INTRODUCTION: We developed a referral pathway for morbidly obese women without known diabetes to receive rapid access to see a hospital dietitian in early pregnancy with the hope of preventing weight gain of more than 5 kilograms (kg)1.
METHOD: We followed pregnant women referred by midwives or obstetricians with a booking body mass index (BMI) of 40 or greater between June 1st and December 31st 2017. We recorded demographic information, attendance at clinic, serial weight changes and pregnancy outcomes. Multiple individual visits were available at the closest clinic to domicile.
RESULTS: There were 1159 hospital deliveries in Northland corresponding to the study period, 54 (4.7 %) of whom had a BMI >= 40. Maori were over-represented in the morbidly obese group (57.4%). There were only 24 referrals received and 5 women did not wish to be seen by a dietitian. Of those who attended clinic, 2/19 lost weight (-5 and-6 kg), 6 gained 0-5kg; 11/19 (58%) gained more than 5 kg over the remaining pregnancy (6-34.7kg, median 18 kg, mean 16.5kg). 10/19 developed gestational diabetes mellitus, of whom 8 gained more than 5 kg. 6 women did not attend for an oral glucose tolerance test.
CONCLUSION: Only 44% of morbidly obese pregnant women were referred for individual specialist dietitian input in early pregnancy and one-fifth declined an appointment when contacted. For those women who attended, 42% achieved our recommended weight change for pregnancy. Further strategies are required.
ACKNOWLEDGEMENT: Shane Stanners, business analyst, NDHB, for providing data
REFERENCE: 1. Bodnar LM et al. Am J Clin Nutr. 2010 Jun; 91(6): 1642–1648