June 7, 2024
Introduction
The global prevalence of obesity has significantly increased in the past decades, and the World Health Organization (WHO) has described the phenomenon as a “global epidemic,” with the number of overweight and obese people nearly tripled between 1975 and 2016. Accordingly, the incidence of maternal obesity has also been increasing, and this has become one of the most important health issues in pregnancy. Obesity affects the mother and her offspring and is associated with various complications, including gestational hypertension, diabetes, preeclampsia, premature delivery, and spontaneous abortions.
Pathophysiology
Obesity mainly develops as an imbalance between calorie intake and energy expenditure. In times of prolonged abundance of food and When energy intake is more than needed, results in the excessive storage of fat and glycogen in subcutaneous adipose tissue (SAT) and organs. Adipose tissue when present in excess, it can have deregulatory effects on metabolic, vascular, and, particularly, inflammatory pathways in many organ systems during pregnancy, and thereby affect obstetric outcomes. For example, obesity-related insulin resistance and abnormalities in inflammatory pathways can affect placental growth and function and have been linked to development of preeclampsia. The observation that some obesity-related pregnancy complications grow with increasing severity of obesity supports the role of obesity in the pathogenesis of these adverse outcomes.
How might a high BMI affect pregnancy?
Obstetric Complications
- Gestational diabetes
- Venous thromboembolism
- Labour and delivery
- Maternal death
- A pregnancy complication characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys (preeclampsia)
- Sleep apnea
- The need for a C-section and the risk of C-section complications, such as wound infections
Fatal neonatal complications
- Miscarriage
- Stillbirth
- Congenital anomalies
- Macrosomia
Postpartum complications
Following delivery, obese women have an increased risk of postpartum haemorrhage and postpartum infection, which substantially increases the risk of Venous Thromboembolism (VTE) both after caesarean and vaginal delivery. Thus, obese women with postpartum infection may be particularly predisposed to Venous Thromboembolism (VTE).
Maternal obesity is linked to reduced breastfeeding rates, both in terms of breastfeeding initiation and duration.
Possible reasons include physical issues such as difficulty with correct positioning of the baby, psychosocial issues, or endocrine issues such as a lower prolactin response to suckling.
Management of overweight and obesity in pregnancy
Standard guidelines for lifestyle management as a component of antenatal care involve advice relating to eating the recommended number of daily serves of the five food-groups, drinking plenty of water.
- low- to moderate-intensity physical activity during pregnancy is associated with a range of health benefits and is not associated with adverse outcomes.
- folic acid supplementation, food hygiene, including how to reduce the risk of a food-acquired infection
- smoking cessation, and stop recreational drug use and alcohol consumption in pregnancy.
- Guidelines also highlight offering women the opportunity to be weighed at the first antenatal visit.
- At every antenatal visit, health professionals should encourage self-monitoring of weight gain and discuss weight gain, diet and level of physical activity with all women.
Nursing care of obese women
Nurses play a crucial role in caring for pregnant women with obesity by means of carefully screening, caring, monitoring, and referring for appropriate treatments to prevent potential complications for mothers and babies.
The following nursing management encompasses the basic dietary and lifestyle adaptations to avoid obesity during pregnancy:
- Assess her previous nutritional status and eating preferences.
- Also, assess for the presence of vices like smoking and alcohol abuse and if there is the presence of illnesses like diabetes, hypertension, or cardiac diseases.
- Check and monitor her weight prior to pregnancy and during prenatal visits, check for consistency on weight gain pattern, and any increase or reduction in weight.
- Educate them on foods necessary during pregnancy like foods rich in iron, iodine, fibre, folic acid, calcium, and phosphate as well as other vitamins and minerals.
- Plan diet modifications considering her cultural, financial, and nutritional aspects. The recommended caloric intake of a pregnant woman should be within 2500 calories.
- Encourage her to have at least a minimum of 30-minute walk per day or any activity program fitting her health status. It could be yoga or some stretching activities.
Conclusion
Obesity can cause severe complications to the mother and fetus. Women need education on the risks and how to decrease these risks before they get pregnant. It is important that all nurses and healthcare providers know these risks and educate their patients.
Deputy Nursing Officer, Sri Ramakrishana Hospital, Coimbatore, Tamil Nadu.
