Summary Obesity is rising in the obstetric population, yet there is an absence of services and guidance for the management of maternal obesity. This systematic review aimed to investigate relationships between obesity and impact on obstetric care. Literature was systematically searched for cohort studies of pregnant women with anthropometric measurements recorded within 16‐weeks gestation, followed up for the term of the pregnancy, with at least one obese and one comparison group. Two researchers independently data‐extracted and quality‐assessed each included study. Outcome measures were those that directly or indirectly impacted on maternity resources. Primary outcomes included instrumental delivery, caesarean delivery, duration of hospital stay, neonatal intensive care, neonatal trauma, haemorrhage, infection and 3rd/4th degree tears. Meta‐analysis shows a significant relationship between obesity and increased odds of caesarean and instrumental deliveries, haemorrhage, infection, longer duration of hospital stay and increased neonatal intensive care requirement. Maternal obesity significantly contributes to a poorer prognosis for mother and baby during delivery and in the immediate post‐partum period. National clinical guidelines for management of obese pregnant women, and public health interventions to help safeguard the health of mothers and their babies are urgently required.

Background: There is an absence of national statistics for maternal obesity in the UK. This study is the first to describe a nationally representative maternal obesity research data set in England. Design: Retrospective epidemiological study of first trimester obesity. Methods: Data from 34 maternity units were analysed, including 619 323 births between 1989 and 2007. Data analysis included trends in first trimester maternal body bass index status over time, and geographical distribution of maternal obesity. Population demographics including maternal age, parity, ethnic group, deprivation and employment were analysed to identify any maternal obesity-associated health inequalities. All demographics were tested for multicollinearity. Logistic regression analyses were adjusted for all demographics as confounders. Results: First trimester maternal obesity is significantly increasing over time, having more than doubled from 7.6% to 15.6% over 19 years (Po0.001), and shows geographic variation in incidence. There are also demographic health inequalities associated with maternal obesity, including increased odds of being obese with increasing age, parity, Black ethnic group and deprivation. There is also an association between morbid obesity and increased levels of unemployment. Conclusions: The increase in maternal obesity has serious implications for the health of mothers, infants and service providers, yielding an additional 47 500 women per year requiring high dependency care in England. The demography of women most at risk of first trimester obesity highlights health inequalities associated with maternal obesity, which urgently needs to be addressed.

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Objective The aim of this study was to identify trends in maternal obesity incidence over time and to identify those women most at risk and potential-associated health inequalities.Design Longitudinal database study.Setting James Cook University Hospital maternity unit, Middlesbrough, UK. Methods Trends in maternal obesity incidence over time were analysed using chi-square test for trend. Demographic predictor variables were analysed using multivariate logistic regression, adjusting for confounding factors after testing for multicollinearity. National census data were used to place the regional data into the context of the general population.Main outcome measure Trends in maternal obesity incidence. Demographic predictor variables included ethnic group, age, parity, marital status, employment and socio-economic disadvantage.Results The proportion of obese women at the start of pregnancy has increased significantly over time from 9.9 to 16.0% (P < 0.01). This is best described by a quadratic model (P < 0.01) showing that the rate is accelerating; by 2010, the rate will have increased to 22% of this population if the trend continues. There is also a significant relationship with maternal obesity and mothers' residing in areas of most deprivation (odds ratio [OR] = 2.44, 95% CI = 1.98, 3.02, P < 0.01), with increasing age (OR = 1.04, 95% CI = 1.04, 1.05, P < 0.01), and parity (OR = 1.17, 95% CI = 1.12, 1.21, P < 0.01).Conclusions The incidence of maternal obesity at the start of pregnancy is increasing and accelerating. Predictors of maternal obesity are associated with health inequalities, particularly socio-economic disadvantage.

Following on the work of Dunnell, the evolutionary archaeology school has made a sharp distinction between functional and stylistic variation in archaeological artifacts. Variation is defined as functional if it is affected by selection processes and as stylistic if it is a result of processes of random drift. The argument has been further developed by Neiman (1995), who showed by simulation that processes of cultural mutation and drift could produce the kinds of "battleship curves" that generally characterize artifact-style frequency distributions through time, and also demonstrated that they could account for patterns of stylistic variation through time in Woodland-period ceramic assemblages from Illinois. In this paper we present a case study of change in the decoration of pottery from early Neolithic Central Europe. We show that the actual diachronic frequency distributions and those expected under the neutral model do not coincide and conclude that in this case the neutral model does not provide an adequate description of change in ceramic decoration. A model involving selection, in the form of a bias in favor of novelty in the later phases of the period studied, seems likely to be more appropriate, and we note the social interpretation of the original investigator of the data. In conclusion, it is suggested that neutral models provide an important heuristic tool but that there is not a radical break between functional and stylistic variation.

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Fair Trade is analysed as a new economic social movement to the extent that it is based on new forms of collective action and directs its demands primarily to the market rather than to the State. In addition, it is intrinsically a global movement harnessing development goals to new market relations. It differs, however, from similar movements (organics, animal welfare) to the extent that it focuses primarily on traditional issues of redistributive justice rather than a new generation of rights and duties. Fair Trade is understood as having three components: (i) the organization of alternative trading networks; (ii) the marketing of Fair Trade labelled products through licensed conventional traders and retailers; and (iii) the campaign-based promotion of Fair Trade to change both purchasing practices and the rules of conventional trade. As a market oriented movement, Fair Trade relies crucially on the emergence of a new politicization of consumer activity comprising not only “consumer-activists” but also the State as consumer and a new layer of political consumers sensitive to issues of social justice in their daily purchasing practices. Copyright Springer Science+Business Media, LLC 2007Fair Trade, New economic social movement, Consumer-oriented social movement, Social justice through markets, Southern Fair Trade,