Impact of Obesity on Fetomaternal Outcome in Pregnant Saudi Females

Introduction

Worldwide obesity is the most prevalent, chronic medical condition [1]. The rate of obesity in pregnant women is rising, increasing the significance of its impact on obesity-related pregnancy complications. Pregnancy complications associated with maternal obesity can be broadly grouped into those primarily affecting the mother and those primarily affecting the fetus, neonate or older child. Obesity influences not only the chance of conception but also reduces the response to fertility treatment, and increases the risk of miscarriage, congenital anomalies as well as pregnancy complications like gestational diabetes, pregnancy induced hypertension, cesarean delivery, macrosomia and infections in addition to potential adverse effects on long term health of both mother and infant.

The aim of this study is to determine frequency of obesity and its adverse effects on fetomaternal outcome in pregnant Saudi females.

Methods

This is a prospective cohort study conducted over eight months (November 2008 to June 2009) in the Maternity and Children Hospital (MCH) Buraydah, Saudi Arabia and including 1000 pregnant Saudi patients admitted through OPD and emergency. The patients’ height was recorded once and the weight was recorded twice, once at the beginning (roughly corresponding to the pre-pregnancy weight) and once at the end of pregnancy. The difference between the two weights was taken as net weight gain during pregnancy. Pre-pregnancy weight was used to calculate the body mass index (BMI) using Weight (Kg) / Height² (m). The sample was divided into 5 groups based upon the BMI: < 18.5, 18.5–24.9, 25–29.9, 30–39.9 and ≥40, classified as underweight (lean), normal weight, overweight, obese and morbidly obese, respectively. The normal weight group was used as control group. Data were also collected regarding complications of obesity in pregnancy and labor. All data were analyzed using SPSS version 13.0 (SPSS Inc., 2006).

Results

The frequency of weight distribution in the subjects was as follows: underweight 2%; normal weight 31%; overweight 33%; obese 30%; and morbidly obese 4%. Compared with normal weight women, both overweight and obese women had a significantly increased risk of gestational diabetes, preeclampsia, Cesarean delivery, and delivery of a macrocosmic infant (P < 0.05).

Discussion

Our study results are comparable to similar national and international studies. With regard to distribution of our subjects by BMI category, previous studies in Saudi Arabia have found similar results, e.g. Al Nuaim et al, in two separate studies [4, 5] reported 29.4% and 27.0% of Saudi females to be overweight, while Rasheed et al [6] in 1994 reported an obesity prevalence of 26.1% and morbid obesity in 4.5% of the Saudi females. We found that adverse pregnancy outcomes are associated with obesity. We conclude that obesity is a growing problem among pregnant Saudi women and that it is associated with an increased risk of fetomaternal complications like preeclampsia, gestational diabetes, cesarean delivery, and delivery of a macrocosmic infant.

Figure 1.

Percentage distribution of subjects by BMI category

Figure 2.

Incidence (%) of complications by BMI category

Figure 3.

Perinatal mortalit (PNM) and incidence (%) of shoulder distocia and macrosomia by BMI category