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Comparative Study
. 2017 Jun 21;7(5):e015218.
doi: 10.1136/bmjopen-2016-015218.

Does attendance at a specialist antenatal clinic improve clinical outcomes in women with class III obesity compared with standard care? A retrospective case-note analysis

Fiona C Denison  1 , Heather MacGregor  1 , Laura I Stirrat  1 , Kerrie Stevenson  1 , Jane E Norman  1 , Rebecca M Reynolds  1   2
Affiliations
Comparative Study

Does attendance at a specialist antenatal clinic improve clinical outcomes in women with class III obesity compared with standard care? A retrospective case-note analysis

Fiona C Denison et al. BMJ Open. .

Abstract

Objectives: To determine whether attendance at a specialised multidisciplinary antenatal clinic for women with class III obesity (BMI >40 kg/m2) is associated with improved clinical outcomes compared with standard antenatal care.

Design: Retrospective cohort study using routinely collected data from electronic patient record.

Setting: Community and hospital based antenatal care.

Participants: Women with a singleton pregnancy with class III obesity booked for antenatal care and delivered in one of two hospitals in NHS Lothian, Scotland, UK between 2008 and 2014. Maternal and offspring outcomes were compared in women who attended a specialised obesity clinic (n=511) compared with standard antenatal care (n=502).

Main outcome measures: Included stillbirth, low birth weight, gestational diabetes, induction of labour and caesarean section.

Results: Compared with standard care, women receiving specialist care were less likely to have a stillbirth (OR 0.12, 95% CI 0.06 to 0.97) and a low birthweight baby (OR 0.57, 95% CI 0.33 to 0.99) and more likely to be screened for (100% vs 73.6%; p<0.001) and diagnosed with (26.0% vs 12.5%; p<0.001) gestational diabetes, to require induction of labour (38.4% vs 29.9%; p=0.009), an elective (20.3% vs 17.7%; p<0.001) and emergency (23.9% vs 20.3%; p<0.001) caesarean section and attend antenatal triage one or more times during pregnancy (77.7% vs 53.1%; p<0.001). Women attending the specialist clinic had a higher BMI (44.5 kg/m2 (4.3) vs 43.2 kg/m2 (3.1); p<0.001) and were more likely to be nulliparous (46.0% vs 24.9%; p<0.001). There were no other differences in maternal demographic or maternal and offspring outcomes between groups.

Conclusions: Attendance at a specialised antenatal clinic for obesity is associated with reduced rates of stillbirth and low birth weight and improved detection of gestational diabetes. The improvement in clinical outcomes is associated with an increase in healthcare attendance to obstetric triage and clinical interventions including induction of labour and caesarean section.

Keywords: Obesity; lowbirth weight; stillbirth.

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Conflict of interest statement

Competing interests: None declared.

References

    1. Centre for Maternal and Child Enquiries (CMACE). Maternal obesity in the UK: findings from a national project. London: CMACE, 2010.
    1. Denison FC, Norwood P, Bhattacharya S, et al. . Association between maternal body mass index during pregnancy, short-term morbidity, and increased health service costs: a population-based study. Bjog 2014;121 p :72–82. discussion 82 10.1111/1471-0528.12443 - DOI - PubMed
    1. Denison FC, Chiswick C. Improving pregnancy outcome in obese women. Proc Nutr Soc 2011;70:457–64. 10.1017/S0029665111001637 - DOI - PubMed
    1. Denison FC, Norrie G, Graham B, et al. . Increased maternal BMI is associated with an increased risk of minor complications during pregnancy with consequent cost implications. Bjog 2009;116:1467–72. 10.1111/j.1471-0528.2009.02222.x - DOI - PubMed
    1. Reynolds RM, et al. . Maternal and offspring outcomes of pregnancies associated with severe obesity: study design and preliminary data from the hormones and inflammation in obese pregnancy study. J Dev Orig Health Dis 2009:P7A–318.

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