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- Akselsson, Anna, et al.
(författare)
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Prolonged pregnancy and stillbirth among women with overweight or obesity : A population-based study in Sweden including 64,632 women
- 2023
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The proportion of overweight or obese pregnant women is increasing in many countries and babies born to a mother who is overweight or obese are at higher risk for complications. Our primary objective was to describe sociodemographic and obstetric factors across Body Mass Index (BMI) classifications, with secondary objective to investigate stillbirth and other pregnancy outcomes in relation to BMI classifications and gestational week.METHODS: This population-based cohort study with data partly based on a cluster-randomized controlled trial includes 64,632 women with singleton pregnancy, giving birth from 28 weeks' gestation. The time period was January 2016 to 30 June 2018 (2.5 years). Women were divided into five groups according to BMI: below 18.5 underweight, 18.5-24.9 normal weight, 25.0-29.9 overweight, 30.0-34.9 obesity, 35.0 and above, severe obesity.RESULTS: Data was obtained for 61,800 women. Women who were overweight/obese/severely obese had lower educational levels, were to a lesser extent employed, were more often multiparas, tobacco users and had maternal diseases to a higher extent than women with normal weight. From 40 weeks' gestation, overweight women had a double risk of stillbirth compared to women of normal weight (RR 2.06, CI 1.01-4.21); the risk increased to almost four times higher for obese women (RR 3.97, CI 1.6-9.7). Women who were obese or severely obese had a higher risk of almost all pregnancy outcomes, compared to women of normal weight, such as Apgar score < 7 at 5 min (RR1.54, CI 1.24-1.90), stillbirth (RR 2.16, CI 1.31-3.55), transfer to neonatal care (RR 1.38, CI 1.26-1.50), and instrumental delivery (RR 1.26, CI 1.21-1.31).CONCLUSIONS: Women who were obese or severely obese had a higher risk of almost all adverse pregnancy outcomes and from gestational week 40, the risk of stillbirth was doubled. The findings indicate a need for national guidelines and individualized care to prevent and reduce negative pregnancy outcomes in overweight/obese women. Preventive methods including preconception care and public health policies are needed to reduce the number of women being overweight/obese when entering pregnancy.
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- Storck Lindholm, Elisabeth
(författare)
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Clinical and epidemiological aspects of obesity during pregnancy and the puerperium
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To study different aspects of obesity during pregnancy, birth and the puerperium. Paper I is an intervention study of obese pregnant women. Paper II compares fatty acid (FA) patterns in breast milk and neonates ́ plasma phospholipids in normal-weight mothers and an intervention group of obese mothers. Paper III reports the risk of obstetric anal sphincter lacerations in relation to maternal obesity among primiparas. Paper IV compares health care consumption and sick-listing among obese and normal-weight pregnant women. Methods: Paper I is a pilot clinical study of women with BMI ≥ 30, included during a first-trimester prenatal visit. Twenty-five pregnant women were included in the intervention program, comprising visits to midwife, obstetrician and dietician, as well as weekly water gymnastics. Paper II is a randomized observational study of 41 obese and 41 normal-weight pregnant women. Twenty-nine obese women participating in a weight reduction program were included for comparison. FA were analyzed with capillary gas chromatography of lipids in breast milk collected at three and 10 days and one and two months postnatally, as well as in infants’ plasma sampled three days after birth. Paper III is a nationwide register-based study including 210,678 primiparas who gave vaginal birth to a singleton, identified from the Swedish Medical Birth Register between January 1, 2003 and December 31, 2008. Body Mass Index (BMI) was categorized into four classes, according to World Health Organization (WHO) guidelines. Paper IV is a nationwide register-based study of 108,103 pregnant women, identified from the Swedish Medical Birth Register, the Maternal Health Care Register and the Swedish National Inpatient Register between January 1, 2003 and December 31, 2008. The women were categorized into four BMI classes, according to WHO guidelines. Results: Paper I. Fourteen (56 %) of the women had a gestational weight gain of ≤ 6 kg (study goal). There were no cases of gestational diabetes. Three (12 %) women had mild hypertension. Three women (12 %) were delivered by emergency cesarean section. All babies were healthy and had normal birth weights. Paper II. The concentrations of omega-3 FA were lower and the omega-6 / omega-3 ratio was higher in neonates and in consecutive samples of breast milk from obese mothers, compared to normal-weight mothers. FA patterns were more similar to those in normal-weight mothers when obese mothers participated in an intervention program with dietary advice and physical activity. Paper III. In multivariate analyses, increasing BMI showed a nearly dose-response-type protective effect against grade III-IV sphincter lacerations. Paper IV. Obese women made more visits to midwives, doctors and the specialized antenatal care unit. They also complained of fear of childbirth more often. They had longer in-hospital stays and were sick-listed more often during pregnancy. Conclusions: Obese pregnant women use more healthcare recourses during pregnancy. During delivery the risk for anal sphincter lacerations decreases with higher BMI. There might be an effect at eating and exercise habits with intervention and the results suggest the importance of health promoting guidance of obese pregnant women also influencing the early fatty acids pattern of their infants.
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