J. R. Bernier, Y. Hanson
This literature review focuses on the implications of maternal overweight and obesity, the experiences of pregnant women who are overweight or obese, and the provision of maternity care for overweight or obese women. Given the rise in rates of overweight and obesity in Canada and in many countries around the world in recent years, researchers, health care providers and policy makers have begun to focus more attention on the relationship between overweight and obesity and health. Of particular interest has been the impact of overweight and obesity on maternal and newborn health. Biomedical research has equipped us with a breadth of knowledge about the physical health implications of overweight and obesity in pregnancy for both mothers and babies, such as infertility, hypertension, gestational diabetes, caesarean delivery, hemorrhage, congenital abnormalities, and late fetal death (Arendas, Qiu & Gruslin, 2008; Heslehurst et al., 2007).
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By comparison, we know little about the psychological and emotional implications of overweight and obesity in pregnancy and about how the social context of women’s lives affects their experiences of overweight and obesity throughout pregnancy. The lack of attention to the psychosocial dimensions of overweight, obesity and pregnancy represents a significant gap in the literature, because we know that individuals who are overweight or obese are more likely to experience stigma, lower self-esteem and negative body image compared to those with a healthy weight (Furber & McGowan, 2010). People living with overweight or obesity may also be more prone to developing psychological distress, including depression, anxiety, and mood disorders than the general population (Furber & McGowan, 2010). Given the findings on the psychological and emotional well-being of overweight and obese individuals in the general public, we might also expect that women who are overweight or obese experience more psychological and emotional distress throughout their pregnancy than women who are at a healthy weight. Indeed, the few studies that have addressed these issues suggests that overweight and obese women experience more stigma and discrimination, as well as greater depressive symptoms than healthy weight women (Amador et al, 2008; LaCoursiere et al., 2006; LaCoursiere, Hutton, & Varner, 2007; Krause, Østbye, & Swamy, 2009). However, little research has been conducted in this area and further exploration is needed.
In addition to learning more about the psychological, emotional and social implications of overweight and obesity in pregnancy, we wanted to understand women’s experiences of maternity care. Research has demonstrated that women and men who are overweight or obese are regularly subjected to stigma and discrimination in the health care system (Budd, Mariotti, Graff, & Falkenstein, 2009; Wray & Dreery, 2008). A literature review by the Atlantic Centre of Excellence for Women’s Health (Petite & Clow, 2010) revealed that little research has been done on the experiences of overweight and obese pregnant women in health care settings. We were able to uncover only a single study related to this topic, but it suggests that this sub-population of pregnant women endure a range of negative maternity care experiences (Nyman, Prebensen & Flensner, 2008).
While we were interested in women’s experiences and their psychosocial needs, we also wanted to learn more about health care providers’ attitudes and their approach to providing care and support for overweight and obese pregnant women. The literature demonstrates that practitioners are aware of the health risks that maternal overweight and obesity pose for both mother and baby, yet it appears that little information has been made available to assist or guide health care providers in managing the
health and well-being of overweight and obese women during pregnancy. In 2010, the College of Midwives of Manitoba commissioned Prairie Women’s Centre of Excellence for Women’s Health (see Hanson, 2010) to conduct a review of existing clinical guidelines related to overweight and obesity in pregnancy and found that across the spectrum of health care professionals few standards of care had been established. Since then, new clinical guidelines have been released in Canada by the Society for Obstetricians and Gynecologists of Canada (SOGC) and the Association of Ontario Midwives (AOM), and other guidelines have been developed in the UK by the Centre for Maternal and Child Enquiries/Royal College of Obstetricians and Gynecologists (CMACE/RCOG), and the National Institute for Health and Clinical Excellence (NICE). Yet, there is still no consensus about “promising practices” frameworks for other providers, such as nurse practitioners, nurses, or dieticians. We also know little about practitioners’ awareness of such guidelines or the degree to which these guidelines have been integrated into practice. Health care practitioners’ experiences of providing maternity care to overweight or obese women remain a subject that requires further research.
This paper comprises a synthesis of information from two separate literature reviews on pregnant women with overweight and obesity, conducted by the Atlantic Centre of Excellence for Women’s Health (see Petite and Clow, 2010) and Prairie Women’s Health Centre of Excellence for the College of Midwives of Manitoba (see Hanson, 2010), and the results of a secondary search of the literature published since the reports were released. Information on the physical health implications of maternal overweight and obesity has been expanded from the earlier reviews and a new analysis of women’s experiences of overweight and obesity during pregnancy has been added. This paper also provides a deeper discussion of the issues associated with the provision of maternity care for women who are overweight or obese, including new information about clinical guidelines.
In all three instances, reviews of the literature were conducted using academic databases (such as Medline and Pubmed), key online academic journals (such as Obesity and Obstetrics and Gynecology) and common web browsers (such as Google Scholar). Some of the common key words used in the searches were: obesity, overweight, BMI, pregnancy, maternal, maternal care, care management, care guidelines, women, fetus, and neonatal. In addition, relevant websites, such as those of the Society of Obstetrics and Gynecology Canada, and the Royal College of Obstetricians and Gynecologists were consulted. Other websites were reviewed for “grey literature.” We focused on information released since 2005 to ensure the most up-to-date analysis of the subject. Some older articles were included because they were relevant and influential and/or cited frequently.
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