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THE IMPACT OF MATERNAL OBESITY ON NEWBORN AND MATERNAL HEALTH STATUS
© Jwan Mohammed Hassan, Yamama Zuhir Abdulkareem, Salwa Hazim AlMukhtar*
College of Nursing, University of Mosul, Mosul, Iraq
BACKGROUND: Obesity and overweight are more common, especially among women of reproductive age. Therefore, the approach to maternal obesity requires a multidisciplinary approach, especially health professionals working in primary care preventive health services.
AIM: The aim of the study is to determine the effect of maternal obesity on maternal and newborn health in Al Khansaa Teaching Hospial, City of Mosul, Iraq.
MATERIALS AND METHODS: The study, which was planned as a case-control study, was conducted in the Al Khansa Teaching Hospital City of Mosul, Iraq.The inclusion criteria included women in postnatal period in the same Hospital, speaking and understanding Arabic, knowing her pre-pregnancy weight, not having any chronic disease (diabetes, hypertension, trioid diseases, etc.) before pregnancy, pre-pregnancy body mass index (BMI) 18.5-25, those with a BMI >29.9, and those with primary school or higher education were included. The exclusion criteria included multiple pregnancies, without any formal education, physical disability (that prevented the completion of the data collection forms), and mental health problems. Data were collected with the data collection form and Edinburgh Postpartum Depression Scale.
RESULTS. The study was completed with 286 women, 142 cases and 144 control groups. There was no statistical difference between the case and control groups in terms of family type and employment status (p>0.050). While the mean age, pregnancy and number of living children of the women in the case group were statistically higher, their educational status was found to be lower (p<0.050). It was found that women with obesity experienced health problems such as urinary tract infection, anemia, gestational diabetes, psychological problems, and preeclampsia/gestational hypertension at a higher rate than women in the control group (p<0.010), and women in the control group gained 13.94±5.29 kg (p=0.001). CONCLUSION In conclusion, it was found that women in the case group experienced pregnancy, early and late postpartum complications at a higher rate than the control group, while there was no difference between the groups in terms of depression at the end of the sixth week postpartum.
КЛЮЧЕВЫЕ СЛОВА: Maternal; Obesity; Newborn.
RATIONALE
Over the course of history, excess weight has been perceived as a sign of health and wealth in almost all societies [1]. Considering that human beings have struggled with hunger, famine, and poverty throughout history, it seems natural to have such a perception [2]. The World Health Organization considers obesity, which is more common in women than men, as an epidemic [3-5]. At least 2.8 million people worldwide die every year due to health problems caused by being overweight or obese [6]. The World Health Organization reports that 15% of the adult female population over the age of 18 in the world in 2016 is obese [7]. Obesity, with its increasing prevalence, has become an important risk factor in pregnancy [8, 9]. Recently, there have been many studies showing the possible risks of obesity on pregnancy and childbirth. All these studies prove that obesity increases the risk of morbidity for both mother and baby [10, 11]. On the other hand, babies born to obese mothers are also at increased risk in terms of congenital anomalies, prematurity, stillbirth, macrosomia, and childhood obesity [12]. More health care resources, and additional equipment are needed both for the care of obese women during pregnancy, childbirth, and postpartum period, and for their newborns. Management of deliveries by obese women can be difficult for hospital systems and
clinicians [13]. As a result, maternal obesity causes not only health problems but also high costs [14]. Obesity and overweight are more common, especially among women of reproductive age. Therefore, the approach to maternal obesity requires a multidisciplinary approach, especially health professionals working in primary care preventive health services. Counseling, care and follow-up to these women starting from the preconceptional period with a comprehensive and appropriate approach will have positive effects on maternal-fetal-neonatal health [15]. In addition, this approach can be a basis for obese women to improve not only their pregnancies, but also their future health with long-term positive effects. With the increase in studies on maternal obesity, it is thought that the importance of starting prenatal services from the preconceptional period to protect and improve maternal-fetal and neonatal health, and especially the care and follow-up of pregnant women with obesity will be emphasized and the awareness of health professionals and managers on this issue will increase.
AIM OF THE STUDY
The aim of the study is to determine the effect of maternal obesity on maternal and newborn health in Al Khansa Teaching Hospital City of Mosul, Iraq.
*Автор, ответственный за переписку / Corresponding author.
© Endocrinology Research Centre, 2021_Received: 02.07.21. Accepted: 03.12.21.
MATERIALS AND METHODS Site and time of the study
Study site. This study was conducted in Al Khansa Teaching Hospital City of Mosul, Iraq. The population of the research consisted of postnatal women in the mentioned hospital.
Time of the study. This study was conducted between March 2020 and August 2020.
Study populations
Population 1 (obese /case group) Inclusion criteria:
1. Women in postnatal period
2. 17 to 45 years old.
3. Speaking and understanding Arabic.
4. Known pre-pregnancy weight with pre-pregnancy body mass index (BMI) = 18.5-25.5.
5. Good health (without any chronic disease like diabetes, hypertension, thyroid diseases, etc. before pregnancy).
6. Availability of verifiable address and contact number.
7. Educated (primary school or higher education).
8. BMI > 29.9
Population 2 (normal weight/control group) Inclusion criteria:
1. Same criteria 1-7 as for case group.
2. BMI = 18.5-24.9 kg/m2
Exclusion criteria for the both populations:
1. Multiple pregnancies,
2. A physical disability that prevented the completion of the data collection forms.
3. Mental health problems diagnosed by a doctor.
4. Any chronic disease like diabetes, hypertension, thyroid, etc. before pregnancy.
Sampling method from the study population (or several sampling methods from several study populations)
Purposive sampling.
Study design
It's a single center case-control study. The follow up was started 24 hrs before delivery and was done till 6 weeks postpartum
Methods
Data were collected with the "Data Collection Form and Edinburgh Postpartum Depression Scale". Data Collection Form: It includes questions prepared by the researcher based on the literature to identify women's socio-demo-graphic characteristics, pregnancy, birth and puerperium periods, and newborn characteristics [16-19].
Before starting the data collection, pre-application was made with 10 puerperant women to determine the clarity of the forms and the forms were finalized. Edinburgh Postpartum Depression Scale: The scale, which was developed by Cox et al. (1987) and validated and reliable by Engindeniz et al. in 1996, determines the risk of depression in the postpartum period. The scale is in the self-assessment type, four-point Likert type and consists of 10 items. The 3rd, 5th, 6th, 7th, 8th, 9th, and 10th items of the scale show decreasing severity and
their scores are 3, 2, 1, 0. The 1st, 2nd and 4th items are scored as 0, 1, 2, and 3. The total score of the scale is obtained by adding these item scores, and the lowest possible score is 0 and the highest score is 30. It was determined that the cut-off point of the scale was 12 and the Cronbach's alpha reliability coefficient was 0.79. Scores of 12 and above as a cut-off point indicate that women are at high risk of depression.
In our country, it is recommended to examine the depression status of women by using this scale in the «Postpartum Care Management Guide» by the Ministry of Health. Edinburgh postpartum depression scale was administered to the women by telephone interview at the end of the sixth postpartum week. In this study, the Cronbach Alpha coefficient of the Edinburgh depression scale was 0.84. Data were collected in the puerperant's room while the babies were sleeping or while the companions were taking care of the babies. At the stage of filling out the data forms, the puerperant women were met, given information about the research subject, and their written consent was obtained with an informed consent form, considering the inclusion criteria of the study. The data were collected by interviewing the puerperant in the patient's room face-to-face and taking from the patient's file (interventions at birth, information about newborns, etc.). The data (continuing to breastfeed, starting complementary foods, problems experienced in the late postpartum period) were questioned and the depression scale was applied. All necessary recommendations as per CDC guidelines were made regarding prospective weight gain like why, when, and how much weight they are going to put on. It took 15-20 minutes to collect the data by face-to-face interviews with the women, and about 10-15 minutes to be interviewed by phone. All the women were tried to be reached by telephone in the seventh week after delivery. The women who could not be reached in the first call were called for the second and third times or by calling the phone numbers of their husbands and trying to reach them all. The body mass index (BMI) was obtained by dividing the body weight [20] by the square of the height (m2) and it was used for the evaluation of obesity .
Statistical analysis
SPSS-21st version (2012) was used for statistical analysis. For evaluating the study data, descriptive statistical methods (mean, standard deviation, frequency, ratio, minimum, maximum), Student's t and chi-square tests were used. Significance was evaluated at p<0.05 levels.
Power analysis was used to determine the sample size. The sample size of the study was 95% probability (a=0.05), effect power w=0.3 (moderate), Df=2 and power=0.80 (80%) for chi-square analysis G Power 3.1.10 statistical program was used, the total was calculated as 108. In order to increase the power of the research as a result of possible losses and analyzes in the data collection process, the number of samples was increased to reach 315 women [20].
Ethical expert review
Ethical Committee approval for the research protocol (final approval dated 23.12.2020 and numbered 627) and written permission from the Al Khanassa Maternity Teaching Hospitals Union General Secretariat was obtained. The puerperant women included in the study were informed verbally about the study and written consent was also obtained.
RESULTS
Total of 14 women (6 in the control group, 8 in the case group) could not be reached so these women were not included in the study. In addition, 7 women in the control group who did not want to participate in the study were not included in the study. Considering the exclusion criteria, 2 women with a pre-pregnancy body mass index below 18.5 and 6 people with pre-pregnancy chronic diseases (2 in the control group, 4 in the case group) were also excluded from the study. The study was completed with a total of 286 women who were divided into two groups as normal weight (BMI= 18.5-24.9; control group n=144) and obese (BMI >30; case group n=142) according to their body mass index before conception. There was no statistical difference between the case and control groups in terms of family type and employment status (p>0.050). While the mean age was found to be (28.70±5.74 years with normal distribution
of (18-42) in case group and 26.85±5.86 years with normal distribution of (17-43) was in control group, pregnancies 2.80±1.54 with normal distribution of (1-9) in case group and 2.34±1.29 with normal distribution of (1-7), and number of living children 2.34±1.14 (0-6) for case and 2.03±0.93 (1-5) for control were statistically higher and their educational status was found to be lower (p<0.050), (Table 1).
It was found that the rate of getting pregnant with assisted reproductive techniques in these pregnancies of the women in the case group was higher than the women in the control group (7% and 2.1%), and this difference was statistically at the limit (p=0.051). It was found that 59.2% of the case group and 25.7% of the control group had health problems during their pregnancies and this difference was statistically significant (OR:4.18) (p=0.001). It was found that women with obesity experienced health problems such as urinary tract infection, anemia, gestational diabetes, psychological problems, and preeclampsia/gestational hyper-
Table 1. Socio-Demographic and Obstetric Characteristics of Women in the Case and Control Group
Features Case group Control group P
n % n %
Age
• 17-24 39 27.5 54 37.5
• 25-34 80 56.3 75 52.1 0.124
• 35-45 23 16.2 15 10.4
Age X±SD* 28.70±5.74 26.85±5.86
(min-max) (18-42) (17-43)
Educational level P
• Primary school graduate 62 43.7 48 33.3
• Middle school graduate 39 27.5 60 41.7 0.030
• High school/ university graduate 41 28.8 36 25
Family type P
• Nuclear family • Extended family 125 17 88 12 123 21 85.4 14.6 0.64
Employment status P
• Working • Housewife 10 132 7 93 18 126 12.5 87.5 0.186
Number of Pregnancy P
• First Pregnancy 32 22.5 42 29.2
• 2 33 23.2 48 33.3 0.401
• >3 77 54.3 54 47.5
Number of living children
No children 1 0.7 0 0
• 1 • 2 39 40 27.5 28.1 47 56 32.6 38.9 0.024
• >3 62 43.7 41 28.5
Number of pregnanciesX±SD* (min-max) 2.80±1.54 (1-9) 2.34±1.29 (1-7)
Number of living children X±SD* (min-max)
2.34±1.14
(0-6)
2.03±0.93 (1-5)
0.008
Note: The table clearly shows the effect of education, number of pregnancy and living children in case group as compared to control. X — Mean; *SD — Standard deviation.
Table 2. Characteristics of Women in the Case and Control Group Regarding Pregnancy and Delivery
Features Case group Control group P
n % n %
Receiving treatment to conceive
Yes 10 7 3 2.1 0.52
Having health problems during pregnancy
Yes 84 59.2 37 25.7 0.001
Health problems experienced
• UTI 41 28.9 9 б.3 0.000
• Anemia 30 21.1 13 9 0.005
• DM 17 12 4 2.8 0.002
• Psychological problems 17 12 2 1.4 0.001
• Preeclampsia/gestational 14 9.9 3 2.1 0.005
• Hypertension 29 20.4 28 9.5 0.784
Type of Birth
• Normal vaginal delivery • cesarean delivery 34 108 23.9 7б.1 41 103 28.5 71.5 0.384
Interventions at birth
• Fundal pressure application 23 б7.б 18 43.9 0.034
• artificial pain application 1б 57.1 12 42.9 0.151
• Episiotomes 18 52.9 31 75.б 0.052
• Perineal tears/repair б 35.3 11 б4.7 0.414
Weight gained during pregnancy X±SD* [20] 11.71±4.19 13.94±5.29 0.001
(Min-max) (3-25) (3-30)
*SD — Standard deviation.
Note: The table clearly shows that the case group shows the high incidence of health problems during pregnancy.
tension at a higher rate than women in the control group (p<0.010). Women in case group gained 11.71±4.19 kg with normal distribution of (3-25) and women in the control group gained 13.94±5.29 kg with (3-30) (p=0.001).
When the delivery types of women were examined, it was found that the cesarean section rates (76.1% vs 71.5%) were high in both groups and there was no statistical difference between the groups (p=0.384). Fundal pressure application at birth was higher in the case group (67.6% and 43.9%). (OR:2.67), p=0.034. In the case group women, artificial pain application was higher than the women in the control group (57.1% vs 42.9%), episiotomy application (52.5%, 75.6%) and perineal tears (26.5% and 36.6%).) was lower, but these differences were not statistically significant (p>0.050) (Table 2). It was found that in the early postpartum period (in the first 24 hours), the women in the case group experienced health problems at a higher rate (35.9% vs. 22.9%) than the women in the control group (OR:1.88) (p=0.016). The most common health problems in both groups are respectively, pain at the cesarean section, headache, pelvic pain and high fever. It was found that 23.2% of the case group and 17.4% of the control group also experienced breastfeeding problems in the first 24 hours after delivery, but there was no statistical difference between the groups (p=0.216).
The women in the case and control group were in the late postpartum period. The state of having health problems
and the problems experienced were questioned by telephone interview in the seventh week. The case group had a higher rate of health problems in the late postpartum period (23.9%) than the women in the control group (13.9%) (OR: 1.95) (p=0.035), and severe headache, pain during urination, and constipation were all reported. It was determined that there were problems in the first order in both groups (Table 3). It was determined that women in the case group started complementary foods at a higher rate (25.4% and 18.8%) at the end of the sixth week, although not at a statistical level (p=0.103). Postpartum depression status of women was evaluated with Edinburgh postpartum depression scale, and it was determined that 21.1% of women in the case group and 12.5% of women in the control group had a risk of depression, but the difference between these two groups was not statistically significant (p=0.073).
It was found that the newborns of the women in the case group were admitted to the intensive care unit at a higher rate than the newborns of the women in the control group (OR: 2.01), (p=0.029), they were born earlier in the week (p=0.035), and the mean Apgar scores at the 1st and 5th minutes were lower. found (first minute p=0.029 and fifth minute p=0.003). The baby of one of the women in the case group died. There was no statistical difference between the groups in the mean weight of newborns at birth (p=0.266) (Table 4).
Table 3. Case and Control Group Women's Postpartum Early (In the First 24 Hours) and Late (Postpartum Sixth Week) Period Health and Breastfeeding Problem
Case group Control group P
n % n %
Early health problems
Yes 51 35.9 33 22.9 0.016
Health problems experienced
• Pain in the cesarean section 24 16.9 13 9
• Headache 11 7.7 8 5.6
• pelvic pain 9 6.3 8 5.6 0.216
• High fever 4 2.8 1 0.7
• Other 9 6.3 13 6.1
Having trouble breastfeeding
The state of having a late-term health problem
Yes 34 23.9 20 13.9 0.035
Health problems experienced
• Headache 13 9.2 8 5.6
• Pain when urinating 11 7.7 6 4.2
• Constipation 6 4.2 3 2.1
• Mastitis 5 3.5 2 1.4
• Redness at the incision site 3 2.1 4 2.8
Total No=141
Note: The table clearly shows that the greater health problems in the case group in postpartum.
Table 4. Characteristics of the Women in the Case and Control Group Regarding their Newborns
Condition of admission of newborn to intensive Case group Control group P
care n % n %
Yes 27 19 15 10.4 0.029
Neonatal survival status
No 1 0.7 0 0
Birth week X±SD* 38.83±1.06 39.10±1.05 0.035
(Min-max) (35-41) (36-41)
1-min Apgar score 8.35 0.96 8.49 1.14 0.029
(Min-max) 4-9 4-10
5-min Apgar score X±SD 9.30±0.90 9.51±1.00 0.003
(Min-max) (6-10) (4-10)
Weight of newborn X±SD* (gr) 3288,2±459,3 3228,6±444,4
(Min-max) (2200-4700) (2000-4500)
Note: The table shows birth weeks, 1st, and 5th minute average Apgar Score of the newborns of the women in the case group were statistically lower than the newborns of the women in the control group; *SD: Standard deviation
DISCUSSION
Representativeness of Samples
The result of the data indicated that the health problems during the pregnancy was found very high (59.2%) for the case group (BMI 30 and above) while significantly low (25.7%) for the control group (BMI=18.5-24.9). This huge difference may be correlated within the groups. In the Case group, education, socioeconomic status (employment status) and cultural influence (multiple pregnancy and number of living children) have
played a very vital role. The large fraction of case group is from housewives, low level of education and with multiple pregnancies. The role of these factors can further be assessed and compared with other centers or part of the country.
Comparison with other publications
The prevalence of overweight and obesity in women of childbearing age in the world and in our country has increased over the years. The reason that makes obesity important is that it causes or exacerbates many diseases both
alone and together with some other factors [3, 21-23]. In our study, urinary tract infection (UTI) was found 6.08 times more in the case group than in the control group. In a retrospective study of 287213 pregnant women in London, urinary system infection was found to be 1.27 times higher in women with obesity [24]. The reason why the risk of UTI in obese women in our study was higher than in this study may be due to the perineal cleaning habits of women in our country. The findings of the study show the importance of regular urinalysis and early initiation of treatment, especially in pregnant women with obesity, due to pregnancy complications such as premature rupture of membranes brought by urinary tract infection.
In our study, the risk of anemia in women in the case group was 2.69 times higher than in the control group. Anemia is one of the most common complications in pregnancy, and iron deficiency anemia is seen in approximately 58% of pregnant women in our country. The findings of the study show the importance of more careful follow-up regarding nutrition and iron supplementation in pregnant women with obesity, although iron supplementation is given to all pregnant women.
It was found that women in the case group had a higher rate of psychological problems during their pregnancies (OR:2,18) and it has been supported by literature, which has mentioned that in addition to physiological problems, psycho-social problems such as depression, eating disorders, mental problems related to body image perception, stigma, night eating syndrome or trying to achieve psychological satisfaction by eating more and sleep disorders are more common in people with obesity [25].
The rate of experiencing preeclampsia/gestational hypertension in case group pregnancies is higher than that of control group (OR:5,14). In a study conducted in Spain, the risk of gestational hypertension was found to be 5.7 times higher in women with obesity and 2.9 times higher than those of normal weight women [26]. Similar to the findings of this study, Ramoniene et al. (2017) found that the risk of pregnancy-induced hypertension increased 8.5 times and the risk of preec-lampsia 2 times increased in pregnant women with obesity in their study conducted in a tertiary health institution [27]. since obesity increases the risk of hypertensive disease during pregnancy and hypertensive diseases during pregnancy is one of the main cause of maternal mortality worldwide [28].
In our study, the incidence of gestational diabetes (GDM) was found to be higher in women with obesity (12%) than in women with normal weight (2.8%) (OR:4.7). Weiss et al. (2004) found that the risk of GDM in pregnant women with obesity was 1.9 times higher, Ovesen et al. (2011) 2.6 times, and Ramoniene et al. (2017) 5.5 times higher than in normal-weight women [16, 27]. In the case-control study of Tajdemir et al. (2015), in which normal weight women and obese women were compared, it was found that the incidence of gestational diabetes and hypertension was high in women with obesity [29]. The findings of our study are like the literature information. Since gestational diabetes carries the risk of maternal, fetal and neonatal complications, it requires careful and conscious monitoring. In line with these findings, it is known that it increases the risk of maternal, fetal and neonatal morbidity and mortality with the accompanying complications and causes the development of diabetes, cardiovascular disease and hypertension in women in the following years [24].
Women with obesity have a high risk for interventions during the birth process. This can be caused by various factors such as ineffective uterine activity. Again, fetal macrosomia reduces the progression of labor [30]. In our study, there was no difference between the groups in terms of delivery types and artificial pain application, but fundal pressure was applied to women in the case group at a higher rate (67.6% vs. 43.9%; OR: 2.67).
In our study, the mean weight gain of obese women during pregnancy was found to be lower than the control group. However, according to the Institute of Medicine [31] women with pre-BMI, BMI=>29.9 should gain 5-9 kg during pregnancy, and 11-15 kg for women with BMI=18.5-24.9 [32]. Accordingly, while the average weight of the women in the control group was normal during their pregnancy, the average weight of the women in the case group was quite high, which is thought to increase the perinatal risks for the mother and fetus.
It was found that the health problems experienced in early postpartum (first 24 hours) (OR: 1.88) and late (postpartum sixth week) (OR: 1.95) periods in women in the case group were higher than that of women in the control group. One of the postpartum problems is problem with breastfeeding. In our study, it was found that women in the case group had more problem in breastfeeding their newborns although it was not at the statistical level. In contrast it was found that as obesity delays prolactin secretion, obese women could start late breastfeeding and also experience a sense of inadequacy in breastfeeding [33, 34]. Li et al. (2003) investigated that maternal obesity and breastfeeding practices with the number of 124151 cases, they found that women who were obese before pregnancy and women who gained excessive weight during pregnancy were inadequate in starting and maintaining breastfeeding [35].
When the depression status of the women was evaluated six weeks after the birth, the depression risks of the women in the case group were found to be high, although not at a statistical level. Contrary to our study, Guelinckx et al. (2008) found that the incidence of postpartum depression is higher in women with obesity [36]. The high risk of postpartum depression suggests that obese women need more support and guidance to deal with entire duration of pregnancy.
In our study, the birth weeks, 1st, and 5th minute average Apgar Score of the newborns of the women in the case group were statistically lower than the newborns of the women in the control group, and the rate of admission to the intensive care unit was higher. In a study conducted in Spain, the 1st and 5th minute Apgar scores of newborns of mothers with obesity were found to be lower than newborns of mothers with normal weight [26]. In another study, it was reported that maternal obesity was a risk for low Apgar score [37]. In contrast to this situation, no relationship was found between Apgar score and body mass index in other studies conducted in our country [29]. More research is needed on this subject.
Tajdemir et al. (2015), reported that monitoring of infants in intensive care was found to be higher in infants of mothers with obesity and same holds true for our study also [29]. Due to the high rate of pregnancy complications in women with obesity, it is thought that the rates of follow-up in the intensive care unit may have increased due to transient tachypnea, respiratory distress and hypoglycemia in newborns. In a meta-analysis of eleven studies, it was found that the risk of early and late neonatal death increased by 1.42 times
in women with obesity [38]. Although it was of no statistical significance in our study, other study showed that obesity is a risk factor for infant mortality and still birth rates are high in obese women [8, 39]. It cannot be generalized to other centers since it was performed only in one hospital.
So, the overall study reflects that a woman has to suffer a lot due to pregnancy induced obesity. It includes various health problems like UTI, gestational hypertension, diabetes, depression as well as chances of more fetal retention in intensive care unit. The Statistical evaluation supports the data that can be revealed from above discussion.
Study limitations
The location of the hospital may be receiving a certain uniform and consistent sample population. Moreover, the result may be indicating to the influence of a specific socio-economic, ethnic and cultural environment affecting the results. And without considering these factors the data might not be directly extrapolated to any other population of the world.
Next studies
To reach normal BMI values without getting pregnant, it may be recommended to provide education and counseling to obese women. More elaborative studies need to be conducted to have clarity on this subject.
CONCLUSION
In conclusion, it was found that women in the case group experienced pregnancy, early and late postpartum complica-
tions at a higher rate than that of control group, while there was no difference between the groups in terms of depression at the end of the sixth week postpartum. Again, it was found that the newborns of the women in the case group had lower Apgar scores and higher rates of admission to the intensive care unit. In addition to the complications with obesity for both mother and her newborns it is necessary to provide appropriate antenatal and obstetric care to women with obesity. And as per the observations of the study there is need for more health care resources and additional equipment for babies born from these pregnancies.
ADDITIONAL INFORMATION
Funding. No Funding
Conflict of interest. The authors declare no obvious and potential conflicts of interest related to the content of this article.
Contribution of authors. Jwan Mohammed Hassan-data acquisition and analysis and findings interpretation, material editing of the manuscript to increase the article scientific value; Yamama Abdulkarim Al Yozbaki — data acquisition and analysis and findings interpretation, material editing of the manuscript to increase the article scientific value; Salwa Hazim Al-Mukhtar — significant contribution into the study concept and design, material editing of the manuscript to increase the article scientific value. All of the authors approved the final version of the article before publication, agreed to be responsible for all aspects of the work, implying proper examination and resolution of issues relating to the accuracy or integrity of any part of the work.
Acknowledgment. We would like to express our special thanks of gratitude to the administration of Al-Khansa Teaching Hospital in the city of Mosul for facilitating the research.
СПИСОК ЛИТЕРАТУРЫ | REFERENCES
10.
Guedes DP, Silva ALDS. Prevalence and correlates of excess body weight in university students. Rev Bras Cineantropometria Desempenho Hum. 2021;23. doi: https://doi.org/10.1590/1980-0037.2021v23e78433 Samuel-Harris SN. Perceptions of Health and Family History Associations in African American Men at Risk for Cardiovascular Disease. Hampton University, 2021.
World Health Organization, Obesity: preventing and managing the global epidemic. 2000. James WPT. WHO recognition
of the global obesity epidemic. Int J Obes. 2008;32(S7):S120-S126. doi: https://doi.org/10.1038/ijo.2008.247 Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol. 2006;35(1):93-99. doi: https://doi.org/10.1093/ije/dyi272
Gupta, H., Garg, S., 2020. Obesity and overweight — their impact on individual and corporate health. J. Public Health (Bangkok). 28, 211-218. doi: https://doi.org/10.1007/s10389-019-01053-9 Arroyo-Johnson C, Mincey KD. Obesity epidemiology trends by race/ ethnicity, gender, and education: National Health Interview Survey, 1997-2012. Gastroenterology Clinics of North America. 2016;45(4):571. doi: https://doi.org/10.1016/j.gtc.2016.07.012 Sirimi N, Goulis D. Obesity in pregnancy. Hormones. 2010;9(4):299-306. doi: https://doi.org/10.14310/horm.2002.1280 Huda SS, Brodie LE, Sattar N. Obesity in pregnancy: prevalence and metabolic consequences. Semin Fetal Neonatal Med. 2010;15(2):70-76. doi: https://doi.org/10.1016/j.siny.2009.09.006 Djelantik A, Kunst A, van der Wal M, et al. Contribution of overweight and obesity to the occurrence of adverse pregnancy outcomes in a multi-ethnic cohort: population attributive fractions for Amsterdam. BJOG An Int J Obstet Gynaecol. 2012;119(3):283-290. doi: https://doi.org/10.1111/j.1471-0528.2011.03205.x
12.
13.
14.
15.
16.
17.
18.
19.
Sheiner E, Levy A, Menes TS, et al. Maternal obesity as an independent risk
factor for caesarean delivery. Paediatr Perinat Epidemiol. 2004;18(3):196-201.
doi: https://doi.org/10.1111/j.1365-3016.2004.00557.x
Triunfo S, Lanzone A. Impact of overweight and obesity on
obstetric outcomes. J Endocrinol Invest. 2014;37(4):323-329.
doi: https://doi.org/10.1007/s40618-014-0058-9
World Health Organization, World Health Organization. Reproductive
Health, World Health Organization. Department of Reproductive
Health. Pregnancy, childbirth, postpartum, and newborn care: a guide
for essential practice. World Health Organization; 2003.
Heslehurst N, Lang R, Rankin J, et al. Obesity in pregnancy:
a study of the impact of maternal obesity on NHS maternity
services. BJOG An Int J Obstet Gynaecol. 2007;114(3):334-342.
doi: https://doi.org/10.1111/j.1471-0528.2006.01230.x
Daniels SR, Hassink SG, Abrams SA, et al. The Role of the Pediatrician
in Primary Prevention of Obesity. Pediatrics. 2015;136(1):e275-e292.
doi: https://doi.org/10.1542/peds.2015-1558
Ovesen P, Rasmussen S, Kesmodel U. Effect of Prepregnancy
Maternal Overweight and Obesity on Pregnancy
Outcome. Obstet Gynecol. 2011;118(2):305-312.
doi: https://doi.org/10.1097/AOG.0b013e3182245d49
Kahveci G, Kahveci B, Aslanhan H, Bucaktepe PGE. Evaluation
of prevalence and risk factors for postpartum depression using
the Edinburgh Postpartum Depression Scale: a cross-sectional
analytic study. Gynecol. Obstet. Reprod. Med. 2021;27(3):227-233.
doi: https://doi.org/10.21613/GORM.2020.1109
van der Zee-van den Berg AI, Boere-Boonekamp MM, Groothuis-
Oudshoorn CGM, Reijneveld SA. The Edinburgh Postpartum
Depression Scale: Stable structure but subscale of limited value
to detect anxiety. Lupattelli A, ed. PLoSOne. 2019;14(9):e0221894.
doi: https://doi.org/10.1371/journal.pone.0221894
Demiröz HP, Tajtan K. The effects of perceived social support on
postpartum depression. J Surg Med. 2018;2(3):298-302.
20. Aygun N. The Relationship Of Magnesium Level With The Recovery Of Parathyroid Function In Post-Thyroidectomy Hypoparathyroidism. SiSli Etfal Hastan Tip Bul/Med Bull Sisli Hosp. 2021;55(1):33.
doi: https://doi.org/10.14744/SEMB.2021.75983
21. Popkin BM, Adair LS, Ng SW. Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev. 2012;70(1):3-21. doi: https://doi.org/10.1111/j.1753-4887.2011.00456.x
22. Baird DT, Cnattingius S, Collins J, et al. Nutrition and reproduction in women. Hum Reprod Update. 2006;12(3):193-207.
doi: https://doi.org/10.1093/humupd/dmk003
23. York DA, Rössner S, Caterson I, et al. Prevention Conference VII. Circulation. 2004;110(18):463-470.
doi: https://doi.org/10.1161/01.CIR.0000140125.26161.49
24. Sebire N, Jolly M, Harris J, et al. Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London. Int J Obes. 2001;25(8):1175-1182. doi: https://doi.org/10.1038/sj.ijo.0801670
25. Ergin AJK. Evaluation of obesity in perspective of women health and gender roles. KASHED. 2014;1(1):41-54.
26. Bautista-Castaño I, Henriquez-Sanchez P, Alemán-Perez N, et al. Maternal Obesity in Early Pregnancy and Risk of Adverse Outcomes. PLoS One. 2013;8(11):e80410. doi: https://doi.org/10.1371/journal.pone.0080410
27. Ramoniené G, Maleckiené L, Nadisauskiené RJ, et al. Maternal obesity and obstetric outcomes in a tertiary referral center. Medicina (BAires). 2017;53(2):109-113. doi: https://doi.org/10.1016/j.medici.2017.03.003
28. Majumdar A, Saleh S, Candelier CK. Failure to recognise
the impact of 'moderate' obesity (BMI 30-40) on adverse obstetric outcomes. J Obstet Gynaecol (Lahore). 2010;30(6):567-570. doi: https://doi.org/10.3109/01443615.2010.492434
29. Tajdemir D, Karaman E, Yildiz A, et al. The Effect of Obesity on Maternal and Fetal Outcomes in Term Pregnant Women:
A Case-Control Stud. istanbul Kanuni Sultan Süleyman Tip Derg. 2015;7(2):2341-2350. doi: https://doi.org/10.5222/iksst.2015.073
30. Dogan R, Sayiner FD, Tanir MD, et al. Investigation of the Effect of Obesity and Obesity on Life Quality in Pregnancy Following
Family Health Center. Arch Health Sci Res. 2018;5:16-23. doi: https://doi.org/10.17681/hsp.332707
31. Engel P, Fagherazzi G, Boutten A, et al. Serum 25(OH) Vitamin D and Risk of Breast Cancer: A Nested Case-Control Study from the French E3N Cohort. Cancer Epidemiol Biomarkers Prev. 2010;19(9):2341-2350. doi: https://doi.org/10.1158/1055-9965.EPI-10-0264
32. Institute of Medicine and National Research Council. 2009. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington, DC: The National Academies Press.https://doi.org/10.17226/12584.
33. Lepe M, Bacardi Gascón M, Castañeda-González LM, et al. Effect of maternal obesity on lactation: systematic review. Nutr Hosp. 2011;26(6):1266-1269. doi: https://doi.org/10.1590/S0212-16112011000600012
34. Amir LH, Donath S. A systematic review of maternal obesity and breastfeeding intention, initiation and duration. BMC Pregnancy Childbirth. 2007;7(1):9. doi: https://doi.org/10.1186/1471-2393-7-9
35. Li R, Jewell S, Grummer-Strawn L. Maternal obesity and breast-feeding practices. Am J Clin Nutr. 2003;77(4):931-936. doi: https://doi.org/10.1093/ajcn/774.931
36. Guelinckx I, Devlieger R, Beckers K, Vansant G. Maternal obesity: pregnancy complications, gestational weight gain and nutrition. Obes Rev. 2008;9(2):140-150.
doi: https://doi.org/10.1111/j.1467-789X.2007.00464.x
37. Blomberg M. Maternal and Neonatal Outcomes Among Obese Women With Weight Gain Below the New Institute of Medicine Recommendations. ObstetGynecol. 2011;117(5):1065-1070. doi: https://doi.org/10.1097/A0G.0b013e318214f1d1
38. Meehan S, Beck CR, Mair-Jenkins J, et al. Maternal Obesity and Infant Mortality: A Meta-Analysis. Pediatrics. 2014;133(5):863-871.
doi: https://doi.org/10.1542/peds.2013-1480
39. McGuire W, Dyson L, Renfrew M. Maternal obesity: consequences for children, challenges for clinicians and carers. Semin Fetal Neonatal Med. 2010;15(2):108-112. doi: https://doi.org/10.1016Zj.siny.2009.09.005
AUTHORS INFO:
*Salwa Hazim Almukhtar, PhD, Professor; address: College of Nursing, University of Mosul, City of Mosul, Iraq; ORCID: https://orcid.org/0000-0002-1504-0473; Scopus Author ID: 1235468755; e-mail: dr.salwa@uomosul.edu.iq
Jwan Mohammed Hassan, M.Sc. Maternal and Child Health Nursing; ORCID: https://orcid.org/0000-0001-5529-6345; e-mail: jwan.m@uomosul.edu.iq
Yamama Abdulkarim Al Yozbaki, M.Sc. Maternal and Child Health Nursing; ORCID: https://orcid.org/0000-0002-5496-584X; e-mail: yamama.zyhair@uomosul.edu.iq
*Corresponding author.
TO CITE THIS ARTICLE:
Hassan JM, Abdulkareem YZ, AlMukhtar SH. The impact of maternal obesity on newborn and maternal health status. Obesity and metabolism. 2021;18(4):417-424. doi: https://doi.org/10.14341/omet12772
