RELATIONSHIP OF MATERNAL MORBIDITY AND MORTALITY TO HIGH BODY MASS INDEX (BMI) PREGNANCIES IN PAKISTAN

Authors

  • Asra Dow University of Health Sciences, DRKMP Civil Hospital, Karachi-Pakistan
  • Riffat Jalil Dow University of Health Sciences, DRKMP Civil Hospital, Karachi-Pakistan
  • Shehla Arif Dow University of Health Sciences, DRKMP Civil Hospital, Karachi-Pakistan

DOI:

https://doi.org/10.55519/JAMC-01-12645

Keywords:

Obesity, Maternal morbidity, Mortality, BMI

Abstract

Background: The average BMI is shifting upwards even in low-resource countries like Pakistan causing an increase in pregnancy-related complications. This study was planned to elaborate the association of maternal morbidity and mortality during pregnancy and puerperium with high BMI. Methods: A descriptive longitudinal study was performed in the Obstetrics and Gynaecology Unit 2 of D. Ruth K. M. Pfau Civil Hospital, Karachi, Pakistan from 1st August 2022 to 31st January 2023. Women delivering in Obstetric Unit 2 having a 1st-trimester record of weight were included. Demographic data, antenatal, intrapartum and postpartum complications noted. Participants were further stratified into 2 groups based on BMI i.e. overweight (25.0-29.9) and obese (30.0 or more) and demographics and clinical characteristics compared. Univariate and multivariate logistic regression analysis was done. Data was entered and analyzed on SPSS version 21. Result: The frequency is calculated to be 15.7%. The observed complications included pre-eclampsia 16.7%, PIH 13%, eclampsia 7%, GDM 18.9%, induction of labour 19.5%, PPH in 15.2% and infected caesarean wound in 19.2% of participants. The caesarean section was the predominant mode of delivery in 55.7%. A significant relationship was found with advancing maternal age, DM/ GDM, hypertension, Pre-eclampsia, IOL, caesarean section, PPH and wound infection. The univariate and multivariate logistic regression models also showed two times higher odd in obese groups as compared to overweight groups. Conclusion: Our study underscores a strong association between maternal obesity in early pregnancy and several threatening complications during pregnancy, delivery, and the postpartum period.

Author Biographies

Asra, Dow University of Health Sciences, DRKMP Civil Hospital, Karachi-Pakistan

 

Riffat Jalil, Dow University of Health Sciences, DRKMP Civil Hospital, Karachi-Pakistan

 

Shehla Arif, Dow University of Health Sciences, DRKMP Civil Hospital, Karachi-Pakistan

 

References

WHO. Obesity and overweight fact sheet. [Internet]. World Health Organization. [cited 2021 June 09] Available from: http://www.who.int/ mediacentre/factsheets/fs311/en/.

Asif M, Aslam M, Altaf S, Atif S, Majid A. Prevalence and Sociodemographic Factors of Overweight and Obesity among Pakistani Adults. J Obes Metab Syndr 2020;29(1):58–66.

Krukowski RA, West DS, DiCarlo M, Shankar K, Cleves MA, Saylors ME, et al. Are early first trimester weights valid proxies for preconception weight? BMC Pregnancy Childbirth 2016;16(1):357.

Yousuf F, Naru T, Sheikh S. Effect of body mass index on outcome of labour induction. J Pak Med Assoc 2016;66(5):598–601.

Vellanki VS, Kocherlakota VL, Kaul R. “High Body Mass Index in Pregnancy, Its Effects on Maternal and Fetal Outcome.” J Clin Gynecol Obstet 2012l;1(1):15–8.

Knight M, Bunch K, Tuffnell D, Patel R, Shakespeare J, Kotnis R, et al. MBRRACE-UK. Saving Lives, Improving Mothers’ Care - CORE report lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2017-19. Oxford: National Perinatal Epidemiology Unit, University of Oxford 2021 [Internet]. [cited 2021 June 9]. Available from: https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2021/MBRRACE-UK_Maternal_Report_2021_-_FINAL_-WEB_VERSION.pdf

Martin KE, Grivell RM, Yelland LN, Dodd JM. The influence of maternal BMI and gestational diabetes on pregnancy outcome. Diabetes Res Clin Pract 2015;108(3):508–13.

Denison FC, Aedla NR, Keag O, Hor K, Reynolds RM, Milne A, et al. Care of Women with Obesity in Pregnancy: Green-top Guideline No. 72. BJOG 2019;126(3):e62–106.

Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ. Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG 2005;112(4):403–8.

Choi H, Lim JY, Lim NK, Ryu HM, Kwak DW, Chung JH, et al. Impact of pre-pregnancy body mass index and gestational weight gain on the risk of maternal and infant pregnancy complicatios in Korean women. Int J Obes (Lond) 2022;46(1):59–67.

Sun D, Li F, Zhang Y, Xu X. Associations of the pre-pregnancy BMI and gestational BMI gain with pregnancy outcomes in Chinese women with gestational diabetes mellitus. Int J Clin Exp Med 2014;7(12):5784–9.

Ahmed F, Amin A, Yasir S. Impact of Obesity on Obstetrical Practice and Outcome. Esculapio J SIMS 2012;8(4):159–62.

Nelson SM, Matthews P, Poston L. Maternal metabolism and obesity: modifiable determinants of pregnancy outcome. Hum Reprod Update 2010;16(3):255–75.

Pirzada S, Haider S, Soomro P, Soomro MA, Zulfiqar K, Kumar N, et al. The Outcome of Pregnancy among Overweight and Obese Women as Compared to Normal Weight Women: A cross sectional study form rural Sindh, Pakistan. Pak J Life Soc Sci 2021;18(2):97–101.

Anwar R, Razzaq K, Parveen N. Maternal obesity and obstetric outcome in pregnant women attending PNS Shifa Karachi. Pak Armed Forces Med J 2021;71(Suppl-1):S245–49.

Razzak L, Devi R, Tariq S, Seetlani A, Jamshed S. Pregnancy outcomes do influence by extremes of body mass index. Pak Armed Forces Med J 2021;71(2):690–3.

Nnoli A, Seligman NS, Dysart K, Baxter JK, Ballas SK. Opioid Utilization by Pregnant Women with Sickle Cell Disease and the Risk of Neonatal Abstinence Syndrome. J Natl Med Assoc 2018;110(2):163–8.

Munim S, Maheen H. Association of gestational weight gain and pre-pregnancy body mass index with adverse pregnancy outcome. J Coll Physicians Surg Pak 2012;22(11):694–8.

Shen J, Zhang Z, Chen K, Lu M, Qian Q, Liu P, et al. Prepregnancy obesity status and risks on pregnancy outcomes in Shanghai: A prospective cohort study. Medicine (Baltimore) 2018;97(40):e12670.

Goldstein RF. Association of Gestational Weight Gain with Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. JAMA 2017;317(21):2207–25.

Mercado A, Marquez B, Abrams B, Phipps MG, Wing RR, Phelan S. Where do women get advice about weight, eating, and physical activity during pregnancy? J Womens Health (Larchmt) 2017;26(9):951–6.

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Published

2024-03-14