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An epidemic of obese pregnant women on a West Essex hospital labour ward

Monday, 24 June, 2013 - 12:42
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An Epidemic Of Obese Pregnant Women On A West Essex Hospital Labour Ward



Consultant Obstetrician and Gynaecologist, Princess Alexandra Hospital NHS Trust, Essex, UK

The UK Centre for Maternal and Child Enquiries (2006–2008) reported that 49% of women who died and for whom the body mass index(BMI) was known were either obese or overweight. Maternal obesity is one of the most commonly occurring risk factors in obstetric practice. In our study, we assessed the incidence, ethnic association and complications of raised body mass index (BMI) in pregnant women at a busy West Essex hospital.

This is a prospective cohort study which includes all women who delivered consecutively in our unit over a 4 months period between April to July 2012. Women with multiple pregnancy were excluded. During that period there were 1539 deliveries, 20 were multiple pregnancy and BMI was not documented in 50 cases, these were excluded from the study. A comparison of pregnancy outcomes was made on the basis of maternal BMI at the time of booking. A total of 1469 singleton pregnancies were studied. There were 249 (17%) normal weight (BMI 19-24.9), 713 (48.5 %) overweight (BMI 25-29.9), 315 (21.4 %) obese (BMI = 30-39.9) and 192 ( 13%) extremely obese ( BMI > 40). Thefollowing antenatal complications were studied. Development of pregnancy induced hypertension, gestational diabetes mellitus, intervention in labour, postpartum complications and birth outcome were examined. The data is presented as frequencies. Adjusted odds ratios looking for trend with 95% confidence interval were used.

The following outcomes were more common in women with BMI of 30 or more compared to women with normal body mass index {odds ratio ( 95% confidence interval]. Pregnancy induced hypertension:2.65(1.73-4.07) p<0.001, gestational diabetes mellitus: 1.98( 0.63-6.19) p<0.05, emergency Caesarean section 1.89(1.89-3.2)p<0.001, postpartum haemorrhage:5.11(2.51-10.38) p<0.001, Apgar scores of < 8 at 5 minutes: 1.86 ( 1.34-2.65), baby weight >3.5 kg: 2.1 ( 1.9-5.1) Women of Caucasian origin were more likely to have a high BMI :2.0 ( CI: 1.9 –4.62 ) p< 0.001 as compared to Afro-carribean and Asian women. There was only 1 shoulder dystocia in a woman of BMI 33.

Obesity has a detrimental effect by increasing antenatal and postnatal complications. Maternity units should develop specialistmultidisciplinary weight management clinics for pre-pregnancy counseling of obese women contemplating pregnancy. Any woman with BMI >35 should be identified as high risk and treated in line with joint CMACE/RCOG guidelines published in March 2010.

•Saving mothers’ lives: reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG 2011;118:1–203.
•CMACE/RCOG joint guideline: Management of women with obesity in pregnancy. March 2010