Abstract
More than half of women are reported to be overweight or obese in Mongolia, thus becoming a big health issue. Though maternal obesity is a known risk factor for cesarean section (CS), it remains unclear how much a high maternal body mass index (BMI) would influence the risk of CS among pregnant women in Mongolia. This study aimed to investigate whether a higher maternal BMI is related to CS delivery in Darkhan-Uul Province, Mongolia. Pregnant women at 20 weeks’ gestation or less who visited public health facilities for antenatal health checkups between November 2015 and January 2016 were recruited. Data were collected using self-administered questionnaires, body weight measurement, and medical records. In total, 508 pregnant women participated, and data from 336 women were analyzed. Multiple logistic regression analysis showed that higher maternal BMI at first antenatal care visit (adjusted odds ratio [AOR] = 1.102, p = .033), higher gestational weight gain (AOR = 1.111, p = .001), older maternal age (AOR = 1.076, p = .030), and gestational age at delivery (AOR = 0.765, p = .005) were associated with CS delivery. This study is the first to demonstrate that higher maternal BMI and higher gestational weight gain are associated with CS delivery in Mongolia. Moreover, older maternal age and lower gestational age at delivery were found to be associated with CS delivery. Preventing obesity among women is important not only from the viewpoint of prevention of lifestyle diseases but also from the obstetric point of view; it is important for medical personnel to communicate the importance of preventing obesity to all women in Mongolia.
Highlights
The prevalence of obesity, which has increased worldwide, is a public health concern (NCD Risk Factor Collaboration, 2017; World Health Organization, 2018) because obesity is a risk factor for several noncommunicable diseases such as hypertension, coronary heart disease (Manson et al, 1990), stroke (Song, Sung, Davey Smith, & Ebrahim, 2004), and many cancers (Calle, Rodriguez, Walker-Thurmond, & Thun, 2003; Reeves et al, 2007)
Data of 356 women were available from medical records, from which we obtained information on gestational age and estimated date of confinement (EDC), and recalculated the gestational age at baseline survey for confirmation
The results of the bivariate analysis showed that maternal age at recruitment, employment status, maternal weight at the first antenatal care visit, maternal weight at recruitment, maternal body mass index (BMI) at recruitment, pre-parturient maternal weight, preparturient maternal BMI, gestational age at childbirth, and gestational weight gain, were significantly correlated with the mode of delivery
Summary
The prevalence of obesity, which has increased worldwide, is a public health concern (NCD Risk Factor Collaboration, 2017; World Health Organization, 2018) because obesity is a risk factor for several noncommunicable diseases such as hypertension, coronary heart disease (Manson et al, 1990), stroke (Song, Sung, Davey Smith, & Ebrahim, 2004), and many cancers (Calle, Rodriguez, Walker-Thurmond, & Thun, 2003; Reeves et al, 2007). In Mongolia, 49.0% of 15–64-yearold men and 59.9% of 15–64-year-old women are either overweight (25.0 kg/m2 ≤ body mass index (BMI) < 30.0 kg/m2) or obese (BMI ≥ 30 kg/m2) (Public Health Institute of the Ministry of Health and Sports, 2013). The CS rates are increasing worldwide despite this recommendation (Ye et al, 2014; World Health Organization, 2015) because maternal age and the prevalence of obesity are increasing (Ye et al, 2014). In Mongolia, CS rates have been increasing as well, with 22.4% in 2012 (Center for Health Development, 2012) and 25.4% in 2016 (Center for Health Development, 2016)
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