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Maternal weight and the obesogenic environment in Nova Scotia
Sara Kirk, Louise Parker, Trevor Dummer, Linda Dodds, Tarra Penney
“…today’s principal neglected public health problem...” (WHO, 1997)
“…one of the most important medical and public health problems of our time..." (Prof. Philip James, IOTF
Chairman) “…given the prevalence of childhood obesity, and
given its contribution to many diseases, this is the first generation that may not live as long as their parents…” (Dr. Kellie Leitch)
The obesity time bomb
Obesity rates, by province and sex, 2004
Overweight and obesity rates: children and youth, by province, 2004
So, what happened?
www.foresight.gov.uk
Pregnancy and post-partum: an ideal time for intervention
• Obese mothers are at a high risk for many complications
• Children with obese parents are themselves more likely to be obese as adults
• Supportive programming for mothers is key to obesity prevention
• No national surveillance system that routinely measures pregnancy weight in Canada
• Canadian Perinatal Surveillance system (CPSS) collects 27 health outcomes but not BMI of the mother
The pregnant population in Canada
• Provincial level population-based, computerized database with information on pregnancy outcomes
• Maternal/newborn data available for every pregnancy of > 20 weeks gestation, with a birth weight of 500g or more
• Data on self-reported pre-pregnancy weights from 1988
The Atlee Perinatal Database
• To describe the temporal, socio-economic and demographic trends in normal weight and obese pregnant women in Nova Scotia
• Part of a larger study investigating the influence of the obesogenic environment on maternal body weight
Objective
• Self-reported pre-pregnancy weights on women in NS (1988-2006)• 172,373 deliveries (2108 multiple births)• normal weight = 55-75 kg• moderately obese = 90-120 kg• severely obese > 120 kg
• Analyses to look at trends in maternal body weight by: • Time• Age• Parity• SES• Urban/rural
Methods
Non obese
(55-75kg)
n=94,655
Moderately obese
(90-120kg) n=12,882
p Severely Obese (>120kg)
n=1,216
p
Maternal age (yrs, mean, SD)
28.5 (5.4) 28.6 (4.9) <0.001 29.2 (4.8) <0.001
Primiparous (n,%) 42,715 (45.1) 5,359 (41.8) <0.001 500 (41.1) <0.01
Low SES (n,%) 18,653 (20.3) 3,089 (24.8) <0.001 323 (27.2) <0.001
Rural (n,%) 35,193 (37.2) 5271 (41.1) <0.001 502 (41.3) <0.01
Weight gain (kg, mean SD)
15.4 (6.0) 11.5 (6.7) <0.001 9.7 (6.8) <0.001
Subject characteristics
Variation in maternal bodyweight over time, 1988-2006
52.0
54.0
56.0
58.0
60.0
62.0
64.0
66.0
68.0
70.0
72.0
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Bo
dyw
eig
ht
(kg
)
mean
median
8.6 kg increase
Percentage of women in obese category (>=90 kg)
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
%
Percentage
Number of deliveries to severely obese women, 1988-2006
0
20
40
60
80
100
120
140
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Num
ber
of d
eliv
erie
s Number of deliveries to women with pre-
pregnancy weight >120kg
Maternal obesity: A provincial problem
Summary of results
• Obese women:• were slightly older• were of lower SES• gained less weight during
pregnancy• were more likely to live in rural
areas
Conclusions
• Maternal weights have increased dramatically over the last 20 years in Nova Scotia
• Deliveries in severely obese women have more than tripled since 1988
• These trends have implications for population health and health care delivery• Maternal and child health• Staffing• Resources
What next?
• In-depth exploration of the influence of the obesogenic environment on maternal body weight
• Investigation of maternal obesity in the context of the child
• Recommendations for family-centred management and prevention
Acknowledgements
• IWK Health Centre funding (Tarra Penney and Trevor Dummer)
• Reproductive Care Program of Nova Scotia (data access)