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.