A qualitative study of the experiences of women who are obese and pregnant in the UK

Objective

to explore the experiences related to obesity in women with a body mass index (BMI)>35 kg/m² during the childbearing process.

Design

a qualitative design was used. Data were collected using semi-structured interviews and field notes. Women were interviewed in the third trimester of pregnancy and between three and nine weeks after the birth. Transcribed data were analysed using framework analysis methods.

Setting

one maternity service in the North of England.

Participants

19 women with BMI>35 kg/m².

Findings

these women highlighted their feelings of humiliation, and the stigma associated with being pregnant, when obese. Interactions with health professionals and the general public reinforced their discomfort about their size. The high-risk status of their pregnancy increased the medicalisation of their pregnancy. The ultrasound scan was a significant source of distress if difficulties imaging the fetus were not clearly explained during the procedure.

Key conclusions

pregnant women who are obese are sensitive of their size. The interactions with health professionals and others that they encounter may increase distress.

Implications for practice

health professionals should be more aware of the psychological implications of being obese. Communication strategies about care should be clear and honest, and conveyed in a sensitive manner. Written comments related to size on ‘hand-held’ notes should be explained at the time of writing.     

The use of midwife-led primary antenatal care by obese women in The Netherlands: An explorative cohort study

Objectiveto study the effect of body mass index (BMI) on the use of antenatal care by women in midwife-led care.Designan explorative cohort study.Setting11 Dutch midwife-led practices.Participantsa cohort of 4421 women, registered in the Midwifery Case Registration System (VeCaS), who received antenatal care in midwife-led practices in the Netherlands and gave birth between October 2012 and October 2014.Findingsthe mean start of initiation of care was at 9.3 (SD 4.6) weeks of pregnancy. Multiple linear regression showed that with an increasing BMI initiation of care was significantly earlier but BMI only predicted 0.2% (R²) of the variance in initiation of care. The mean number of face-to- face antenatal visits in midwife-led care was 11.8 (SD 3.8) and linear regression showed that with increasing BMI the number of antenatal visits increased. BMI predicted 0.1% of the variance in number of antenatal visits. The mean number of antenatal contacts by phone was 2.2 (SD 2.6). Multiple linear regression showed an increased number of contacts by phone for BMI categories 'underweight' and 'obese class I'. BMI categories predicted 1% of the variance in number of contacts by phone.Key conclusionsBMI was not a relevant predictor of variance in initiation of care and number of antenatal visits. Obese pregnant women in midwife-led practices do not delay or avoid antenatal care.Implications for practiceTaking care of pregnant women with a high BMI does not significantly add to the workload of primary care midwives. Further research is needed to more fully understand the primary maternal health services given to obese women.     

Obstetric outcomes associated with increase in BMI category during pregnancy

OBJECTIVE: The purpose of this study was to investigate effect of increase in body mass index (BMI) category on obstetric outcomes. STUDY DESIGN: A cohort study was conducted from 1999 to 2002. Women with singleton pregnancies were placed in standard BMI categories. Increase in BMI was calculated as difference between initial BMI and delivery BMI. ANOVA was used to compare continuous variables, and chi-square test for categorical variables. RESULTS: This study included 5131 women: 49.8% had no change in BMI category, 43.9% increased by 1 BMI category, and 6.3% by >1 category. Increase in BMI category was associated with higher rates of gestational diabetes (P = .005), failed induction (P < .001), lacerations (P < .001), cesarean deliveries (P < .001), and postpartum infection (P = .007) in normal weight women. Overweight women also had increased rates of preeclampsia (P = .002) and operative vaginal deliveries (P < .001). Obese women had higher rates of chorioamnionitis (P = .003), failed induction (P < .001), and cesarean deliveries (P = .016). CONCLUSION: Increase in BMI category is associated with increased risk of complications.     

Patterns of gestational weight gain in healthy,low-risk pregnant women without co-morbidities

Background

little is known of the impact of gestational weight gain (GWG) in relation to Body Mass Index (BMI) classification on perinatal outcomes in healthy pregnant women without co-morbidities. As a first step, the prevalence of obesity and the distribution of GWG in relation to the Institute of Medicine (IOM) 2009 guidelines for GWG were examined.

Methods

data from a prospective cohort study of – a priori – low risk, pregnant women from five midwife-led practices (n=1449) were analysed. Weight was measured at 12, 24 and 36 weeks.

Findings

at 12 weeks, 1.4% of the women were underweight, 53.8% had a normal weight, 29.6% were overweight, and 15.1% were obese according to the WHO classification of BMI. In our study population, 60% of the women did not meet the IOM recommendations: 33.4% had insufficient GWG and 26.7% gained too much weight. Although BMI was negatively correlated to total GWG (p<.001), overweight and obese women class I had a significant higher risk of exceeding the IOM guidelines. Normal weight women had a significantly higher risk of gaining less weight than recommended. Obese women classes II and III were at risk in both over- and undergaining.

Conclusions

our data showed that the majority of women were unable to stay within recommended GWG ranges without additional interventions. The effects on pregnancy and health outcomes of falling out the IOM guidelines remain unclear for – a priori – low risk women. Since interventions to control GWG would have considerable impact on women and caregivers, harms and benefits should be well-considered before implementation.     

孕前体重指数对糖筛选异常孕妇妊娠结局的影响

目的：探讨孕前体重指数对单纯50g糖筛选阳性的孕妇母儿预后的影响。方法：选取2000年1月至2006年12月在上海第一人民医院行50g糖筛选异常而75g葡萄糖耐量试验结果正常的孕妇655例为研究对象,按孕前体重指数（BMI）分为3组：A：消瘦组（〈18.5kg/m^2）,B：体重正常组（18.5~24.9kg/m^2）,C.超重及肥胖组（〉25kg/m^2）,比较3组孕妇的妊娠结局。结果：655例孕妇中,A组95例（14.5%）,B组483例（73.7%）,C组77例（11.8%）。与B组相比,C组孕妇发生妊娠不良结局的危险度增高,其中子痫前期OR为3.58（95%Cl2.28~9.98）,早产OR3.64（95%Cl1.73~7.67）,巨大儿OR1.49（95%Cl1.23~3.01）,低出生体重儿OR2.55（95%Cl1.03~6.32）,新生儿低血糖OR4.07（95%Cl2.31~12.78）;A组发生低出生体重儿的几率增加,为2.70（95%Cl1.66~4.40）。结论：孕前体重指数是影响妊娠结局的独立因素。     

Effects of maternal obesity on antenatal,perinatal and neonatal outcomes

Objective: Obesity is critically important to maternal and fetal health during the perinatal period. We have detected an increasing prevalence of maternal obesity in recent years and investigated its complications during pregnancy.

Methods: A total of 931 pregnant females were investigated between March 2012 and March 2013. The patients were divided into four groups: body mass index (BMI)?<?18.5?kg/m² was underweight, 18.5–24.9?kg/m² was normal weight, 25–29.9?kg/m² was overweight and ≥30?kg/m² was obese. The effects of obesity on fetal and maternal outcomes were investigated.

Results: Significant increases in pregnancy-induced hypertension, gestational diabetes mellitus, cesarean delivery, premature rupture of membranes, shoulder dystocia, meconium-stained amniotic fluid, abnormal heart rate pattern and postpartum infection rates were found in the obese group during the perinatal period. Adverse maternal effects in obese cases were significantly more frequent than those in normal-weight cases. Preterm birth, perinatal mortality, low APGAR scores, newborn intensive care unit requirement, hypoglycemia and macrosomia rates were significantly higher in obese cases than those in non-obese cases. However, low birth weight infant rate was higher in the low BMI cases than that in the other BMI categories (p?<?0.01).

Conclusion: We conclude that obesity is an important factor associated with pregnancy complications and the increase in maternal-fetal morbidity and mortality.     

Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes

Objectives To examine the association between body mass index (BMI) and obstetrical and neonatal outcomes.Methods We conducted a cohort study comparing prepregnant BMI categories with obstetrical and neonatal outcomes using the McGill Obstetrical and Neonatal Database on all deliveries in 10 year period (1987–1997). Prepregnant BMI was categorized into underweight (<20), normal (20–24.9), overweight (25–29.9), obese (30–39.9), and morbidly obese (40+). Logistic regression analysis was used to adjust for age, smoking, parity, and preexisting diabetes using normal BMI as the reference.Results The population consisted of underweight 4,312 (23.1%), normal weight 10,021 (53.8%), overweight 3,069 (16.5%), obese 1,137 (6.1%), and morbidly obese 104 (0.6%). As compared to women with normal BMIs, overweight, obese, and morbidly obese women had an increased risk of preeclampsia 2.28 (1.88–2.77), 4.65 (3.71–5.83), 6.26 (3.48–11.26); gestational hypertension 1.56 (1.35–1.81), 2.01 (1.64–2.45), 2.77 (1.60–4.78); gestational diabetes 1.89 (1.63–2.19), 3.22 (2.68–3.87), 4.71 (2.89–7.67); preterm birth 1.20 (1.04–1.38), 1.60 (1.32–1.94), 2.43 (1.46–4.05); cesarean section 1.48 (1.35–1.62), 1.85 (1.62–2.11), 2.92 (1.97–4.34); and macrosomia 1.66 (1.23–2.24), 2.32 (1.58–3.41), 2.10 (0.64–6.86). Underweight women were less likely to have: preeclampsia 0.67 (0.52–0.86), gestational hypertension 0.71 (0.60–0.83), gestational diabetes 0.82 (0.69–0.97), cesarean section 0.89 (0.81–0.97), shoulder dystocia 0.88 (0.80–0.96), birth injuries 0.40 (0.21–0.77), and macrosomia 0.43 (0.28–0.68) but more likely to have small for gestational age infants 1.54 (1.37–1.72) and intrauterine growth restricted infants 1.33 (1.07–1.67).Conclusion In a large Canadian teaching hospital, increasing prepregnancy BMI category was associated with an increasing risk of adverse pregnancy outcomes. Underweight prepregnancy BMI was associated with a reduced risk of adverse pregnancy outcomes.     

The impact of obesity on seminal fluid in men with infertility

Background

Data on the effect of obesity on seminal fluid and men fertility are inconsistent. The aim of this study was to evaluate the impact of obesity on semen characteristics in infertile men.

Kurdish pregnant women's feelings: A qualitative study

Objective

to gain a deeper understanding of how Kurdish pregnant women feel about their pregnancy.

Design

a qualitative study analysed by a grounded theory approach.

Setting

the study was conducted among women in the third trimester of their pregnancy in either their homes or the health-care centres in Sanandaj in the western part of Iran.

Participants

22 pregnant women were recruited and interviewed.

Findings

during pregnancy, women experienced a variety of feelings: ‘satisfied and happy’, ‘unpleasant’ and ‘ambivalent’.

Conclusions and implications for practice

it is important for midwives to ask pregnant women about their feelings concerning their current pregnancy, childbirth and future motherhood. If they express negative or ambivalent feelings, these should be discussed in greater detail and their causes identified. Special consideration should be given to primiparous women and multiparous women with negative experiences of previous pregnancies.     

Information-hungry and disempowered: A qualitative study of women and their partners' experiences of severe postpartum haemorrhage

Objective

to explore how severe postpartum haemorrhage (PPH) and its management is experienced by women and their partners, and how they later view events.

Design

interpretive phenomenological qualitative study with semi-structured interviews.

Setting

in-depth interviews were conducted in participants' homes and focused on experiences of PPH in hospital and post-discharge.

Participants

nine women who had experienced severe PPH and six partners.

Findings

this study demonstrates the stressful and emotional nature of severe PPH and extends the literature by considering partners' perspectives. Women and men had different experiences and information needs, but interviewees often shared a common desire for help to understand past events. A dominant theme of communication difficulties, and two subthemes, disempowerment and information-deprivation arose strongly from the data. Communication difficulties were understandable during the emergency but were frustrating and upsetting in postpartum care and the longer term.

Conclusions and implications for practice

research is needed to develop better communication and supportive strategies, which might avoid the sense of disempowerment in this potentially vulnerable population. Different information and support needs for women and men should be considered whatever policies are implemented.     

A qualitative study of mothers' and fathers' experiences of routine ultrasound examination in Sweden

OBJECTIVE: to conceptualise mothers' and fathers' thoughts and feelings before, during and after the routine ultrasound examination during the second trimester of pregnancy. DESIGN, SETTING AND PARTICIPANTS: a grounded theory study. Two to four weeks after their ultrasound examination, 22 Swedish mothers and 22 fathers were interviewed in their homes. FINDINGS: the basic social process was confirmation of a new life. The four categories, visualising-the evident option, overwhelming to see life; becoming a family and reassuring, all represent a time span in the parents' process towards confirmation of a new life. The caregivers' way of assisting and supporting the process by information and treatment was very important to parents. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: as the ultrasound examination is perceived as a confirmation of a new life it is an extremely important milestone for both parents so the father should be encouraged to participate. It is an important and unique event for both women and men in their process towards becoming parents. This process was largely dependent on the treatment the parents had received during the examination and the information given. The findings of this study are of interest to midwives and others who perform ultrasound examinations as it explains why adequate time must be allowed for the examination and the importance of the information given before hand. When introducing new forms of fetal diagnosis in the future it should be kept in mind that this might irrevocably be accepted by parents who long for confirmation of a new life.     

单纯性肥胖儿童血清脑源性神经营养因子表达的变化及意义

目的观察单纯性肥胖儿童和健康正常体重儿童血清脑源性神经营养因子(BDNF)质量浓度的差异,探讨BDNF与儿童肥胖及瘦素抵抗、胰岛素抵抗的关系。 方法南京军区福州总医院儿科等于2004年5月至2005年5月应用酶联免疫法检测单纯性肥胖儿童(37例)和健康儿童(31例)血清BDNF质量浓度与胰岛素(INS)浓度，应用放射免疫法检测血清瘦素(LEP)质量浓度。比较两组儿童血清BDNF、INS、LEP的差异，分析血清BDNF质量浓度与血清LEP质量浓度和INS浓度的关系。 结果(1)两组儿童的体重指数(BMI)、BDNF、INS及LEP均差异显著(BMI：F=175.05，P<0.01；BDNF：F=12.35，P<0.01；INS：F=21.71，P<0.01；LEP：F=48.89，P<0.01)，肥胖组BMI、INS及LEP均明显高于健康组，而肥胖组BDNF明显低于健康组。(2)影响LEP的因素依次为BMI、丙氨酸转氨酶(ALT)、BDNF(R2=0.5946，F=0.31，P<0.01)；影响INS的因素依次为BMI、BDNF(R2=0.2647，F=11.34，P<0.01)。去除BMI、ALT影响后，BDNF与LEP、INS负相关(BDNF与LEP：r=-0.2455，P<0.05；BDNF与INS：r=-0.2878，P<0.05)。 结论(1)肥胖儿童血清BDNF缺乏，未发现“BDNF抵抗”的特点。(2)学龄前儿童血清LEP、INS受BMI影响最大，还受血清BDNF影响。BDNF是二者独立的负相关因素。     

Somali women's experiences of antenatal care: A qualitative interview study

ObjectiveTo explore Somali women's experiences of antenatal care in Norway.DesignA qualitative study based on individual semi-structured interviews conducted either face-to-face or over the phone.SettingNorway.ParticipantsEight Somali-born women living in Norway.Key findingsFour themes were generated from the analysis. From their experiences of antenatal care in Norway, the Somali women described: 1) when care was provided in a way that gained their trust, they made better use of the available health services, 2) the importance of continuity of care and of sharing commonalities with the caregiver, 3) a need for accessible information, specifically tailored to the needs of Somali women and 4) how culturally insensitive caregivers had a negative impact on the quality of care.Conclusion and implications for practiceThe Somali women in this study were grateful for the care provided, although the quality of antenatal care did not always meet their needs. This study should serve as a reminder of the importance of establishing trust between the pregnant woman and the caregiver, strengthening interpretation services and assuring tailored information is available to Somali women at an early stage. The findings further suggest that antenatal care for Somali women may be improved by offering continuity of care and improving clinical and cultural skills in clinicians. Suggestions for practice, and future research, include initiating group antenatal care especially tailored to Somali women.     

Risk factors for gestational diabetes mellitus among women screened with the two-step and one-step methods: A before-and-after study

Objective

To compare the risk profiles for gestational diabetes mellitus (GDM) using a one-step and two-step screening method and diagnostic criteria.

Perceptions and experiences of parenthood and maternal health care among Latin American women living in Spain: a qualitative study

Objective

to explore the experiences and perceptions of parenthood and maternal health care among Latin American women living in Spain.

Design

an exploratory qualitative research using focus groups and thematic analysis of the discussion.

Setting and participants

three focus groups with 26 women from Bolivia and Ecuador and three focus groups with 24 midwives were performed in three towns in the Valencian Community receiving a large influx of immigrants.

Findings

the women interpreted motherhood as the role through which they achieve fulfilment and assumed that they were the ones who could best take care of their children. They perceived that men usually make decisions about sex and pregnancy and recognised a poor or inadequate use of contraceptive methods in planning their pregnancies. Women reported that it was not necessary to go as soon and as frequently for health examinations during pregnancy as the midwives suggested. The main barriers identified to health-care services were linked to insecure or illegal employment status, inflexible appointment timetables for prenatal checkups and sometimes to ignorance about how public services worked.

Key conclusions and implications for practice

empowering immigrant women is essential to having a long-term positive effect on their reproductive health. Antenatal care providers should be trained to build maternity care that is culturally sensitive and responds better to the health needs of different pregnant women and their newborns.     

Menarche among Brazilian women: memories of experiences

Objective

to present women's experiences of menarche and related memories.

Design

qualitative study using focus groups for data collection.

Setting

the city of Campinas, São Paulo state, Brazil.

Participants

64 women aged 21-51 years, experiencing menstrual periods, with former or current sexual activity and no perceived infertility.

Methods

eight focus groups were carried out using a semi-structured guideline. Discussions were recorded with participants’ consent, and transcribed and revised. Thematic content analysis was carried out using gender relations as the theoretical framework.

Findings

menarche was experienced as a passage from childhood to womanhood, associated with belonging to a new group and acquiring a new status in the family. The experiences of menarche were not always welcomed or expected, but were recalled as associated with body changes and awareness of sexual issues. The mother's behaviour and attitudes towards menarche were clearly seen as generators of strong and everlasting impressions, either in a positive or negative way. Memories related to the experience of menarche extended through their life, interfering with their relation with their own body, including their reproductive health.

Key conclusions

the way in which menarche is experienced may exert an impact on women's reproductive health, sexuality and lifestyle behaviours.

Implications for practice

the acknowledgement of menarche experiences can be useful to guide health-care providers towards more effective education of girls on sexual and reproductive health issues and better attention to women's needs.     

Strategies to reduce disparities in maternal morbidity and mortality: The role of obesity and metabolic disease

Maternal obesity, excessive gestational weight gain, and preexisting diabetes are known risk factors for increased maternal and neonatal morbidity. These conditions are more prevalent in certain racial and ethnic minorities. Identification and acknowledgement of racial and ethnic inequalities related to maternal metabolic disease is crucial for clinicians to provide the most comprehensive care in pregnancy. Research and clinical efforts should focus on implementation of healthy lifestyle interventions preconceptually and risk reduction efforts in disease complications during pregnancy. In addition, obstetrical providers can provide the framework and ongoing support for sustainable lifestyle modifications, thereby, improving a woman’s long-term metabolic health.     

Induction of labour in pregnant individuals with obesity

People with obesity may require induction of labour (IoL) due to a higher incidence of pre-existing comorbidities and pregnancy complications, as well as to prevent post-term pregnancies and late-term stillbirths. IoL at 39–40 weeks is associated with fewer caesarean births and lower morbidity for the pregnant person and neonate when compared with expectant management. Ensuring the success and safety of IoL in people with obesity requires adherence to evidence-based protocols for the management of labour induction and augmentation. Cervical ripening as well as the latent and active phases of labour in people with obesity may be considerably prolonged, requiring higher cumulative doses of oxytocin. This should be guided by intrauterine pressure catheters and early provision of neuraxial analgesia, where possible. There is insufficient evidence to recommend one method of IoL over another. The need for higher doses of prostaglandins and concurrent agents for cervical ripening should be studied in prospective studies.