Obesity is a worldwide public health concern that affects many pregnant women. According to new research published in British Journal of Obstetrics and Gynaecology, pregnancy is an ideal time to initiate healthy weight and lifestyle discussions with patients.
Dr Debbie Smith, research associate in the school of nursing, midwifery, and social work at the University of Manchester in the United Kingdom, and Dr Tina Lavender, professor of midwifery in the school of nursing, midwifery, and social work, recognized the lack of evidence for effective maternal care for pregnant women who have a BMI of 30 kg/m2 or higher. They conducted a meta-synthesis of 6 studies conducted over a 13-year period to better understand the issues facing these women and how clinicians might improve care for these patients.
Their results yielded 3 main themes: acceptance and inevitability of weight gain in pregnancy; depersonalization resulting from the medicalization of treatment; and healthy lifestyle benefits for self and baby. Specifically, many of the women felt weight gain during pregnancy was acceptable and could be addressed during the postnatal period. Women also reported that they did not receive adequate information about the risks associated with obesity during pregnancy or even why they were being screened and monitored. Some women also reported receiving negative treatment as a result of their weight. On the upside, many women could appreciate the benefits of a healthy lifestyle and weight and considered pregnancy as a good opportunity for them to begin improvements.
“Pregnancy is an ideal period for health professionals to intervene, as women with a BMI ≥ 30 kg/m2 perceive their weight as more acceptable than when they were not pregnant, and are aware of the benefits of having a healthy lifestyle,” concluded Smith and Lavender. “Antenatal care should include postnatal weight management advice, as this is the period when women with a BMI ≥ 30 kg/m2 want to lose weight; this may enable subsequent pregnancies to start with a lower BMI. Such advice should be sensitive and tailored to the individual.”
The results of this study have important clinical significance and should serve as a wake-up call for all obstetricians treating larger women. As Dr Philip Steer, emeritus professor of obstetrics and gynecology in the faculty of medicine at Imperial College in London, UK, and editor-in-chief of BJOG, commented, “Maternity services are a vital component of care for pregnant women with a BMI of more than 30kg, as a healthy pregnancy determines a baby’s life chances, and interventions are needed to ensure that maternal obesity is associated with minimal maternal and fetal risk. Therefore, pregnancy is a good time to intervene and this paper provides valuable insight into the needs of these pregnant women.”
Smith D, Lavender T. The maternity experience for women with a body mass index ≥ 30 kg/m2: a meta-synthesis. BJOG. 2011; doi: 10.1111/j.1471-0528.2011.02924.x
What is the maternity experience for obese women, researchers ask.
BJOG.org. March 9, 2011.