Paediatric obesity diagnosis and intervention practices in Australian hospitals - Australia-wide survey.

AIM: Previous studies suggest a lack of a unified approach in identifying and addressing children with obesity while being inpatients in individual Australian hospitals. Our study aimed to describe current clinical practice across Australia and identify discrepancies that can aid in developing a more unified response to children identified with obesity as hospital inpatients. METHODS: A cross-sectional exploratory online survey was distributed to major paediatric in-patient departments in Australia, with a response rate of 68%. Questions focused on education, identification, interventions and attitudes towards a national protocol. RESULTS: Twenty percent of respondents indicated that staff in their department regularly record body mass index, 66% address weight issues and only 8% consistently refer to appropriate outpatient services. Although 88% of respondents believe that a national protocol for addressing paediatric obesity would be beneficial, respondents emphasised concerns regarding their local resources. CONCLUSION: Our study can inform the development of a guideline for a unified response to opportunistically identify children with overweight and obesity as inpatients.

Maternal and neonatal health outcomes for First Nations Australian women and children: A retrospective cohort study in a Western Sydney metropolitan tertiary referral centre.

AIM: To analyse key pregnancy and birth outcomes for First Nations women and children at a Western Sydney metropolitan tertiary referral centre. METHODS: The birth and health-determining characteristics of 470 First Nations infants born at Nepean Hospital in 2018 and their mothers were included in a retrospective audit and compared with a contemporaneous control group of 470 infants and their mothers. RESULTS: Mothers of First Nations infants had significantly higher rates of socioeconomic disadvantage (P < 0.001), psychosocial vulnerability (P < 0.007), mental illness (P < 0.001), teenage pregnancy (P < 0.001), smoking (45.6% vs. 19.4%, P < 0.001) and drug and alcohol use than control mothers (P < 0.001, P < 0.048). First Nations peoples did not have increased rates of maternal morbidity, nor any difference in rates of Caesarean section, resuscitation at birth, NICU admission, preterm birth or low birth weight in multivariable analysis. However, multivariable analysis demonstrated significant associations between low birth weight and maternal smoking (P < 0.001), hypertension (P < 0.01) and drug use (P < 0.01). CONCLUSIONS: Despite challenges facing First Nations mothers and infants, our study found no significant difference in maternal morbidity nor adverse birth outcomes for First Nations infants. The study occurred in the context of culturally specific, First Nations-led antenatal and infant services. Future studies should further investigate relationships between participation in these services and health outcomes. This could identify strengths and areas for improvement in current services, with the goal of further improving outcomes for First Nations peoples through targeted health services that address their psychosocial vulnerabilities and support women to make healthy choices during pregnancy.

General practitioners' attitudes and knowledge about attention-deficit hyperactivity disorder (ADHD): Insights from a survey.

OBJECTIVE: The Review of health services for children, young people and families within the NSW Health system identified that novel models of care were needed to improve access to clinical management for people with ADHD. The present study aimed to evaluate GPs' knowledge of and attitudes towards ADHD and the challenges and opportunities for a more substantial role for GPs in ADHD management. METHOD: An online survey of Australian GPs was conducted, with recruitment via email invitation. RESULTS: Out of 230 respondents, 213 surveys could be analysed. Of these, 97% believed ADHD was a genuine condition, with 90% identifying inattention as a primary symptom. Most (92%) had seen and diagnosed ADHD within the past year. Prevalent concerns included inadequate access to specialist assessment and treatment; 77% felt that GPs should have a more substantial role in ADHD management. Barriers included lack of time, knowledge and experience. CONCLUSIONS: There was willingness amongst respondents take on a greater role in managing individuals with ADHD. However, a need for further training and education was highlighted. The Australian Evidence-Based Clinical Practice Guideline for ADHD may resolve an identified need for clinical guidance.

Biopsychosocial characteristics of children admitted with failure to thrive.

AIMS: The aim of this study was to characterise and compare the biopsychosocial characteristics of children admitted with failure to thrive (FTT), subdivided into those with underlying medical complexities (categorised as organic FTT - OFTT) and those with none (categorised as non-organic FTT - NOFTT), with a focus on the medical, nutritional, feeding skills and psychosocial domains. METHODS: A retrospective review of medical records was conducted in children admitted with FTT from January 2010 to December 2020. Descriptive statistics were used for data analysis. RESULTS: A total of 353 children were included, with the mean age of presentation 0.82 ± 2.05 years (OFTT 1.16 ± 2.50 years, NOFTT 0.49 ± 1.41 years, P = 0.002). Approximately, half of the children were classified as having OFTT. These children had lower birth weights, were more likely to have a history of intrauterine growth restriction and had longer hospital stays. The NOFTT group had significantly more abnormal feeding strategies identified in their caregivers, whereas the OFTT group had more delayed feeding skills and oral aversion. There was no significant difference in psychosocial domains, with both groups having a comparably high risk of abuse and neglect. CONCLUSIONS: The classification of FTT as non-organic or organic based purely on psychosocial parameters did not reflect the complex nature of FTT within our local population. These groups had different medical variables, and caregiver feeding strategies. A multidisciplinary team approach is recommended for the assessment and intervention for children with FTT to address these domains and the complex interactions between them.

The psychosocial impact of type 1 diabetes mellitus in children and adolescents during the COVID-19 pandemic.

AIM: Type 1 diabetes mellitus has a large psychosocial impact on children and their families. This study's primary aim was to investigate whether the COVID-19 pandemic affects the psychosocial impact of T1DM and glycaemic control. METHODS: During the 2020 lockdown, New South Wales residents were not allowed to leave home except for essential activities. After 3 months, children with T1DM and their parents were invited to complete online questionnaires. Data on glycaemic control were extracted from the children's clinical records with informed consent. Descriptive and comparative statistics were used to analyse the responses. RESULTS: Out of 149 families, 99 responses were received, with 92 participants identified. Comparable proportions of parents (56%) and children (45%) were anxious about the child's increased risk of contracting severe illness due to COVID-19. Most responses from parents and children were closely correlated (r > 0.5, P ≤ 0.001) There was no consistent effect of lockdown on HbA1c levels, but there was a significant inverse correlation between HbA1c levels and parents' perception of the child having clear and concrete goals for diabetes care (r = -0.25, P < 0.05). The HbA1c also correlated positively with the child feeling depressed and alone with their diabetes when isolated (r = 0.36, P = 0.02). CONCLUSIONS: Despite life-style changes and a negative psychosocial impact, we did not find objective evidence of any detrimental impact of the lockdown on diabetic control. However, higher HbA1c correlated with children feeling more depressed and alone. There was a comparable frequency of anxiety concerning the risk of severe COVID illness in children and their parents.

A community survey of adults with attention deficit hyperactivity disorder (ADHD) and their experience of medication effectiveness.

OBJECTIVE: Survey of ADHD-affected adult participants attending educational meetings of 'ADDults with ADHD', to ascertain age of diagnosis and treatment effects of psychostimulant medication on symptoms across functional and emotional domains. METHOD: From 2016 to 2019, self-assessments of functional impairment were collected from ADHD-affected adults attending educational meetings of an Australian community support organisation (ADDults with ADHD). Participants were asked to rate their functioning on and off medication. Some demographic and treatment details were also collected. RESULTS: Questionnaires were collected from 117 attendees of five meetings. Their mean age was 42.5 (SD 15.0) years; their age of diagnosis and of starting treatment were 31.9 (SD 16.6) and 32.8 (SD 16.4) years, respectively, with no significant differences between men and women. Most (93%) reported symptom onset before age 18. Ninety (77%) had been treated medically, with self-ratings indicating significantly less impairment on treatment (p < 0.001). CONCLUSION: Adults with ADHD reported substantial impairment but significant benefit from medication. Despite a mean age of over 30 at diagnosis, most recalled being symptomatic in childhood. This suggests many may experience a prolonged period of impaired function before starting treatment.

Stimulant prescribing for attention deficit hyperactivity disorder (ADHD): what guides clinicians in their choice of an upper limit for dose titration?

OBJECTIVE: There is little evidence to support the current stimulant dose upper limit restrictions in the treatment of attention deficit hyperactivity disorder (ADHD). Within Australasia, there is inconsistency in dose maxima in different jurisdictions. Clinician experience in this area may be worth gauging when trying to improve the understanding of optimal maximal dosing. Our objective was to survey prescribers' experience of whether the current stimulant maximum doses ever conflict with dose optimisation and how such conflicts are managed. METHOD: We conducted an anonymous online survey of health professionals treating children, adolescents and adults with ADHD. RESULTS: Responses were received from 128 prescribers, mainly paediatricians (52%) and adult psychiatrists (39%). The designated maximum dose of stimulant was a constraint to dose optimisation experienced by 91% for the Product Information maxima and 82% for their respective state/territory regulations maxima. When clinically indicated, 72% would exceed the designated maxima, either with or without obtaining a second opinion or applying for special authority. Of the remaining 28%, the majority (16%) would opt for polypharmacy, with only two accepting a suboptimal dose. CONCLUSION: The current stimulant dose maxima act as a constraint to stimulant dose optimisation and may promote undertreatment and polypharmacy.

Walking and living independently with spina bifida: a 50-year prospective cohort study.

AIM: To describe trends in walking and living independently in a cohort of consecutive cases of spina bifida, followed-up over 50 years. METHOD: From 1972 to 2017, a cohort of 117 (born 1963-1971, 50 males, 67 females) survivors and/or carers was surveyed approximately every 5 years by clinical examination and/or postal questionnaire/telephone interview. The Office for National Statistics provided details of deaths. RESULTS: The follow-up in 2016 and 2017 was 99% (116/117). There were 37 survivors (17 males, 20 females) aged 46 to 53 years and 79 deaths (50y survival, 32%). The percentage of survivors who could walk more than 50m at the mean ages of 9 years, 18 years, 25 years, 30 years, 35 years, 40 years, 45 years, and 50 years was 51% (38/75), 50% (34/68), 33% (20/61), 30% (17/57), 30% (16/54), 30% (14/46), 31% (12/39), and 27% (10/37) respectively. However, the percentage living independently in the community after age 25 years increased over time: 23% (14/61); 37% (21/57); 41% (22/54); 39% (18/46); 56% (22/39); and 54% (20/37). Living independently at age 50 years was more common in survivors without a history of raised intracranial pressure or cerebrospinal fluid shunt revisions. INTERPRETATION: In this unselected cohort, mobility declined with age, possibly because of increasing obesity and deteriorating health. By contrast, partly because survival was better in those least disabled, the percentage living independently increased. WHAT THIS PAPER ADDS: By age 50 years, the percentage of patients who could walk more than 50m had declined to 27%. By age 50 years, the percentage living independently had doubled to over 50%. Survivors without a history of raised intracranial pressure or cerebrospinal fluid shunt revision are more likely to live independently.

CAMINAR Y VIVIR DE MANERA INDEPENDIENTE CUANDO SE TIENE UN DIAGNÓSTICO DE ESPINA BÍFIDA: UN ESTUDIO PROSPECTIVO DE COHORTE DE 50 AÑOS: OBJETIVO: Describir las tendencias para caminar y vivir de forma independiente en una cohorte de casos consecutivos de espina bífida, seguidos durante 50 años. MÉTODO: Desde 1.972 hasta 2.017, una cohorte de 117 (nacidos entre 1.963-1.971, 50 varones, 67 mujeres) sobrevivientes y/o cuidadores fueron encuestados aproximadamente cada 5 años mediante examen clínico y/o cuestionario postal/entrevista telefónica. La Oficina de Estadísticas Nacionales proporcionó detalles de las muertes. RESULTADOS: El seguimiento en 2.016 y 2.017 fue del 99% (116/117). Hubo 37 sobrevivientes (17 varones, 20 mujeres) de 46 a 53 años y 79 muertes (50 años de supervivencia, 32%). El porcentaje de sobrevivientes que pudieron caminar más de 50 metros en las edades medias de 9, 18, 25, 30, 35, 40, 45 y 50 años fue del 51% (38/75), 50% (34/68), 33% (20/61), 30% (17/57), 30% (16/54), 30% (14/46), 31% (12/39) y 27% (10/37) respectivamente. Sin embargo, el porcentaje de vida independiente en la comunidad después de los 25 años aumentó con el tiempo: 23% (14/61); 37% (21/57); 41% (22/54); 39% (18/46); 56% (22/39); y 54% (20/37). Vivir de forma independiente a los 50 años de edad fue más común en los sobrevivientes sin antecedentes de aumento de la presión intracraneal o revisiones de derivación del líquido cefalorraquídeo. INTERPRETACIÓN: En esta cohorte no seleccionada, la movilidad disminuyó con la edad, posiblemente debido al aumento de la obesidad y al deterioro de la salud. Por el contrario, en parte porque la supervivencia fue mejor en los individuos con menos desafíos fisicos, el porcentaje de vida independiente aumentó.

CAMINHANDO E VIVENDO COM INDEPENDÊNCIA TENDO ESPINHA BÍFIDA: UM ESTUDO DE COORTE PROSPECTIVO DE 50 ANOS: OBJETIVO: Descrever tendências no caminhar e viver com independência em uma coorte de casos consecutivos de espinha bífida, acompanhados por 50 anos. MÉTODO: De 1972 a 2017, uma coorte de 117 (nascidos 1963-1971, 50 do sexo masculino, 67 do sexo feminino) sobreviventes e/ou cuidadores foi avaliada aproximadamente a cada 5 anos por exame clínico e/ou entrevista por telefone ou correios. O Escritório de Estatística Nacional forneceu detalhes sobre óbitos. RESULTADOS: O acompanhamento em 2016 e 2017 foi 99% (116/117). Houve 37 sobreviventes (17 do sexo masculino, 20 do sexo feminino) com idades de 46 to 53 anos e 79 óbitos (sobrevivência em 50a, 32%). A porcentagem de sobreviventes que podiam andar mais de 50m nas idades médias de 9, 18, 25, 30, 35, 40, 45, e 50 foi 51% (38/75), 50% (34/68), 33% (20/61), 30% (17/57), 30% (16/54), 30% (14/46), 31% (12/39), and 27% (10/37) respectivamente. No entanto, a porcentagem vivendo independentemente na comunidade após a idade de 25 anos aumentou com o tempo: 23% (14/61); 37% (21/57); 41% (22/54); 39% (18/46); 56% (22/39); e 54% (20/37). Viver com independência na idade de 50 anos foi mais comum em sobreviventes sem história de aumento de pressão intra-craniana ou revisões da válvula de líquido cérebro-espinhal. INTERPRETAÇÃO: Nesta coorte não selecionada, a mobilidade diminuiu com a idade, possivelmente por causa do aumento da obesidade e deterioração das condições de saúde. Em contraste, em parte porque a sobrevivência foi melhor naqueles com menos incapacidades, a porcentagem dos que viviam com independência aumentou.

Transition in ADHD: attention to the lifespan.

OBJECTIVES: This paper reviews the importance of transition to adult services for young people with ADHD. METHOD: Different models are described and evidence sought for their effectiveness in clinical practice. RESULTS: Models of care for children with ADHD include specialised mental health services, individual paediatricians and child and adolescent psychiatrists. Although it might be expected that transition would be to equivalent adult teams or specialists, studies have shown that transition may not run smoothly, and the adult services are frequently inadequate. This may result in attrition from treatment or discharge to the general practitioner. CONCLUSIONS: Adult mental health services for transitioning young people with ADHD are under-resourced. The way forward may be a generic ADHD specialist or service, treating ADHD across the lifespan and avoiding the need for transition.

Neurological level at birth predicts survival to the mid-40s and urological deaths in open spina bifida: a complete prospective cohort study.

AIM: To conduct a 50-year complete, community-based, prospective cohort study to investigate long-term survival, causes of death, and influence of level of the lesion in treated open spina bifida. METHOD: The cohort comprised 117 consecutive cases whose backs were closed non-selectively at birth between 1963 and 1971 in Cambridge, UK. In 2013 we surveyed the survivors (n=39, 18 males, 21 females; mean age 46y, range 43-49y) by postal questionnaire and telephone interview. We compared outcomes in those born with a neurological deficit in terms of sensory and motor levels of L1 and above versus L2 and below. RESULTS: Two-thirds of the cohort (78/117) had died. Causes of death were cardiorespiratory (n=26), neurological (n=24), urological (n=22), or other (n=6). Only the urological deaths were related to level of the lesion: there were none in those with a sensory level of L2 or below (p<0.001). Birth findings also predicted survival: of the 57 infants with a neurological level of L1 or above, only 12% (n=7) survived compared with 55% (30/55) of the remainder (p<0.001). INTERPRETATION: The increased mortality in those born with an extensive neurological deficit was mainly due to urological deaths. Neurological level, particularly the sensory level, is the best predictor of long-term outcome and should be assessed routinely at birth.

The attention deficit hyperactivity disorder phenotype as a summation of deficits in executive functioning and reward sensitivity: does this explain its relationship with oppositional defiant disorder?

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) commonly coexist but the relationship between them has not been well explained. We present a view of the ADHD phenotype as a summation of deficits in executive functioning and reward sensitivity and apply this to explain its co-occurrence with ODD. MODEL: ADHD relates to difficulty in sustaining concentration for completing tasks. This is associated with lack of reward due to lack of achievement. The unfavorable balance of effort to reward in ADHD is exacerbated in ODD, a condition in which lack of reward is responsible for an adverse effect on mood resulting in a negative attitude and oppositional behavior. We have called this model the "Mental effort-reward imbalances model". CONCLUSION: This model predicts that oppositional symptoms would be highly prevalent in ADHD, to the extent that ODD would be a frequent co-morbidity.

Documentation and management of paediatric obesity: Evidence from a paediatric inpatient unit.

INTRODUCTION: The obesity epidemic is a worldwide phenomenon.1 In Australia, the prevalence of paediatric overweight or obesity is 25%.2 Children with obesity present to medical services more frequently than children with a healthy weight.3 Therefore, any hospital admission is an opportunity for clinicians to identify and manage children with overweight or obesity. Previous research has not objectively measured how frequently clinicians document a child as being above the healthy weight range and initiate weight management strategies. This study addresses this gap in the literature by demonstrating the prevalence rate and clinical characteristics of children with overweight/obesity in a non-tertiary paediatric inpatient unit and measuring the rate of clinician recognition, documentation, and initiation of weight management strategies.

Growth and pubertal development of adolescent boys on stimulant medication for attention deficit hyperactivity disorder.

OBJECTIVE: To investigate the growth and pubertal attainment of boys with attention deficit hyperactivity disorder (ADHD) on stimulant medication. DESIGN, SETTING AND PARTICIPANTS: Longitudinal study of boys aged 12.00-15.99 years at recruitment in 2005-2011, with stimulant-treated ADHD for at least 3 years, attending three paediatric practices (subjects), compared with longitudinal data from 174 boys from the Nepean longitudinal study (controls). MAIN OUTCOME MEASURES: Subjects' growth parameters before treatment were compared with controls aged 7 or 8 years; growth parameters and longitudinal changes on treatment to ages 12.00-13.99 and 14.00-15.99 years were compared with controls reviewed at 13 and 15 years of age, respectively. The subjects' pubertal staging and height velocity were related to their treatment history. RESULTS: Sixty-five subjects were recruited; mean duration of treatment was 6.3 ± 1.9 years. At baseline, their growth parameters were not significantly different from those of the controls after adjusting for age. Compared with the controls, after adjusting for current age and baseline growth parameter z score, subjects aged 12.00-13.99 years had significantly lower weight and body mass index (P < 0.01), and those aged 14.00-15.99 years had significantly lower height and weight (P < 0.05). At 12.00-13.99 years of age, the subjects were comparable to the controls in their pubertal development adjusted for age, but those aged 14.00-15.99 years reported significant delay (mean Tanner stage, 3.6 for subjects v 4.0 for controls; P < 0.05). The dose of medication was inversely correlated with the height velocity from baseline to 14.00-15.99 years of age (P < 0.05). CONCLUSIONS: Prolonged treatment (more than 3 years) with stimulant medication was associated with a slower rate of physical development during puberty. To maintain adequate height velocity during puberty, we recommend keeping the dose as low as possible.

Understanding Attentional Functioning in Adult Attention Deficit Hyperactivity Disorder-Could This Improve Diagnostic Specificity?

The diagnostic criteria for attention deficit hyperactivity disorder (ADHD) reflect the behavioural and functional outcomes of cognitive processes. Historically they have been based on external observations and lack specificity: clinical cohorts of children meeting diagnostic criteria show that around 40% may also meet diagnostic criteria for oppositional defiant disorder (ODD). We have proposed a clinical model to explain this: the Mental Effort Reward Imbalances model of ADHD (MERIM). This model views the lower levels of task completion that underlie several of the diagnostic criteria for ADHD as being due to a summation of deficits in executive functioning and reward processing. The subjective experience of inadequate reward from task completion may explain the reduced motivation, negativity, and oppositional attitude associated with ODD. The hypothesis for this study is that descriptions of affected individuals' attentional characteristics could be more specific for the executive functioning deficits associated with ADHD than the current symptom-based approaches. To test whether this might be usable in practice, we conducted a workshop that aimed to characterise in depth the patterns of attention experienced by adults with ADHD and how they impact functioning. Three main patterns were described: (1) complete lapses in attention; (2) partial attention to a task; (3) attending to multiple tasks and distractions, either simultaneously or in rapid sequence. All of these resulted in reduced productivity. They also described strategies for managing their attention deficits. Some people used distractions positively, to stimulate the mind to remain active and engaged rather than losing focus. Multi-tasking could also achieve this by providing higher levels of stimulation, however, the stimulation could itself become a distraction. Interest or stress might maintain engagement; extremes could sometimes lead to hyperfocusing, which was typically infrequent but could be highly productive. Focusing on executive functions may improve diagnostic sensitivity, as the current criteria fail to identify people who function adequately due to their use of strategies that mitigate the effects of their attentional deficits. Such people may present with secondary depression or anxiety rather than clear, behavioural symptoms of ADHD. With further development, the approach described in this paper may provide a more simple and fundamental way of recognising ADHD within the community. In the longer term, focusing more specifically on executive functions may provide cohorts with a 'purer' form of ADHD for scientific study.

Barriers to identification and reporting of child abuse and neglect experienced by medical officers and nursing staff in emergency departments of the Nepean Blue Mountains Local Health District.

OBJECTIVE: This structured survey sought to identify barriers to recognising and reporting potential child abuse by medical officers and nursing staff in the EDs of three Western Sydney hospitals. These include a large metropolitan teaching hospital, a small metropolitan hospital and a rural hospital. METHODS: A mixed approach of qualitative and quantitative study methodology was used to survey potential participants. The electronic survey was distributed to participants to assess knowledge and experiences with identifying child abuse presenting to the ED over a 6-month period. A descriptive analysis of the data was performed. RESULTS: A total of 121 responses were received from 340 potential participants, giving a participation rate of 35%. The majority of the respondents were senior medical officers (38/110, 34%) or registered nurses (35/110, 32%). The study participants perceived the lack of time as the most significant barrier to reporting child abuse (85/101, 84%). This was followed by a lack of education (35/101, 34%), resources (33/101, 32%) and support (30/101, 29%). CONCLUSION: The combination of hospital, departmental and individual staff issues such as time limitations, lack of resources, education and support are potential barriers to reporting suspected child abuse. We recommend tailored teaching sessions, improved reporting procedures and increased support from senior staff to overcome these barriers.

Comparison of maternal abdominal subcutaneous fat thickness and body mass index as markers for pregnancy outcomes: A stratified cohort study.

BACKGROUND: Obesity in pregnancy is associated with a number of adverse outcomes. The effects of central versus general obesity in pregnancy have not been well established. AIM: To compare subcutaneous fat thickness (SFT) with body mass index (BMI) as a marker for pregnancy outcomes. METHODS: A stratified retrospective cohort study was performed on 1200 pregnancies, selected from a total of 4862 nulliparous, nonsmoking women between 2006 and 2010. SFT was measured on routine ultrasound at 18-22 weeks gestation. BMI and SFT measurements were compared for estimating risks for obesity-related pregnancy outcomes using logistic regression adjusted for maternal age. RESULTS: The median SFT was 18.2 mm (range 6.3-50.9 mm), the median BMI was 23.8 kg/m(2) (range 15.2-52.5), and the correlation between SFT and BMI was 0.53. For every 5 mm increase in SFT and every 5 kg/m(2) increase in BMI, the odds ratios for developing gestational diabetes mellitus were 1.40 (CI 1.22-1.61, P < 0.001) and 1.16 (CI 0.95-1.40, P = 0.1), for caesarean section 1.28 (CI 1.16-1.40, P < 0.001) and 1.16 (CI 1.05-1.28, P = 0.003), large for gestational age 1.28 (CI 1.16-1.47, P = 0.001) and 1.10 (CI 0.95-1.28, P = 0.16) and cumulative adverse obesity-related pregnancy outcomes 1.16 (CI 1.10-1.28, P = 0.002) and 1.05 (CI 0.95-1.16, P = 0.45), respectively. CONCLUSION: SFT at 18-22 weeks gestation is better than BMI as a marker for obesity-related pregnancy outcomes. As SFT is considered a surrogate measure for visceral fat, these results suggest that central obesity is a stronger risk factor than general adiposity in pregnancy.