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Simon Ash Profile picture
@OBsleepmerchant
May 24 • 14 tweets • 16 min read Twitter logo Read on Twitter
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@rr_metabolicmed presents the Bruce Scott Lecture 2023 at #OAA23ASM: Obesity & diabetes in pregnancy - legacy for the child. #OBAnes Image
Study of 1.3 million pregnant women reveals global obesity crisis: 75% pregnant women fail to achieve healthy weight gain during pregnancy, leading to preventable adverse health consequences for both the women and their babies. Obesity has strong evidence for increased risk of… twitter.com/i/web/status/1… ImageImageImage
Maternal obesity and offspring cardiovascular disease: maternal obesity increases offspring cardiovascular death (Hazard ratio [all cause mortality] = 1.35). At current UK maternal obesity rates, this equates to extra 650 deaths before age 50 each year. The Hazard ratio for type… twitter.com/i/web/status/1… ImageImageImage
Underlying mechanisms? Multiple intrauterine effects, shared environmental factors, shared genetics. On genetics: 60 loci, 15% birthweight variance. #OBAnes #OAA23ASM ImageImage
Antenatal metabolic clinic allowed detailed characterization of >300 mothers & babies during pregnancy and postpartum. Cohort study of BMI > 40 vs BMI < 25, with follow up of children to age 4-5years. #OBAnes #OAA23ASM Image
Care of women with Obesity in Pregnancy. Multimodal, multidisciplinary and #OBAnes have a role to play. Bruce Scott was the only anaesthetist since James Young to be awarded Fellowship of the Edinburgh Society of Obstetricians for his work in epidural anaesthesia since Simpson… twitter.com/i/web/status/1… ImageImage
High risk obese women who attend a multidisciplinary clinic have better outcomes: more likely to diagnose GDM; less likely to have LBW baby; lower risk of stillbirth (relative risk of stillbirth 8.14 among women not attending clinic). Multidisciplinary clinic allows platform for… twitter.com/i/web/status/1… ImageImage
Embedded experimental medicine studies: maternal stressors, maternal physiology, and placental structure & function. Clinical trials have resulted - metformin in obese pregnancy; first trial of glibenclamide as alternative to insulin; CBT intervention for anxiety. #OBAnes… twitter.com/i/web/status/1… ImageImage
Consequences of obesity in pregnancy for the child: developmental delay (was this controlled for in @Anaes_Journal neurodevelopmental outcomes study by Bleeser et al @noolslucas @DevroeSarah @MarcVandeVelde6 @rex_steffen? Adds an interesting dimension). Maternal BMI > 40 is… twitter.com/i/web/status/1… ImageImageImage
Imaging the fetal brain in vivo. Brain development of fetuses of mothers with diabetes is statistically different. (Similar question for Bleeser et al; @DevroeSarah @noolslucas @MarcVandeVelde6 @rex_steffen, it may well have been but thinking aloud) #OBAnes #OAA23ASM ImageImageImage
Media coverage - balanced? Pregnancy as an opportunity to improve population health? Intergenerational cycle of obesity - time to break the cycle? #OBAnes #OAA23ASM ImageImageImage
Virtual pregnancy and child cohort (pandemic baby cohort) - virtual allows to reach hard to reach groups (@jaymcv @DrWesleyEdwards along the lines of other conversation on maternal care networks). New demographics and pregnancy challenges: increasing obesity rates; older mothers… twitter.com/i/web/status/1… ImageImageImage
@rr_metabolicmed is recruiting. A lifecourse approach. A GLOBAL strategy would yield tremendous returns. Thank you’s and acknowledgements #OBAnes #OAA23ASM ImageImageImageImage
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More from @OBsleepmerchant

Simon Ash Profile picture
May 24
Just off great @dasairway @OAAinfo #OBAnes airway masterclass webinar with @silv24 chairing, @ProfEllenO @noolslucas @Chakladar_A and @DesireOnwochei giving expert opinions - lots of notes taken, tweets to follow twitter.com/i/web/status/1… Image
Right, let’s get to it. The #OBAnes airway - shifting the paradigm; a @dasairway & @OAAinfo masterclass. Two Profs in the corner… this should be interesting. @noolslucas kicks off the webinar. Image
What is a difficult airway? @ASALifeline definition: a clinical situation, conventionally trained anesthesiologist, difficult face mask ventilation/ intubation/ both.

Complications - hypoxemia: @MariePierreBon2 et al @BJAJournals 2020, @DavidGray37 @rosshofmeyr and co, SAJAA… twitter.com/i/web/status/1… ImageImageImageImage
Read 38 tweets
Simon Ash Profile picture
May 23
@TasPirani presents of Liver disease in pregnancy. A lot to cover! #OBAnes #OAA23ASM ImageImage
Physiological changes in pregnancy. Normal LFT/ laboratory changes. #OBAnes #OAA23ASM ImageImage
Causes of liver derangement in pregnancy: flare of pre-existing liver disease (known or unknown). Incidence of pregnancy in people with chronic liver disease at King’s College Hospital. Historically, cirrhotic patients have been infertile d/t anovulation. Population based data… twitter.com/i/web/status/1… ImageImageImageImage
Read 18 tweets
Simon Ash Profile picture
May 22
@ICULone presents on Severe Maternal Morbidity (SMM) and its consequences at #OAA23ASM. #OBAnes Image
Definition of acute SMM: severe, life threatening event during pregnancy & within 6 weeks of delivery. @NPEU_UKOSS provides UK wide high quality obstetric surveillance. Deaths, while uncommon, investigated in depth.

Study Aims: operationalise definition of SMM; report incidence… twitter.com/i/web/status/1… ImageImageImage
SMM at a population level. Study population derivation. #OBAnes #OAA23ASM ImageImage
Read 11 tweets
Simon Ash Profile picture
May 22
Prof Donald Peebles on Embedding Maternal Medicine Networks at #OAA23ASM. Knowing who to call is half the solution to any problem? (Touched on by @elsmere_g during #OBAnes session at #Anaesthesia2023) Image
Direct maternal mortality rate per 100,000 maternities had been decreasing over the last 2 decades, but should a remarkable upswing since 2018, not all accounted for by #COVID19. @mbrrace outlined a case for change: most parts of UK have MDT, but make up variable most without… twitter.com/i/web/status/1… ImageImage
The Maternal Medicine Network (MMN) mandate: ensure timely access to specialist advice and care at all stages of pregnancy. Development of Maternal Medicine specialist centres as regional hub & spoke model = urgent national priority (@DOckendenLtd report)

MMN Ambition and… twitter.com/i/web/status/1… ImageImage
Read 5 tweets
Simon Ash Profile picture
May 21
Dr Katy Sheehan and @ArcBroom present the pick of the posters at #OAA23ASM. 4 criteria for selection of #OBAnes abstracts. ImageImage
A positive start, with the power of positive communication on patient satisfaction, morale & culture, and #patientsafety #OBAnes #OAA23ASM ImageImageImageImage
Barriers to care. Ethnicity, Language and Socioeconomic deprivation. @mbrrace, @TheLancet, and most recently @Anaes_Journal (@LateralTilt @noolslucas @SQuashie @Marianfknight) set the stage. #OBAnes #OAA23ASM ImageImageImageImage
Read 18 tweets
Simon Ash Profile picture
May 21
@NoelleHealy (another 🇮🇪 representative - @ISOA_Ireland well represented!) presents on #OBAnes as a team sport - how do we perform better? at #OAA23ASM. Quite an inspiring quote, then setting the stage with @Fionafionakel et al #humanfactors guidelines in @Anaes_Journal… twitter.com/i/web/status/1… ImageImageImage
Why is teamwork important in OB/ #OBAnes? @mbrrace suggests some lessons to be learned. Prompt action is arguably reliant on good communication, within & between teams. Involving consultant/ specialist care early has been a theme for over a decade. #OAA23ASM ImageImageImage
@DOckendenLtd’ final report highlighted “conflicting agendas and poor teamwork” contribute to adverse maternal & neonatal outcomes? So how do we create good teams?

The @JulieAndrews approach may have the hills alive, but for #OBAnes we may need to start at the very beginning,… twitter.com/i/web/status/1… ImageImage
Read 10 tweets

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