Overweight and Obese Mothers At Risk for Adverse Pregnancy Outcomes
Asma’ Hemeid, Zaher Nazzal, Lubna AlSaudi.
*High Specialty in Family Medicine, Department of Family and Community Medicine, AnNajah National University, Nablus, West Bank/Palestine
Adverse pregnancy outcomes either maternal or neonatal are very serious. According to Palestinian Health Annual Report of 2017, we have a maternal mortality ratio of 5.9/100 000, a significant number of near miss cases (56 cases) mostly due to pre-eclampsia and hemorrhage, more than 4.4/1000 stillbirths and 6.4/1000 early neonatal deaths (0-6 days old) which occurs mostly due to prenatal conditions.
We aim to study various risk factors and their relation to adverse pregnancy outcomes including Pre-pregnancy overweight and obesity, smoking, parity, gaining weight more than or below recommended according to BMI, Birth space and the number of antenatal care visits (ANC).
Methods: A 1:1 matched case-control study of 300 mothers who gave birth in Hebron Hospital (Alia) Obstetric department during 2019 were studied. Women, aged 15-49 years, who gave birth to a singleton were included. Cases had at least one adverse pregnancy outcome, while controls had none. Adverse outcomes were defined as gestational hypertension, preeclampsia, gestational diabetes, cesarean section, postpartum hemorrhage (blood loss ≥1000), admission to intensive care unit, Preterm delivery<37 weeks, shoulder dystocia, low birth weight neonates<2500 g, high birth weight neonates ≥4000 g, Apgar at 5 min <7, admission to neonatal intensive care unit, and congenital malformation.
Postpartum women completed a questionnaire during a face to face interview in the obstetric department. Data from hospital charts were extracted and interview responses were correlated with data in the “Mother and Child Health Handbook”, which is completed during antenatal care visits. Data were analyzed using SPSS, logistic regression is used and significance was set at a p value of less than 0.05. This study was approved by the Institutional Review Board committee at An-Najah National University.
Results: The median age of participants is 26.4 years. There is no significant difference between cases and controls in Demographic factors. Pre-pregnancy overweight and obesity (p is 0.03), Primigravidity (p is 0.015) and multiparity ≥5 (p is 0.007) were found to be associated with adverse pregnancy outcomes.
Conclusion: Given our findings, we need to encourage health providers to do Healthy dietary promotion programs and exercise for reproductive age women in the community, to address weight management in pre-pregnancy counseling and consider elevated prepregnancy BMI as high risk group.
I recommend doing clinical trials to determine whether dietary and lifestyle interventions among women with elevated prepregnancy BMI can reduce adverse pregnancy outcomes.
Keywords: adverse outcomes, overweight, obesity, mothers, pregnancy.