Overweight and obesity are rapidly growing concerns in all regions, are now common in some low- and middle-income countries and are becoming significant public health priorities just like undernutrition and infectious diseases. Obesity is a risk factor for many noncommunicable diseases, including hypertension and diabetes, which are known causes of complications of pregnancy, including those that lead to maternal deaths. (1)
A conference on 'Obesity in Pregnancy' was held in London, UK, in January 2009. Richard Congdon (above), Chief Executive of the UK Confidential Enquiry into Maternal & Child Health (CEMACH), opened the conference by emphasising the importance of the topic and its increasing prevalence in the UK and elsewhere.
Catherine Nelson-Piercy, a Medical Assessor for CEMACH, summarised some of the results of the latest enquiry. Among direct causes of death, the four most frequent are venous thrombo-embolism (VTE), sepsis, pre-eclampsia and amniotic fluid embolism. Of women who died (of all causes) 52% were overweight, and over half of these were obese (body mass index--BMI >30). A substantial amount of data demonstrated an association between deaths from embolism and high BMI. Cardiac disease is the leading indirect cause of maternal death and this too is associated with high BMI. Data from the USA were also considered which explored differences in BMI aming different ethnic groups. (2)
Midwives' views were presented by Nicola Heslehurst of the Centre for Food, Physical Activity and Obesity at the University of Teesside where practical and psycho-social issues of developing an appropriate service were discussed.
Obstetric anaesthetist Martin Dresner stressed that 'obesity increases both the need for and the risks of anaesthesia'. He summarised the problems when caring for an obese patient: co-morbidities (cardiac disease, etc); airway access (in patients with fat around the face and neck); vascular access (patients with limb obesity); and epidural access (excess fat on the back). Because the distribution of body fat is significant in these ways, a BMI cut-off point for 'risk' is not helpful: physical assessment must be carried out.
Hassan Shehata from St George's Medical School added to the quantity of data already heard about the high risks of obesity, demonstrating association with maternal hypertension, fetal macrosomia (baby >4kg), frequency of caesarean section delivery, stillbirth and neonatal death, and greater length of...