Obesity in pregnancy
– a risk women can do without
No pregnancy is without risk. Many factors are beyond our control. However, there are pregnancy risk factors we can tackle and, at the Obstetrics and Gynaecology unit in UCD School of Medicine, researchers are working to equip women and their clinicians with the best information available on how to reduce the potential for complications in pregnancy and childbirth.
Obesity is a major risk factor for a range of complications from gestational diabetes to premature birth. In a recent UCD audit of births at the Coombe Hospital, it was established that women with obesity are up to three times more likely to have a premature child during their first pregnancy*. This is worrying not only for the mothers involved, but also for our national neonatal health outlook. In Ireland, the rate of obesity in mothers during the first 12 weeks of pregnancy is between 19 and 25 per cent.
Professor Michael Turner, UCD School of Medicine has spent much of his career dealing with health problems that arise in pregnancy; “fire-fighting” as he describes it. He knows that many of the issues arising for pregnant women are preventable and he is now focused on heading off problems before they surface.
“When I took up the post of Professor of Obstetrics and Gynaecology in UCD in 2008 I set up the Centre for Human Reproduction with the intention of studying risk factors that are modifiable. We have focused on a number of areas such as maternal infection, smoking and diabetes.”
We were the first group in the country to focus on the subject of maternal obesity. One in 6 women presenting for antenatal care to the Coombe is obese.
A key area of enquiry has been obesity. “We were the first group in the country to focus on the subject of maternal obesity. One in 6 women presenting for antenatal care to the Coombe is obese. The evidence suggests that maternal obesity is increasing. The first piece of research we undertook looked at how people calculate Body Mass Index – under-reporting of obesity rates in this group was an issue.”
Gathering accurate data is a critical first step in improving outcomes for women and their babies. Having established the real rates of obesity in pregnancy in Ireland, the Centre turned its attention to the examination of causal links between obesity and pregnancy complications. “We found that maternal obesity is associated with an increase in pregnancy complications such as gestational diabetes, preeclampsia, hypertension and thromboembolism – pulmonary embolism is one of the most common direct causes of maternal death in Ireland,” Professor Turner explains.
Centre studies also found that pregnant women with obesity are more likely to need childbirth interventions – they are twice as likely to require a C-Section, for example.
The Centre has also done a great deal of work improving the screening process for gestational diabetes, a rising problem in pregnant women with obesity. Dr Niamh Daly was awarded a major international prize for her work on the pre-analytic handling of blood sugar samples as a result.
“When we did research to apply best international test handling standards we discovered that half of the women in the study who were obese had gestational diabetes,” says Professor Turner.
Armed with this information, the Centre for Human Reproduction is now working on interventions to help women with obesity to improve outcomes through lifestyle changes. It’s difficult, if not impossible, to achieve significant weight loss during pregnancy – dieting is not an option when the nutritional needs of the foetus are factored in. Exercise, however, can help. Professor Turner and Dr Daly conducted an intensive exercise programme using the Random Control Trial method. One group took part in sessions three times a week.
Gestational weight gain was reduced in the participant group compared to the control group. The work was published in the US journal ‘Obstetrics and Gynaecology’.
“One of the main things we have learned is that it is hard to modify risk during the course of pregnancy,” says Professor Turner.“A lot of these modifications need to take place before or after. However, exercise is an intervention women should be encouraged to partake in right throughout pregnancy – this goes against the old advice about resting up.”
A lot of these modifications need to take place before or after. However, exercise is an intervention women should be encouraged to partake in right throughout pregnancy – this goes against the old advice about resting up.
Another positive finding of the Centre has been the engagement of pregnant women from all socio-economic groups with smartphone apps about pregnancy and childbirth. “In the past there was a social gradient; well-off women tended to have more access to pregnancy information. Everyone has a smartphone now and virtually all the women we studied were getting pregnancy information from apps.”
As Director of the HSE clinical programme in Obstetrics and Gynaecology, Professor Turner has been able to translate much of his research with Dr Daly into national policy and guidelines. There is much to build on – the ongoing work of the Centre will hopefully give women of all backgrounds the opportunity to have greater control over their gestational health and the health of their infants.
Professor Michael Turner was in conversation with Louise Holden (MEd 2007), Director FH Media Consulting and journalist with the Irish Times
*A total of 39,528 pregnancies were studied by UCD researchers. Of these, 2,361 were premature deliveries. 1,075 were unplanned deliveries and 1,286 were planned. The title of the paper was Maternal body mass index and the prevalence of spontaneous and elective preterm deliveries in an Irish obstetric population: a retrospective cohort study. It was published in BMJ Open (volume 7, issue 10) in October 2017.