Maternal obesity trends in a large Irish university hospital

Reynolds, Ciara; Egan, Brendan; McMahon, Léan; O’Malley, Eimer G.; Sheehan, Sharon R.; Turner, Michael J.

doi:10.1016/j.ejogrb.2019.05.003

Cited by 23 publications

(21 citation statements)

References 21 publications

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“…While there is considerable data available on national and international rates of adult obesity, including on women of childbearing age, there is a dearth of high quality measured data on maternal obesity rates. A recent study from our hospital reported that about one in five women presenting for antenatal care is in the obesity category and that the rate has increased over the last decade [5]. Similar trends have been reported in other high income countries [6].…”

Section: Introductionsupporting

confidence: 83%

Maternal obesity and depression reported at the first antenatal visit

et al. 2021

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Background Maternal obesity and depression are common and both have been associated with adverse pregnancy outcomes. Aims The aim of this observational study was to examine the relationship between maternal body mass index (BMI) category and self-reported depression at the first antenatal visit. Methods Women who delivered a baby weighing ≥ 500 g over nine years 2009–2017 were included. Self-reported sociodemographic and clinical details were computerised at the first antenatal visit by a trained midwife, and maternal BMI was calculated after standardised measurement of weight and height. Results Of 73,266 women, 12,304 (16.7%) had obesity, 1.6% (n = 1126) reported current depression and 7.5% (n = 3277) multiparas reported a history of postnatal depression. The prevalence of self-reported maternal depression was higher in women who had obesity, > 35 years old, were socially disadvantaged, smokers, had an unplanned pregnancy and used illicit drugs. After adjustment for confounding variables, obesity was associated with an increased odds ratio (aOR) for current depression in both nulliparas (aOR 1.7, 95% CI 1.3–2.3, p < 0.001) and multiparas (aOR 1.8, 95% CI 1.5–2.1, p < 0.001) and postnatal depression in multiparas (aOR 1.4, 95% CI 1.3–1.5, p < 0.001). The prevalence of current depression was higher in women with moderate/severe obesity than in women with mild obesity (both p < 0.001). Conclusions We found that self-reported maternal depression in early pregnancy was independently associated with obesity. The prevalence of depression increased with the severity of obesity. Our findings highlight the need for implementation of strategies and provision of services for the prevention and treatment of both obesity and depression.

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Section: Introductionsupporting

confidence: 83%

Maternal obesity and depression reported at the first antenatal visit

et al. 2021

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“…The operation has become much safer for mothers [ 6 , 7 ]. Sociodemographic changes have increased the levels of risk factors such as advancing maternal age, rising obesity levels and the associated increased rates of gestational diabetes mellitus [ 8 , 9 ]. Technical advances, such as ultrasound scanning, can identify cases where a CS is deemed to be in the fetal interest.…”

Section: Introductionmentioning

confidence: 99%

Caesarean section rates in women in the Republic of Ireland who chose to attend their obstetrician privately: a retrospective observational study

Turner

Reynolds

McMahon

et al. 2020

BMC Pregnancy Childbirth

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Background Caesarean section (CS) rates are increasing and there are wide variations in rates internationally and nationally. There is evidence that women who attend their obstetrician privately have a higher incidence of CS than those who attend publicly. The purpose of this observational study was to further investigate why CS rates may be higher in women who chose to attend their obstetrician privately. Methods This study analysed data collected as part of the clinical records by midwives at the woman’s first antenatal appointment in a large European maternity hospital. All women who delivered between the years 2009 and 2017 were included. Data were analysed both cross-sectionally and longitudinally. Results Overall, 73,266 women had a singleton pregnancy and 1830 had a multiple pregnancy. Of the packages of maternity care, 75.2% chose public, 10.8% chose semiprivate and 14.0% chose private. During the study, 11,991 women attended the hospital for their first and second pregnancies. Overall, women who attended privately were older and had higher proportions of infertility treatment and history of miscarriage (all p < 0.001) compared to those publicly-funded. Private patients were more likely to have a history of infertility, a history of miscarriage, a multiple pregnancy and to be ≥35 yrs. They had lower rates of obesity, smoking and illicit drug use in pregnancy (all p < 0.001). In women who chose private care, the overall rate of CS was higher compared to women choosing publicly-funded (42.7% vs 25.3%, p < 0.001) The increase was due to an increase in elective rather than emergency CS. The increase in elective CS fell after adjustment for clinical risks. In the longitudinal analysis, 89.7% chose the same package second time around. Women who changed from public to private care for the second pregnancy were more likely to have had a previous emergency CS or admission to the Neonatal Unit. Conclusions This study suggests that the increased CS rate in women privately insured may be attributed, in part, to the fact that women who can afford health insurance choose continuity of care from a senior obstetrician because they are risk adverse and wish to have the option of an elective CS.

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“…Our findings suggest that the increase in older mothers may be contributing to the escalating rate of GDM. Another factor may be an increase in the incidence of maternal obesity, which is a major risk for GDM [ 25 ]. While this has been reported elsewhere for our own hospital, the information on national trends in BMI is not available.…”

Section: Discussionmentioning

confidence: 99%

The impact of revised diagnostic criteria on hospital trends in gestational diabetes mellitus rates in a high income country

McMahon

O’Malley

Reynolds

et al. 2020

BMC Health Serv Res

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Objective In 2010, national guidelines were published in Ireland recommending more sensitive criteria for the diagnosis of Gestational Diabetes Mellitus (GDM). The criteria were based on the 2008 Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study and were endorsed subsequently by the World Health Organization (WHO). Screening nationally is selective based on risk factors. We examined the impact of the new criteria on hospital trends nationally for GDM over the 10 years 2008–17. Research design and methods Data from three national databases, the Hospital Inpatient Enquiry System (HIPE), National Perinatal Reporting System (NPRS) and the Irish Maternity Indicator System (IMIS), were analyzed using descriptive statistics, analysis of variance, and Poisson loglinear modelling. Results The overall incidence of GDM nationally increased almost five-fold from 3.1% in 2008 to 14.8% in 2017 ( p ≤ 0.001). The incidence varied widely across maternity units. In 2008, the incidence varied from 0.4 to 5.9% and in 2017 it varied from 1.9 to 29.4%. There were increased obstetric interventions among women with GDM over the decade, specifically women with GDM having increased cesarean sections (CS) and induction of labor (IOL) ( p ≤ 0.001). These trends were significant in large and mid-sized maternity hospitals ( p ≤ 0.001). The increase in GDM diagnosis could not be explained by an increase in maternal age nationally over the decade. The data did not include information on other risk factors such as obesity. The increased incidence in GDM diagnosis was accompanied by a decrease in high birthweight ≥ 4.5 kg nationally. Conclusions We found adoption of the new criteria for diagnosis of GDM resulted in a major increase in the incidence of GDM rates. Inter-hospital variations increased over the decade, which may be explained by variations in the implementation of the new national guidelines in different maternity units. It is likely to escalate further as compliance with national guidelines improves at all maternity hospitals, with implications for provision and configuration of maternity services. We observed trends that may indicate improvements for women and their offspring, but more research is required to understand patterns of guideline implementation across hospitals and to demonstrate how increased GDM diagnosis will improve clinical outcomes.

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Maternal obesity trends in a large Irish university hospital

Cited by 23 publications

References 21 publications

Maternal obesity and depression reported at the first antenatal visit

Maternal obesity and depression reported at the first antenatal visit

Caesarean section rates in women in the Republic of Ireland who chose to attend their obstetrician privately: a retrospective observational study

The impact of revised diagnostic criteria on hospital trends in gestational diabetes mellitus rates in a high income country

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