Significance of Maternal Obesity - Research Paper Example

? Maternal Obesity Introduction The terms overweight and obesity are related to those ranges of body weight that are in general considered to be unhealthy, being higher than the maximum weight recommended for a given height of an individual. The excess weight in obesity is a reflection of the excess of fat present in the body, which has a frequent consequence of significant impairment of health. The Body Mass Index (BMI) is most widely used measure of obesity (Garde, 2010). According to the World Health Organization (WHO), obesity “is a BMI superior or equal to 30 and morbid obesity is assumed from a BMI of 40 and beyond” (Garde, 2010, p.2). In the USA in the ranking of health indicators that are a matter of deep concern regarding the health of the nation, obesity ranks second after physical activity. The health indicators were developed on the rationale that they related to several of the chronic disease states and the exercise of control over these indicators would lead to significant improvement of health to a high proportion of the population (Pivarnik, 2008). Obesity is considered to have reached epidemic proportions globally in the modern world. Along with growing rise of obesity in the general population, obesity during pregnancy is also on the rise. Obesity during pregnancy is now considered a common obstetric high-risk condition (Conway, 2011). Estimates suggest that one in four of women in the reproductive age group are obese in the USA (March of Dimes, 2010). This translates into one out of every five women being obese at the start of pregnancy highlighting the depth of the public health problem of maternal obesity (Kim et al, 2007). Significance of Maternal Obesity While in general the risk of obesity among the general population is heightened due to the life styles, the risk of obesity during pregnancy is even more because of the erstwhile practices and beliefs of women during pregnancy. Earlier it was believed that maternal weight gain was useful in enhancing infant health and reducing perinatal mortality. However, evidence from studies now point to excess of weight gain during pregnancy is detrimental to the mother, enhanced risks during delivery, and undesirable birth outcomes. It has also been found that 40% to 50 % of women during pregnancy put on more weight than is recommended by the Institute of medicine. Risk factors for this unwanted weight gain during pregnancy include higher pre-pregnancy weight, primiparity, lower income, poor knowledge of weight gain recommendations, lower levels of physical activity, and enhanced food consumption (Herring et al, 2008). Evaluation of the prevalence of maternal obesity across the cross-section of the female population in the US shows that the women from the racial and ethnic minorities and low socio-economic status are more prone to maternal obesity than women from the majority population and higher socio-economic groupings (DHHS, 2007). There are several reasons as to why maternal obesity is more prevalent among racial and ethnic minorities and the low socio-economic groups in the community. False beliefs of greater weight gain being beneficial to both mother and child make them prone to excess of nutritional intake. The high cost of healthy foods like fruits, vegetables, and whole grain and easy availability of low cost fast foods results in women from the economically segments of society more likely to use low cost unhealthy fast foods as the source of their increased nutrition, leading to unwanted weight gain and obesity during pregnancy (Larson, Story & Nelson, 2009). Lack of or poor facilities for physical activity in the lower income communities, depression, fatigue, and the lack of motivation to maintain one’s health among the women with low socioeconomic status also contributes to the greater prevalence of maternal obesity in this segment of the population (APA, 2011). Consequences of Maternal Obesity Evaluation of the consequences of maternal obesity has to be viewed from the three perspectives of consequences to the mother, enhanced obstetric risks, and consequences for the child. Though maternal mortality has shown marked decline in the US due to advances in medical science and awareness of the risks, over the last two decades there is little to show in reduction of maternal obesity. Growing maternal obesity could contribute to this. Even though there is less risk for maternal mortality, obesity during pregnancy elevates the economic costs due to increased morbidity. This is particularly relevant, taking into consideration that it is women from the racial and ethnic minorities and from the lower social-economic groups that are at higher risk for obesity during pregnancy. Maternal obesity leads to greater requirement for health care services and extended stay in the hospitals (CDC, 2010). Prenatal care for women who are overweight or obese has been estimated to cost five times as much as that for women of normal weight. Hospital costs are estimated to be about 600% higher for obese and overweight women than for women of normal weight, arising mostly due to the requirement of longer stay in the hospitals on an average by 4.75 days (Galtier-Dereure, Boegner, & Bringer, 2000). In addition, there is the infants born to overweight and obese women have a 350% higher probability of being admitted into the NICU (Galtier-Dereure, Boegner, & Bringer, 2000). Evidence from studies has demonstrated that maternal obesity is associated with higher rates of cesarean section and also with high-risk obstetric conditions that include diabetes and hypertension (Kulie, 2011). Other issues of concern in maternal obesity are recurrent miscarriage and preeclampsia (Abrams et al, 2009). Additionally, obese women are more likely to experience induction of labor, shoulder-dystocia, postpartum hemorrhage and anemia (Walters & Taylor, 2009). Summing up the obstetric risks involved as a result of obesity during pregnancy, they include enhanced chances of cesarian delivery, macrosomia, gestational hypertension, preeclampsia, gestational diabetes mellitus, fetal death and increased chances of birth defects (CDC, 2010). Moving to the consequences for the new born in the case of maternal obesity, fetal abnormalities are an issue of severe concern. Findings from studies have clearly demonstrated the association between maternal obesity and neural tube defects. IN addition evidence from studies establishes the association of maternal obesity with higher possibility of congenital hear diseases in the new-born. Clear evidence is also found in the association of high risk for orofacial clefts with maternal obesity. In general, these fetal abnormalities strongly associated with maternal obesity are believed to be the result of the poorer nutritional status of obese women in comparison with normal weight women, with particular emphasis on folic acid (Dudley, 2011). There is a long list of possible consequence to the new born. Women who are overweight or obese are also more likely to have a baby with multiple anomalies, spina-bifida, omphalocele, anencephaly, heart defects and macrosomia (Watkins et al, 2003). Babies born to obese women are also more likely to need resuscitation at birth (Rowlands et al, 2009). Children of obese women are more likely to develop metabolic syndrome and type II diabetes (Ruager-Martin, Hyde, & Modi, 2010). There is additionally a strong correlation between maternal obesity and childhood asthma, and between maternal obesity and attention deficit disorder (Ruager-Martin, Hyde & Modi, 2010). Depression is a common occurrence in obese pregnant women and this depression often leads to decreased intention of breastfeeding, reduced initiation of breastfeeding, and reduced duration of breastfeeding, decreasing the health benefits that accrue to the infant from breastfeeding (Kulie, 2011). Consequences of maternal obesity thus transcend immediate issues for the mother and child extending into long term health problems, with particular emphasis on the infant. Addressing the Problem of Maternal Obesity There is clear evidence that maternal obesity is a growing health problem with implications on the health of the woman during pregnancy, at the time of delivery, and into the life thereafter, and also implications on fetal health and the health of the child in the future. Maintaining a healthy weight during pregnancy thus becomes a public health priority for ensuring better health to the female segment of population and children (CDC, 2010). Very clear messages are received by women through visual as well as the print media on the manner in which society looks at women. To be loveable, successful, and considered beautiful avoiding excessive weight is necessary. There may be racial and ethnic variances to the extent of what is considered adequate body weight, but nevertheless women are strongly influenced by such strong social bias (Alexander, Shimp & Smith, 2000).This desire for a sociably acceptable body weight is an asset that is useful in addressing the issue of maternal obesity, as evinced from a study that looked into the impact of body image on weight gain during pregnancy, wherein weight gain during pregnancy was influenced by beliefs in body shape and image (Mehta, Siega-Riz & Herring, 2011). The challenge however remains with respect to the level of awareness of the health problems for the mother and infant associated with maternal pregnancy among women in general and obese women in particular (Poston, Harthoorn & Van Der Beek, 2011). Creating awareness of the health risks associated with maternal pregnancy with regards to women themselves and the outcomes of children born from obese women coupled with exploiting the desire for women to maintain a socially acceptable body weight are the intervention strategies planned for dealing with the challenge of maternal obesity at the community level. The health belief model (HBM) supports such an intervention strategy. The health belief model is one of the social cognition theories that are based on the principle of thoughts and beliefs can be used to improve health-related behaviours. The social cognition theories are based on the use of cues involving health messages, media messages, health advice, illness related information, family and peer influence that are used and understood within the social and cultural context of the individual or the selected target of population (Walker et al, 2007). Figure -1 provides the factors involved in social cognition theories Figure – 1 Factors Involved in Social Cognition Theories Cues ? Appraisals ? Attitudes/Beliefs ? Intentions ? Behaviour (Walker et al, 2007). HBM developed in the 1950s is commonly employed to bring about changes in health behaviour in targeted groups of population to enhance the health of these segments of populations. The planned intervention targets improving the dietary perception of women particularly during pregnancy, so that they there are efforts to maintain an optimal body weight. Application of HBM to dietary change becomes more effective when input provided is adequate to cause belief that lack of dietary change could have serious consequences; cause belief that the benefits of making the change are more advantageous than any of the barriers perceived for the change; give value to health, so that efforts are really put in towards the dietary change; and adequate external cues for action in the form of health information, advice, and messages are made available to the target population (Walker et al, 2007). The intervention strategy at the community level for reducing maternal pregnancy based on HBM will thus require several actions on the part of the health care professionals. The first such action is providing the required information on the risks involved in maternal pregnancy for the mother and child and also the required dietary information to maintain optimal weight during pregnancy. Monitoring the effect of this information input during the regular check-ups that pregnant women make and making the appropriate changes in information input will also be required. Print and visual media will have to be used to ensure continuation flow of cues containing the risks of poor dietary habits and the benefits from maintaining a healthy diet in terms of better and health and more acceptable looks in the eyes of society (Walker et al, 2007). Conclusion The prevalence of maternal obesity is on the rise. This places several health risks on the mother and child during pregnancy, at the time of labor, and into their future lives. Maternal pregnancy is thus an issue of grave to society in general for it puts at health risk a segment of population. Targeting this segment of population to reduce the incidence of maternal obesity is a significant public health issue. Intervention is suggested at the community. This intervention involves the use of HBM to improve the attitude towards diet to maintain the optimum weight desired during pregnancy. The interventional efforts will involve the dissemination of adequate information on the health risks due to maternal pregnancy and the benefits that accrue from maintaining a healthy diet in an appropriate manner, monitoring the impact of this information dissemination effort and the use of the print and visual media for a continual flow of reminders on the benefits of maintaining a healthy diet, from the perspective of health and general acceptance in society. . Literary References Abrams, B., Bodnar, L., Bouchard, C., Butte, N., Catalano, P., Gillman, M. & Siega-Riz, A. (2009). Weight gain during pregnancy: Reexamining the guidelines (Consensus Report). Retrieved July 25, 2011, from, Institute of Medicine of the National Academies Web site: http://iom.edu/report/2009/weight-gain-during-pregnancy/ Alexander, E. A., Shimp, L. A. & Smith, M. A. 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