‘Prevalence of obesity during, after pregnancy high in 30 dists.’

Study examines risk factors and consequences of maternal obesity

A study published in the journal ‘Obstetrics and Gynaecology’ has found that the overall prevalence of obesity in India during and after pregnancy is high, with huge variation across regions. A high prevalence of obesity (>40%) was observed in over 30 districts across 10 States.

The study titled ‘Population estimates, consequences, and risk factors of obesity among pregnant and postpartum women in India: Results from a national survey and policy recommendations’ was aimed at examining prevalence, risk factors, and consequences of maternal obesity; and provide evidence on current policies and programmes to manage maternal obesity in India.

The authors - Mansi Chopra, Naman Kaur, Konsam Dinachandra Singh, Chandni Maria Jacob, Hema Divakar, Giridhara R. Babu, Vani Sethi and others - analysed the National Family Health Survey (NFHS)4 data (2015–2016) to estimate the prevalence and risk factors of obesity, followed by a desk review of papers published in India between January 2011 and November 2019 and stakeholder mapping with interviews to develop policy guidance.

The authors analysed that the national prevalence of obesity (as defined by WHO as body mass index ≥25) was comparable among pregnant (12%) and postpartum women (13%) greater than or equal to 20 years of age. A high prevalence of obesity (>40%) was observed in over 30 districts in multiple States. “Older maternal age, urban residence, increasing wealth quintile, and secondary education were associated with increased odds of obesity among pregnant and postpartum women; higher education increased odds among postpartum women only. Dietary variables were not associated with obesity,” said Mansi Chopra, the corresponding author of the study.

Bengaluru-based Consultant Obstetrician/Gynecologist Hema Divakar, who is one of the authors, said among the consequences, overweight/obesity among pregnant and postpartum women was associated with low birth weight, intrauterine growth restriction, macrosomia, and adverse pregnancy outcomes such as prolonged/induced labour, postpartum haemorrhage, high gestational weight gain, pregnancy-induced hypertension/pre-eclampsia and gestational diabetes mellitus.

Prevalence

More than 30 districts had a high prevalence of obesity (>40%) among pregnant and postpartum women, across the 10 States. Among pregnant women, the prevalence of obesity was over 40% in 31 districts, with the highest prevalence of 72% in Shopian district (Jammu and Kashmir). The prevalence of obesity among postpartum women was over 40% in 37 districts, with the highest prevalence of 61% in Pathanamthitta district (Kerala). This is based on the NFHS data analysis.

“Our findings are consistent with previous estimates from Global Burden of Disease studies, which demonstrate an increasing trend in the prevalence of Non-Communicable Diseases (NCDs) such as diabetes in the States of Tamil Nadu and Kerala where the prevalence of undernutrition is low, highlighting the need to focus on both sides of the spectrums of malnutrition,” said Vani Sethi from UNICEF, another author.

“Existing partnerships with other departments such as the Ministry of Women and Child Development and National/State Rural Livelihood Mission through their self-help group platforms, Panchayat Raj Institutions etc. to provide rations/supplementary foods and use behaviour change communication for better counselling in these areas should be strengthened,” she said.

Asserting that a closer review of maternal nutrition services in districts with a high prevalence of obesity is needed, Dr. Hema Divakar said: “We have recommended the inclusion of BMI-based screening for overweight/obesity (BMI ≥23) and obesity (BMI ≥25) for all pregnant women contacted within the first trimester by a healthcare service provider, and weight gain over three kg per month after the first trimester as a high-risk indicator.”

“Innovative strategies should be developed to counsel pregnant women and demonstrate low-cost, nutrient-dense meals to manage weight gain and follow up pregnant women to understand the effect of counselling on weight maintenance,” she added.