M. S. Charnley

Screening methods for obstructive sleep apnoea in severely obese pregnant women

Obstructive sleep apnoea (OSA) is an often‐overlooked diagnosis, more prevalent in the obese population. Screening method accuracy, uptake and hence diagnosis is variable. There is limited data available regarding the obese pregnant population; however, many studies highlight potential risks of apnoeic episodes to mother and foetus, including hypertension, diabetes and preeclampsia. A total of 162 women with a body mass index (BMI)u2009≥u200935 were recruited from a tertiary referral hospital in the northwest of England. They were invited to attend three research antenatal clinics, completing an Epworth Sleepiness Scale (ESS) questionnaire at each visit. A monitor measuring the apnoea hypopnoea index (AHI) was offered at the second visit. Data taken from consent forms, hospital notes and hospital computer records were collated and anonymized prior to statistical analysis. A total of 12.1% of women had an ESS score of >10, suggesting possible OSA. Rates increased throughout pregnancy, although unfortunately, the attrition rate was high; 29.0% of women used the RUSleeping (RUS) meter, and only one (2.1%) met pre‐specified criteria for OSA (AHIu2009≥u200915). This individual had OSA categorized as severe and underwent investigations for preeclampsia, eventually delivering by emergency caesarean section due to foetal distress. The accuracy of the ESS questionnaire, particularly the RUS monitor, to screen for OSA in the pregnant population remains unclear. Further research on a larger sample size using more user‐friendly technology to confidently measure AHI would be beneficial. There are currently no guidelines regarding screening for OSA in the obese pregnant population, yet risks to both mother and foetus are well researched.

The quality of dietary intake in obese pregnant women

Data were collected for 140 women with a BMI ≥35 kg/m 2 and a mean booking in weight of 110·2 kg (SD15·7). Nutrients were measured as a proportion of MJ/d and data shows an increase in mean total energy and fat intakes but a decrease in NSP and micronutrient intakes between visits 1 and 3. This suggests that the quality of dietary intake deteriorated during gestation. Negative correlations between total energy intake at visit 3 and birth weight (r= −0.285, p= 0·014), total fat intakes at visit 3 (r= −0.272, p= 0·020) were also demonstrated. Pregnancy is viewed as an ideal window of opportunity to improve eating behaviours and it may be a pertinent time to remind women that during pregnancy they are ‘eating for two’ when it comes to the quality of dietary intakes, as an energy dense ‘empty calorie’ diet with inadequate nutrient intakes may be an important determinant of future offspring obesity and disease risk.

A qualitative study exploring midwives’ perceptions and knowledge of maternal obesity. Reflecting on their experiences of providing healthy eating and weight management advice to pregnant women.

Midwives are responsible for providing advice regarding the complex issues of healthy eating and weight management during pregnancy. This study utilised an inductive data-driven thematic approach in order to determine midwives perceptions, knowledge, and experiences of providing healthy eating and weight management advice to pregnant women. Semistructured interviews with 17 midwives were transcribed verbatim and data subjected to thematic analysis. The findings offer insight into the challenges facing midwives in their role trying to promote healthy eating and appropriate weight management to pregnant women. Three core themes were identified: (a) If they eat healthily it will bring their weight down: Midwives Misunderstood; (b) I dont think we are experienced enough: Midwives Lack Resources and Expertise; and (c) BMI of 32 wouldnt bother me: Midwives Normalised Obesity. The midwives recognised the importance of providing healthy eating advice to pregnant women and the health risks associated with poor diet and obesity. However, they reported the normalisation of obesity in pregnant women and suggested that this, together with their high workload and lack of expertise, explained the reasons why systematic advice was not in standard antenatal care. In addition, the current lack of UK clinical guidance, and thus, possibly lack of clinical leadership are also preventing delivery of tailored advice. Implementation literature on understanding the barriers to optimal health care delivery and informing clinical practice through research evidence needs to be further investigated in this field. This study has recommendations for policy makers, commissioners, service providers, and midwives.

Midwives’ knowledge and experiences of providing weight management advice to pregnant women

M.T. McCann, L.M. Newson, M.S. Charnley, J.S. Rooney, C. Burden and J.C. Abayomi Northern Ireland Centre for Food and Health (NICHE), Ulster University, Coleraine, BT52 1SA Faculty of Science, Liverpool John Moores University, L3 3AF Faculty of Education, Community and Leisure, Liverpool John Moores University, L17 6BD and Faculty of Education Health and Communication, Community and Leisure, Liverpool John Moores University, L2 2ER

Childhood obesity is associated with maternal nutrition and gestational weight gain

. The aim of this study was to investigate the associations between dietary intake in obese pregnant women relative to GWGand infant birth weight (BW). Participants were asked to complete three-day food diaries during each trimester of pregnancy. Dataregarding food portion size was verix1eed using a food atlas

Birth outcomes relative to dietary vitamin D & calcium intake in obese pregnant women

For individuals with limited exposure to ultra-violet B, a recommended nutrient intake (RNI) of 10mg/day of vitamin D is recommended; this includes all pregnant and lactating women. Despite this, research suggests a subset of pregnant women are at risk of vitamin D insufficiency due to obesity, darker skin pigmentation and estimated delivery date in spring or summer. There is no increase in requirements for calcium during pregnancy however a positive maternal calcium balance is dependent on adequate circulating levels of 25(OH)D3 . Maternal outcomes such as gestational diabetes, pre-eclampsia and increased risk of caesarean section are all associated with low vitamin D status. The aim of this study was to investigate whether dietary intakes of vitamin D and calcium were associated with adverse maternal and birth outcomes. Participants were asked to complete three-day food diaries during each trimester of pregnancy. Data regarding food portion size was verified using a food atlas and the diaries were then analysed using Microdiet2.

Iron consumption in obese pregnant women and birth outcome

(1849kcal/d;1984kcal/d; 2066kcal/d respectively). Overall iron intakes were low with 63.6% achieving 0.05) but all 6 womenwith a LBW baby ( < 2.5kg) and 7 out of 8 women with pre-term delivery ( < 37 weeks) failed to achieve RNI for iron. The results suggestthat despite a high BMI and an adequate energy intake, quality of diet may be lacking in obese pregnant women. This provides furtherevidence of the association between iron deÞciency and LBW and PTD.

Energy intake and weight gain of morbidly obese pregnant women in Liverpool

Obesity is a major public health risk in the UK and globally. A BMI of >29.9 kg/m is indicative of obesity, with a BMI >39.9 kg/m representing morbid obesity. Being obese during pregnancy can result in major complications for both mother and/or baby. For the mother, there is increased risk of gestational diabetes, type 2 diabetes, hypertensive disorders including pre-eclampsia, thrombo embolism and an increased risk of emergency caesarean or instrumental delivery. Risks to the baby include macrosomia, genetic malformation, neural tube defects, stillbirth, neonatal death or late fetal death and intrauterine growth retardation. Current American guidelines suggest that women with a BMI >29.9 kg/m should limit weight gain in pregnancy to 6.8 kg, for optimum birth outcomes. There are no specific guidelines for women with a BMI >40 kg/m, where the risks are greatly increased. The aim of this study was to estimate the nutrient and energy intake of obese pregnant women and compare intake to pregnancy weight gain and birth outcomes. Women were recruited from one antenatal clinic and asked to complete 3-d food diaries during each trimester of pregnancy. Food portion size was estimated using a food atlas and the data were then analysed using Microdiet.