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Alves FCR, Moreira A, Moutinho O. Maternal and long-term offspring outcomes of obesity during pregnancy. Arch Gynecol Obstet 2024; 309:2315-2321. [PMID: 38502190 DOI: 10.1007/s00404-023-07349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 03/21/2024]
Abstract
PURPOSE Obesity`s prevalence is rising in women of reproductive age worldwide and has become the most common medical condition at this age group. Besides, its occurrence is also rising during pregnancy. This condition not only increases the risk of noncommunicable diseases on the mother, such as cardiovascular disease and diabetes, but also transfers this risk to the offspring. METHODS This is a narrative review based on scientific and review articles on the matter. RESULTS Obesity is associated with an increased risk of gestational diabetes mellitus, gestational hypertension and preeclampsia, venous thromboembolism, infection, and mental health problems. Furthermore, it has an impact on the progress of labor and induction matters. Regarding offspring outcomes, it is related to higher incidence of congenital anomalies, perinatal mortality, and the occurrence of large for gestational age newborns. Still, it has implications on cardiometabolic risk and neurodevelopment in offspring. CONCLUSION It is, therefore, imperative to encourage the adoption of healthy lifestyles, especially in the peri-conception and interpregnancy periods. Likewise, there must be support in the multidisciplinary monitoring of these pregnant women to minimize associated complication rates.
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Affiliation(s)
- Fernanda Cristina Ribeiro Alves
- Obstetrics and Gynecology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, Vila Real, Portugal.
| | - Ana Moreira
- Obstetrics and Gynecology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, Vila Real, Portugal
| | - Osvaldo Moutinho
- Obstetrics and Gynecology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, Vila Real, Portugal
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2
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Kehl S. Obesity at term: What to consider? How to deliver? Arch Gynecol Obstet 2024; 309:1725-1733. [PMID: 38326633 DOI: 10.1007/s00404-023-07354-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
Obesity presents significant challenges during pregnancy, increasing the risk of complications and adverse outcomes for both mother and baby. With the rising prevalence of obesity among pregnant women, questions arise regarding optimal management, including timing of delivery and choice of delivery mode. Labour induction in obese women may require a combination of mechanical and pharmacological methods due to increased risk of failed induction. Caesarean section in obese women presents unique challenges, requiring comprehensive perioperative planning and specialized care to optimize outcomes. However, specific guidelines tailored to obese patients undergoing caesarean sections are lacking. Postpartum care should include vigilant monitoring for complications. Addressing obesity in pregnancy necessitates a multidisciplinary approach and specialized care to ensure the best outcomes.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Universitätsstr. 21-23, 91054, Erlangen, Germany.
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Heslehurst N, McParlin C, Sniehotta FF, Rankin J, Crowe L, McColl E. The Gestational Obesity Weight Management: Implementation of National Guidelines (GLOWING) study: a pilot cluster randomised controlled trial. Pilot Feasibility Stud 2024; 10:47. [PMID: 38429853 PMCID: PMC10905942 DOI: 10.1186/s40814-024-01450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/12/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Pregnancy weight management interventions can improve maternal diet, physical activity, gestational weight gain, and postnatal weight retention. UK guidelines were published in 2010 but health professionals report multiple complex barriers to practice. GLOWING used social cognitive theory to address evidence-based barriers to midwives' implementation of weight management guidelines into routine practice. This paper reports the pilot trial outcomes relating to feasibility and acceptability of intervention delivery and trial procedures. METHODS GLOWING was a multi-centre parallel-group pilot cluster RCT comparing the delivery of a behaviour change intervention for midwives (delivered as training workshops) with usual practice. The clusters were four NHS Trusts in Northeast England, randomised to intervention or control arms. Blinding of allocation was not possible due to the nature of the intervention. We aimed to deliver the intervention to all eligible midwives in the intervention arm, in groups of 6 midwives per workshop, and to pilot questionnaire data collection for a future definitive trial. Intervention arm midwives' acceptability of GLOWING content and delivery was assessed using a mixed methods questionnaire, and pregnant women's acceptability of trial procedures by interviews. Quantitative data were analysed descriptively and qualitative data thematically. RESULTS In intervention arm Trusts, 100% of eligible midwives (n = 67) were recruited to, and received, the intervention; however, not all workshops had the planned number of attendees (range 3-8). The consent rate amongst midwives randomised (n = 100) to complete questionnaires was 74% (n = 74) (95% CI 65%, 83%), and overall completion rate 89% (n = 66) (95% CI 82%, 96%). Follow-up response rate was 66% (n = 49) (95% CI 55%, 77%), with a marked difference between intervention (39%, n = 15) and control (94%, n = 34) groups potentially due to the volume of research activities. Overall, 64% (n = 47) (95% CI 53%, 75%) completed both baseline and follow-up questionnaires. Midwives viewed the intervention as acceptable and directly relevant to routine practice. The least popular components related to scripted role-plays. Pregnant women viewed the recruitment and trial processes to be acceptable. CONCLUSIONS This rigorously conducted pilot study demonstrated feasibility intervention delivery and a high level of acceptability amongst participants. It has provided information required to refine the intervention and trial protocol, enhancing confidence that a definitive trial could be carried out. TRIAL REGISTRATION ISRCTN46869894; retrospectively registered 25th May 2016, www.isrctn.com/ISRCTN46869894 .
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK.
| | - Catherine McParlin
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Falko F Sniehotta
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Lisa Crowe
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
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Michalopoulou M, Jebb SA, Astbury NM. Dietary interventions in pregnancy for the prevention of gestational diabetes: a literature review. Proc Nutr Soc 2023:1-13. [PMID: 38124663 DOI: 10.1017/s0029665123004822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
The aim of this review is to provide an overview of dietary interventions delivered during pregnancy for the prevention of gestational diabetes mellitus (GDM). GDM increases the risk of adverse pregnancy and neonatal outcomes, and also increases future cardiometabolic risks for both the mother and the offspring. Carrying or gaining excessive weight during pregnancy increases the risk of developing GDM, and several clinical trials in women with overweight or obesity have tested whether interventions aimed at limiting gestational weight gain (GWG) could help prevent GDM. Most dietary interventions have provided general healthy eating guidelines, while some had a specific focus, such as low glycaemic index, increased fibre intake, reducing saturated fat or a Mediterranean-style diet. Although trials have generally been successful in attenuating GWG, the majority have been unable to reduce GDM risk, which suggests that limiting GWG may not be sufficient in itself to prevent GDM. The trials which have shown effectiveness in GDM prevention have included intensive face-to-face dietetic support, and/or provision of key foods to participants, but it is unclear whether these strategies could be delivered in routine practice. The mechanism behind the effectiveness of some interventions over others remains unclear. Dietary modifications from early stages of pregnancy seem to be key, but the optimum dietary composition is unknown. Future research should focus on designing acceptable and scalable dietary interventions to be tested early in pregnancy in women at risk of GDM.
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Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Nerys M Astbury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
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Hajizadeh A, Heath L, Ahmad A, Kebbe M, Jebb SA, Aveyard P, Hughes G. Clinician resistance to broaching the topic of weight in primary care: Digging deeper into weight management using strong structuration theory. Soc Sci Med 2023; 329:115997. [PMID: 37327596 DOI: 10.1016/j.socscimed.2023.115997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/06/2023] [Accepted: 05/26/2023] [Indexed: 06/18/2023]
Abstract
Clinical trials have shown that providing advice and support for people with excess weight can lead to meaningful weight loss. Despite this evidence and guidelines endorsing this approach, provision in real-world clinical settings remains low. We used Strong Structuration Theory (SST) to understand why people are often not offered weight management advice in primary care in England. Data from policy, clinical practice and focus groups were analysed using SST to consider how the interplay between weight stigma and structures of professional responsibilities influenced clinicians to raise (or not) the issue of excess weight with patients. We found that general practitioners (GPs) often accounted for their actions by referring to obesity as a health problem, consistent with policy documents and clinical guidelines. However, they were also aware of weight stigma as a social process that can be internalised by their patients. GPs identified addressing obesity as a priority in their work, but described wanting to care for their patients by avoiding unnecessary suffering, which they were concerned could be caused by talking about weight. We observed tensions between knowledge of clinical guidelines and understanding of the lived experience of their patients. We interpreted that the practice of 'caring by not offering care' produced the outcome of an absence of weight management advice in consultations. There is a risk that this outcome reinforces the external structure of weight stigma as a delicate topic to be avoided, while at the same time denying patients the offer of support to manage their weight.
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Affiliation(s)
- Anisa Hajizadeh
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Laura Heath
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Aryati Ahmad
- School of Nutrition and Dietetics, Universiti Sultan Zainal Abidin, Kampung Gong Badak, 21300, Terengganu, Malaysia.
| | - Maryam Kebbe
- Pennington Biomedical Research Centre, Louisiana State University, 6400 Perkins Rd, Baton Rouge, LA, 70808, United States.
| | - Susan Anne Jebb
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Paul Aveyard
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
| | - Gemma Hughes
- Nuffield Department of Primary Care, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom.
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Hyer S, Davis JW, Slowik JL, Dove-Medows E, Giurgescu C. A mixed methods systematic review of midwives' clinical practices related to prenatal care of women with obesity. Midwifery 2023; 121:103653. [PMID: 36907010 PMCID: PMC10147579 DOI: 10.1016/j.midw.2023.103653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/13/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Maternal obesity has been related to adverse maternal and infant outcomes. It is a persistent challenge of midwifery care worldwide and can present clinical challenges and complications. This review sought to identify evidence on the practice patterns of midwives related to prenatal care of women with obesity. METHODS The databases Academic Search Premier, APA PsycInfo, CINAHL PLUS with Full Text, Health Source: Nursing/Academic Edition, and MEDLINE were searched November 2021. Search terms included weight, obesity, practices, and midwives. Inclusion criteria included quantitative, qualitative, and mixed method studies that addressed practice patterns of midwives related to prenatal care of women with obesity published in peer-reviewed journals, written in English. The recommended Joanna Briggs Institute approach to mixed methods systematic reviews was followed e.g. study selection, critical appraisal, data extraction, and a convergent segregated method of data synthesis and integration. RESULTS Seventeen articles from 16 studies were included. The quantitative evidence showed a lack of knowledge, confidence, and support for midwives that would facilitate adequate management of pregnant women with obesity while the qualitative evidence revealed that midwives desire a sensitive approach to discussing obesity and the risks associated with maternal obesity. DISCUSSION Quantitative and qualitative literature report consistent individual and system-level barriers to implementing evidence-based practices. Implicit bias training, midwifery curriculum updates, and the use of patient centered care models may help overcome these challenges.
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Affiliation(s)
- Suzanne Hyer
- College of Nursing, University of Central Florida, 12201 Research Parkway, Suite 300, Orlando, FL, USA.
| | - Jean W Davis
- College of Nursing, University of Central Florida, 12201 Research Parkway, Suite 300, Orlando, FL, USA
| | - Jordan Lee Slowik
- College of Nursing, University of Central Florida, 12201 Research Parkway, Suite 300, Orlando, FL, USA
| | - Emily Dove-Medows
- School of Nursing, University of Michigan, 500 S State St, Ann Arbor, MI, USA
| | - Carmen Giurgescu
- College of Nursing, University of Central Florida, 12201 Research Parkway, Suite 300, Orlando, FL, USA
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Fussi N, Mandoura N. Perceptions and Beliefs About Preconceptional Care Among Primary Healthcare Workers in Jeddah City, Saudi Arabia: An Analytical Cross-Sectional Study. Cureus 2023; 15:e41178. [PMID: 37397668 PMCID: PMC10311934 DOI: 10.7759/cureus.41178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Preconception care (PCC) is one of the important aspects of reproductive health and family planning, from the preventive aspect as primordial prevention for future offspring and primary prevention for females before pregnancy. However, there is no written protocol about PCC and it is not routinely practiced in Saudi Arabia. This study aimed to assess the perceptions and beliefs among care workers regarding PCC. Methods A cross-sectional study was conducted on general practitioners (GP), family physicians (FP), practitioner nurses (PN), and midwives (MW) in primary healthcare centers (PHC) in Jeddah City using a validated questionnaire that assesses their preconception practices, perceptions, and beliefs. Results This study included 201 participants, of whom 98.5% were Saudi nationals and 80.1% were female. Most (64.7%) were 30-39 years old, followed by 40-49 years old (21.9%). The majority (67.7%) were married and had one or two children (37.3%). Most (36%) were practitioner nurses, followed by family physicians (31%), and had 11-15 years of experience (32%), followed by six to 10 years of experience. The majority (44%) reported providing PCC one to five times last month. Of all participants, 72.63% agreed that PCC affected pregnancy outcomes, and 83% agreed that PCC is important. However, 51.7% agreed there is not enough time to provide PCC services. The service rated as the highest priority was providing advice regarding smoking cessation (82.1%), alcohol cessation (84.6%), control of chronic diseases (85.1%), and information about drug use (86.6%). Most participants rated rubella screening as highly important (89.9%), followed by hepatitis screening (88.6%). Family physicians and practitioner nurses perceived PCC as more important than general practitioners and midwives (p=0.026) and were more likely to perceive hospitals as the optimal setting for PCC (p=0.015). General practitioners were more likely to believe in the insufficient evidence base for PCC (p < 0.001). Conclusion The study found that healthcare workers had good perceptions, knowledge, and attitudes toward the PCC, but their practice was poor. Most lacked formal training and had differing perspectives on PCC, depending on their professions. The findings could inform strategies and measures to improve PCC practice among healthcare workers and raise awareness as well as capacity building by enhancing the training of healthcare workers.
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Affiliation(s)
- Nada Fussi
- Preventive Medicine, Ministry of Health, Riyadh/Jeddah, SAU
| | - Najlaa Mandoura
- Epidemiology and Public Health, Directorate of Health Affairs, Public Health Division, Jeddah, SAU
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Association of Body Mass Index With the Use of Health Care Resources in Low-Risk Nulliparous Pregnancies After 39 Weeks of Gestation. Obstet Gynecol 2022; 139:866-876. [PMID: 35576345 PMCID: PMC9142136 DOI: 10.1097/aog.0000000000004753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/03/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare health care medical resource utilization in low-risk nulliparous pregnancies according to body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) categories. METHODS This is a secondary analysis of a multicenter randomized controlled trial of induction of labor between 39 0/7 39 and 4/7 weeks of gestation compared with expectant management in low-risk nulliparous pregnant people, defined as those without standard obstetric indications for delivery at 39 weeks. Body mass index at randomization was categorized into four groups (lower than 25, 25-29, 30-39, and 40 or higher). The primary outcome of this analysis was time spent in the labor and delivery department from admission to delivery. Secondary outcomes included length of stay (LOS) postdelivery, total hospital LOS, and antepartum, intrapartum, and postpartum resource utilization, which were defined a priori. Multivariable generalized linear modeling and logistic regressions were performed, and 99% CIs were calculated. RESULTS A total of 6,058 pregnant people were included in the analysis; 640 (10.6%) had BMIs of lower than 25, 2,222 (36.7%) had BMIs between 25 and 29, 2,577 (42.5%) had BMIs of 30-39, and 619 (10.2%) had BMIs of 40 or higher. Time spent in the labor and delivery department increased from 15.1±9.2 hours for people with BMIs of lower than 25 to 23.5±13.6 hours for people with BMIs of 40 or higher, and every 5-unit increase in BMI was associated with an average 9.8% increase in time spent in the labor and delivery department (adjusted estimate per 5-unit increase in BMI 1.10, 99% CI 1.08-1.11). Increasing BMI was not associated with an increase in antepartum resource utilization, except for blood tests and urinalysis. However, increasing BMI was associated with higher odds of intrapartum resource utilization, longer total hospital LOS, and postpartum resource utilization. For example, every 5-unit increase in BMI was associated with an increase of 26.1% in the odds of antibiotic administration, 57.6% in placement of intrauterine pressure catheter, 5.1% in total inpatient LOS, 31.0 in postpartum emergency department visit, and 23.9% in postpartum hospital admission. CONCLUSION Among low-risk nulliparous people, higher BMI was associated with longer time from admission to delivery, total hospital LOS, and more frequent utilization of intrapartum and postpartum resources. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01990612.
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Langley-Evans SC. Early life programming of health and disease: the long-term consequences of obesity in pregnancy: a narrative review. J Hum Nutr Diet 2022; 35:816-832. [PMID: 35475555 PMCID: PMC9540012 DOI: 10.1111/jhn.13023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
The prevalence of overweight and obesity is rising in all parts of the world and among young women it presents a very clear danger during pregnancy. Women who are overweight or who gain excessive weight during pregnancy are at greater risk of complications in pregnancy and labour, and are more likely to lose their child to stillbirth, or themselves die during pregnancy. This narrative review considers the evidence that in addition to increasing risk of poor pregnancy outcomes, obesity has the capacity to programme fetuses to be at greater risk of cardiometabolic disorders later in life. An extensive body of evidence from prospective and retrospective cohorts, and record linkage studies demonstrates associations of maternal obesity and/or gestational diabetes with cardiovascular disease, type-1 and type-2 diabetes. Studies in animals suggest that these associations are underpinned by adaptations that occur in fetal life, which remodel the structures of major organs including the brain, kidney and pancreas. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Simon C Langley-Evans
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD
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Langley-Evans SC, Pearce J, Ellis S. Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: a narrative review. J Hum Nutr Diet 2022; 35:250-264. [PMID: 35239212 PMCID: PMC9311414 DOI: 10.1111/jhn.12999] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Abstract
The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre‐pregnancy body mass index greater than 25 kg m–2 are more likely than those with a body mass index in the ideal range (20–24.99 kg m–2) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care. Overweight and obesity before pregnancy and excessive gestational weight gain are major determinants of risk for pregnancy loss, gestational diabetes, hypertensive conditions, labour complications and maternal death. Pregnancy is regarded as a teachable moment when women are at their most receptive to messages about their health. However, unclear guidance on diet and physical activity, weight stigma from health professionals, inexperience and reluctance among professionals about raising issues about weight, and stretched resources put the health of women and babies at risk. Excessive weight gain in pregnancy and post‐partum weight retention compromise future fertility and increase risk for future pregnancies. Large randomised controlled trials have had little success in addressing excessive gestational weight gain or antenatal complications. Individualised, culturally sensitive and responsive interventions appear to have greater success.
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Affiliation(s)
- Simon C Langley-Evans
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, LE12 5RD, UK
| | - Jo Pearce
- Food & Nutrition Subject Group, Sheffield Hallam University, Sheffield, UK
| | - Sarah Ellis
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, LE12 5RD, UK
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Thorbjörnsdottir KE, Karlsen IE, Dahl B, Røseth I. "Talk to me, not at me": obese women's experiences of birth and their encounter with birth attendants-a qualitative study. Int J Qual Stud Health Well-being 2020; 15:1845286. [PMID: 33180659 PMCID: PMC7671589 DOI: 10.1080/17482631.2020.1845286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: To explore the birth experiences of obese women in regard to their encounter with birth attendants. Methods: Qualitative, in-depth interviews with 10 women were conducted in February 2020. Data were analysed using a descriptive phenomenological method. Results: Four interrelated constituents were identified: The preconception and prejudice of being unhealthy and less able; Being unique among all the other unique women; “Talk to me, not at me”—the importance of information and communication, and; Feeling secure enough to be in the 'birthing bubble'. Conclusion: For the women in our study, being obese meant experiencing challenges as well as opportunities during childbirth and in their encounter with birth attendants. Experiences of preconceptions, alienation, a focus on risk and a loss of autonomy in encounters with birth attendants were found to negatively impact the birthing process. The women desired affirmative and inclusive encounters; these kinds of encounters may improve the birth experiences of obese women.
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Affiliation(s)
- Katrin Erna Thorbjörnsdottir
- Center for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway , Kongsberg, Norway
| | - Ida Emilie Karlsen
- Center for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway , Kongsberg, Norway
| | - Bente Dahl
- Center for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway , Kongsberg, Norway
| | - Idun Røseth
- Center for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway , Kongsberg, Norway.,Department of Child and Adolescent Mental Health, Telemark Hospital Trust , Skien, Norway
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Patel S, Wali A. Airway Management of the Obstetric Patient. CURRENT ANESTHESIOLOGY REPORTS 2020. [DOI: 10.1007/s40140-020-00422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Khalil A, Giallongo E, Bhide A, Papageorghiou AT, Thilaganathan B. Reduction in twin stillbirth following implementation of NICE guidance. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:566-571. [PMID: 32304623 DOI: 10.1002/uog.22051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/23/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE There has been an unprecedented fall in the rate of stillbirth in twin pregnancy in the UK. It is contested whether implementation of the National Institute for Health and Care Excellence (NICE) guidance on the antenatal management of uncomplicated twin pregnancies has contributed to this change. The aim of this study was to investigate whether the implementation of NICE guidance was associated with a reduction in the rate of stillbirth in twin pregnancies delivered in a large UK hospital. METHODS This was a retrospective cohort study including all twin pregnancies delivered at St George's Hospital, London, UK, between 2000 and 2018. Data were analyzed according to two time periods: before implementation of the NICE guidance on twins (before June 2013; pre-NICE) and after its implementation (after June 2013; post-NICE). The exclusion criteria were higher-order multiple gestations, pregnancies of unknown chorionicity, pregnancies complicated by miscarriage, those that underwent termination and those diagnosed with vanishing twin. The main outcome was stillbirth. Other outcomes included neonatal death (NND), admission to the neonatal intensive care unit (NICU) and emergency Cesarean section. We planned a priori a sensitivity analysis according to chorionicity. The chi-square test and Mann-Whitney U-test were used to compare outcomes between the study groups. RESULTS We included in the analysis 1666 twin pregnancies (3332 fetuses), of which 1114 pregnancies (2228 fetuses) were delivered before and 552 pregnancies (1104 fetuses) after June 2013. Of those, 1299 were dichorionic and 354 were monochorionic diamniotic. The incidence of stillbirth was significantly lower in the post-NICE than in the pre-NICE group (3.6 per 1000 births vs 13.5 per 1000 births; P = 0.008). The reduction in stillbirth rate was from 8.5 to 3.6 per 1000 births (P = 0.161) in dichorionic and from 33.6 to 3.8 per 1000 births (P = 0.011) in monochorionic diamniotic twin pregnancies. There was no significant difference in the rates of NND (P = 0.625), NICU admission (P = 0.506) or emergency Cesarean section (P = 0.820) between the two groups. The median gestational age at delivery was significantly lower in the post-NICE than in the pre-NICE group (median 36.3 vs 36.9 weeks; P < 0.001), as a consequence of a significant increase in preterm birth between 34 and 37 weeks' gestation (39.3% vs 27.0%; P = 0.002), but not before 34 weeks (P = 0.473). CONCLUSIONS A significant reduction of > 70% in the stillbirth rate in twin pregnancies was noted after implementation of the NICE guidance. This reduction was statistically significant in monochorionic, but not dichorionic, twin pregnancies. The improvement in twin pregnancy outcome was achieved without a concomitant increase in NND, admission to the NICU or emergency Cesarean section. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Twins Trust Centre for Research and Clinical Excellence, St George's Hospital, London, UK
| | - E Giallongo
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - A T Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - B Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Nurul-Farehah S, Rohana AJ. Maternal obesity and its determinants: A neglected issue? MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2020; 15:34-42. [PMID: 32843943 PMCID: PMC7430315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Maternal obesity is a global public health concern that affects every aspect of maternity care. It affects the short-term and long-term health of the mother and her offspring. Obese pregnant mothers are at an increased risk of developing complications during antenatal, intrapartum, and postnatal periods. Maternal complications include gestational diabetes mellitus, hypertensive disorder in pregnancy, pre-eclampsia and eclampsia, increased rate of cesarean delivery, pulmonary embolism, and maternal mortality; fetal complications include congenital malformation, stillbirth, and macrosomia. Moreover, both mother and infant are at an increased risk of developing subsequent non-communicable diseases and cardiovascular problems later in life. Several factors are associated with the likelihood of maternal obesity, including sociodemographic characteristics, obstetric characteristics, knowledge, and perception of health-promoting behavior. Gaining a sound understanding of these factors is vital to reaching the targets of Sustainable Developmental Goal 3-to reduce global maternal mortality and end preventable deaths of children under 5 years of age-by 2030. It is essential to identify pregnant women who are at risk of maternal obesity in order to plan and implement effective and timely interventions for optimal pregnancy outcomes. Importantly, maternal obesity as a significant pregnancy risk factor is largely modifiable.
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Affiliation(s)
- S Nurul-Farehah
- MBBS, MPH Department of Community Medicine Universiti Sains Malaysia, Malaysia
| | - A J Rohana
- Ph.D Department of Community Medicine Universiti Sains Malaysia, Malaysia
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Mocarzel CC, Velarde GC, Antunes RDA, Moreira de Sá RA, Kurjak A. Maternal obesity influences the endocrine cord blood profile of their offspring. J Perinat Med 2020; 48:242-248. [PMID: 32083452 DOI: 10.1515/jpm-2019-0387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/28/2020] [Indexed: 12/27/2022]
Abstract
UNLABELLED Objective To compare the endocrine cord blood characteristics of offspring from obese mothers with those of offspring from healthy controls. Methods Cross-sectional case control study. SETTING University medical centers. PATIENT(S) Offspring from obese mothers (n = 41) and healthy controls (n = 31). INTERVENTION(S) Cord blood withdrawal from neonates. MAIN OUTCOME MEASURE(S) Cord blood total cholesterol (TC), triglycerides (TGs), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), blood glucose (GL) and insulin (Ins). Result(s) Fetal GL and TGs were reduced in the offspring of obese women when compared to those in the offspring of the controls. The mean cord blood GL level was 47.8 mg/dL standard deviation (SD 33.1) in the offspring of the obese group vs. 57.9 mg/dL (SD 12.5) in the offspring of the control group, and the mean cord blood TG level was 26.5 (SD 33.6) in the offspring of the obese group vs. 34.6 (SD 12.3) in the offspring of the control group. Maternal obesity was also associated with reduced levels of TC and HDL-C in the pregnant women. Conclusion The observed results suggest that GL and TGs in the cord blood of the offspring of obese mothers were significantly lower than those in the offspring of the control group.
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Affiliation(s)
| | | | | | | | - Asim Kurjak
- Medical School Universities of Zagreb and Sarajevo, Zagreb, Croatia
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Stockton J, Nield L. An antenatal wish list: A qualitative systematic review and thematic synthesis of UK dietary advice for weight management and food borne illness. Midwifery 2019; 82:102624. [PMID: 31931359 DOI: 10.1016/j.midw.2019.102624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To understand UK women's experiences of antenatal dietary advice for risk of food borne illness and weight gain. DESIGN A systematic review and thematic synthesis of peer-reviewed qualitative studies. PubMed, MEDLINE, CINAHL and PMC databases were searched for articles published from January 2008 to June 2018. The search strategy combined terms for pregnancy with terms for body composition, weight change, food safety, nutrition, diet and qualitative terminology. Studies were eligible for inclusion if (1) they explored experiences of implementing advice received during pregnancy for nutrition, physical activity and/or weight gain, and (2) participants were women who had experienced maternity care in the UK. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool. FINDINGS Of 25,688 articles identified by the search strategy, 20 studies were identified that met the inclusion criteria. Five major themes were recognised: control, barriers to diet and exercise, motivators, relationship with weight, and information, with a further 12 subthemes. The majority of studies reported on weight gain (n = 10). KEY CONCLUSIONS Evidence shows that UK antenatal dietary advice is currently inconsistent, vague and overwhelming despite pregnancy being an excellent time for lifestyle change. Women are primarily driven by the health of their baby and desire support to facilitate positive changes. IMPLICATIONS FOR PRACTICE Findings outline a wishlist which highlights a desire for tailored information on preventing weight gain, dietary requirements, safe physical activity and a deprioritisation of food safety guidelines. This provision should be delivered by HCP. e.g. midwives, in a sensitive and supportive way to bridge the gap between women's needs and the current antenatal provision.
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Affiliation(s)
- Jessica Stockton
- Department of Nutrition, Sheffield Business School, Sheffield Hallam University, Sheffield, S1 1WB, United Kingdom.
| | - Lucie Nield
- Department of Nutrition, Sheffield Business School, Sheffield Hallam University, Sheffield, S1 1WB, United Kingdom.
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Walker R, Morris H, Lang S, Hampton K, Boyle J, Skouteris H. Co-designing preconception and pregnancy care for healthy maternal lifestyles and obesity prevention. Women Birth 2019; 33:473-478. [PMID: 31812498 DOI: 10.1016/j.wombi.2019.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 01/17/2023]
Abstract
PROBLEM A recognised gap exists between current and recommended practices in the provision of lifestyle advice and weight management support for women across preconception and pregnancy care. BACKGROUND Preconception and pregnancy are critical stages for promoting healthy maternal lifestyles and obesity prevention. Co-design is a novel approach with the potential to strengthen existing models of care to facilitate the implementation of clinical practice guidelines promoting preconception and pregnancy health, especially in relation to preconception weight management and preventing excessive gestational weight gain. AIM AND METHODS The aims of this discussion paper are to (i) define co-design in the context of preconception and pregnancy care, (ii) outline key considerations when planning co-design initiatives and (iii) describe co-design opportunities in preconception and pregnancy care for promoting women's health and obesity prevention. DISCUSSION While several definitions of co-design exist, one critical element is the meaningful involvement of all key stakeholders. In this discussion, we specifically identified the involvement of women and expanding the role of practice nurses in primary care may assist to overcome barriers to the provision of healthy lifestyle advice and support for women during preconception. Co-designing pregnancy care will involve input from women, nurses, midwives, obstetricians, allied health and administration and management staff. Additional attention is required to co-design care for women considered most at-risk. CONCLUSION There is potential to enhance current provision of preconception and pregnancy care using co-design. Nursing and midwifery professions are active across both preconception and pregnancy and therefore, they have an important role to play.
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Affiliation(s)
- Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 41-52 Kanooka Grove, Clayton, Victoria 3168, Australia.
| | - Heather Morris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 41-52 Kanooka Grove, Clayton, Victoria 3168, Australia
| | - Sarah Lang
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Level 1 264 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia
| | - Kerry Hampton
- Department of Nursing and Midwifery, School of Clinical Sciences, Monash University, Clayton Road, Clayton, Victoria, 3168, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 41-52 Kanooka Grove, Clayton, Victoria 3168, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 41-52 Kanooka Grove, Clayton, Victoria 3168, Australia; Warwick Business School, Warwick University, Coventry, CV4 7AL, United Kingdom.
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Ijäs H, Koivunen S, Raudaskoski T, Kajantie E, Gissler M, Vääräsmäki M. Independent and concomitant associations of gestational diabetes and maternal obesity to perinatal outcome: A register-based study. PLoS One 2019; 14:e0221549. [PMID: 31465425 PMCID: PMC6715199 DOI: 10.1371/journal.pone.0221549] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/09/2019] [Indexed: 12/03/2022] Open
Abstract
AIMS Gestational diabetes (GDM) is often accompanied by maternal overweight. Our aim was to evaluate the separate and concomitant effects of GDM and maternal overweight/obesity on perinatal outcomes. METHODS We used the Finnish Medical Birth Register to identify all 24,577 women with a singleton pregnancy who delivered in 2009 in Finland and underwent an oral glucose tolerance test (OGTT). Women were divided into groups according to the result of OGTT (GDM/no GDM) and pre-pregnancy body mass index (BMI): normal weight (≤24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30.0 kg/m2). Primary outcomes included macrosomia, caesarean delivery, and treatment at neonatal ward. Normal weight women without GDM constituted the reference group. RESULTS Compared to reference group, overweight or obese women without GDM had an increased risk of macrosomia [odds ratio adjusted for age, parity, smoking and socio-economic status (aOR)1.18 (95% CI 1.09-1.28) and 1.50 (95% CI 1.19-1.88)], and caesarean delivery [aORs 1.17 (95% CI 1.07-1.28) and 1.52 (95% CI 1.37-1.69)], respectively. In normal weight GDM women the risk of macrosomia [aOR 1.17 (95% CI 0.85-1.62)] and caesarean delivery [aOR 1.10 (95% CI 0.96-1.27)] was not significantly increased as compared to normal weight women without GDM. GDM increased the risk of treatment at neonatal ward in all BMI categories and maternal obesity without GDM was also a risk factor for treatment at neonatal ward. Interaction p values between BMI and GDM on these outcomes were <0.001. CONCLUSIONS Maternal overweight and obesity without GDM increased the risk of macrosomia and caesarean delivery when compared to the reference group. These risks were amplified when overweight/obesity was accompanied by GDM. Obesity without GDM was a risk factor for treatment at neonatal ward; GDM increased this risk in all BMI categories. Our results suggest that especially maternal obesity should be considered as a risk factor for adverse pregnancy outcomes and GDM further amplifies this risk.
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Affiliation(s)
- Hilkka Ijäs
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
| | - Sanna Koivunen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
| | - Tytti Raudaskoski
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Kajantie
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mika Gissler
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
- Karolinska Institute, Stockholm, Sweden
| | - Marja Vääräsmäki
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
- THL National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki and Oulu, Finland
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Khadilkar SS. Obesity in Pregnancy: Obstetrician' s Obstacle. J Obstet Gynaecol India 2019; 69:197-202. [PMID: 31178633 DOI: 10.1007/s13224-019-01235-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022] Open
Abstract
Obesity in pregnancy is associated with several complications which today's obstetricians have to face often. Overcoming these obstacles is truly challenging. There is a steady rise in incidence of overweight or obese women at reproductive age group in India and as well as other countries. Recent advances in bariatric medicine as well bariatric surgery have led to increasing number of pregnancies in obese women. Since obesity is associated with adverse maternal and fetal outcome, it is considered as a high-risk pregnancy and such pregnancies need to be managed in maternity units which are well equipped with necessary infrastructure and availability of expert multidisciplinary faculty. This editorial will look into various challenges and difficulties faced by obstetricians and provide practical tips for managing obese pregnant women. We are introducing a new type of article "Invited Debate," with this issue. It deals with pros and cons of bariatric surgery. I sincerely hope that readers are benefitted from views and reviews presented in the invited debate as well as the editorial.
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Flannery C, McHugh S, Kenny LC, O’Riordan MN, McAuliffe FM, Bradley C, Kearney PM, Byrne M. Exploring obstetricians', midwives' and general practitioners' approach to weight management in pregnant women with a BMI ≥25 kg/m 2: a qualitative study. BMJ Open 2019; 9:e024808. [PMID: 30696684 PMCID: PMC6352774 DOI: 10.1136/bmjopen-2018-024808] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore healthcare professionals' (HCPs) beliefs and attitudes towards weight management for pregnant women with a body mass index (BMI) ≥25 kg/m2. DESIGN Qualitative study. SETTING A public antenatal clinic in a large academic maternity hospital in Cork, Ireland, and general practice clinics in the same region. PARTICIPANTS HCPs such as hospital-based midwives and consultant obstetricians and general practitioners (GPs). METHOD Semistructured interviews were conducted with a purposive sample of hospital-based HCPs and a sample of GPs working in the same region. Interviews were recorded, transcribed and thematically analysed using NVivo software. RESULTS Seventeen HCPs were interviewed (hospital based=10; GPs=7). Four themes identified the complexity of weight management in pregnancy and the challenges HCPs faced when trying to balance the medical and psychosocial needs of the women. HCPs acknowledged weight as a sensitive conversation topic, leading to a 'softly-softly approach' to weight management. HCPs tried to strike a balance between being woman centred and empathetic and medicalising the conversation. HCPs described 'doing what you can with what you have' and shifting the focus to managing obstetric complications. Furthermore, there were unclear roles and responsibilities in terms of weight management. CONCLUSION HCPs need to have standardised approaches and evidence-based guidelines that support the consistent monitoring and management of weight during pregnancy.
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Affiliation(s)
- Caragh Flannery
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Louise C Kenny
- Department of Women’s and Children’s Health, University of Liverpool School of Life Sciences, Liverpool, UK
| | - Mairead N O’Riordan
- Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, National Maternity Hospital, University College Dublin, Dublin, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | | | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
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Denison FC, Aedla NR, Keag O, Hor K, Reynolds RM, Milne A, Diamond A. Care of Women with Obesity in Pregnancy. BJOG 2018; 126:e62-e106. [DOI: 10.1111/1471-0528.15386] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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22
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Solmi F, Morris S. Overweight and obese pre-pregnancy BMI is associated with higher hospital costs of childbirth in England. BMC Pregnancy Childbirth 2018; 18:253. [PMID: 29925340 PMCID: PMC6011257 DOI: 10.1186/s12884-018-1893-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Women who have an overweight or obese BMI are more likely to experience pregnancy complications. However, little is known on the cost of childbirth in this group and no studies have been undertaken in England to date. The aim of this paper is therefore to investigate whether women with overweight and obese pre-pregnancy body mass index (BMI) incur higher average hospital costs of childbirth. Methods We employed data from 7564 women in the first wave of data collection of the Millennium Cohort Study. Using interval regression, we investigated the association between hospital costs of childbirth and pre-pregnancy BMI, fitting four models, progressively adjusting for additional potential confounders and mediators. Model 1 was a univariate model; model 2 adjusted for maternal age, education, marital status, ethnicity, income, and region; model 3 additionally included number of previous children, number of babies delivered, whether birth was at term, and type of delivery; model 4 also included length of hospital stay. Results Childbirth costs incurred by women who were overweight, obese class I and obese class II and III were £22, £82 and £126 higher than those incurred by women whose BMI was in the normal range (p ≤ 0.05). Delivery method, pre-term delivery, and length of hospital stay accounted for the observed difference. Conclusions Women with elevated pre-pregnancy BMI make greater use of services resulting in higher hospital costs. Interventions promoting healthy BMI in pre-pregnancy among women of child-bearing age have the potential to reduce pregnancy complications and be cost-effective. Electronic supplementary material The online version of this article (10.1186/s12884-018-1893-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francesca Solmi
- Department of Applied Health Research, University College London, London, UK. .,Division of Psychiatry, University College London, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
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Angeliki A, Dimitrios P, Chara T. Maternal obesity and its association with the mode of delivery and the neonatal outcome in induced labour: Implications for midwifery practice. Eur J Midwifery 2018; 2:4. [PMID: 33537565 PMCID: PMC7839088 DOI: 10.18332/ejm/85792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/27/2018] [Accepted: 02/26/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Maternal obesity carries an increased risk of complications during pregnancy and childbirth. This study investigated whether the body mass index (BMI) of women with induced labour was associated with the mode of delivery and neonatal outcome. METHODS This was a retrospective study of primigravidae women under the age of 40 years who were induced at term for various indications. Data were collected from the electronic database of the Maternity Unit where these women gave birth. RESULTS We sampled 1274 women with a mean age of 26.3±5.9 years. The mean BMI at booking was 26.5 kg/m2, with 28.8% being overweight and 24.3% obese. In the sample, 70.4% had a normal vaginal delivery, 15.4% a caesarean section (CS) and 14.2% an instrumental delivery. An increasing BMI was independently associated with the odds for a CS, with women who were overweight and obese having a 1.58 and 2.75 times greater likelihood for a CS. The CS rate was 10.2% in women with a normal BMI, and increased to 15.8% for overweight and 24.9% for obese women (p<0.001). The increasing BMI did not affect the instrumental delivery rates in our cohort. The Apgar scores at one and five minutes were significantly lower in overweight and obese women compared to women with a normal BMI. CONCLUSIONS We show that an increasing BMI in women with induced labour was associated with increased CS rates and lower Apgar scores. These findings highlight the important role of midwives in engaging women in weight management before they get pregnant.
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Affiliation(s)
- Antonakou Angeliki
- Department of Midwifery, Midwifery School, 'Alexander' Technological Educational Institute of Thessaloniki, Greece
| | - Papoutsis Dimitrios
- Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom
| | - Tzavara Chara
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Greece
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Slack E, Rankin J, Jones D, Heslehurst N. Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review. Obes Rev 2018; 19:485-500. [PMID: 29349860 PMCID: PMC5969310 DOI: 10.1111/obr.12636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/07/2017] [Accepted: 09/26/2017] [Indexed: 12/16/2022]
Abstract
AIM This systematic review investigates associations between maternal pre-pregnancy/early-pregnancy anthropometrics (e.g. weight and body fat), anthropometric change and pregnancy outcomes in South Asian and White women. METHODS Twelve electronic literature databases, reference lists and citations of all included studies were searched. Observational studies published in the English language were included. Descriptive synthesis was used to summarize the evidence base. RESULTS Twenty-two studies met the inclusion criteria (403,609 births [351,856 White and 51,753 South Asian]). Nine were prospective cohort studies, nine were retrospective cohort studies and two were cross-sectional studies. Results suggested that in South Asian women, maternal pre-pregnancy/early-pregnancy anthropometrics were associated with anthropometric change, birthweight, mode of delivery and gestational diabetes mellitus (GDM). Gestational anthropometric change was found to be associated with GDM. There was limited evidence to suggest that there may be associations between maternal pre-anthropometrics/early anthropometrics and hypertensive disorders, stillbirth, congenital anomalies, post-natal weight retention and post-natal impaired glucose tolerance. The evidence suggested a combined effect of pre-pregnancy/early-pregnancy anthropometrics and gestational anthropometric change on both GDM and post-natal weight retention. CONCLUSION The increased risk of adverse pregnancy outcomes in South Asian women should be considered in guidelines for weight management before and during pregnancy.
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Affiliation(s)
- E. Slack
- Institute of Health & SocietyNewcastle UniversityNewcastle upon TyneUK
| | - J. Rankin
- Institute of Health & SocietyNewcastle UniversityNewcastle upon TyneUK
| | - D. Jones
- Health and Social Care InstituteTeesside UniversityMiddlesbroughUK
| | - N. Heslehurst
- Institute of Health & SocietyNewcastle UniversityNewcastle upon TyneUK
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Walker R, Kumar A, Blumfield M, Truby H. Maternal nutrition and weight management in pregnancy: A nudge in the right direction. NUTR BULL 2018. [DOI: 10.1111/nbu.12308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- R. Walker
- Monash University; Melbourne Victoria Australia
| | - A. Kumar
- Monash University; Melbourne Victoria Australia
| | | | - H. Truby
- Monash University; Melbourne Victoria Australia
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Heslehurst N, Rankin J, McParlin C, Sniehotta FF, Howel D, Rice S, McColl E. GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING): a pilot cluster randomised controlled trial of a guideline implementation intervention for the management of maternal obesity by midwives. Pilot Feasibility Stud 2018; 4:47. [PMID: 29456871 PMCID: PMC5807844 DOI: 10.1186/s40814-018-0241-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 01/24/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Weight management in pregnancy guidelines exist, although dissemination alone is an ineffective means of implementation. Midwives identify the need for support to overcome complex barriers to practice. An evaluation of an intervention to support midwives' guideline implementation would require a large-scale cluster randomised controlled trial. A pilot study is necessary to explore the feasibility of delivery and evaluation prior to a definitive trial. The GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING) trial aims to test whether it is feasible and acceptable to deliver a behaviour change intervention to support midwives' implementation of weight management guidelines. METHODS GLOWING is a multi-centre parallel group pilot cluster randomised controlled trial comparing the delivery of a behaviour change intervention for midwives versus usual practice. Four NHS Trusts (clusters) will be randomised to intervention and control arms, stratified by size of maternity services. The intervention uses social cognitive theory and consists of face-to-face midwifery training plus information resources for routine practice. The main outcomes are whether the intervention and trial procedures are feasible and acceptable to participants and the feasibility of recruitment and data collection for a definitive trial. Target recruitment involves all eligible midwives in the intervention arm recruited to receive the intervention, 30 midwives and pregnant women per arm for baseline and outcome questionnaire data collection and 20 midwives and women to provide qualitative data. All quantitative and qualitative analyses will be descriptive with the purpose of informing the development of the definitive trial. DISCUSSION This pilot study has been developed to support community midwives' implementation of guidelines. Community midwives have been selected as they usually carry out the booking appointment which includes measuring and discussing maternal body mass index. A cluster design is the gold standard in implementation research as there would be a high risk of contamination if randomisation was at individual midwife level: community midwives usually work in locality-based teams, interact on a daily basis, and share care of pregnant women. The results of the pilot trial will be used to further develop and refine GLOWING prior to a definitive trial to evaluate effectiveness and cost-effectiveness. TRIAL REGISTRATION ISRCTN46869894; retrospectively registered 25th May 2016.
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Affiliation(s)
- Nicola Heslehurst
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Catherine McParlin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Falko F. Sniehotta
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Stephen Rice
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
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McNamara K, O'Donoghue K, Greene RA. Intrapartum fetal deaths and unexpected neonatal deaths in the Republic of Ireland: 2011 - 2014; a descriptive study. BMC Pregnancy Childbirth 2018; 18:9. [PMID: 29301489 PMCID: PMC5755435 DOI: 10.1186/s12884-017-1636-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrapartum fetal death, the death of a fetus during labour, is a tragic outcome of pregnancy. The intrapartum death rate of a country is reflective of the care received by mothers and babies in labour and it is through analysing these cases that good aspects of care, as well as areas for improvement can be identified. Investigating unexpected neonatal deaths that may be associated with an intrapartum event is also helpful to fully appraise intrapartum care. This is a descriptive study of intrapartum fetal deaths and unexpected neonatal deaths in Ireland from 2011 to 2014. METHODS Anonymised data pertaining to all intrapartum fetal deaths and unexpected neonatal deaths for the study time period was obtained from the national perinatal epidemiology centre. All statistical analyses were conducted using Statistical package for the Social Sciences (SPSS). RESULTS There were 81 intrapartum fetal deaths from 2011 to 2014, and 36 unexpected neonatal deaths from 2012 to 2014. The overall intrapartum death rate was 0.29 per 1000 births and the corrected intrapartum fetal death rate was 0.16 per 1000 births. The overall unexpected neonatal death rate was 0.17 per 1000 live births. Major Congenital Malformation accounted for 36/81 intrapartum deaths, chorioamnionitis for 18/81, and placental abruption accounted for eight babies' deaths. Intrapartum asphyxia accounted for eight of the intrapartum deaths. With respect to the neonatal deaths over half (21/36, 58.3%) of the babies died as a result of hypoxic ischaemic encephalopathy. Information is also reported on both maternal and individual baby demographics. CONCLUSIONS This is the first detailed descriptive analysis of intrapartum deaths and unexpected intrapartum event related neonatal deaths in Ireland. The corrected intrapartum fetal death rate was 0.16 per 1000 births. Despite our results being based on the best available national data on intrapartum deaths and unexpected neonatal deaths, we were unable to identify if any of these deaths could have been prevented. A more formal confidential inquiry based system is necessary to fully appraise these cases.
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Affiliation(s)
- K McNamara
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland. .,Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, 5th Floor, Wilton, Cork, Ireland.
| | - K O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - R A Greene
- The National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
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Dutton HP, Borengasser SJ, Gaudet LM, Barbour LA, Keely EJ. Obesity in Pregnancy: Optimizing Outcomes for Mom and Baby. Med Clin North Am 2018; 102:87-106. [PMID: 29156189 PMCID: PMC6016082 DOI: 10.1016/j.mcna.2017.08.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Obesity is common in women of childbearing age, and management of this population around the time of pregnancy involves specific challenges. Weight and medical comorbidities should be optimized both before and during pregnancy. During pregnancy, gestational weight gain should be limited, comorbidities should be appropriately screened for and managed, and fetal health should be monitored. Consideration should be given to the optimal timing of delivery and to reducing surgical and anesthetic complications. In the postpartum period, breastfeeding and weight loss should be promoted. Maternal obesity is associated with adverse metabolic effects in offspring, promoting an intergenerational cycle of obesity.
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Affiliation(s)
- Heidi Pauline Dutton
- University of Ottawa, 1967 Riverside Dr., Ottawa On Canada, K1h7W9, , 613 738 8400 ext 81946
| | - Sarah Jean Borengasser
- University of Colorado – Anschutz, 12631 E. 17 Ave. Mailstop F561, Aurora, CO 80045, USA, , 303 724 9550
| | - Laura Marie Gaudet
- University of Ottawa, 1053 Carling Ave, Ottawa On Canada, K1Y 4E9, , 613 737 8899 ext 73056
| | - Linda A Barbour
- Professor of Endocrinology and Maternal-Fetal Medicine, University of Colorado School of Medicine, 12801 E 17 Ave RC1 South Room 7103, Aurora, CO 80405, , 303 724 3921
| | - Erin Joanne Keely
- University of Ottawa, 1967 Riverside Dr., Ottawa On Canada, K1h7W9, , 613 738 8400 ext 81941
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Maternal Obesity and Cardiac Development in the Offspring: Study in Human Neonates and Minipigs. JACC Cardiovasc Imaging 2017; 11:1750-1755. [PMID: 29153568 DOI: 10.1016/j.jcmg.2017.08.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/04/2017] [Accepted: 08/23/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the consequences of maternal overweight on cardiac development in offspring in infants (short term) and minipigs (short and longer term). BACKGROUND The epidemic of overweight involves pregnant women. The uterine environment affects organ development, modulating disease susceptibility. Offspring of obese mothers have higher rates of cardiovascular events and mortality. METHODS Echocardiography was performed in infants born to lean and overweight mothers at birth and at 3, 6, and 12 months of age. In minipigs born to mothers fed a high-fat diet or a normal diet, cardiac development (echocardiography, histology), glucose metabolism and perfusion (positron emission tomography), triglyceride and glycogen content, and myocardial enzymes regulating metabolism (mass spectrometry) were determined from birth to adulthood. RESULTS In neonates, maternal overweight, especially in the last trimester, predicted a thicker left ventricular posterior wall at birth (4.1 ± 0.3 vs. 3.3 ± 0.2 mm; p < 0.05) and larger end-diastolic and stroke volumes at 1 year. Minipigs born to mothers fed a high-fat diet showed greater left ventricular mass (p = 0.0001), chambers (+100%; p < 0.001), stroke volume (+75%; p = 0.001), cardiomyocyte nuclei (+28%; p = 0.02), glucose uptake, and glycogen accumulation at birth (+100%; p < 0.005), with lower levels of oxidative enzymes, compared with those born to mothers fed a normal diet. Subsequently, they developed myocardial insulin resistance and glycogen depletion. Late adulthood showed elevated heart rate (111 ± 5 vs. 84 ± 8 beats/min; p < 0.05) and ejection fraction and deficient fatty acid oxidative enzymes. CONCLUSIONS Neonatal changes in cardiac morphology were explained by late-trimester maternal body mass index; myocardial glucose overexposure seen in minipigs can justify early human findings. Longer term effects in minipigs consisted of myocardial insulin resistance, enzymatic alterations, and hyperdynamic systolic function.
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Freeman MP, Sosinsky AZ, Goez-Mogollon L, Savella GM, Moustafa D, Viguera AC, Cohen LS. Gestational Weight Gain and Pre-pregnancy Body Mass Index Associated With Second-Generation Antipsychotic Drug Use During Pregnancy. PSYCHOSOMATICS 2017; 59:125-134. [PMID: 29078988 DOI: 10.1016/j.psym.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity during pregnancy is the most common high-risk obstetric condition, resulting in increased rates of adverse maternal and neonatal outcomes. Individuals with psychiatric disorders have a higher risk of obesity than the general population, but data regarding implications of obesity in women with psychiatric disorders are sparse. OBJECTIVE The objective of this study was to assess pre-pregnancy weights and gestational weight gain in women who were exposed to second-generation antipsychotics (SGAs) during pregnancy compared to controls. METHODS We assessed pre-pregnancy weights and gestational weight gain from the Massachusetts General Hospital National Pregnancy Registry for Atypical Antipsychotics for patients exposed to SGAs and controls unexposed to these medicines during pregnancy. Both groups experienced similar psychiatric morbidity. RESULTS A total of 403 participants had evaluable data for these analyses (N = 279 exposed to SGAs; N = 124 controls). The mean pre-pregnancy weight, body mass index (BMI), and likelihood to begin pregnancy with an obese BMI were significantly higher in the exposed group compared to controls (p = 0.0003, p < 0.0001, and p < 0.0001 respectively), as were the mean weight and BMI at delivery (p < 0.0001). The mean weight gain did not differ significantly between groups. Across pre-pregnancy BMI categories, both groups gained more than the recommended amount of weight during pregnancy. CONCLUSION We found that women exposed to SGAs began pregnancy with higher BMIs than controls. Both exposed and unexposed groups experienced similar weight gain during pregnancy. Strategies are needed to prevent excessive gestational weight gain and to reduce pre-pregnancy obesity in women with psychiatric disorders, especially those treated with SGAs.
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Affiliation(s)
- Marlene P Freeman
- Massachusetts General Hospital, Department of Psychiatry, Ammon-Pinizzotto, Center for Women's Mental Health, Boston, MA.
| | - Alexandra Z Sosinsky
- Massachusetts General Hospital, Department of Psychiatry, Ammon-Pinizzotto, Center for Women's Mental Health, Boston, MA
| | - Lina Goez-Mogollon
- Massachusetts General Hospital, Department of Psychiatry, Ammon-Pinizzotto, Center for Women's Mental Health, Boston, MA
| | - Gina M Savella
- Massachusetts General Hospital, Department of Psychiatry, Ammon-Pinizzotto, Center for Women's Mental Health, Boston, MA
| | - Danna Moustafa
- Massachusetts General Hospital, Department of Psychiatry, Ammon-Pinizzotto, Center for Women's Mental Health, Boston, MA
| | - Adele C Viguera
- Massachusetts General Hospital, Department of Psychiatry, Ammon-Pinizzotto, Center for Women's Mental Health, Boston, MA; Cleveland Clinic, Department of Psychiatry, Neurological Institute, Cleveland, OH
| | - Lee S Cohen
- Massachusetts General Hospital, Department of Psychiatry, Ammon-Pinizzotto, Center for Women's Mental Health, Boston, MA
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Fitzgerald DA. The weighty issue of obesity in paediatric respiratory medicine. Paediatr Respir Rev 2017; 24:4-7. [PMID: 28797888 DOI: 10.1016/j.prrv.2017.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/01/2017] [Indexed: 11/26/2022]
Abstract
Some have observed that developed world is fat and getting fatter. This is even extending into the developing world, and it is important to appreciate that the consequences of childhood obesity last into adulthood and are associated with premature death. From the paediatric respiratory perspective, the deposition of excess adipose tissue in the thoraco-abdominal region begins early in life and is believed to alter diaphragm mobility and chest wall expansion, reduce lung compliance, and result in a rapid shallow breathing pattern with an increased work of breathing and reduction in maximum ventilatory capacity. This results in respiratory symptoms of exertional dyspnoea related to deconditioning which may present as exercise limitation, leading to confusion with common lung diseases such as asthma. The manifestations of the increasingly prevalent problems of overweight and obesity in young people and their interaction with common conditions of asthma and obstructive sleep apnoea will be discussed.
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Affiliation(s)
- Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Discipline Child & Adolescent Health, Sydney Medical School, University of Sydney, Sydney, Australia.
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How do women feel about being weighed during pregnancy? A qualitative exploration of the opinions and experiences of postnatal women. Midwifery 2017; 49:95-101. [DOI: 10.1016/j.midw.2016.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/26/2016] [Accepted: 12/11/2016] [Indexed: 11/17/2022]
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Atkinson S, McNamara PM. Unconscious collusion: An interpretative phenomenological analysis of the maternity care experiences of women with obesity (BMI≥30 kg/m²). Midwifery 2017; 49:54-64. [DOI: 10.1016/j.midw.2016.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 10/27/2016] [Accepted: 12/11/2016] [Indexed: 11/16/2022]
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Nikolopoulos H, Mayan M, MacIsaac J, Miller T, Bell RC. Women's perceptions of discussions about gestational weight gain with health care providers during pregnancy and postpartum: a qualitative study. BMC Pregnancy Childbirth 2017; 17:97. [PMID: 28335749 PMCID: PMC5364680 DOI: 10.1186/s12884-017-1257-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 02/17/2017] [Indexed: 01/14/2023] Open
Abstract
Background Maternal body weight is an indicator of the health of a mother and her developing fetus. Risks of poor maternal and fetal health issues increase when women gain too little or too much weight during pregnancy. A study of 600 women from Alberta, Canada, reported approximately 30, 46, 80, and 80% of underweight, healthy weight, overweight, and obese women, respectively, gained in excess of Health Canada gestational weight gain guidelines. Behavioural interventions during pregnancy have shown to be effective at supporting women achieve gestational weight gain (GWG) recommendations and return to their pre-pregnancy weight postpartum, yet few women are counseled about weight gain during pregnancy. A discrepancy exists between health care providers’ (HCP) reported counseling behaviours and women’s perceptions of counseling by HCPs; most HCPs report counseling women about GWG; conversely, most women report not receiving counseling about GWG. This study explored women’s experiences with GWG and their perceptions of discussions about GWG with HCPs during pregnancy and postpartum. This will help to identify gaps in service delivery and highlight areas for improvement that may better support women to achieve GWG recommendations leading to better health outcomes for women and children. Methods Five focus groups (n = 26) were conducted with women up to 1 year postpartum across the five Alberta health zones. Focus groups were transcribed verbatim and analyzed using qualitative content analysis. Results GWG is important to women, for their health and for the health of their baby. In-depth conversations with HCPs about GWG or weight loss do not occur; however, women want the opportunity to discuss weight gain/loss with HCPs. Women would like discussions about gestational weight gain/loss to become part of standard care and offered to all women. Conclusions Women suggested that discussions about GWG should occur with all women, and that HCPs should initiate these discussions by asking women how they feel about discussing weight. Conversations should begin early on in pregnancy and continue through to the postpartum period. Interventions assessing discussions about GWG should be implemented and evaluated as this has been identified as a gap in prenatal service delivery.
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Affiliation(s)
- Hara Nikolopoulos
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, 4-126 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Maria Mayan
- University of Alberta, Community University Partnership, Facility of Extension, 2nd Floor, 2-281 Enterprise Square, 10230 Jasper Avenue, Edmonton, AB, T5J 4P6, Canada
| | - Jessica MacIsaac
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, 4-126 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada
| | - Terri Miller
- Healthy Living, Population, Public and Aboriginal Health, Reproductive Health, Healthy Children and Families, Alberta Health Services, 10101 Southport Road SW cubicle #1740, Calgary, AB, T2W 3N2, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, 4-126 Li Ka Shing Centre for Health Research Innovation, Edmonton, AB, T6G 2E1, Canada.
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Daemers DOA, van Limbeek EBM, Budé LM, Wijnen HAA, Nieuwenhuijze MJ, de Vries RG. The use of midwife-led primary antenatal care by obese women in The Netherlands: An explorative cohort study. Midwifery 2016; 49:72-78. [PMID: 27955942 DOI: 10.1016/j.midw.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/14/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE to study the effect of body mass index (BMI) on the use of antenatal care by women in midwife-led care. DESIGN an explorative cohort study. SETTING 11 Dutch midwife-led practices. PARTICIPANTS a cohort of 4421 women, registered in the Midwifery Case Registration System (VeCaS), who received antenatal care in midwife-led practices in the Netherlands and gave birth between October 2012 and October 2014. FINDINGS the mean start of initiation of care was at 9.3 (SD 4.6) weeks of pregnancy. Multiple linear regression showed that with an increasing BMI initiation of care was significantly earlier but BMI only predicted 0.2% (R2) of the variance in initiation of care. The mean number of face-to- face antenatal visits in midwife-led care was 11.8 (SD 3.8) and linear regression showed that with increasing BMI the number of antenatal visits increased. BMI predicted 0.1% of the variance in number of antenatal visits. The mean number of antenatal contacts by phone was 2.2 (SD 2.6). Multiple linear regression showed an increased number of contacts by phone for BMI categories 'underweight' and 'obese class I'. BMI categories predicted 1% of the variance in number of contacts by phone. KEY CONCLUSIONS BMI was not a relevant predictor of variance in initiation of care and number of antenatal visits. Obese pregnant women in midwife-led practices do not delay or avoid antenatal care. IMPLICATIONS FOR PRACTICE Taking care of pregnant women with a high BMI does not significantly add to the workload of primary care midwives. Further research is needed to more fully understand the primary maternal health services given to obese women.
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Affiliation(s)
- Darie O A Daemers
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Evelien B M van Limbeek
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Luc M Budé
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Hennie A A Wijnen
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Marianne J Nieuwenhuijze
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Raymond G de Vries
- Research Centre for Midwifery Science Maastricht (Zuyd University), PO Box 1256, 6201 BG Maastricht, The Netherlands; Caphri School for Public Health and Primary Care (Maastricht University), The Netherlands.
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Antenatal Weight Management: Women's Experiences, Behaviours, and Expectations of Weighing in Early Pregnancy. J Pregnancy 2016; 2016:8454759. [PMID: 27843648 PMCID: PMC5098086 DOI: 10.1155/2016/8454759] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/19/2016] [Indexed: 11/17/2022] Open
Abstract
The current emphasis on obstetric risk management helps to frame gestational weight gain as problematic and encourages intervention by healthcare professionals. However pregnant women have reported confusion, distrust, and negative effects associated with antenatal weight management interactions. The MAGIC study (MAnaging weiGht In pregnanCy) sought to examine women's self-reported experiences of usual-care antenatal weight management in early pregnancy and consider these alongside weight monitoring behaviours and future expectations. 193 women (18 yrs+) were recruited from routine antenatal clinics at the Nottingham University Hospital NHS Trust. Self-reported gestation was 10-27 weeks, with 41.5% (n = 80) between 12 and 14 and 43.0% (n = 83) between 20 and 22 weeks. At recruitment 50.3% of participants (n = 97) could be classified as overweight or obese. 69.4% of highest weight women (≥30 kg/m2) did not report receiving advice about weight, although they were significantly more likely compared to women with BMI < 30 kg/m2. The majority of women (regardless of BMI) did not express any barriers to being weighed and 40.8% reported weighing themselves at home. Women across the BMI categories expressed a desire for more engagement from healthcare professionals on the issue of bodyweight. Women are clearly not being served appropriately in the current situation which simultaneously problematizes and fails to offer constructive dialogue.
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Clinician's Attitudes to the Introduction of Routine Weighing in Pregnancy. J Pregnancy 2016; 2016:2049673. [PMID: 27446614 PMCID: PMC4944081 DOI: 10.1155/2016/2049673] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 06/12/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Excessive gestational weight gain poses significant short- and long-term health risks to both mother and baby. Professional bodies and health services increasingly recommend greater attention be paid to weight gain in pregnancy. A large Australian tertiary maternity hospital plans to facilitate the (re)introduction of routine weighing of all women at every antenatal visit. Objective. To identify clinicians' perspectives of barriers and enablers to routinely weighing pregnant women and variations in current practice, knowledge, and attitudes between different staff groups. Method. Forty-four maternity staff from three professional groups were interviewed in four focus groups. Staff included midwives; medical staff; and dietitians. Transcripts underwent qualitative content analysis to identify and examine barriers and enablers to the routine weighing of women throughout pregnancy. Results. While most staff supported routine weighing, various concerns were raised. Issues included access to resources and staff; the ability to provide appropriate counselling and evidence-based interventions; and the impact of weighing on patients and the therapeutic relationship. Conclusion. Many clinicians supported the practice of routine weighing in pregnancy, but barriers were also identified. Implementation strategies will be tailored to the discrete professional groups and will address identified gaps in knowledge, resources, and clinician skills and confidence.
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Lavender T, Smith DM. Seeing it through their eyes: a qualitative study of the pregnancy experiences of women with a body mass index of 30 or more. Health Expect 2016; 19:222-33. [PMID: 25601510 PMCID: PMC5055269 DOI: 10.1111/hex.12339] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Maternal obesity [body mass index (BMI) ≥ 30 kg/m(2)] is associated with numerous complications, but currently, little is known about the pregnancy experiences of these women. OBJECTIVE To gain insight into the experience of pregnant women with BMI ≥ 30 kg/m(2), when accessing maternity services and attending a community lifestyle programme. DESIGN Qualitative methodology, utilizing focus groups and semi-structured interviews with post-natal women who had an antenatal BMI ≥ 30 kg/m(2). The sample was obtained from a larger study. RESULTS Thirty-four women participated. Three main themes were identified using thematic analysis. Women described disappointment with their pregnancy. In particular, their informational expectations were not met; some health professionals appeared uninterested, insensitive or unconfident. Women described readiness to make a lifestyle change, but this was not encouraged during routine care. Attending the programme began the process of behavioural change. Women's beliefs that small changes make a big difference led to them being spurred on by success; driven by a desire to improve the health of their family. DISCUSSION AND CONCLUSION Pregnant women who are obese know this is the case and expect to be provided with information to assist them in making lifestyle changes. Health professionals should be aware of women's readiness for change and view pregnancy as an ideal time to communicate. Pregnant women with a BMI ≥ 30 kg/m(2) should contribute to health professional training, to highlight the reality of the maternity system journey; first-hand accounts may improve the way health professionals' approach these women. Lifestyle interventions should be developed with input from the intended target group.
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Affiliation(s)
- Tina Lavender
- The School of Nursing, Midwifery and Social WorkManchester Academic Health Science Centre'The University of ManchesterManchesterUK
| | - Debbie M. Smith
- The School of Psychological SciencesManchester Academic Health Science CentreThe University of ManchesterManchesterUK
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The perspectives of obese women receiving antenatal care: A qualitative study of women's experiences. Women Birth 2015; 29:189-95. [PMID: 26563638 DOI: 10.1016/j.wombi.2015.10.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/09/2015] [Accepted: 10/17/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The prevalence of overweight and obesity is increasing amongst women of child bearing age. Maternal obesity has implications for both mother and baby including increased health risks from gestational hypertensive disorders, caesarean section and stillbirth. Despite the increasing prevalence of maternal obesity little is known of the experiences of these women within the health care system. The aim of this research was to investigate the perspectives of pregnant women with a body mass index (BMI) of ≥30kg/m(2) receiving antenatal care. METHODS A qualitative study using individual interviews was undertaken. Sixteen pregnant women with a BMI ≥30kg/m(2) participated. Interviews were audio recorded, transcribed, cross checked for consistency and then entered into a word processing document for analysis. Data was analysed using Interpretative Phenomenological Analysis. In any phenomenological study the researcher's objective is to elicit the participant's views on their lived experiences. FINDINGS Four major themes emerged: (1) obese during pregnancy as part of a long history of obesity; (2) lack of knowledge of the key complications of obesity for both mother and child; (3) communication about weight and gestational weight gain can be conflicting, confusing and judgmental; (4) most women are motivated to eat well during pregnancy and want help to do so. CONCLUSION Specialist lifestyle interventions for obese women should be a priority in antenatal care. Extra support is required to assist obese women in pregnancy achieve recommended nutritional and weight goals. Health professionals should approach the issue of maternal obesity in an informative but non-judgmental way.
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Pan SY, Dixon L, Paterson H, Campbell N. Increased BMI during pregnancy: how do midwife lead maternity carers respond? ACTA ACUST UNITED AC 2015; 11:461-9. [PMID: 26238556 DOI: 10.2217/whe.15.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM To determine the knowledge base of midwife lead maternity carers (LMCs) and explore their adjustments in practice for obese women. MATERIALS & METHODS A nationwide cohort study of LMC midwives in New Zealand concerning obesity in pregnancy using an electronic survey. RESULTS A total of 428 LMCs responded. Most respondents were aware of the risks of obesity during pregnancy. Midwives felt it was important to provide customized care. Various barriers to accessing support for obese women within the health system were identified. Discussing weight and obesity was acknowledged as a sensitive issue for both the woman and the midwife. CONCLUSION This study highlights the need to improve access to and availability of supportive maternity services and resources for pregnant women with increased BMI.
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Affiliation(s)
- Sze Yin Pan
- Palmerston North Hospital, Palmerston North, New Zealand
| | - Lesley Dixon
- Practice Advice & Research Development, New Zealand College of Midwives, 376 Manchester Street, Richmond 8014, New Zealand
| | - Helen Paterson
- Dunedin School of Medicine, Otago University, 201 Great King Street, Dunedin 9016, New Zealand
| | - Norma Campbell
- New Zealand College of Midwives, 376 Manchester Street, Richmond 8014, New Zealand
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McCance DR. Diabetes in pregnancy. Best Pract Res Clin Obstet Gynaecol 2015; 29:685-99. [PMID: 26004196 DOI: 10.1016/j.bpobgyn.2015.04.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 01/22/2023]
Abstract
Diabetes in pregnancy is still considered a high-risk condition for both mother and baby. Even in the best centres, malformation and mortality rates are reportedly twofold to fivefold higher than in the background population, and pregnancy planning rates remain obstinately poor. Increasing global rates of type 2 diabetes are now extending into pregnancy, with similarly poor outcomes to type 1 diabetes, and excess maternal weight is adding to the complexity of management. Over the last 5-10 years, several randomised trials have offered new insight into the role of oral hypoglycaemic drugs and insulin analogues in pregnancy, while continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitors (CGMs) are under scrutiny. The relevance of minor degrees of hyperglycaemia to adverse pregnancy outcome was clearly demonstrated by the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) study, but translation of these data into clinical practice has proved challenging because of the continuum of risk. Long-term metabolic and cardiovascular implications of hyperglycaemia during pregnancy for mother and child are now generally recognised with major implications for public health.
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Affiliation(s)
- David R McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, UK.
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Verret-Chalifour J, Giguère Y, Forest JC, Croteau J, Zhang P, Marc I. Breastfeeding initiation: impact of obesity in a large Canadian perinatal cohort study. PLoS One 2015; 10:e0117512. [PMID: 25659144 PMCID: PMC4320116 DOI: 10.1371/journal.pone.0117512] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 12/26/2014] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate incidence of breastfeeding initiation according to maternal pre-pregnancy body mass index (BMI) in "Grossesse en Santé", a large prospective birth cohort in Quebec City. METHODS Breastfeeding initiation in the post-partum period, pre-pregnancy BMI, sociodemographic determinants and obstetrical and neonatal factors were collected from years 2005 to 2010 in 6592 women with single pregnancies. Prenatal non-intention to breastfeed was documented in a subgroup of the cohort (years 2009-2010). Log-binomial regression analyses were performed to assess relative risk (RR) of non-initiation of breastfeeding between maternal BMI categories in models including pre- and post-natal determinants, after exclusion of variables with a mediating effect. RESULTS Twenty percent (20%) of obese women did not initiate breastfeeding in the post-natal period at hospital compared to 12% for normal weight women. Compared with those having a normal pre-pregnancy BMI, obese women had a higher risk of non-initiation of breastfeeding (RRunadj 1.69, 95% CI 1.44-1.98), even after adjustment for prenatal and sociodemographic factors (RRadj 1.26, 95% CI 1.08-1.46). Furthermore, the risk of non-initiation of breastfeeding in obese women still remained higher after introduction of per- and post-natal factors (RR 1.22, 95% CI 1.04-1.42). The prenatal non-intention to breastfeed was strongly associated with the non-initiation of breastfeeding for all categories of BMI. CONCLUSION Maternal obesity is associated with a two-fold rate of non-initiation of breastfeeding. Considering the benefits of breastfeeding and the increasing obesity rate, adapted interventions and specialized support should target both pre- and immediate post-natal periods in this population.
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Affiliation(s)
- Julie Verret-Chalifour
- Departments of Pediatrics, Centre hospitalier universitaire (CHU) de Quebec, Quebec city, Quebec, Canada
| | - Yves Giguère
- Departments of Medical Biology, Centre hospitalier universitaire (CHU) de Quebec, Quebec city, Quebec, Canada
| | - Jean-Claude Forest
- Departments of Medical Biology, Centre hospitalier universitaire (CHU) de Quebec, Quebec city, Quebec, Canada
| | - Jordie Croteau
- Laboratory of Biostatistics, Centre de recherche de l’institut universitaire en santé mentale de Quebec (Université Laval), Quebec city, Quebec, Canada
| | - Peiyin Zhang
- Departments of Pediatrics, Centre hospitalier universitaire (CHU) de Quebec, Quebec city, Quebec, Canada
| | - Isabelle Marc
- Departments of Pediatrics, Centre hospitalier universitaire (CHU) de Quebec, Quebec city, Quebec, Canada
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Gaudet L, Ferraro ZM, Wen SW, Walker M. Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:640291. [PMID: 25544943 PMCID: PMC4273542 DOI: 10.1155/2014/640291] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/09/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine a precise estimate for the contribution of maternal obesity to macrosomia. DATA SOURCES The search strategy included database searches in 2011 of PubMed, Medline (In-Process & Other Non-Indexed Citations and Ovid Medline, 1950-2011), and EMBASE Classic + EMBASE. Appropriate search terms were used for each database. Reference lists of retrieved articles and review articles were cross-referenced. METHODS OF STUDY SELECTION All studies that examined the relationship between maternal obesity (BMI ≥30 kg/m(2)) (pregravid or at 1st prenatal visit) and fetal macrosomia (birth weight ≥4000 g, ≥4500 g, or ≥90th percentile) were considered for inclusion. TABULATION, INTEGRATION, AND RESULTS Data regarding the outcomes of interest and study quality were independently extracted by two reviewers. Results from the meta-analysis showed that maternal obesity is associated with fetal overgrowth, defined as birth weight ≥ 4000 g (OR 2.17, 95% CI 1.92, 2.45), birth weight ≥4500 g (OR 2.77,95% CI 2.22, 3.45), and birth weight ≥90% ile for gestational age (OR 2.42, 95% CI 2.16, 2.72). CONCLUSION Maternal obesity appears to play a significant role in the development of fetal overgrowth. There is a critical need for effective personal and public health initiatives designed to decrease prepregnancy weight and optimize gestational weight gain.
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Affiliation(s)
- Laura Gaudet
- University of Ottawa, Faculty of Medicine, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
| | - Zachary M. Ferraro
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Healthy Active Living and Obesity (HALO) Research Group, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, Canada K1H 8L1
| | - Shi Wu Wen
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
| | - Mark Walker
- University of Ottawa, Faculty of Medicine, 451 Smyth Road, Ottawa, ON, Canada K1H 8M5
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, Canada K1H 8L6
- Ottawa Hospital Research Institute, Ottawa, ON, Canada K1H 8L6
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Garner CD, Ratcliff SL, Devine CM, Thornburg LL, Rasmussen KM. Health professionals' experiences providing breastfeeding-related care for obese women. Breastfeed Med 2014; 9:503-9. [PMID: 25347705 PMCID: PMC4267547 DOI: 10.1089/bfm.2014.0104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Obese women are at high risk of early breastfeeding cessation, and health professionals (HPs) have a unique opportunity to provide them with breastfeeding support. Our objective was to describe HPs' experiences providing breastfeeding care for obese women during the prenatal, peripartum, and postpartum periods. MATERIALS AND METHODS In-depth, qualitative interviews were conducted with 34 HPs (including obstetricians, midwives, pediatricians, nurses, and lactation consultants) who care for pregnant or lactating women. They were recruited from a variety of settings in central New York. Interviews were audio-recorded, transcribed, verified for accuracy, and then analyzed qualitatively. RESULTS HPs identified obesity in multiple ways, some of which were consistent with standard cutoffs, whereas others implied extreme obesity. Nearly all HPs discussed ways they perceive obese women have challenges with breastfeeding. Some HPs described challenges as specific to obese women (e.g., limited mobility), whereas others described challenges as universal but more likely to occur among obese women (e.g., difficulties positioning the infant to breastfeed). Across professions, HPs described providing breastfeeding care for obese women as requiring more time and physical work and as being more challenging. HPs acknowledged stigma around obesity and discussed treating obese women with dignity and the same as other women. Strategies were suggested for improving breastfeeding support for obese women. CONCLUSIONS HPs identified multiple challenges that obese women encounter with breastfeeding, as well as their own challenges with providing care. Comprehensive strategies are needed to assist obese women with breastfeeding and to alleviate strain on HPs who provide their care.
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Affiliation(s)
| | | | - Carol M. Devine
- Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Loralei L. Thornburg
- Department of Obstetrics and Gynecology, University of Rochester, Rochester, New York
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Heslehurst N, Newham J, Maniatopoulos G, Fleetwood C, Robalino S, Rankin J. Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework. Obes Rev 2014; 15:462-86. [PMID: 24629076 DOI: 10.1111/obr.12160] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 01/19/2023]
Abstract
Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty-five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included 'knowledge', 'beliefs about consequences' and 'environmental context and resources'. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change.
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Affiliation(s)
- N Heslehurst
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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John E, Cassidy DM, Playle R, Jewell K, Cohen D, Duncan D, Newcombe RG, Busse M, Owen-Jones E, Williams N, Longo M, Avery A, Simpson SA. Healthy eating and lifestyle in pregnancy (HELP): a protocol for a cluster randomised trial to evaluate the effectiveness of a weight management intervention in pregnancy. BMC Public Health 2014; 14:439. [PMID: 24886352 PMCID: PMC4018969 DOI: 10.1186/1471-2458-14-439] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 05/01/2014] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 1 in 5 pregnant women in the United Kingdom are obese. In addition to being associated generally with poor health, obesity is known to be a contributing factor to pregnancy and birth complications and the retention of gestational weight can lead to long term obesity. This paper describes the protocol for a cluster randomised trial to evaluate whether a weight management intervention for obese pregnant women is effective in reducing women’s Body Mass Index at 12 months following birth. Methods/design The study is a cluster randomised controlled trial involving 20 maternity units across England and Wales. The units will be randomised, 10 to the intervention group and 10 to the control group. 570 pregnant women aged 18 years or over, with a Body Mass Index of +/=30 (kg/m2) and between 12 and 20 weeks gestation will be recruited. Women allocated to the control group will receive usual care and two leaflets giving advice on diet and physical activity. In addition to their usual care and the leaflets, women allocated to the intervention group will be offered to attend a weekly 1.5 hour weight management group, which combines expertise from Slimming World with clinical advice and supervision from National Health Service midwives, until 6 weeks postpartum. Participants will be followed up at 36 weeks gestation and at 6 weeks, 6 months and 12 months postpartum. Body Mass Index at 12 months postpartum is the primary outcome. Secondary outcomes include pregnancy weight gain, quality of life, mental health, waist-hip ratio, child weight centile, admission to neonatal unit, diet, physical activity levels, pregnancy and birth complications, social support, self-regulation and self-efficacy. A cost effectiveness analysis and process evaluation will also be conducted. Discussion This study will evaluate the effectiveness of a theory-based intervention developed for obese pregnant women. If successful the intervention will equip women with the necessary knowledge and skills to enable them to make healthier choices for themselves and their unborn child. Trial registration Current Controlled Trials: ISRCTN25260464 Date of registration: 16th April 2010.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Sharon A Simpson
- South East Wales Trials Unit, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
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Foster CE, Hirst J. Midwives' attitudes towards giving weight-related advice to obese pregnant women. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjom.2014.22.4.254] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christine E Foster
- Midwife and a Supervisor, Midwives York Teaching Hospitals NHS Foundation Trust
| | - Janet Hirst
- Associate Professor, Maternal Care School of Healthcare University of Leeds Leeds West Yorkshire
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Morgan KL, Rahman MA, Macey S, Atkinson MD, Hill RA, Khanom A, Paranjothy S, Husain MJ, Brophy ST. Obesity in pregnancy: a retrospective prevalence-based study on health service utilisation and costs on the NHS. BMJ Open 2014; 4:e003983. [PMID: 24578535 PMCID: PMC3939655 DOI: 10.1136/bmjopen-2013-003983] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To estimate the direct healthcare cost of being overweight or obese throughout pregnancy to the National Health Service in Wales. DESIGN Retrospective prevalence-based study. SETTING Combined linked anonymised electronic datasets gathered on a cohort of women enrolled on the Growing Up in Wales: Environments for Healthy Living (EHL) study. Women were categorised into two groups: normal body mass index (BMI; n=260) and overweight/obese (BMI>25; n=224). PARTICIPANTS 484 singleton pregnancies with available health service records and an antenatal BMI. PRIMARY OUTCOME MEASURE Total health service utilisation (comprising all general practitioner visits and prescribed medications, inpatient admissions and outpatient visits) and direct healthcare costs for providing these services in the year 2011-2012. Costs are calculated as cost of mother (no infant costs are included) and are related to health service usage throughout pregnancy and 2 months following delivery. RESULTS There was a strong association between healthcare usage cost and BMI (p<0.001). Adjusting for maternal age, parity, ethnicity and comorbidity, mean total costs were 23% higher among overweight women (rate ratios (RR) 1.23, 95% CI 1.230 to 1.233) and 37% higher among obese women (RR 1.39, 95% CI 1.38 to 1.39) compared with women with normal weight. Adjusting for smoking, consumption of alcohol, or the presence of any comorbidities did not materially affect the results. The total mean cost estimates were £3546.3 for normal weight, £4244.4 for overweight and £4717.64 for obese women. CONCLUSIONS Increased health service usage and healthcare costs during pregnancy are associated with increasing maternal BMI; this was apparent across all health services considered within this study. Interventions costing less than £1171.34 per person could be cost-effective if they reduce healthcare usage among obese pregnant women to levels equivalent to that of normal weight women.
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The experiences of midwives when caring for obese women in labour, a qualitative study. Midwifery 2014; 30:103-11. [DOI: 10.1016/j.midw.2013.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 01/29/2013] [Accepted: 02/24/2013] [Indexed: 01/26/2023]
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The views and attitudes of health professionals providing antenatal care to women with a high BMI: a qualitative research study. Women Birth 2013; 27:138-44. [PMID: 24295597 DOI: 10.1016/j.wombi.2013.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 11/01/2013] [Accepted: 11/04/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND The prevalence of overweight and obesity is increasing amongst women of child bearing age. The objective of this study was to investigate the views and attitudes of providers of antenatal care for women who have a body mass index (BMI) of 30 kg/m(2) and over. METHODS A qualitative study using focus groups was undertaken within the department of obstetrics and gynaecology at a large teaching hospital in south-eastern Australia. Three focus group discussions were held. One with hospital midwives (n=10), one with continuity of care midwives (n=18) and one with obstetricians (n=5). Data were analysed using Interpretative Phenomenological Analysis (IPA). FINDINGS Six dominant themes emerged: (1) obesity puts the health of mothers, babies and health professionals at risk; (2) overweight and obesity has become the norm; (3) weighing women and advising about weight gain is out of fashion; (4) weight is a sensitive topic to discuss; (5) there are significant barriers to weight control in pregnancy; and (6) health professionals and women need to deal with maternal obesity. These themes are drawn together to form a model representing current health care issues for these women. CONCLUSION Health professionals, who have a high BMI, can find it difficult to discuss obesity during antenatal visits with obese women. Specialist dietary interventions and evidence based guidelines for working with child-bearing women is seen as a public health priority by health care professionals.
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