title: Developing a clinical care pathway for obese pregnant women: A quality improvement project.
abstract: OBJECTIVE
  Obesity in pregnancy is associated with an increased incidence of maternal and foetal morbidity and mortality, from conditions like preeclampsia, gestational diabetes, preterm birth and stillbirth. Between 20% and 25% of pregnant women in Australia are presenting to their first antenatal appointment with a body mass index (BMI) ≥ 30 kg/m(2), defined as obesity in pregnancy. These figures are concerning for midwifery and obstetric staff directly involved in the clinical care of these women and their families. In the absence of national or state clinical practice guidelines for managing the risks for obese pregnant women, a local quality improvement project was conducted.
  
  
  OBJECTIVE
  To plan, implement, and evaluate the impact of an alternative clinical care pathway for pregnant women with a BMI ≥ 35 kg/m(2) at their first antenatal visit.
  The project was undertaken in the antenatal clinic of a rural referral hospital in NSW, Australia.
  
  
  METHODS
  Eighty-two women with a BMI ≥ 35 kg/m(2) were eligible for the alternative care pathway, offered between January and December 2010.
  
  
  METHODS
  The alternative care pathway included the following options, in addition to usual care: written information on obesity in pregnancy, referral to a dietitian, early plus repeat screening for gestational diabetes, liver and renal function pathology tests, serial self-weighing, serial foetal growth ultrasounds, and a pre-labour anaesthetic consultation.
  
  
  RESULTS
  Despite being educated on the risk associated with obesity in pregnancy, women did not take up the offers of dietetic support or self-weighing at each antenatal visit. Ultrasounds were well received and most women underwent gestational diabetes screening.
authors.affiliation: Port Macquarie Base Hospital, Wrights Road, NSW, Australia; The University of Newcastle, University Drive, Callaghan, NSW, Australia. Electronic address: shanna.fealy@newcastle.edu.au.
authors.forename: Shanna
authors.initials: S
authors.lastname: Fealy
authors.affiliation: The University of Newcastle, University Drive, Callaghan, NSW, Australia.
authors.forename: Alexis
authors.initials: A
authors.lastname: Hure
authors.affiliation: The University of Newcastle, University Drive, Callaghan, NSW, Australia.
authors.forename: Graeme
authors.initials: G
authors.lastname: Browne
authors.affiliation: Port Macquarie Base Hospital, Wrights Road, NSW, Australia.
authors.forename: Carol
authors.initials: C
authors.lastname: Prince
mesh_terms: D000328:Adult; D001315:Australia; D015992:Body Mass Index; D016640:Diabetes, Gestational; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D008880:Midwifery; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D037841:Pregnant People; D047928:Premature Birth; D011295:Prenatal Care / Q000379:methods*; D058996:Quality Improvement; D050497:Stillbirth; D016216:Ultrasonography, Prenatal
keywords: Implementation Science; Management; Obesity; Pregnancy; Risks