Management Of Maternal Obesity Research Articles

Obesity in pregnant females- A review article

Obesity is known as a prominent public health issue. It can be featured as an epidemic as it does no discrimination on the basis of age, gender, and socioeconomic status. Among pregnant females, incidence of obesity is getting increased and it is found to be linked with many complications that obstetricians are facing now-a-days. It also poses a huge confront to pregnant females as it is linked with unfavourable perinatal and maternal outcomes. Still, various studies revealed conflicting results between improvement in pregnancy outcome and lifestyle intervention. The objective of present review is to emphasize about complications, clinical significance and management of maternal obesity.

Obesity in Pregnancy: A Comprehensive Review of Influential Guidelines.

Obesity is one of the most common clinical entities complicating pregnancies and is associated with short- and long-term consequences for both the mother and the offspring. The aim of this study were to review and compare the most recently published influential guidelines on the management of maternal obesity in the preconceptional, antenatal, intrapartum, and postpartum period. A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynecologists of Canada, the Royal College of Obstetricians and Gynecologists, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists on obesity in pregnancy was carried out. There is an overall agreement among the reviewed guidelines regarding the importance of prepregnancy weight loss with behavioral modification, optimization of gestational weight gain, and screening for comorbidities in improving pregnancy outcomes of obese women. Women with previous bariatric surgery should be screened for nutritional deficiencies and have a closer antenatal surveillance, according to all guidelines. In addition, folic acid supplementation is recommended for 1 to 3 months before conception and during the first trimester, but several discrepancies were identified with regard to other vitamins, iodine, calcium, and iron supplementation. All medical societies recommend early screening for gestational diabetes mellitus and early anesthetic assessment in obese women and suggest the use of aspirin for the prevention of preeclampsia when additional risk factors are present, although the optimal dosage is controversial. The International Federation of Gynecology and Obstetrics, Society of Obstetricians and Gynecologists of Canada, Royal College of Obstetricians and Gynecologists, and Royal Australian and New Zealand College of Obstetricians and Gynecologists point out that specific equipment and adequate resources must be readily available in all health care facilities managing obese pregnant women. Moreover, thromboprophylaxis and prophylactic antibiotics are indicated in case of cesarean delivery, and intrapartum fetal monitoring is justified during active labor in obese patients. However, there are no consistent protocols regarding the fetal surveillance, the monitoring of multiple gestations, the timing and mode of delivery, and the postpartum follow-up, although weight loss and breastfeeding are unanimously supported. Obesity in pregnancy is a significant contributor to maternal and perinatal morbidity with a constantly rising global prevalence among reproductive-aged women. Thus, the development of uniform international protocols for the effective management of obese women is of paramount importance to safely guide clinical practice and subsequently improve pregnancy outcomes.

Socio-economic indicators, dietary patterns, and physical activity as determinants of maternal obesity in middle-income countries: Evidences from a cohort study in Mexico.

SummaryMaternal obesity is one of the main public health problems at a world level. It is a multifactorial disease with multiple causes, and few studies exist on its dietary patterns, physical activity and social determinants. This work aims to identify determinants of maternal obesity in a middle income country. Research is based on a prospective cohort design. Data were collected using questionnaires applied to pregnant women. Three dietary patterns were identified, and only half of the women carry out physical activity. The regression analysis showed an association between overweight/obesity and the following variables: age 25 to 29 years old (3.8; CI 1.6‐9.0), 30 to 34 years old (3.7; CI 1.2‐11.6); health problems during pregnancy (2.1; CI 1.0‐4.1); socio‐economic income (1.73; CI 1.54‐2.05); hypertension (2.7; CI 1.4‐4.5); mild food insecurity (1.9; CI 1.0‐3.8); moderate insecurity (3.7; CI 0.92‐15.4); refined food dietary pattern (.76; CI.61‐.95). The risk of increasing BMI during pregnancy mainly depends on socioeconomic and demographic variables such as age, educational level, income, food insecurity, and dietary pattern. This study's results could be used as evidences for the revision, planning, and adjustment of interventions for the prevention and management of maternal obesity, as a part of the national strategies against overweight and obesity.

Domestic and international management of maternal obesity in pregnancy

Domestic and international management of maternal obesity in pregnancy

Maternal Obesity Management Using Mobile Technology: A Feasibility Study to Evaluate a Text Messaging Based Complex Intervention during Pregnancy.

Background. Maternal obesity and excessive gestational weight gain (GWG) are on the rise with negative impact on pregnancy and birth outcomes. Research into managing GWG using accessible technology is limited. The maternal obesity management using mobile technology (MOMTech) study aimed at evaluating the feasibility of text messaging based complex intervention designed to support obese women (BMI ≥ 30) with healthier lifestyles and limit GWG. Methods. Participants received two daily text messages, supported by four appointments with healthy lifestyle midwife, diet and activity goal setting, and self-monitoring diaries. The comparison group were obese mothers who declined to participate but consented for their routinely collected data to be used for comparison. Postnatal interviews and focus groups with participants and the comparison group explored the intervention's acceptability and suggested improvements. Results. Fourteen women completed the study which did not allow statistical analyses. However, participants had lower mean GWG than the comparison group (6.65 kg versus 9.74 kg) and few (28% versus 50%) exceeded the Institute of Medicine's upper limit of 9 kg GWG for obese women. Conclusions. MOMTech was feasible within clinical setting and acceptable intervention to support women to limit GWG. Before further trials, slight modifications are planned to recruitment, text messages, and the logistics of consultation visits.

The role of GPs in preventing excessive gestational weight gain among obese women early in pregnancy

Background: Gestational weight gain (GWG) interventions early in pregnancy are an important part of a comprehensive approach to addressing maternal obesity. Given that General Practitioners (GPs) are most likely to confirm pregnancies and to provide early antenatal care, understanding their role in managing maternal obesity is an important first step in designing interventions for GPs that assist them in providing support and preventive care to their obese patients. Aims: (1) To determine how GPs perceive their role in managing maternal obesity; (2) To explore GPs experiences in managing maternal obesity and GWG; (3) To explore possible intervention components that would help GPs to manage maternal obesity. Methods: A semi-structured interview was designed to address the three aims of the study. GPs participating in shared antenatal care in the Perth metropolitan area were invited to participate. Data from the semi-structured interview were analysed using thematic analysis. Results: Fifteen GPs completed an individual interview. In discussing how GPs perceive their role in managing maternal obesity and minimising GWG, all respondents agreed that GPs have a key role. Despite this, most GPs recognised that they lacked the skills and confidence. On the topic of current experiences in managing maternal obesity, two themes were identified: (1) variation in the scope, timing, and effectiveness of discussing the risks of maternal obesity; and (2) barriers to managing GWG in a GP setting (e.g. skills and time). In discussing components of an intervention, GPs suggested incorporating training, as well as practical strategies and information on GWG and weight management. Conclusions: GPs acknowledged that they have a vital role to play in the management of maternal obesity and GWG, however, their current practice and skills varied widely. This study suggests supporting GPs to deliver a GWG intervention is essential to managing maternal obesity in the primary care setting.

A review of national health policies and professional guidelines on maternal obesity and weight gain in pregnancy.

Maternal obesity creates an additional demand for health-care services, as the routine obstetric care pathway requires alterations to ensure the most optimal care for obese women of childbearing age. This review examines the extent to which relevant national health documents reflect and respond to the health implications of maternal obesity and excessive gestational weight gain. A targeted search of peer-reviewed publications and grey literature was conducted for each country to identify national health documents, which were subsequently content analyzed according to an adapted framework. A total of 37 documents were identified, including one policy, 10 strategies and 26 guidelines, published within the last 10 years. Out of the 31 countries investigated, only 13 countries address maternal obesity while none address excessive gestational weight gain. We found inconsistencies and gaps in the recommendations to health-care service providers for the management of maternal obesity and weight gain in pregnancy. The findings show that only limited guidance on maternal obesity and gestational weight gain exists. The authors recommend that international, evidence-based guidelines on the management of maternal obesity and excessive gestational weight gain should be developed to reduce the associated health-care and economic costs.

The Maternal Obesity Management (MOM) Trial Protocol: A lifestyle intervention during pregnancy to minimize downstream obesity

BackgroundMaternal obesity and/or high gestational weight gain (GWG) are associated with downstream child obesity. Pregnancy represents a critical period for prevention as women are highly motivated and more receptive to behavior change. ObjectiveThis pilot study was developed to test the feasibility of intervening with the mother, specifically keeping her GWG within the Institute of Medicine (IOM) limits, with the intended target of preventing obesity in her child downstream. We are testing the practicality of delivering a structured physical activity and nutrition intervention to pregnant women during gestation and then following mom and baby to 24months of age. Study designThis study is a two-arm, parallel group, randomized controlled trial being conducted in Ottawa. Pregnant women, with pregavid BMI >18.5, between 12 and 20weeks gestation are randomized to one of two groups: intervention (n=30) who receive the MOM trial Handbook (guide to healthy gestation) plus a structured physical activity and nutrition program, or a standard clinical care control group (n=30). The intervention lasts 25–28weeks (6months) depending on anticipated delivery date, with follow-up assessment on mother and child at 3, 6, 12 and 24months post-delivery. SignificancePregnancy, a critical time of growth, development and physiological change, provides an opportunity for early lifestyle intervention. The goal of identifying an effective lifestyle program for the gestational period that leads to healthy fetal development and subsequently normal weight offspring, less likely to develop obesity and its co-morbidities, is unique and could possibly attenuate the inter-generational cycle of obesity.

Implementing change through clinical audit cycle to improve care of obese pregnant women: a reality!

BackgroundObesity is increasing in prevalence and maternal obesity confers high risk status. Focussed local efforts are needed in all care settings to ensure that a strategic framework is in place...

Maternal Obesity: Consequences and Prevention Strategies

Obesity is a medical condition in which excess body fat that it may have an adverse effect on health, leading to life expectancy and increased health problems. In keeping with the general international trend of rising prevalence of obesity, maternal obesity prevalence is rising. According to WHO, the prevalence of obesity in pregnancy ranges from 1.8 to 25.3%. Maternal obesity has been identified to be a risk factor for maternal and perinatal mortality. The aim of this article was reviewed in research about maternal obesity in Pubmed, which published between 2009 and 2010. 7 reviews and 13 studies was examined and they presented under this headings: impacts of maternal obesity in pregnancy, obstetric outcomes of maternal obesity, postpartum outcomes of maternal obesity, impact of maternal obesity on breastfeeding, impact of maternal obesity on procedure of anomaly scan and risk determination, maternal obesity and fetal complications, impact of maternal obesity on Apgar scores, obesity and infertility, pregnancy following bariatric surgery, long term effects of obesity, management of maternal obesity.

Community-based service provision for the prevention and management of maternal obesity in the North East of England: A qualitative study

This study was conducted to develop a better understanding of community-based initiatives relating to maternal obesity, and to gain community service providers' views on maternal obesity services and their perceived role in the management and prevention of maternal obesity. An interpretive constructionist approach using semi-structured interviews and focus groups. Semi-structured interviews and focus groups were carried out with community service providers in the North East of England, UK. Data were analysed using thematic content analysis. Five dominant themes emerged: community-based obesity services, understanding maternal obesity services, participation in maternal obesity services, challenges in the development of community maternal obesity services, and factors contributing to successful maternal obesity services. Community service providers identified their role in tackling maternal obesity alongside maternity services. Participants identified a lack of community maternal obesity services, distinct training requirements, and felt that a multi-agency approach was likely to be required. Increasing rates of maternal obesity and the relationship between maternal obesity and childhood obesity mean that the preconception, pregnancy and postnatal periods are important and timely stages in the life course for public health intervention. However, current public health and community service provision lacks structured maternal obesity objectives.