Women ’ s Knowledge and Perceptions of the Risks of Excess Weight in Pregnancy

1. Women’s Knowledge and Perceptions of the Risks of Excess Weight in Pregnancy Emma Jeffs1, Joanna Gullam2, Benjamin Sharp3, Helen Paterson1 1 Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, New Zealand. 2 Department of Obstetrics and Gynaecology, Christchurch School of Medicine, University of Otago, New Zealand. 3 Department of Obstetrics and Gynaecology, Christchurch Women’s Hospital, New Zealand Contact: emma.jeffs@cdhb.govt.nz Background Results • Calculated BMI of participants: • 1% (n=6) underweight • 49% (n=200) normal weight • 27% (n=112) overweight • 17% (n=70) obese • 6% (n=23) of participants declined to be weighed • The worldwide prevalence of overweight and obesity has more than doubled since 1980[1] .The increase in overweight and obesity prevalence is proportionately affecting women of childbearing age, leading to increased numbers of women being overweight or obese when registering for obstetric care in pregnancy. • Women who are overweight or obese when entering pregnancy are more likely to have worse pregnancy outcomes. Consequently, this population represents a significant and increasing problem encountered in obstetric practice. • There are a small number of intervention studies designed to restrict gestational weight gain in pregnancy. To increase the likelihood of successful intervention in overweight and obese individuals it is recommended the views and perceptions of this population should be considered when planning services for the treatment of overweight and obesity [2, 3]. • In order to assess the extent to which knowledge is lacking regarding risks associated with excess weight and appropriate weight gain, it is advantageous to explore the perceptions that pregnant women have regarding these issues. This line of investigation may give rise to a wider perspective for informing more effective intervention studies, as well as indicating where future education strategies are required, important factors in the increasing need to temper the effect of excess weight in pregnancy. • To describe pregnant women’s knowledge and perceptions of the risks of excess weight in pregnancy. • A cross-sectional survey of 411 pregnant women attending a nuchal translucency scan at 11 to 13+6 weeks gestation in community radiology units in Christchurch, New Zealand was carried out over a three month period in 2011. • Women completed a questionnaire to establish basic demographics. Knowledge of risks was assessed via indication of agreement with statements posed on a seven-point Likert scale. • The main outcome measure was knowledge regarding the risks of excess weight in pregnancy. • Knowledge was assessed for; stillbirth, small for gestational age infant, macrosomia, normal and uncomplicated vaginal delivery, structural anomaly, caesarean section delivery, high blood pressure (including pre-eclampsia), gestational diabetes and shoulder dystocia. Knowledge related to the risks of smoking in pregnancy was also considered as a comparison. • A literature search was conducted to establish known rates of complications. Using this information, a panel of obstetricians identified the answers they considered correct for each question (identified on figures in blue). • Participants’ age ranged from 17-50 (mean 31) • 50% of women were nulliparous • 53% of women had a university qualification • Ethnicity; 75% New Zealand European, 5% Asian, 4.5% Maori and 15.5% ‘other’ Objective Methods • Participants identified that excess weight in pregnancy increases your risk of macrosomia, caesarean section delivery, gestational diabetes and shoulder dystocia, but not to the extent the specialist panel estimated. • Participants significantly underestimated the risk for stillbirth and structural anomaly. Conclusion Women’s knowledge of the increased risk of pregnancy complications associated with excess weight is limited. Many women correctly identify that excess weight increases the risk of complications of pregnancy and delivery but the majority were unaware of the increased risk of congenital anomaly which may be reduced by treatment of 5mg of folic acid pre-conceptually. Further education of the risks of excess weight in pregnancy is required. References 1 World Health Organisation. WHO obesity and overweight factsheet (number 311; September 2006). 2006; Available from: http://www.who.int/mediacentre/factsheets/fs311/en/print.html. 2 Nyman , V., A. Prebensen, and G. Flesner, Obese women’s experiences of encounters with midwives and physicians during pregnancy and childbirth. Midwifery, 2010. 26(424-429). 3 Thompson, R., and D. Thomas, A cross-sectional survey of the opinions on weight loss treatments of adult obese patients attending a dietetic clinic. International Journal of Obesity, 2000. 24(164-170).