jsmc-10117

DOES AN ANTENATAL EDUCATIONAL PROGRAM IMPROVE MATERNAL OUTCOMES AMONG OBESE PREGNANT WOMEN IN THE KURDISTAN REGION OF IRAQ 

Aveen F. Hajimam a and Tina Harris b

a Gasha Institute, Erbil city- Iraqi Kurdistan.

b School of Nursing and Midwifery, De Montfort University, Leicester. UK.  

Submitted: 31/3/2017; Accepted: 1/8/2017; Published: 15/8/2017

DOI Link: https://doi.org/10.17656/jsmc.10117

ABSTRACT

Background

Maternal obesity is associated with health risks for mother and new-born. Obesity during pregnancy has increased dramatically in Iraqi Kurdistan.

Objectives 

The aim for this study is to assess the influence of an educational program on the maternal pregnancy outcomes of obese women attending primary health centres in a large city in the Kurdistan region of Iraq.

Methods

A quasi –experiment was undertaken. 292 pregnant women who attended one of three health centres for their antenatal care prior to 20 weeks gestation were recruited to the study. 99 women were recruited were of normal weight with a BMI of 20-25Kg/m2, (baseline group), 96 women had a BMI ≥ 30 and were randomised to receive normal care (control group) and 97 obese women were allocated to received normal antenatal care and invited to participate in an antenatal education programme (intervention group). Maternal outcomes measured were gestational weight gain during pregnancy, pregnancy induced hypertension, Gestational Diabetes Mellitus and duration of pregnancy.

Results

Obese women were older and were more likely to have had more pregnancies than normal weight women. Regarding maternal outcomes there was no statistically significant difference among the three groups regarding pregnancy induced hypertension, and Gestational age at onset of labour. In relation to gestational diabetes mellitus findings indicated that the prevalence of gestational diabetes mellitus was reduced among those obese women who received the educational programme compared to the control and baseline groups. In addition all obese women (intervention and control groups) had a statistically significant lower weight gain in pregnancy compared to baseline group. 

Conclusions

The antenatal education programme made a small difference to maternal outcomes. The prevalence of gestational diabetes was reduced in women who accessed the programme suggesting that gestational diabetescould be decreased by educating women during pregnancy regarding healthy diet and exercise.One factor which may have affected the results of this study was the low attendance rate among women who were randomised to receive the education programme. A higher rate of attendance at education classes may have improved outcomes in others areas. 

KEYWORDS

Antenatal education, Maternal outcomes, Obesity, BMI, Gestational diabetes.

References 

1. Nascimento, S. L., F. G. Surita, et al. The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: a randomised clinical trial.” Bjog-an International Journal of Obstetrics and Gynaecology 2011:118(12): 1455-1463.

2. Heslehurst, N et all. Symposium I: Consequences of obesity and overweight during pregnancy Identifying ‘at risk’ women and the impact of maternal obesity on National Health Service maternity services.” Proceedings of the Nutrition Society 2011: 70(4): 439-449.

3. National Obesity Observatory (NOO) (2010). www.noo.org.uk/NOO obesity/maternal obesity/epidemiology (accessed 14/11/2012)

4. Sirimi, Natalia,&Goulis, Dimitrios.G. Obesity in pregnancy, Hormones,2010:vol. 9, no. 4, pp. 299-306. 

5. Morgan, K.L., Rahman, M.A., Macey, S., Atkinson, M.D., Hill, R.A., Khanom, A., Paranjothy, S., Husain, M.J. &Brophy, S.T. Obesity in pregnancy: a retrospective prevalence-based study on health service utilisation and costs on the NHS, BMJ open 2014, vol. 4, no. 2, pp. e003983-2013-003983. 

6. Namir, Al-Tawil., M.M. Abdulla and A.J. Abdul Ameer. Prevalence of and factors associated with overweight and obesity among a group of Iraqi women’’, Eastern Mediterranean Health Journal 2007:13(2) 420-429.

7. Vahratian, A., A. M. Siega-RizAM, Zhang J, Troendle J, Savitz D. Maternal pre-pregnancy overweight and obesity and the risk of cesarean delivery in nulliparous women.” Annals of Epidemiology 2005: 15(7): 467-474.

8. Campbell, F., Johnson, M., Messina, J., Guillaume, L. &Goyder, E. Behavioural interventions for weight management in pregnancy: a systematic review of quantitative and qualitative data”, BMC public health 2011;,vol. 11, pp. 491-2458-11-491.

9. National institute for Health and care Excellence. Weight management before, during and after pregnancy 2010,PH27, accessed from http://www.nice.org.uk/guidance/PH27 on (25/2/2016).

10. Mirkhan, H. Fattah, A. and Najib, B. Initial Statistics on obesity in Erbil city/ Kurdistan region-Iraq; Personal communication 2012.

11. Hettema, J., Steele, J. & Miller, W.R.Motivational interviewing, Annu.Rev.Clin.Psychol 2005.,vol. 1, pp. 91-111. 

12. IOM NRC, R.K. &Yaktine, A. Weight gain during pregnancy: re-examining the guidelines”, Washington: The National Academies,2009.

13. Morin, K. H., & Reilly, L.Caring for obese pregnant women.Jognn-Journal of Obstetric Gynecologic and Neonatal Nursing 2007: 36(5): 482-489.

14. Weiss JL, Malone FD. Caring for obese obstetric patients.Contemp Ob/Gyn 2001;6:12–26

15. Thangaratinam, S., Rogozinska, E., Jolly, K., Glinkowski, S., Roseboom, T., Tomlinson, J.W., Kunz, R., Mol, B.W., Coomarasamy, A. & Khan, K.S. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence, BMJ (Clinical research ed.) 2012, vol. 344, pp. e2088. 

16. Dodd, J., Grivell, R., Crowther, C. & Robinson, J. Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials,BJOG: An International Journal of Obstetrics & Gynaecology 2010, vol. 117, no. 11, pp. 1316-1326. 

17. Claesson, I., Brynhildsen, J., Cedergren, M., Jeppsson, A., Sydsjö, A. &Josefsson, A. Weight Gain Restriction During Pregnancy Is Safe for Both the Mother and Neonate, Obstetric Anesthesia Digest 2011, vol. 31, no. 1, pp. 48. 

18. Wolff, S., Legarth, J., Vangsgaard, K., Toubro, S. &Astrup, A. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women, International journal of obesity 2008, vol. 32, no. 3, pp. 495-501. 

19. Guelinckx, I., Devlieger, R., Mullie, P. & Vansant, G. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial,The American Journal of Clinical Nutrition 2010, vol. 91, no. 2, pp. 373-380.

20. Vinter, C.A., Jensen, D.M., Ovesen, P., Beck-Nielsen, H. & Jorgensen, J.S. “The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women”, Diabetes care 2011, vol. 34, no. 12, pp. 2502-2507.

21. Oteng-Ntim, E., Varma, R., Croker, H., Poston, L. & Doyle, P. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis”, BMC medicine 2012, vol. 10, no. 1, pp. 1. 

22. Basu JK, Jeketera CM, Basu D. Obesity and its outcomes among pregnant South African women. International Journal of Gynecology& Obstetrics 2010;110(2):101-104. 

23. Kazemian, E., Sotoudeh, G., Dorosty-Motlagh, A.R., Eshraghian, M.R. &Bagheri, M. Maternal Obesity and Energy Intake as Risk Factors of Pregnancy-induced Hypertension among Iranian Women”, Journal of health, population, and nutrition 2014, vol. 32, no. 3, pp. 486.

24. Dodd, J.M., Turnbull, D., McPhee, A.J., Deussen, A.R., Grivell, R.M., Yelland, L.N., Crowther, C.A., Wittert, G., Owens, J.A., Robinson, J.S. & LIMIT Randomised Trial Group Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial”, BMJ (Clinical research ed. 2014), vol. 348, pp. g1285. 

25. Smith, G.C., Shah, I., Pell, J.P., Crossley, J.A. &Dobbie, R. Maternal obesity in early pregnancy and risk of spontaneous and elective preterm deliveries: a retrospective cohort study,American Journal of Public Health 2007, vol. 97, no. 1, pp. 157-162.

26. Phelan, S., Phipps, M.G., Abrams, B., Darroch, F., Schaffner, A. & Wing, R.R. Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study,The American Journal of Clinical Nutrition 2011, vol. 93, no. 4, pp. 772-779. 

27. Thornton, Y.S., Smarkola, C., Kopacz, S.M. &Ishoof, S.B. Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial”, Journal of the National Medical Association 2009, vol. 101, no. 6, pp. 569-577

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