A dedicated antenatal clinic for pregnant women with morbid and super-obesity: Patient characteristics, outcomes, perceptions and lessons learnt from establishing the DIAMOND clinic.

BACKGROUND

The DIAMOND antenatal clinic was established to provide multidisciplinary continuity of care to pregnant women living with morbid (body mass index (BMI) ≥40 kg/m2 ) or super-obesity (BMI ≥50 kg/m2 ).

AIM: The aim was to describe clinic processes, demographics, clinical outcomes and women's perceptions of the clinic.

METHODS

Women who received antenatal care in the clinic between 2016 and 2019 (n = 257) had routine data collected for retrospective analysis. A patient satisfaction survey was conducted for women who received care in 2019 (n = 89).

RESULTS

The median BMI was 49 kg/m2 (max = 81 kg/m2 ). The mean age was 32 years. The largest proportion of women (27.6%) resided in the most disadvantaged suburbs of the region. Primipara comprised 29.6%, and 4.7% of women identified as Aboriginal or Torres Strait Islander. Diabetes was present in 47.5%, and 9.3% developed pre-eclampsia. Half (49.4%) had their labour induced (49.8% required cervical ripening), and 37% had an elective caesarean section. Almost a quarter (24.1%) of women underwent emergency caesarean section. One in six women had a measured blood loss of more than 1000 mL. The unadjusted stillbirth rate was 0.8%. Blood transfusions were required by 3.9%, and 1.9% of women required intensive care admission. Survey responses showed women valued the clinic for the enhanced surveillance, continuity, care coordination and respectful care. Improvements to waiting times were recommended.

CONCLUSIONS

Establishing a dedicated clinic for women living with high BMI provides a well-liked environment for a high-risk cohort of women. Our review identified opportunities for improvement in clinic processes. We plan to assess overall impact on perinatal outcomes.