A Paradigm Shift of Services by Providing Simple Cost Effective Interventions and Future Considerations in Managing the Care of Obese Women in Pregnancy

Abstract

Objective: Our study explored a cohort of pregnant women in pregnancy to evaluate clinical care antenatally, at delivery and postpartum. We piloted the use of two simple measures: firstly the use of a patient educational leaflet in improving knowledge of risks associated with obesity during pregnancy and secondly, the use of a proforma to improve documentation in the management of obese women in pregnancy.

Study Design: This was an observational study performed in Ealing Hospital, a district general hospital within Greater London. Fifty pregnant women with a Body Mass Index (BMI) >30kg/m² were asked to complete a questionnaire to assess their knowledge and understanding of obesity during pregnancy, before and after reading a patient educational leaflet. The notes of pregnant women with a BMI >30 kg/m² were audited against the CMACE/RCOG joint guideline. The feedback from the questionnaire and data from the audit were used to develop a service model to improve the care of obese women in pregnancy.

Results: 60% of women knew the meaning of BMI, but only 32% could recall their own BMI. 72% of women were taking the recommended dose of folic acid. The extensive risks of obesity on fetal and maternal health during pregnancy were largely unknown. Women welcomed an educational leaflet that improved their motivation to make lifestyle changes. We selected 50 sets of patient notes at random to audit; obesity was not recognised as a risk factor in over half the pregnant women with a BMI >30 kg/m². Height and weight was recorded well but few took the recommended folic acid&Vitamin D. Majority of women was offered GTT and received an appropriate anaesthetic review. There was no documentation of manual handling requirements and little discussion about complications. Blood pressure was measured appropriately in majority of cases but size of cuff was not documented in all.

Conclusion: There was poor knowledge of obesity effects on pregnancy. An educational leaflet and care pro forma may help achieve standards of healthcare. If the suggested leaflet and pro forma were used, the management of women in antenatally should improve.