Browsing by Author "LeJour, Caroline"
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- ItemOpen AccessDoes the Amount of Gestational Weight Gain Modify the Risk of Adverse Maternal and Neonatal Outcomes for Obese Women?(2017) Salmon, Charleen Nicole; Metcalfe, Amy Lynn; Sauve, Reg; LeJour, Caroline; Fenton, TanisBackground: Obesity during pregnancy is growing in prevalence. There has been a significant linear increase in the prevalence of obesity in American women from 35% (95% CI: 32 – 38) in 2005 to 40.5% (95% CI: 37.6 – 43.4) in 2014 (1). The increase in prevalence of obesity (body mass index (BMI) ≥ 30 kg/m2) is also seen in women of reproductive age (2). Previous studies suggested that the Institute of Medicine (IOM) gestational weight gain (GWG) guidelines needed modification by obesity severity. Objectives: The present study investigated whether the IOM guidelines for obese women needed modification for obesity severity by determining the risk of maternal, obstetric, and neonatal outcomes for class I, II and III obese pregnant women who either: lost weight during pregnancy, gained below the IOM guidelines, or gained above the IOM guidelines, compared to women who gained within the IOM guidelines (11-20 lbs). Methods: A cross-sectional study using 2014 U.S. birth certificate data (N=646,642). Chi-square tests examined associations between GWG categories and adverse outcomes. Log-binomial regression models were built to examine relative risks of adverse maternal, obstetric, and neonatal outcomes following adjustment for maternal age, education, marital status, race, insurance status, and parity. Results: The observed pattern of association was the same between all 3 obese classes indicating evidence for a single GWG recommendation for all 3 classes of obesity. Obese women who lost weight during pregnancy or gained below the IOM recommendations were at a significantly decreased risk for caesarean delivery (RR, 95% CI class I: 0.92, 0.90-0.94; II: 0.91, 0.89-0.93; III: 0.92, 0.90-0.93) and large-for-gestational age (LGA) births (class I: 0.80, 0.77-0.83; II: 0.76, 0.73-0.78; III: 0.73, 0.70-0.75) but had a significantly increased risk of small-for-gestational age (SGA) births (class I: 1.34, 1.26-1.43; II: 1.381.28-1.49; III: 1.35, 1.24-1.46) compared to women who had GWG within IOM guidelines. Obese women who gained above IOM guidelines were at an increased risk for caesarean delivery and LGA births but are at a decreased risk for SGA births. Conclusion: A single GWG recommendation for all obese women is possible, but 2009 IOM guidelines may need to be updated as current recommendations may be too high.
- ItemOpen Access‘It’s not me, it’s them’ – a report describing the weight-related attitudes towards obesity in pregnancy among maternal healthcare providers(2024-06-03) Nagpal, Taniya S.; Angrish, Kirina; Bonisteel, Emily; Puhl, Rebecca M.; Ferraro, Zachary M.; Malkani, Niyati M.; LeJour, Caroline; Adamo, Kristi B.Abstract Background Occurrences of weight stigma have been documented in prenatal clinical settings from the perspective of pregnant patients, however little is known from the viewpoint of healthcare providers themselves. Reported experiences of weight stigma caused by maternal healthcare providers may be due to negative attitudes towards obesity in pregnancy and a lack of obesity specific education. The objective of this study was to assess weight-related attitudes and assumptions towards obesity in pregnancy among maternal healthcare providers in order to inform future interventions to mitigate weight stigma in prenatal clinical settings. Methods A cross-sectional survey was administered online for maternal healthcare providers in Canada that assessed weight-related attitudes and assumptions towards lifestyle behaviours in pregnancy for patients who have obesity. Participants indicated their level of agreement on a 5-point likert scale, and mean scores were calculated with higher scores indicating poorer attitudes. Participants reported whether they had observed weight stigma occur in clinical settings. Finally, participants were asked whether or not they had received obesity-specific training, and attitude scores were compared between the two groups. Results Seventy-two maternal healthcare providers (midwives, OBGYNs, residents, perinatal nurses, and family physicians) completed the survey, and 79.2% indicated that they had observed pregnant patients with obesity experience weight stigma in a clinical setting. Those who had obesity training perceived that their peers had poorer attitudes (3.7 ± 0.9) than those without training (3.1 ± 0.7; t(70) = 2.23, p = 0.029, Cohen’s d = 0.86). Conclusions Weight stigma occurs in prenatal clinical environments, and this was confirmed by maternal healthcare providers themselves. These findings support advocacy efforts to integrate weight stigma related content and mitigation strategies in medical education for health professionals, including maternal healthcare providers. Future work should include prospective examination of weight related attitudes among maternal healthcare providers and implications of obesity specific education, including strategies on mitigating weight stigma in the delivery of prenatal care.