Existing maternal obesity guidelines may increase inequalities between ethnic groups: a national epidemiological study of 502,474 births in England

Challenges of prenatal diagnosis in obese pregnant women

Obesity rates are increasing world-wide with most of the increase in women of the reproductive age group. While recognised as an important contributor to non-communicable diseases, pregnant women with obesity are particularly at risk of not only maternal and pregnant complications but also have an increased risk of congenital malformations. Furthermore, pregnant obese women are more likely to be older and therefore at a greater risk of aneuploidy. Prenatal diagnosis in these women especially those who are morbidly obese is challenging due not only to their weight but the implications of the increase adiposity on biochemical markers of aneuploidy. In this review we discuss the current challenges in providing prenatal diagnosis for these women including those related to the ergonomics of ultrasound and those inherent in them because of their obesity. Appropriate counselling for these women should include the lower sensitivity of the tests, the difficulties in performing some of the procedures (imaging and invasive testing) as well as the increased risk of structural abnormalities related to their obesity.

Addressing inequalities and improving maternal and infant outcomes: the potential power of nutritional interventions across the reproductive cycle

Maternal nutrition is essential for optimal health and well-being of women and their infants. This review aims to provide a critical overview of the evidence-base relating to maternal weight, obesity-related health inequalities and dietary interventions encompassing the reproductive cycle: preconception, pregnancy, postnatal and interpregnancy. We provide an overview of UK data showing that overweight and obesity affects half of UK pregnancies, with increased prevalence among more deprived and minoritised ethnic populations, and with significant health and cost implications. The existing intervention evidence-base primarily focuses on the pregnancy period, where extensive evidence demonstrates the power of interventions to improve maternal diet behaviours, and minimise gestational weight gain and postnatal weight retention. There is a lack of consistency in the intervention evidence-base relating to interventions improving pregnancy health outcomes, although there is evidence of the potential power of the Mediterranean and low glycaemic index diets in improving short- and long-term health of women and their infants. Postnatal interventions focus on weight loss, with some evidence of cost-effectiveness. There is an evidence gap for preconception and interpregnancy interventions. We conclude by identifying that interventions do not address cumulative maternal obesity inequalities and overly focus on individual behaviour change. There is a lack of a joined-up approach for interventions throughout the entire reproductive cycle, with a current focus on specific stages (i.e. pregnancy) in isolation. Moving forward, the potential power of nutritional interventions using a more holistic approach across the different reproductive stages is needed to maximise the benefits on health for women and children.

Factors associated with Diabetes Empowerment among patients with type 2 diabetes, at OPD setting, Karachi, Pakistan

Diabetes Empowerment is important for diabetic control as it postpones the onset of complications. This study aimed to investigate the association of medication adherence, self-care behaviors, and diabetes knowledge with Diabetes Empowerment among patients with type II diabetes. A cross-sectional study was conducted on 451 type II diabetes patients attending Endocrinology clinics at OPD setting in Karachi. Data was collected electronically using a structured questionnaire comprising of tools to measure Diabetes Empowerment, medication adherence, self-care behaviors, diabetes knowledge, and socioeconomic scale. It also included health-related information from patients' medical record. As outcome variable was continuous, so multiple linear regression analysis was used to assess the independent effect of Diabetes Empowerment on medication adherence, self-care behaviors and diabetes knowledge with other co-variates. The mean Diabetes Empowerment score was 3.62 (SD = 0.31). The mean age of the participants was 56.68 (SD = 11.76). 53.88% were females, 80.71% were married, 77.56% were obese, and 66.30% were upper-middle class with average diabetes duration of 11.7 years (SD = 7.89). HbA1c values were ≥ 7 in 63.41% of study participants. Diabetes Empowerment was significantly associated with medication adherence (P = 0.001), general diet (P < 0.001), special diet (P = 0.011), smoking status (P = 0.001), and socioeconomic status (upper lower, P = 0.085). A comprehensive strategy for the treatment of type II diabetes is essential to enhance clinical results, improve patient quality of life, and prevent diabetes-related comorbidities. People with type II diabetes should be encouraged to embrace an empowerment-based approach by healthcare providers. It is critical to do research that promotes empowerment.

Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: a narrative review

The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre‐pregnancy body mass index greater than 25 kg m^–2 are more likely than those with a body mass index in the ideal range (20–24.99 kg m^–2) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care.

Overweight and obesity before pregnancy and excessive gestational weight gain are major determinants of risk for pregnancy loss, gestational diabetes, hypertensive conditions, labour complications and maternal death.

Pregnancy is regarded as a teachable moment when women are at their most receptive to messages about their health. However, unclear guidance on diet and physical activity, weight stigma from health professionals, inexperience and reluctance among professionals about raising issues about weight, and stretched resources put the health of women and babies at risk.

Excessive weight gain in pregnancy and post‐partum weight retention compromise future fertility and increase risk for future pregnancies.

Large randomised controlled trials have had little success in addressing excessive gestational weight gain or antenatal complications. Individualised, culturally sensitive and responsive interventions appear to have greater success.

Multiple deprivation and other risk factors for maternal obesity in Portsmouth, UK

BACKGROUND

Maternal obesity is known to be associated with a range of adverse outcomes, both for the mothers and their children. It may be more prevalent in areas with higher deprivation as measured by the Index of Multiple Deprivation (IMD), but this has not been demonstrated consistently. This study focused primarily on the relationship between maternal obesity and deprivation in a setting where areas of significant deprivation are surrounded by the overall affluent South East England.

METHODS

The study used the records of 3830 women who delivered under the care of a Portsmouth hospital from 1 April 2013 to 31 March 2014. Logistic regression was used to analyse the association between national IMD quintiles and maternal obesity, accounting for the potential confounders of age, ethnic origin, smoking status and parity.

RESULTS

Following adjustment, women in the most deprived IMD quintile were 1.60 (95% CI: 1.13, 2.26) times more likely to be obese compared to those in the least deprived quintile. Maternal obesity was also found to be associated with ethnicity and parity, but not with age or smoking status.

CONCLUSIONS

Maternal obesity increased with increasing deprivation. IMD may be a useful group-level indicator when planning interventions aimed at tackling maternal obesity.

Are pre-pregnancy weight fluctuations and adherence to prenatal nutrition and exercise recommendations related to excessive gestational weight gain?

Women who have an overweight or obese pre-pregnancy body mass index (BMI) may be recommended to lose weight before pregnancy, however the association of preconception weight fluctuations and prenatal adherence to nutrition and exercise recommendations with gestational weight gain (GWG) have not been assessed. One hundred women with a pre-pregnancy BMI ≥ 25.0 kg/m² who participated in the Nutrition and Exercise Lifestyle Intervention Program (NELIP) were included and stratified as gained weight excessively (n = 47) or not (n = 53) using the 2009 Institute of Medicine GWG guidelines. Participants completed a Weight Health History Questionnaire providing information about weight loss prior to the index pregnancy. Adherence was scored based on meeting six nutrition and exercise goals for the NELIP (/6). More women who gained excessively reported that they had actively tried to lose weight a year before the current pregnancy (61%) than women who did not gain excessively (39%; p = 0.02). Of the women attempting preconception weight loss, those who gained excessively lost more weight (6.7 ± 10.2 kg) than women who did not (2.1 ± 3.8 kg; p = 0.003). Adherence to the NELIP was lower among women who gained excessively (3.3 ± 0.8; 55%) than those who did not (4.4 ± 0.9;73%; p < 0.001). Program adherence (p < 0.001) was related to excessive GWG.

A low intensity dietary intervention for reducing excessive gestational weight gain in an overweight and obese pregnant cohort

PURPOSE

Excessive gestational weight gain is associated with detrimental outcomes to both the mother and baby. Currently, the best approach to prevent excessive gestational weight gain in overweight and obese women is undetermined. The present study aimed to evaluate the effectiveness of a group-based outpatient dietary intervention in pregnancy to reduce excessive gestational weight gain.

METHODS

In this retrospective study, overweight and obese pregnant women who attended a single 90-min group education session were compared to women who received standard care alone. Total gestational weight gain, maternal and neonatal outcomes were compared between the intervention and control groups. Data were analysed using Student t, Mann-Whitney and Chi-squared tests as appropriate. A 24-h dietary recall was analysed and compared to the Australian National Nutrition Survey.

RESULTS

A significant reduction in gestational weight gain was observed with this intervention (P = 0.010), as well as in the rate of small for gestational age births (P = 0.043). Those who attended the intervention had saturated fat and sodium intake levels that exceeded recommendations. Intake of pregnancy-specific micronutrients including folate, calcium and iron were poor from diet alone.

CONCLUSIONS

A low-intensity antenatal dietary intervention may be effective in reducing excessive gestational weight gain, although multi-disciplinary interventions yield the best success. Further research is required to identify the optimal modality and frequency to limit excessive gestational weight gain. Dietary interventions tailored to ethnicity should also be explored.

LEVEL OF EVIDENCE

Level II, controlled trial without randomization.

Association of Sleep Quality and Macronutrient Distribution: A Systematic Review and Meta-Regression

Sleep is involved in metabolic, emotional and cognitive regulation and is therefore an essential part of our health. Although an association between sleep quality and macronutrient intake has been reported, studies on the effect of macronutrient distribution with sleep quality are limited, and available results are inconsistent. In this study, we aim to assess the association between sleep quality and macronutrient distribution in healthy adults from systematically reviewed cross-sectional studies and randomized controlled trials (RCTs). A total of 19 relevant articles were selected and it was observed that good sleepers (sleep duration ≥ 7 h, global sleep score ≤ 5, sleep latency ≤ 30 min and sleep efficiency >85%) had a higher energy distribution from dietary protein than poor sleepers. On the other hand, good sleepers showed a relatively lower percentage of energy from dietary carbohydrate and fat than poor sleepers. However, meta-regression analysis revealed no dose-dependent association between the macronutrient distributions and sleep duration. These results suggest that consuming a greater proportion of dietary protein may benefit on improving sleep quality in healthy adults. However, findings may be susceptible to reverse causality and additional RCTs are needed.

Maternal obesity classes, preterm and post-term birth: a retrospective analysis of 479,864 births in England

BACKGROUND

Preterm (< 37 weeks gestation) and post-term birth (≥42 weeks gestation) are associated with increased morbidity and mortality for mother and infant. Obesity (body mass index (BMI) ≥30 kg/m²) is increasing in women of reproductive age. Maternal obesity has been associated with adverse pregnancy outcomes including preterm and post-term birth. However, the effect sizes vary according to the subgroups of both maternal BMI and gestational age considered. The aim of this retrospective analysis was to determine the association between maternal obesity classes and gestational age at delivery.

METHODS

A secondary data analysis of 13 maternity units in England with information on 479,864 singleton live births between 1990 and 2007. BMI categories were: underweight (< 18.5 kg/m²), recommended weight (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²) and obesity classes I (30.0-34.9 kg/m²), II (35.0-39.9 kg/m²), IIIa (40-49.9 kg/m²) and IIIb (≥50 kg/m²). Gestational age at delivery categories were: Gestational age at delivery (weeks): extreme preterm (20-27), very preterm (28-31), moderately preterm (32-36), early term (37, 38), full term (39-40), late term (41) and post-term (≥42). The adjusted odds of births in each gestational age category (compared to full-term birth), according to maternal BMI categories were estimated using multinomial logistic regression. Missing data were estimated using multiple imputation with chained equations.

RESULTS

There was a J-shaped association between the absolute risk of extreme, very and moderate preterm birth and BMI category, with the greatest effect size for extreme preterm. The absolute risk of post-term birth increased monotonically as BMI category increased. The largest effect sizes were observed for class IIIb obesity and extreme preterm birth (adjusted OR 2.80, 95% CI 1.31-5.98).

CONCLUSION

Women with class IIIb obesity have the greatest risks for inadequate gestational age. Combining obesity classes does not accurately represent risks for many women as it overestimates the risk of all preterm and post-term categories for women with class I obesity, and underestimates the risk for women in all other obesity classes.

Birth weight trends in England and Wales (1986-2012): babies are getting heavier

INTRODUCTION

Birth weight is a strong predictor of infant mortality, morbidity and later disease risk. Previous work from the 1980s indicated a shift in the UK towards heavier births; this descriptive analysis looks at more recent trends.

METHODS

Office for National Statistics (ONS) registration data on 17.2 million live, single births from 1986 to 2012 were investigated for temporal trends in mean birth weight, potential years of birth weight change and changes in the proportions of very low (<1500 g), low (<2500 g) and high (≥4000 g) birth weight. Analysis used multiple linear and logistic regression adjusted for maternal age, marital status, area-level deprivation and ethnicity. Additional analyses used the ONS NHS Numbers for Babies data set for 2006-2012, which has information on individual ethnicity and gestational age.

RESULTS

Over 27 years there was an increase in birth weight of 43 g (95% CI 42 to 44) in females and 44 g (95% CI 43 to 45) in males, driven by birth weight increases between 1986-1990 and 2007-2012. There was a concurrent decreased risk of having low birth weight but an 8% increased risk in males and 10% increased risk in females of having high birth weight. For 2006-2012 the birth weight increase was greater in preterm as compared with term births.

CONCLUSIONS

Since 1986 the birth weight distribution of live, single births in England and Wales has shifted towards heavier births, partly explained by increases in maternal age and non-white ethnicity, as well as changes in deprivation levels. Other potential influences include increases in maternal obesity and reductions in smoking prevalence particularly following the introduction of legislation restricting smoking in public places in 2007.

Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review

AIM

This systematic review investigates associations between maternal pre-pregnancy/early-pregnancy anthropometrics (e.g. weight and body fat), anthropometric change and pregnancy outcomes in South Asian and White women.

METHODS

Twelve electronic literature databases, reference lists and citations of all included studies were searched. Observational studies published in the English language were included. Descriptive synthesis was used to summarize the evidence base.

RESULTS

Twenty-two studies met the inclusion criteria (403,609 births [351,856 White and 51,753 South Asian]). Nine were prospective cohort studies, nine were retrospective cohort studies and two were cross-sectional studies. Results suggested that in South Asian women, maternal pre-pregnancy/early-pregnancy anthropometrics were associated with anthropometric change, birthweight, mode of delivery and gestational diabetes mellitus (GDM). Gestational anthropometric change was found to be associated with GDM. There was limited evidence to suggest that there may be associations between maternal pre-anthropometrics/early anthropometrics and hypertensive disorders, stillbirth, congenital anomalies, post-natal weight retention and post-natal impaired glucose tolerance. The evidence suggested a combined effect of pre-pregnancy/early-pregnancy anthropometrics and gestational anthropometric change on both GDM and post-natal weight retention.

CONCLUSION

The increased risk of adverse pregnancy outcomes in South Asian women should be considered in guidelines for weight management before and during pregnancy.

GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING): a pilot cluster randomised controlled trial of a guideline implementation intervention for the management of maternal obesity by midwives

BACKGROUND

Weight management in pregnancy guidelines exist, although dissemination alone is an ineffective means of implementation. Midwives identify the need for support to overcome complex barriers to practice. An evaluation of an intervention to support midwives' guideline implementation would require a large-scale cluster randomised controlled trial. A pilot study is necessary to explore the feasibility of delivery and evaluation prior to a definitive trial. The GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING) trial aims to test whether it is feasible and acceptable to deliver a behaviour change intervention to support midwives' implementation of weight management guidelines.

METHODS

GLOWING is a multi-centre parallel group pilot cluster randomised controlled trial comparing the delivery of a behaviour change intervention for midwives versus usual practice. Four NHS Trusts (clusters) will be randomised to intervention and control arms, stratified by size of maternity services. The intervention uses social cognitive theory and consists of face-to-face midwifery training plus information resources for routine practice. The main outcomes are whether the intervention and trial procedures are feasible and acceptable to participants and the feasibility of recruitment and data collection for a definitive trial. Target recruitment involves all eligible midwives in the intervention arm recruited to receive the intervention, 30 midwives and pregnant women per arm for baseline and outcome questionnaire data collection and 20 midwives and women to provide qualitative data. All quantitative and qualitative analyses will be descriptive with the purpose of informing the development of the definitive trial.

DISCUSSION

This pilot study has been developed to support community midwives' implementation of guidelines. Community midwives have been selected as they usually carry out the booking appointment which includes measuring and discussing maternal body mass index. A cluster design is the gold standard in implementation research as there would be a high risk of contamination if randomisation was at individual midwife level: community midwives usually work in locality-based teams, interact on a daily basis, and share care of pregnant women. The results of the pilot trial will be used to further develop and refine GLOWING prior to a definitive trial to evaluate effectiveness and cost-effectiveness.

TRIAL REGISTRATION

ISRCTN46869894; retrospectively registered 25th May 2016.

Maternal body mass index and access to antenatal care: a retrospective analysis of 619,502 births in England

BACKGROUND

Late access to antenatal care increases risks of adverse outcomes including maternal and perinatal mortality. There is evidence that BMI influences patient engagement with health services, such as cancer screening services and delayed access to treatment; this association has not been fully explored in the context of antenatal care. This study investigated the association between the stage of pregnancy women access antenatal care, BMI, and other socio-demographic factors.

METHODS

Retrospective analysis of routine hospital data from 34 NHS maternity units in England, UK, including 619,502 singleton births between 1989 and 2007. Analyses used logistic regression to investigate the association between maternal BMI categories and stage of pregnancy women accessed antenatal care. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were used to estimate associations, adjusting for maternal age, ethnic group, parity, Index of Multiple Deprivation score and employment status. The primary outcome was late access to antenatal care (>13+6 weeks). Secondary outcomes were trimester of access, and the association between late access and other socio-demographic variables.

RESULTS

Women with an overweight or obese BMI accessed antenatal care later than women with a recommended BMI (aOR 1.11, 95%CI 1.09-1.12; aOR 1.04, 95%CI 1.02-1.06 respectively), and underweight women accessed care earlier (aOR 0.77, 95%CI 0.74-0.81). Women with obesity were 42% more likely to access care in the third trimester compared with women with a recommended BMI. Additional significant socio-demographic associations with late access included women from minority ethnic groups, teenagers, unemployment and deprivation. The greatest association was observed among Black/Black British women accessing care in the third trimester (aOR 5.07, 95% CI 4.76, 5.40).

CONCLUSIONS

There are significant and complex socio-demographic inequalities associated with the stage of pregnancy women access maternity care, particularly for women with obesity accessing care very late in their pregnancy, and among BME groups, teenagers, deprived and unemployed women. These populations are at increased risk of adverse maternal and fetal outcomes and require support to address inequalities in access to antenatal care. Interventions to facilitate earlier access to care should address the complex and inter-related nature of these inequalities to improve pregnancy outcomes among high-risk groups.

Maternal BMI and diabetes in pregnancy: Investigating variations between ethnic groups using routine maternity data from London, UK

Objective

To investigate the ethnicity-specific association between body mass index (BMI) and diabetes in pregnancy, with a focus on the appropriateness of using BMI cut-offs to identify pregnant women at risk of diabetes.

Study design

Analysis of routinely-collected data from a maternity unit in London, UK. Data were available on 53 264 women delivering between 2004 and 2012. Logistic regression was used to explore the association between diabetes in pregnancy and BMI among women of different ethnicities, and adjusted probability estimates were used to derive risk equivalent cut-offs. ROC curve analysis was used to assess the performance of BMI as a predictor of diabetes in pregnancy.

Results

The prevalence of diabetes in pregnancy was 2.3% overall; highest in South and East Asian women (4.6% and 3.7%). In adjusted analysis, BMI category was strongly associated with diabetes in all ethnic groups. Modelled as a continuous variable with a quadratic term, BMI was an acceptable predictor of diabetes according to ROC curve analysis. Applying a BMI cut-off of 30 kg/m² would identify just over half of Black women with diabetes in pregnancy, a third of White (32%) and South Asian (35%) women, but only 13% of East Asian women. The ‘risk equivalent’ (comparable to 30 kg/m² in White women) threshold for South Asian and East Asian women was approximately 21 kg/m², and 27.5 kg/m² for Black women.

Conclusions

This study suggests that current BMI thresholds are likely to be ineffective for diabetes screening in South and East Asian women, as many cases of diabetes will occur at low BMI levels. Our results suggest that East Asian women appear to face a similarly high risk of diabetes to South Asian women. Current UK guidelines recommend diabetes screening should be offered to all pregnant South Asian women; extending this recommendation to include women of East Asian ethnicity may be appropriate.

Anaesthetic Management of Obese Parturients: What is the Evidence Supporting Practice Guidelines?

Increasing rates of obesity in western populations present management difficulties for clinicians caring for obese pregnant women. Various governing bodies have published clinical guidelines for the care of obese parturients. These guidelines refer to two components of anaesthetic care: anaesthetic consultation in the antenatal period for women with a body mass index (BMI) > 40 kg/m2 and the provision of early epidural analgesia in labour. These recommendations are based on the increased incidence of obstetric complications and the predicted risks and difficulties in providing anaesthetic care. The concept behind early epidural analgesia is logical—site the epidural early, use it for surgical anaesthesia and avoid general anaesthesia if surgery is required. Experts support this recommendation, but there is weak supporting evidence. It is known that the management of labour epidurals in obese women is complicated and that women with extreme obesity require higher rates of general anaesthesia. Anecdotally, anaesthetists view and apply the early epidural recommendation inconsistently and the acceptability of early epidural analgesia to pregnant women is variable. In this topic review, we critically appraise these two practice recommendations. The elements required for effective implementation in multidisciplinary maternity care are considered. We identify gaps in the current literature and suggest areas for future research. While prospective cohort studies addressing epidural extension (‘top-up’) in obese parturients would help inform practice, audit of local practice may better answer the question “is early epidural analgesia beneficial to obese women in my practice?”.

Seeing it through their eyes: a qualitative study of the pregnancy experiences of women with a body mass index of 30 or more

BACKGROUND

Maternal obesity [body mass index (BMI) ≥ 30 kg/m(2)] is associated with numerous complications, but currently, little is known about the pregnancy experiences of these women.

OBJECTIVE

To gain insight into the experience of pregnant women with BMI ≥ 30 kg/m(2), when accessing maternity services and attending a community lifestyle programme.

DESIGN

Qualitative methodology, utilizing focus groups and semi-structured interviews with post-natal women who had an antenatal BMI ≥ 30 kg/m(2). The sample was obtained from a larger study.

RESULTS

Thirty-four women participated. Three main themes were identified using thematic analysis. Women described disappointment with their pregnancy. In particular, their informational expectations were not met; some health professionals appeared uninterested, insensitive or unconfident. Women described readiness to make a lifestyle change, but this was not encouraged during routine care. Attending the programme began the process of behavioural change. Women's beliefs that small changes make a big difference led to them being spurred on by success; driven by a desire to improve the health of their family.

DISCUSSION AND CONCLUSION

Pregnant women who are obese know this is the case and expect to be provided with information to assist them in making lifestyle changes. Health professionals should be aware of women's readiness for change and view pregnancy as an ideal time to communicate. Pregnant women with a BMI ≥ 30 kg/m(2) should contribute to health professional training, to highlight the reality of the maternity system journey; first-hand accounts may improve the way health professionals' approach these women. Lifestyle interventions should be developed with input from the intended target group.

Maternal obesity, inflammation, and developmental programming

The prevalence of obesity, especially in women of child-bearing age, is a global health concern. In addition to increasing the immediate risk of gestational complications, there is accumulating evidence that maternal obesity also has long-term consequences for the offspring. The concept of developmental programming describes the process in which an environmental stimulus, including altered nutrition, during critical periods of development can program alterations in organogenesis, tissue development, and metabolism, predisposing offspring to obesity and metabolic and cardiovascular disorders in later life. Although the mechanisms underpinning programming of metabolic disorders remain poorly defined, it has become increasingly clear that low-grade inflammation is associated with obesity and its comorbidities. This review will discuss maternal metainflammation as a mediator of programming in insulin sensitive tissues in offspring. Use of nutritional anti-inflammatories in pregnancy including omega 3 fatty acids, resveratrol, curcumin, and taurine may provide beneficial intervention strategies to ameliorate maternal obesity-induced programming.

Experiencing maternity care: the care received and perceptions of women from different ethnic groups

BACKGROUND

According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women.

METHODS

Secondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women's experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity.

RESULTS

A total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff.

CONCLUSION

Women in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern.

Chorionic plate arterial function is altered in maternal obesity

Objectives

To characterise Chorionic Plate Artery (CPA) function in maternal obesity, and investigate whether leptin exposure reproduces the obese CPA phenotype in normal-BMI women.

Study design

CPA responses to the thromboxane-A₂ mimetic U46619 (pre/post leptin incubation), to the nitric oxide donor sodium nitroprusside (SNP) and the occurrence of tone oscillations (pre/post leptin incubation) were assessed in 46 term placentas from women of normal (18.5–24.9) or obese (>30) Body Mass Index (BMI).

Outcome measures

Area Under the dose response Curve (AUC), maximum response (V_max), sensitivity (EC₅₀) to U46619 (pre/post leptin) and SNP; average vessel tone, oscillation amplitude and frequency (pre/post leptin).

Results

U46619 vasoconstriction was similar between BMI categories (p > 0.05), however vasodilatation to SNP was reduced in obesity (AUC p = 0.02, V_maxp = 0.04) compared to normal-BMI women. Leptin incubation altered responses to U46619 in both normal-BMI (EC₅₀ at 100 ng/ml leptin; p < 0.05) and obese women (AUC at 50 ng/ml; p < 0.05) but vasomotion was unaffected (p > 0.05).

Conclusions

Maternal obesity is associated with altered placental vascular function which may adversely affect placental oxygen and nutrient transport, placing the fetus at risk. Leptin incubation altered CPA vascular function but did not reproduce the obese phenotype.