Download School of Health Administration - Canadian Public Health Association

Maternal weight and the obesogenic
environment in Nova Scotia
Sara Kirk, Louise Parker, Trevor Dummer,
Linda Dodds, Tarra Penney
The obesity time bomb
“…today’s principal neglected public health
problem...” (WHO, 1997)
“…one of the most important medical and public
health problems of our time..." (Prof. Philip James, IOTF
Chairman)
“…given the prevalence of childhood obesity, and
given its contribution to many diseases, this is the
first generation that may not live as long as their
parents…” (Dr. Kellie Leitch)
Obesity rates, by province and sex, 2004
Overweight and obesity rates: children
and youth, by province, 2004
So, what happened?
www.foresight.gov.uk
Pregnancy and post-partum:
an ideal time for intervention
• Obese mothers are at a high risk for many
complications
• Children with obese parents are themselves
more likely to be obese as adults
• Supportive programming for mothers is key to
obesity prevention
The pregnant population in Canada
• No national surveillance system that routinely
measures pregnancy weight in Canada
• Canadian Perinatal Surveillance system (CPSS)
collects 27 health outcomes but not BMI of the mother
The Atlee Perinatal Database
• Provincial level population-based, computerized
database with information on pregnancy outcomes
• Maternal/newborn data available for every
pregnancy of > 20 weeks gestation, with a birth
weight of 500g or more
• Data on self-reported pre-pregnancy weights from
1988
Objective
• To describe the temporal, socio-economic
and demographic trends in normal weight
and obese pregnant women in Nova
Scotia
• Part of a larger study investigating the
influence of the obesogenic environment
on maternal body weight
Methods
• Self-reported pre-pregnancy weights on women in NS
(1988-2006)
•
•
•
•
172,373 deliveries (2108 multiple births)
normal weight = 55-75 kg
moderately obese = 90-120 kg
severely obese > 120 kg
• Analyses to look at trends in maternal body weight by:
•
•
•
•
•
Time
Age
Parity
SES
Urban/rural
Subject characteristics
Non obese
(55-75kg)
n=94,655
Moderately
obese
(90-120kg)
n=12,882
p
28.5 (5.4)
28.6 (4.9)
<0.001
29.2 (4.8)
<0.001
Primiparous (n,%)
42,715 (45.1)
5,359 (41.8)
<0.001
500 (41.1)
<0.01
Low SES (n,%)
18,653 (20.3)
3,089 (24.8)
<0.001
323 (27.2)
<0.001
Rural (n,%)
35,193 (37.2)
5271 (41.1)
<0.001
502 (41.3)
<0.01
15.4 (6.0)
11.5 (6.7)
<0.001
9.7 (6.8)
<0.001
Maternal age
(yrs, mean, SD)
Weight gain (kg,
mean SD)
Severely Obese
(>120kg)
n=1,216
p
Variation in maternal bodyweight over time,
1988-2006
8.6 kg
increase
72.0
70.0
Bodyweight (kg)
68.0
mean
median
66.0
64.0
62.0
60.0
58.0
56.0
54.0
52.0
Year
Percentage of women in obese category (>=90 kg)
16.0
Percentage
14.0
12.0
8.0
6.0
4.0
2.0
0.0
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
%
10.0
Year
Number of deliveries to women with prepregnancy weight >120kg
Number of deliveries to severely obese women, 1988-2006
140
100
80
60
40
20
0
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
Number of deliveries
120
Year
Maternal obesity: A provincial problem
Summary of results
• Obese women:
• were slightly older
• were of lower SES
• gained less weight during
pregnancy
• were more likely to live in rural
areas
Conclusions
• Maternal weights have increased dramatically over
the last 20 years in Nova Scotia
• Deliveries in severely obese women have more than
tripled since 1988
• These trends have implications for population health
and health care delivery
• Maternal and child health
• Staffing
• Resources
What next?
• In-depth exploration of the influence of the
obesogenic environment on maternal body weight
• Investigation of maternal obesity in the context of
the child
• Recommendations for family-centred
management and prevention
Acknowledgements
• IWK Health Centre funding (Tarra Penney and Trevor
Dummer)
• Reproductive Care Program of Nova Scotia (data
access)