Wednesday, May 15, 2019
Last week, I had the pleasure of sitting on the thesis defence committees of two extraordinarily dedicated young trainees, currently completing their medical residencies in obstetrics and gynaecology. Both theses focussed on issues related to obesity within the obstetric community as well as the implications of obesity for the care of women during the gestational period and during delivery (more on these theses in coming posts).
For those interested in this topic, I would like to draw your attention to a short review paper by Cecilia Jevitt, Chair of the Midwifery Program at the University of British Columbia, published in the Journal of Perinatal and Neonatal Nursing.
Although the paper focusses on the social determinants of health that underly a substantial proportion of the risk for developing obesity (these include socio-economic disparities
in employment, education, healthcare access, food quality,
and availability), the paper also looks at many of the environment and biological factors that may promote obesity including environmental toxins, epigentics, and the microbiota.
As for the impacts of excess body fat on pregnancy, Levitt lists over 30 conditions that can affect the pregnancy, delivery, and the post-partum period, threathening the health of mother and child, which are far more common in women with obesity.
This is not to say that many of these problems can not also be encountered in the care of women without obesity, however, excess body weight makes these conditions far more likely and often much more difficult to manage.
As Levitt points out, reducing the risk for obesity in the first place would need comprehensive changes at the policy level that not only address issues related to food and activity but also the socio-economic and other social determinants of health that disproportionately affect women of lower socio-economic status.
As currently, no such policies are in sight, those charged with the care of women of childbearing age will continue having to watch for and deal with the increased risk for adverse outcomes in women with excess weight – a challenge that is only slowly (as evidenced by the theses mentioned above) coming to the centre of attention of obstetric health professionals.
On the positive side, Levitt reminds us that, “Although obesity places women at risk for numerous morbidities, most women with obese BMIs [sic] complete pregnancy and birth without complications.” Improved training of health professionals in the care of women with obesity can no doubt further decrease the risk to both mother and child.