Mary Holliday

The impact of pregnancy on the long-term weight gain of primiparous women in England

OBJECTIVES: To investigate the impact of pregnancy on long-term weight gain of primiparous mothers in England, and to identify potential risk factors for maternal obesity. DESIGN: A retrospective, repeat-pregnancy study which examined the change in maternal body weight from the beginning of the first successful pregnancy to the beginning of the second. SUBJECTS: Two hundred and forty-three mothers, all of whom had been weighed during the first trimester of their first and second pregnancies, and none of whom had fallen pregnant less than 12 months after the birth of their first child. MEASUREMENTS: Sociodemographic, behavioural, medical, obstetric and perinatal data, together with antenatal measurements of maternal body weight and height, were extracted from each mother’s obstetric notes. A comprehensive survey of weighing scales used at all antenatal clinics was undertaken. RESULTS: After accounting for the effect of ageing, there was no significant long-term increase in mean maternal body weight following the first pregnancy (95% Confidence Intervals: −0.82–0.28 kg). While most mothers (70.8%) gained 1.0 kg or less, 24.7% gained more than 1.54 kg. Even after accounting for the maximum error in clinic scales, 14.8% of the mothers gained 1.54 kg or more in association with their first pregnancy. Mothers with higher BMIs at the beginning of their first pregnancy, who gained more weight during pregnancy, gave birth to heavier babies and had longer intervals between their pregnancies, gained significantly more weight from one pregnancy to the next. CONCLUSIONS: Pregnancy has little impact on the mean weight gain of primiparous women from England, who have a low prevalence of obesity (BMI≥26.0, 25.5%). Nevertheless, pregnancy may be associated with a permanent increase in maternal body weight simply because it is a period of positive energy balance during which some women gain excessive weight. Other factors, such as prepregnant BMI, determine whether long-term weight gain actually occurs.

Is there an independent association between parity and maternal weight gain

The independent associations between parity and maternal body mass index (BMI), and between parity and maternal weight gain, were investigated using a combination of cross-sectional and longitudinal analyses based on a retrospective, repeat-pregnancy study that examined the change in maternal body weight from the beginning of one pregnancy to the beginning of the next. A group of 523 multiparous women who had been weighed regularly during pregnancy, and none of whom had fallen pregnant less than 12 months after the birth of their previous child, were examined. Sociodemographic, behavioural, medical, obstetric and perinatal data, together with antenatal measurements of maternal body weight and height, were abstracted from each mothers obstetric notes. Parity was found to be independently associated with maternal BMI (p < 0.001), gestational weight gain (p < 0.001) and interpregnancy weight gain (p = 0.032). Women of different parities were found to be at differential risk of long-term weight gain for two reasons. First, primiparous women are at risk of long-term weight gain because they gain the most weight during pregnancy, and high gestational weight gain is in itself a risk factor for long-term weight gain. Second, women of higher parity (4+) are at risk of long-term weight gain because they gain more weight in association with pregnancy, irrespective of the amount of weight they gain during their pregnancies. For women of parity 3 or less, the association between maternal body weight and parity appears to be the result of cumulative weight gained during successive pregnancies. For women of greater parity, the association between maternal body weight and parity is partly the result of cumulative excess gestational weight gained during successive pregnancies, and partly the result of gaining more weight from the beginning of one pregnancy to the next at later pregnancies.

Midwifery in the Gambia

The Gambia is a developing country with a rapidly rising population and limited economic potential. Despite lack of equipment and resources, the government is determined to provide a comprehensive health and education service. This article examines the approach to midwifery education and practice in a developing country. In particular, it outlines the structure of midwifery care and the issues faced by the practitioner in the field in the effort to reduce maternal and infant mortality and morbidity. Practical guidelines are suggested for western midwives considering practicing in a developing country and the challenges they may face compared to modern European practice.