Engagement with and outcomes of a Midwifery-led intervention group for pregnant women of high body mass index.

Abstract

To compare pregnancy care, maternal and neonatal outcomes of women with Body Mass Index (BMI) >30 enrolled in a Weight Intervention Group versus other models of antenatal care. Retrospective, case-control study of mothers with BMI >30 managed with a specialised programme versus age-matched women enrolled in standard models of care. One thousand, one hundred and fifteen of 9954 pregnant women with singleton pregnancies, had a BMI >30, of whom 9.6% enrolled in the intervention group. Compared to controls, the intervention group had superior implementation of local high BMI guidelines, including; nutritional /weight gain advice (86% vs. 46%, p < 0.001), regular weighing (80% vs. 33%, p < 0.001), lactation consultant referrals (8% vs. 1%, p = 0.02), third trimester anaesthetic review and ultrasound (50% vs. 20.9%, p = 0.04 and 55% vs. 43%). Initiation of breastfeeding was higher in the intervention group (100% vs. 90%, p = 0.001). No significant difference was noted in Caesarean rate (30% vs 32%) and birthweight (3538 g vs 3560 g). Women with high BMI enrolled in a specialised antenatal management programme received increased care, and had superior breastfeeding initiation rates. However, engagement was poor, and no significant differences were noted in antenatal or postnatal complications, mode of birth or neonatal outcome.