Obesity and pregnancy, an epidemiological and intervention study from a psychosocial perspective

Abstract

Background: Maternal obesity is a growing public health concern in Belgium as well as in other European countries and is now becoming the most common risk factor associated with pregnancy complications with impact on the health of the women and her offspring. At this moment, there is no specific management strategy for obese pregnant women and mothers, focusing on physical health and psychological well-being.

Objectives: We aimed (1) to study the influence of socio-demographic and obstetrical correlates on pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in different regions of Flanders, Belgium, (2) to review the literature on the onset and progression of labour in normal weight and obese pregnant women, (3) to compare levels and evolution of anxiety and depressed mood during pregnancy between obese women and normal-weight women, (4) to examine whether a prenatal lifestyle intervention programme, based on principles of motivational interviewing, in obese pregnant women reduces GWG and lowers levels of anxiety and depressed mood during pregnancy, (5) to examine associations between inter-pregnancy weight change from the first to the second pregnancy and the risk for adverse perinatal outcomes during the second pregnancy and finally (6) to study predictors of postpartum weight retention (PPWR) in obese mothers at six months after delivery in order to provide clues for the design of interventions aimed at preventing weight retention related to childbearing.

Methods: We performed an epidemiological study, an intervention study during pregnancy with postpartum follow up and a literature review.

Results: One in three Flemish women start pregnancy being overweight or obese and this prevalence has slowly been rising since 2009 in the Flanders. We identified women at risk for a high pre-pregnancy BMI and excessive GWG, both being important predictors for increased pregnancy and birth related complications. In a literature review, we showed that the combination of a higher incidence of post-term deliveries and increased inadequate contraction pattern during the first stage of labour in obese women suggests an influence of obesity on myometrial activity. Given the low compliance for adequate GWG in obese women in the general Flemish population and their increased psycho-social vulnerability compar-ed to the normal weight pregnant women, counselling obese pregnant women can lead to a reduced GWG and increased psychological comfort. Stabilizing inter-pregnancy maternal weight for all women is an important target for reducing adverse perinatal outcomes in the subsequent pregnancy. Psychological discomfort during pregnancy does impact on PPWR in obese mothers six months after delivery.

Discussion and conclusion: Focusing on weight management in obese women before, during and after a pregnancy has advantages for both the mother and her infant. Theoretical and practice based training modules should be developed and focus on: (1) awareness of techniques for identifying the clearly identified risk groups with a high pre-pregnancy BMI and excessive GWG, (2) the increased perinatal risks, (3) an adapted perinatal management and (4) counselling techniques for an adequate weight management and psychological wellbeing in obese pregnant women. To achieve better care for the future, we must focus on tackling maternal obesity. This means that obese women should be reached before they get pregnant for the first time. Targeting primary and community based care, promotion and education are challenging, but the psychosocial context should be acknowledged.

Keywords: Pregnancy; epidemiological study; interpregnancy; intervention study; obesity; perinatal outcome; psychological outcome.

Fig. 1. Intergenerational cycle of obesity: in utero programming of obesity and metabolic dysfunction.

Fig. 2. Distribution of maternal BMI (a) and GWG (b) in total population (n = 54 022).

Fig. 3. Percentage of maternal overweight, obesity and excessive GWG, respectively in 2009 by region in Flanders (N = 54022).

Fig. 4. Hypothetical model, on maternal, foetal and placental factors playing a role in the initiation of labour.

Fig. 5. Mean levels and error bars of State and Trait Anxiety and Depressed mood in obese and normal-weight pregnant women by trimester.

Fig. 6. Levels of state anxiety by trimester in the 3 study groups.

Table III.. Adjusted odds ratios for adverse perinatal outcomes during second pregnancy in relation to change in categories of BMI between the first and second pregnancy, stratified by prepregnancy BMI at first pregnancy.