Existing maternal obesity guidelines may increase inequalities between ethnic groups: a national epidemiological study of 502,474 births in England

BMC Pregnancy and Childbirth

Judith Rankin⁴  Carolyn D Summerbell¹  John Wilkinson¹  Daghni Rajasingam³  Naveed Sattar²  Nicola Heslehurst⁴ 

[1] School of Medicine, Pharmacy and Health, Durham University, England, UK;Faculty of Medicine, University of Glasgow, Glasgow, UK;Obstetrics, Guys and St Thomas’ Hospital NHS Foundation Trust Hospital, London, UK;Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK

关键词: Body Mass Index (BMI);    Guidelines;    Asian;    Ethnic group;    Inequalities;    Epidemiology;    Pregnancy;    Obesity;   

Others  :  1151425
DOI  :  10.1186/1471-2393-12-156

 received in 2012-08-08, accepted in 2012-12-07,  发布年份 2012

【 摘 要 】

Background

Asians are at increased risk of morbidity at a lower body mass index (BMI) than European Whites, particularly relating to metabolic risk. UK maternal obesity guidelines use general population BMI criteria to define obesity, which do not represent the risk of morbidity among Asian populations. This study compares incidence of first trimester obesity using Asian-specific and general population BMI criteria.

Method

A retrospective epidemiological study of 502,474 births between 1995 and 2007, from 34 maternity units across England. Data analyses included a comparison of trends over time between ethnic groups using Asian-specific and general population BMI criteria. Logistic regression estimated odds ratios for first trimester obesity among ethnic groups following adjustment for population demographics.

Results

Black and South Asian women have a higher incidence of first trimester obesity compared with White women. This is most pronounced for Pakistani women following adjustment for population structure (OR 2.19, 95% C.I. 2.08, 2.31). There is a twofold increase in the proportion of South Asian women classified as obese when using the Asian-specific BMI criteria rather than general population BMI criteria. The incidence of obesity among Black women is increasing at the most rapid rate over time (p=0.01).

Conclusion

The twofold increase in maternal obesity among South Asians when using Asian-specific BMI criteria highlights inequalities among pregnant women. A large proportion of South Asian women are potentially being wrongly assigned to low risk care using current UK guidelines to classify obesity and determine care requirements. Further research is required to identify if there is any improvement in pregnancy outcomes if Asian-specific BMI criteria are utilised in the clinical management of maternal obesity to ensure the best quality of care is provided for women irrespective of ethnicity.

【 授权许可】

   
2012 Heslehurst et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Centre for Maternal and Child Enquiries: Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011, 118(1):1-203.
• [2]Centre for Maternal and Child Enquiries: Perinatal Mortality 2009. London: CMACE; 2011.
• [3]Rajasingam D, Seed PT, Briley AL, Shennan AH, Poston L: A prospective study of pregnancy outcome and biomarkers of oxidative stress in nulliparous obese women. Am J Obstet Gynecol 2009, 200(4):395.e391-395.e399.
• [4]Stothard KJ, Tennant PWG, Bell R, Rankin J: Maternal Overweight and Obesity and the Risk of Congenital Anomalies: A Systematic Review and Meta-analysis. JAMA 2009, 301(6):636-650.
• [5]Heslehurst N, Simpson H, Ells LJ, Rankin J, Wilkinson J, Lang R, Brown TJ, Summerbell CD: The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev 2008, 9(6):635-683.
• [6]Ramsay JE, Greer I, Sattar N: Obesity and reproduction. Br Med J 2006, 333:1159-1162.
• [7]Heslehurst N, Lang R, Rankin J, Wilkinson J, Summerbell C: Obesity in pregnancy: a study of the impact of maternal obesity on NHS maternity services. BJOG 2007, 114:334-342.
• [8]Heslehurst N: Identifying groups of ‘at risk’ women, associated health inequalities and the impact of maternal obesity on NHS maternity services. Proc Nutr Soc 2011, 70(4):439-449.
• [9]CMACE-RCOG: Management of Women with Obesity in Pregnancy. London: Jointly published by the Centre for Maternal and Child Enquiries and the Royal College of Obstetricians and Gynaecologists; 2010.
• [10]National Institute for Health and Clinical Excellence: Antenatal Care: Routine care for the healthy pregnant woman. London: Department of Health; 2008.
• [11]National Institute for Health and Clinical Excellence: Weight Management Before, During and After Pregnancy. London: Department of Health; 2010.
• [12]Centre for Maternal and Child Enquiries (CMACE): Maternal obesity in the UK: Findings from a national project. London: CMACE; 2010.
• [13]Institute of Medicine: Weight Gain During Pregnancy: Reexamining the Guidelines. Washington DC: National Academic Press; 2009.
• [14]Institute of Obstetricians and Gynaecologists, Health Service Executive: Obesity and Pregnancy Clinical Practice Guideline. Ireland; 2011.
• [15]American College of Obstetricians and Gynecologists (ACOG): Practice bulletin no. 105: Bariatric surgery and pregnancy. Obstetrics & Gynecology 2009, 113:1405-1413.
• [16]Society of Obstetricians and Gynaecologists of Canada (SOGC): Clinical Practice Guideline No. 239: Obesity in Pregnancy. J Obstet Gynaecol Canada 2010, 239:165-173.
• [17]Maternity & Newborn Clinical Network: Statewide Clinical Guideline: Care of the Obese Pregnant Woman and Weight Management in Pregnancy. Victoria, Australia; 2011.
• [18]Queensland Maternity and Neonatal Clinical Guidelines Program: Clinical Guideline: Obesity. Australia: State of Queensland (Queensland Health); 2010.
• [19]World Health Organisation: Obesity; Preventing and Managing the Global Epidemic. Geneva: WHO; 2000.
• [20]World Health Organisation: Expert consultation: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004, 363:157-163.
• [21]Hall LML, Sattar N, JMR G: Risk of metabolic and vascular disease in South Asians: potential mechanisms for increased insulin resistance. Futur Lipidol 2008, 3(4):411-424.
• [22]Hall L, Moran C, Milne G, Wilson J, MacFarlane N, Forouhi N, Hariharan N, Salt I, Sattar N, Gill J: Fat Oxidation, Fitness and Skeletal Muscle Expression of Oxidative/ Lipid Metabolism Genes in South Asians: Implications for Insulin Resistance? PloSONE 2010, 5(12):e14197.
• [23]Retnakaran R, Hanley AJ, Connelly PW, Sermer M, Zinman B: Ethnicity modifies the effect of obesity on insulin resistance in pregnancy: a comparison of Asian, South Asian, and Caucasian women. J Clin Endocrinol Metab 2006, 91(1):93-97.
• [24]Shen JJ, Tymkow C, MacMullen N: Disparities in Maternal Outcomes Among Four Ethnic Populations. Ethn Dis 2005, 15:492-497.
• [25]Ramos GA, Caughy AB: The interrelationship between ethnicity and obesity on obstetric outcomes. Am J Obstet Gynecol 2005, 193:1089-1093.
• [26]Steinfeld JD, Valentine S, Lerer T, Ingardia CJ, Wax JR, Curry SL: Obesity-related complications of pregnancy vary by race. J Matern Fetal Med 2000, 9(4):238-241.
• [27]Bryant AS, Washington S, Kuppermann M, Cheng YW AB, Bryant AS, Washington S, Kuppermann M, Cheng YW ABC: Quality and equality in obstetric care: racial and ethnic differences in caesarean section delivery rates. Paediatr Perinat Epidemiol 2009, 23(5):454-462.
• [28]Wong LF, Caughey AB, Nakagawa S, Kaimal AJ, Tran SH YWC: Perinatal outcomes among different Asian-American subgroups. Am J Obstet Gynecol 2008, 199(4):e381-386.
• [29]Guendelman S, Thornton D, Gould J, N H: Obstetric complications during labor and delivery: assessing ethnic differences in California. Womens Health Issues 2006, 16(4):189-197.
• [30]Lawrence JM, Contreras R, Chen W, DA S: Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes Care 2008, 31(5):899-904.
• [31]Silva JK, Kaholokula JK, Ratner R, M. M: Ethnic differences in perinatal outcome of gestational diabetes mellitus. Diabetes Care 2006, 29(9):2058-2063.
• [32]Heslehurst N, Rankin J, Wilkinson JR, Summerbell CD: A Nationally Representative Study of Maternal Obesity in England, UK: Trends in Incidence and Demographic Inequalities in 619 323 Births, 1989–2007. Int J Obes 2010, 34:420-428.
• [33]Knight M, Kurinczuk JJ, Spark P, Brocklehurst P, on behalf of the UK Obstetric Surveillance System: Extreme Obesity in Pregnancy in the United Kingdom. Obstet Gynecol 2010, 115(5):989-997.
• [34]Chu SY, Abe K, Hall LR, Kim SY, Njoroge T, Qin C: Gestational diabetes mellitus: all Asians are not alike. Preventative Medicine 2009, 49:265-268.
• [35]Dillman DA: Mail and Internet Surveys: The Tailored Design Method. 2nd edition. New Jersey: John Wiley & Sons; 2007.
• [36]Census: Standard Tables: ST101 Sex and Age by Ethnic Group. Newport, South Wales: Office of National Statistics; 2001.
• [37]Index of Multiple Deprivation: The English Indices of Deprivation. Department of Communities and Local Government; 2007.
• [38]Ochsenbein-Kolble N, Roos M, Gasser T, Zimmermann R: Cross-sectional study of weight gain and increase in BMI throughout pregnancy. Eur J Obstet Gynecol Reprod Biol 2007, 130:180-186.
• [39]Census: Standard Tables: ST001 Age by Sex and Marital Status, ST028 Sex and Age by Economic Activity, ST101 Sex and Age by Ethnic Group, ST007 Age of FRP (Family Reference Person) and Number and Age of Dependent Children by Family Type. Newport, South Wales: Office of National Statistics; 2001.
• [40]Department of Health: Health Survey for England 2004. London: HMSO; 2005.
• [41]Rasak F, Anand SS, Shannon H, Vuksan V, Davis B, Jacobs R, Teo KK, McQueen M, Yusuf S, for the SHARE Investigators: Defining Obesity Cut Points in a Multiethnic Population. Circulation 2007, 115:2111-2118.
• [42]Information Centre: Health Survey for England 2004, Vol 1: Minority Ethnic Groups. NHS; 2006.
• [43]House of Commons Health Committee: Inequalities in Access to Maternity Services. London: The Stationary Office; 2003.
• [44]Knight M, JJ K, Spark P, Brocklehurst P: Inequalities in maternal health: national cohort study of ethnic variation in severe maternal morbidities. BMJ 2009, 338:b542.
• [45]Van Roosmalen J, Schuitemaker NWE, Brand R, Van Dongen PWJ, Gravenhorst JB: Substandard care in immigrant versus indigenous maternal deaths in The Netherlands. BJOG 2002, 109(2):212-213.
• [46]Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, HAPO Study Cooperative Research Group, et al.: Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008, 358(19):1991-2002.
• [47]Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JMJ, et al.: A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009, 361(14):1339-1348.