The Impact Of Obesity And Pregnancy

THE IMPACT OF OBESITY AND PREGNANCY

CHAPTER ONE

INTRODUCTION

• Background

Obesity during pregnancy has been associated with increased risk of fetal macrosomia and medical complications, including pregnancy-induced hypertension, gestational diabetes, and cesarean delivery.Historically, gaining a healthy weight appropriate for pregnancy was a struggle for women due to insufficient nutrition (Samura et al., 2016). However, in the past few decades, excessive weight gain has become prevalent globally, affecting all age groups, including pregnant women (Yao, Park, Foster, &Caughey, 2017; Guelinckx, Devlieger, Beckers, & Vansant, 2008). Excessive weight gain also known as obesity, is a global epidemic and pregnant women are more vulnerable to gaining excessive weight as a result of increased nutritional requirement during the period of pregnancy necessary for the mother and baby’s health (Guilloty et al., 2015; Melere et al., 2013).

The weight gained by a woman during pregnancy known as gestational weight has important health implications for both mother and child (Institute of Medicine, IOM, 2009). Inadequate and excessive weight gain is linked with health risks for the mother and the foetus (Rhodes JR &Schoendorf KC, 2013). In spite of this, most developing countries in Africa have overweight and obesity prevalence rate of above 10% (Neupane, Prakash, &Doku, 2016). Two-thirds of American women are overweight or obese, and up to 50% of American women gain excess weight as compared to the current recommendation (Samura et al., 2016).

While inadequate Obesity is associated with low birth weight, preterm delivery and anaemia, excessive weight gain can lead to adverse maternal and fetal outcomes such as large for gestational age (LGA) infants, caesarian delivery, gestational diabetes mellitus

(GDM), preeclampsia, early pregnancy loss, and post-partum weight retention (Catalano & Ehrenberg, 2006). Optimal Obesity contributes to positive pregnancy outcomes such as growth and development of the foetus and reduced likelihood of mortality during pregnancy (Butte & King, 2005).

In recognition of the importance of gestational weight and its role in determining the health of the mother, foetus as well as birth outcomes, the Institute of Medicine (IOM) in 1990, issued the first evidence-based guidelines for Obesity in relation to maternal pre-pregnancy body mass index (BMI). Primarily it was a concern for women with prepregnancy underweight and low Obesity that spurred the creation of the first IOM guidelines (IOM, 1990). Now, amidst the prevalence of obesity among all groups and the observation that an increasing number of women were gaining weight excessively during pregnancy, the IOM revised their guidelines in 2009, adding recommendations for Obesity based on a woman’s pre-pregnancy body mass index (Samura et al., 2016; IOM & NRC, 2009). The IOM guidelines have defined limits for weight gain in pregnancy according to initial or pre-pregnancy BMI ranging from 12.5-18 kg in those with a BMI<18.5 kg/m2, 11.5 – 16 kg for those with a healthy BMI of <24.9 kg/m2 to 7 -11.5 kg in the overweight (BMI 25.0-29.9 kg/ m2) and 5.0 -9.0 kg in the obese (≥ 30 kg/m2). For twin pregnancy, the IOM recommends a Obesity of 16.8–24.5 kg for women of normal weight, 14.1–22.7 kg for overweight women, and 11.3 –19.1 kg for obese women. The IOM guidelines recognize that data is insufficient to determine the amount of weight women with multifetal (triplet and higher order) gestations should gain (Gain & Pregnancy, 2013).

Additionally, Obesity is also influenced by a range of biological, metabolic, and social factors, which include maternal multi-parity (Thame, Jackson, Maxwell, Osmond,& Antoine, 2010), maternal age, smoking, educational status (Rasmussen et al., 2009b), healthy eating, physical activity (Butte & King, 2005), and inadequate counseling of mothers on weight gain during pregnancy (Brawarsky et al., 2005). The prevalence and factors influencing Obesity are varied across different regions and settings highlighting the need for studies to identify the prevalence and influencing factors specific to different settings to inform recommendations regarding weight gain goals during pregnancy so as to avoid complications   (Choi, 2017; Drehmer et al., 2010).

Recent epidemiologic findings indicate that weight control may offer the potential for affecting gestational outcomes, especially among women planning a first pregnancy.With this in mind, this paper conducted  a study of the impact of obesity and pregnancy.

1.2 Problem Statement

There is a rising prevalence of excessive weight gain in pregnancy which is of public health concern (Yao, Park, Foster, &Caughey, 2017). Several studies on Obesity in developed countries indicated that more than 40% of women are gaining weight above the recommended IOM ranges(Campbell, Johnson, Messina, Guillaume, &Goyder, 2011; Yao et al., 2017). It is further estimated that over 75 % of African American women of reproductive age are overweight or obese and this increases their already high risk for obesity-related adverse pregnancy outcomes (Goodrich, Cregger, Wilcox, & Liu, 2013).

It is well documented that Obesity and obesity is associated with adverse maternal and neonatal outcomes such as increased risk of pre-eclampsia, caesarean section, instrumental delivery, preterm delivery and gestational diabetes(Hui et al., 2014; Campbell et al., 2011; Guilloty et al., 2015; Tabb, Malinga, Pineros-Leano, & Andrade, 2017). In spite of the dangers posed by inadequate and excessive Obesity, monitoring of Obesity in developing countries is poor and there are few studies conducted in developing countries investigating weight gain during pregnancy (Drehmer et al., 2010). This can be attributed to the challenges associated with collecting data throughout the pregnancy period in developing countries (Winkvist, Stenlund, Hakimi, Nurdiati, & Dibley, 2002) leading to a neglect of Obesity as a public health issue in the developing world (Asefa&Nemomsa, 2016).

Despite increasing obesity and Obesity especially among women of reproductive age, the government of Ghana has committed resources to fighting infectious diseases because of the limited healthcare resources (Anderson, 2017). Pre-eclampsia which is a consequence of Obesity has contributed to the high maternal mortality rate in Ghana (Bailey et al., 2017; Sumankuuro, Crockett, & Wang, 2017) yet there is little studies done to determine the prevalence of Obesity and the contributory factors among different groups across the Ghanaian society (Addo, 2010; Abubakari&Jahn, 2016; Abubakari, Kynast-Wolf, &Jahn, 2015). Review of literature as far as this study is concerned found that no study has examined the prevalence of Obesity and contributory factors in the Tema General Hospital. Therefore, this study aimed to assess the prevalence of Obesity and its contributory factors among pregnant women in the Tema General Hospital of the Greater Accra Region.

1.3 Justification Of The Study

The prevalence of Obesity as well as associated factors are not well established and highlighted in developing countries due to limited research investigating the issue of weight gain during pregnancy (Drehmer et al., 2010). There has been consistent evidence that the gestational period is a critical part of life in which both excessive and inadequate weight gain are associated with adverse pregnancy outcomes (Widen et al., 2015; Yao et al., 2017) yet there remains a lack of information in terms of prevalence and contributory factors to determine the scope and magnitude of the problem and the interventions which need to be put in place to tackle the associated factors. The numerous adverse outcomes associated with inadequate and excessive weight gain can only be minimized if the prevalence and contributing factors are comprehensively identified and adequately articulated through research. According to Drehmer et al., (2010) it is important to understand the extent of prevalence of gestational weight and its associated factors in order to be able to revise guidelines and plans to address the situation. Results from this study would provide baseline information on prevalence of Obesity and unearth the factors that contribute to sub optimal, adequate and excessive weight gain among pregnant women.

1.4 Research Questions

The following questions were asked in relation to the objectives of the study;

1. What is the health effect of obesity on the pregnant mother and the unborn child?
2. What is the association between obesity and complications during pregnancy?

1.5 General Objective

To determine the Impact of Obesityon Pregnancy

1.4.1 Specific objectives

1. To determine the health effect of obesity on the pregnant mother and the unborn child.
2. To find out whether Obesity is capable causing complications during pregnancy

1.6 Restatement of Hypothesis

The following hypothesis were adopted for the study:

• Hypothesis One

H0: Obesity affects Child health negatively

Hi: Obesity does not  affect Child health negatively

Hypothesis Two

H0: Obesity causes complications during pregnancy

Hi:Obesity does not  cause complications during pregnancy

1.7 Scope Of The Study

The research mainly targeted the impact of obesity on pregnancy.It also examined factors the health effect of obesity among  pregnant mothers.

1.8 Organization Of The Study

The success of any research work depends on how it is orderly organized.This thesis consisted of five chapters. Chapter one involved the introduction and provided background information, and then discussed key research issues such as, statement of the problem, rationale of the study, research questions, objectives, profile of the study area, the scope as well as the organization of the study which was relevant to this research and establishes an understanding as to why this research was undertaken. Chapter two is the review of the literature on  obesity .  Chapter three comprised of, methodology, limitations and assumptions of the study as well as the ethical considerations. Chapter four showed the description of the characteristics of the study population in a form of frequencies, percentages and tables. Chapter four also covered the analysis and discussion which involved the background characteristics with the dependent variable. Finally, chapter five presented a summary, conclusion and recommendations of the study.

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