (0.06)1.56 (0.07)1.401.82 Pre pregnancy BMI (kg/m 2 ) 24.25 (5.09)23.60 (6.54) 14.34 46.56 Weight at delivery (kg) 69.00 (12.92) 67.50 (16.0) 39.00 120.00 Gestational weight gain (kg) 10.30 (4.95)10.00 (6.00)0.00 35.50 Overall study population characteristics (n=674 ) Age (in years)Pre-pregnancy weight (in kg) Total weight gain(in kg) Primigravida, n=202  Mean (std dev)  Minimum  Maximum 25.21 (3.85) 16 37 55.78 (11.9) 35.5 93.7 12.39 (5.27) 2.0 35.5 Gravida 2 & 3, n=300  Mean (std dev)  Minimum  Maximum 28.41 (4.44) 19 41 58.43 (13.27) 34.0 100.0 10.06 (4.32) 0.3 24.4 Gravida 4, n=84  Mean (std dev)  Minimum  Maximum 33.14 (3.83) 24 42 62.63 (12.89) 40.9 109.0 9.24 (4.97) 0.0 25.0 Gravida 5 and above, n=88  Mean (std dev)  Minimum  Maximum 35.25 (4.04) 26.0 44.0 63.11 (13.61) 39.0 105.0 8.13 (3.92) 0.9 23.50 Age, Pre pregnancy weight and Total weight gain in different group of Gravidity (n=674 ) Age (in years) Pre-pregnancy weight (in kg) Total weight gain (in kg) Baby birth weight (in grams) No GDM, n=569  Mean (std dev)  Minimum  Maximum 28.47 (5.21) 16.0 44.0 57.31 (12.19) 34.0 100.0 10.56 (4.93) 0.6 35.5 3019.23 (459.20) 1570 4390 GDM on diet control, n=85  Mean (std dev)  Minimum  Maximum 31.01 (5.38) 20.0 43.0 65.44 (14.24) 36.0 103.0 9.51 (4.91) 0.9 24.4 3094.91 (435.64) 1620 4330 GDM on insulin, n=19  Mean (std dev)  Minimum  Maximum 33.37 (6.31) 23.0 43.0 72.75 (17.76) 47.0 109.0 6.12 (3.63) 2.0 13.0 2994.74 (462.71) 2240 3960 Age, Pre-pregnancy weight, Total weight gain and Birth weight in different group of patient with Gestational Diabetes Mellitus (n=674) Variables nWeight gain mean (sd) F (df) p-value GDM  No GDM  Diet Control  On Insulin 569 85 19 10.56 (4.93) 9.51 (4.91) 6.12 (3.63) 8.841 (2,670) <0.001 Analgesia  No Analgesia  Entonox  I/M Pethidine  Epidural 358 28 222 60 9.61 (4.74) 11.14 (5.81) 11.17 (5.02) 10.64 (5.09) 4.990 (3,664) 0.002 PPH  No  Yes 654 20 10.21 (4.92) 13.17 (5.20) 6.955 (1,672) 0.009 Wound Complication  Yes  No 6 668 10.26 (4.94) 14.53 (4.68) 4.445 (1,672) 0.035 Birthweight  Less than 2500g  2500g – 3599g  3600g – 3999g  More than 4000g 72 538 44 20 9.21 (4.51) 10.17 (4.86) 12.77 (6.10) 12.20 (4.11) 6.641 (1.672) <0.001 Shoulder dystocia  Yes  No 1 673 23.00 (-) 10.28 (4.93) 0.010 VariablesnCorrelation p-value Age674-0.261#<0.001 Gravidity674-0.331@<0.001 Parity 674-0.322@<0.001 POG at delivery 6690.125@0.001 Maternal weight at delivery 6740.173#<0.001 Pre-pregnancy weight 674-0.208#<0.001 Pre-pregnancy BMI 674-0.255#<0.001 Duration of labour in SVD 5090.105@0.018 Perineal tear 5120.275@<0.001 Apgar score (at 1 minute) 674-0.088@0.023 Birthweight 6730.162#<0.001 Comparison in the mean of total gestational weight gain and the statistically significant categorical independent variables using ANOVA (F test) Correlation between total gestational weight gain and statistically significant continuous variable ( @ Spearman rho’s correlation, # Pearson correlation ) 1.Health implications of obesity. 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