Elsevier

Midwifery

Volume 29, Issue 4, April 2013, Pages 338-343
Midwifery

Applying a social disparities lens to obesity in pregnancy to inform efforts to intervene

https://doi.org/10.1016/j.midw.2012.01.016Get rights and content

Abstract

Objective

to examine the social correlates of pre-pregnancy overweight and obesity in an Australian population-based sample and consider implications for intervention effectiveness during pregnancy.

Design

population-based survey distributed by hospitals to women 6 months after birth.

Setting

two states of Australia.

Participants

women who gave birth in Victoria and South Australia in September/October 2007.

Measurements and findings

surveys were completed by 4,366 women. Pre-pregnancy body mass index (BMI) was calculated from women's self-reported weight in kilograms/(height in metres)2. Results showed high rates of overweight (22%) and obesity (14%) among Australian women entering pregnancy. After adjusting for other factors in the model, pre-pregnancy obesity was significantly associated with lower household income levels, less education, the experience of financial stress in pregnancy and increasing parity.

Key conclusions

to date, there is little evidence to support the efficacy of interventions to manage problematic weight in pregnancy. Applying a social disparities lens to obesity in pregnancy challenges us to consider social factors that may seem distal to obesity but are highly relevant to efficacious intervention.

Implications for practice

pregnancy care offers an opportunity to address social issues on the pathway to obesity. Current clinical care guidelines on maternal overweight and obesity in pregnancy rarely consider social contexts that place some women at risk and are a likely impediment to efficacious intervention.

Introduction

The increased risk of poor maternal and perinatal outcomes for women who are obese during pregnancy is well-established. An extensive international literature leaves no doubt about the deleterious consequences of maternal overweight and obesity on women's and babies health during pregnancy, labour and birth (Ramachenderan et al., 2008, Stotland, 2009, Dodd et al., 2011), as well as the early and later postnatal stages (Cnattingius et al., 1998, Sebire et al., 2001, Ruager-Martin, 2010). Overweight and obesity in pregnancy also negatively affect breast-feeding initiation and duration (Amir and Donath, 2007, Kitsantas and Pawloski, 2010), has been linked to an increased risk of postnatal depression (Krause et al., 2008, LaCoursiere et al., 2010), increases perinatal health-care costs (Colagiuri et al., 2010), and debate continues about potential intergenerational effects (Rooney et al., 2010, Poston et al., 2011). This breadth of evidence has led to increasing pressure in research, practice and policy-making environments to consider appropriate intervention.

Despite a clear desire for prevention by engaging with women prior to conception, finding approaches to modifying risk for women who enter pregnancy overweight or obese requires attention. A recent review of interventions designed to ameliorate adverse health outcomes by targeting overweight and obesity in pregnancy reported a lack of evidence that antenatal dietary and lifestyle modifications are efficacious (Dodd et al., 2010). The authors did not consider the possibility that lifestyle interventions may fail if the social antecedents of overweight and obesity are not addressed. With an abundance of evidence about the social distribution of obesity it is unclear why social inequalities are not widely considered in the obstetric literature. Currently, the evidence-based is dominated by the consequence of maternal overweight and obesity in pregnancy. Studies that collect and report on maternal socio-demographic disparities in obesity usually only collect these data to characterise participants or control for their effect (Callaway et al., 2006, Centre for Maternal and Child Enquiries (CMACE), 2010). Few studies specifically report the social context of maternal populations at risk (Heslehurst et al., 2007, Heslehurst et al., 2010).

This paper builds on existing evidence that overweight and obesity are common among pregnant women by drawing on epidemiological data from an Australian population-based birth cohort to (i) assess social correlates of pre-pregnancy overweight and obesity and (ii) consider how these relationships represent challenges for effective intervention in pregnancy.

Section snippets

Method

All public and private hospitals (n=110) with maternity facilities and homebirth practitioners in two Australian states (South Australia and Victoria) agreed to distribute surveys to women who gave birth under their care in an 8 week study period (September/October 2007). One small public hospital withdrew at the time of the mail out because distribution of the survey coincided with major organisational change to clinical services.

Findings

Participating hospitals and homebirth practitioners identified 8,597 eligible women. Several participating hospitals reported difficulties with identification, exclusion and mail out processes. Some hospitals did not mail all questionnaires and/or mailed questionnaires to women who were ineligible. A number of surveys were excluded (n=129) because they were ‘returned to sender’, with dates outside the study period or from women who were ineligible (e.g., due to stillbirth). The adjusted

Discussion

In developed countries like Australia, young women are gaining weight faster than any other generation of women, raising concerns about their health and the health of future generations (Australian Government Preventative Health Taskforce, 2009; Haby et al., 2011). Although current and estimated prevalence rates highlight obesity as a significant and increasing problem in obstetric care, there remains little consensus around effective strategies to engage with women about managing problematic

Conflict of interest

None.

Acknowledgements

We would like to thank all the women who took time to complete the survey at a particularly busy time in their lives. We are also grateful to staff at the hospitals in South Australia and Victoria for assisting us to mail surveys and to staff in the Healthy Mothers Healthy Families research group for their contributions to the conduct of the study.

Funding: The study was funded by a National Health and Medical Research Council (NHMRC) project grant and grants from the South Australian Department

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