27.04.2014

Pre pregnancy predictors of obesity

The Project envisages the development of a common methodology for the preparation, storage, dissemination and evaluation of scientific literature in electronic format. In Thailand, there is not much study showing both the prevalence and complications of these conditions.
The objectives of this study were to estimate the prevalence of pre-pregnancy overweight and obesity and their impacts on adverse pregnancy outcomes. After multiple logistic regression analysis was done, women in obesity group were correlated with having 1, 2 and 3 complications. They were also correlated with preeclampsia, gestational diabetes, cesarean section, higher birth weight group and long neonatal length. Conclusions: This Thai prevalence of obesity in pregnancy should alarm health care providers to be more prepared, for a future health problem of the country.
Many complications that come with obese pregnant women that were reported in western countries also happen in Thai population.
INTRODUCTIONIn 2009, World Health Organization (WHO) announced obesity in pregnancy as one of the important non-communicable diseases that threaten maternal and child health [1]. And it established the roles of health care personnel in early detection and giving interventions to prevent complications from high pre-pregnancy body mass index (PP-BMI) and obesity [2].The prevalence of obesity in pregnancy has been increasing along with the prevalence of obesity in general population [3,4].
There was a report from another Thai hospital showed that the prevalence of overweight was 13% and obesity was only 4% [13].Obesity along with high PP-BMI is also known to cause many complications ranging from increased risks of infertility, hypertensive disorders, gestational diabetes mellitus, pregnancy-related pelvic pain, preterm labor, postterm, obstructed labor, intrauterine fetal death, stillbirth, operative obstetrics procedure and cesarean section [3,6,10-12,14-27]. Moreover, there are reports stating that obesity also increased minor complications in pregnancy and caused additional costs from using more frequent health care services [29-31].In Thailand, there is not much study showing the relation of adverse outcomes of obesity and high PP-BMI in pregnant women.
The first study reported the correlation of obesity only with higher cesarean delivery, pregnancy-induced hypertension and large for gestational age [32]. Another study in 2011 showed that overweight and obesity resulted in significant risk of cesarean section, preeclampsia, diabetes mellitus and postpartum hemorrhage. But no correlation was found between PP-BMI to stillbirth and congenital anomaly [13].The first objective of this study was to estimate the prevalence of pre-pregnancy overweight and obesity in pregnant women at LPH.
The second objective was to identify the increased proportion of adverse pregnancy outcomes in these groups of women. Data of all pregnant women who delivered at labor room LPH were collected from 1st February 2011 to 31st August 2012. But from 2011, health care personnel of LPH were encouraged to document pre-pregnancy weight and height data of every pregnant woman from her first antenatal care visit.


Data collection of this study were pre-pregnancy weight, height and BMI along with demographic, obstetric and pregnancy outcomes of both mother and child. Categorization of BMI This study used the definition of The National Heart, Lung and Blood Institute in 1998 to classify pre-pregnancy BMI [33]. Nevertheless, low BMI group was also supplemental defined for the analysis as pre-pregnancy BMI 2. Analysis ProcedureIn the analysis, the proportions of pregnant women with each group of PP-BMI were calculated. Demographic, obstetric, complications in pregnancy and pregnancy outcomes of both mother and child were compared among 4 groups of PP-BMI. The interested variables were maternal age, maternal height, gravidity, private delivery case, frequency of antenatal care (ANC), health benefit scheme, places of ANC, HIV infection, 1st and 2nd hemoglobin test, complication in pregnancy, gestational age, mode of delivery, presentation, neonatal sex, birth weight, neonatal length and Apgar score.Data were analyzed in a retrospective cohort approach using standard statistical software. Univariate analysis showed that overweight and obesity group had significantly more women with elderly pregnancy. Proportions of short maternal stature (height The proportions of nulliparous women in overweight and obesity group were significantly much lower than the other 2 groups. The proportions of private delivery case were significantly lower in overweight and obesity group too. Demographic and obstetric characteristics of women classified into 4 pre-pregnancy BMI groups.Table 2. Complications during pregnancy in women classified into 4 pre-pregnancy BMI groups.and obesity group had significantly higher proportions of women with universal coverage scheme.
Nevertheless, these 4 groups of PP-BMI did not have significant difference of proportions of women having twins pregnancy, no antenatal care (ANC), private ANC only and HIV infection.The overweight and obesity group significantly had lower proportion of women with anemia from both routine Hemoglobin 1 (Hb1) and Hemoglobin 2 (Hb2) test. Regarding complication in pregnancy, overweight and obesity group significantly had higher proportions of women having 1, 2 and 3 complications.
Further analysis of these complications showed that overweight and obesity group significantly had higher proportions of women with preeclampsia and gestational diabetes but not with Antepartum hemorrhage, chorioamnionitis, postpartum hemorrhage and premature rupture of membrane.Table 3 shows the results of univariate analysis of pregnancy outcomes. These 4 groups of PP-BMI had comparable proportions of women with preterm and postterm birth.
Regarding mode of delivery, overweight and obesity group had significantly more women who delivered by cesarean section (CS). Outcomes of pregnancy in women classified into 4 pre-pregnant BMI groups.cesarean and cephalopelvic disproportion (CPD), while the indication of fetal distress were comparable among 4 groups of PP-BMI.


The proportions of vertex presentation and male neonate were comparable among these 4 groups of PP-BMI.Overweight and obesity group had significantly higher proportions of neonates with birth weight ? 3500 gm.
Women in overweight and obesity groups were still correlated with having 1 and 2 complications.
Knowing that obesity prevalence in Thai population is still low, should not prohibit Thai health care personnel from good public health policies to decrease obesity in reproductive age women.The second objective of this study showed that prepregnancy overweight and obesity posed many morbidities to both mother and child.
Women with overweight and obesity were correlated with having more items of complication comparing to normal and low prepregnancy BMI.
This is especially true for obesity strongly correlated with having 3 items of complication. This also concurs with some studies that gestational age was not affected by obesity in pregnancy [6,10,11,21]. Cesarean section and high birth weight had always been shown from other studies to be correlated with overweight and obesity [6,10,12,13,21]. When comparing with the result from a Thai study that showed PPH as a significant complication of obesity, its prevalence of PPH in every group of PP-BMI was much higher than this study [13]. First, the prevalence of obesity in pregnancy should alarm health care providers to be more prepared, for this should be a future health problem of the country. Future study should be done using these criteria, for it should increase the prevalence drastically.The second result of this study added important knowledge for Thai obstetric society as well. It showed that there are many complications that come with obese pregnant women even for Thais.
This should alert health care providers to prevent these adverse events either before or during pregnancy.
Since obesity is a modifiable risk factor, decreasing body weight before conception, giving correct health education, well planned pregnancy, antenatal lifestyle intervention and even gestational weight gain restriction could help avoiding the uneventful morbidities [34-37].Further research should be done focusing on the criteria of obesity adjusted for the increased pregnancy complications.
Moreover, future studies should have more samples than this study and prospective data collection should be considered if uncommon pregnancy complications would be investigated.



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