(GIST OF KURUKSHETRA) Rising Maternal Obesity

(August-2023)

Rising Maternal Obesity

Introduction:

The Union Government has introduced several policies, such as JananiShishu Suraksha Karyakram, Janani Suraksha Yojana, and Pradhan Mantri Surakshit Matritva Abhiyan, to address problems in maternal health care. The Mission POSHAN 2.0 and National Health Mission can play a significant role in promoting healthy diets and healthy lifestyles through the most powerful platform in the country, i.e., Aanganwadi Centres.

Prevalence of Maternal Obesity in India

In India, 24% of women in the age group of 15-49 years are overweight or obese. Moreover, 56.7% of the women also have a high waist to hip ratio [NFHS 5]. A study conducted by Chopra et al. (2020) based on NFHS – 4 population estimates reported that 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).

Complications Associated with Maternal Obesity

Obesity during pregnancy is related to worse health outcomes for both mothers and their offspring, sustaining intergenerational cycles of obesity and associated NCDs, according to evidence from observational research. Obesity during pregnancy is linked to an increased risk of gestational diabetes (GDM), preeclampsia, miscarriage, venous thromboembolism, infection, and haemorrhage in the mother. Furthermore, obese women may be subjected to nutrient-poor but energy-dense diets, which may contribute to bad pregnancy outcomes.

Time Point A: Pre-Pregnancy

A.1 All women should have their weight and height measured and their body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) calculated. Consider ethnic differences.

A.2 All women with a BMI of ≥30 should be advised of the effect of obesity on fertility, the immediate risks of obesity during pregnancy and childbirth, and the subsequent long-term health effect of obesity including the higher risk of noncommunicable diseases for them and their children.

A.3 All women with obesity should be encouraged to lose weight through diet and adopting a healthy lifestyle including moderate physical activity. If indicated and available, other weight management interventions might be considered, including bariatric surgery.

A.4 All women with obesity should be advised to take at least 0.4 mg (400 μg) and consider up to 5 mg folic acid supplementation daily for at least 1–3 months before conception.

Time Point B: Pregnancy

B.1 All women should have their weight and height measured and their BMI calculated at the first antenatal visit. Consider ethnic differences. Advise on appropriate gestational weight gain.

B.2 All women should receive information on diet and lifestyle appropriate to their gestation including nutrient supplements, weight management, and regular physical activity.

B.3 All women with obesity should be advised of the risks of obesity and excess gestational weight gain on pregnancy, childbirth, and long-term health including risk of noncommunicable diseases for them and their children.

B.4 All antenatal healthcare facilities should have well-defined multidisciplinary pathways for the clinical management of pregnant women with obesity including the identification and treatment of pregnancy-related complications.

Time Point C: Postpartum

C.1 All women with pre-pregnancy obesity should receive support on breastfeeding initiation and maintenance.

C.2 All women with obesity and pregnancy complications should receive appropriate postnatal follow-up in line with local resources, care pathways, and in response to the individual health requirements of each woman and her children.

C.3 All women with obesity should be encouraged to lose weight post partum with emphasis on healthy diet, breastfeeding if possible, and regular moderate physical activity. They should be advised of the importance of long-term follow-up as they and their children are at increased risk for noncommunicable diseases.

C.4 Maternal obesity should be considered when making the decision regarding the most appropriate form of postnatal contraception.

Key challenges for the policy implementation

Lack of gestational weight gain charts and corresponding optimal weight gain recommendations for pregnant women; nutrition norms for preventing and managing maternal malnutrition lack penetration in service delivery system;
Budget for implementation under several heads (capacity building, equipment, supplies, human resource, dissemination, etc) not costed; engagement of private sector for demand creation; targets for maternal obesity missed in the Poshan Abhiyaan;
Indicators for tracking and review missing from the government’s health information management system.

Conclusion:

India is at a historic juncture with respect to its development and its position in the world. The country faces critical choices in terms of benefiting from its recent economic growth. The cost of NCDs to women in terms of health, productivity, and economic development is tremendous. In order to make the dream of Kuposhan Mukt Bharat a reality, all stakeholders must strive to fight against all forms of malnutrition, including overweight-obesity.