Existing maternal obesity guidelines may increase inequalities between ethnic groups: a national epidemiological study of 502,474 births in England

TY - JOUR

T1 - Existing maternal obesity guidelines may increase inequalities between ethnic groups

T2 - a national epidemiological study of 502,474 births in England

AU - Heslehurst, Nicola

AU - Sattar, Naveed

AU - Rajasingam, Daghni

AU - Wilkinson, John

AU - Summerbell, Carolyn D.

AU - Rankin, Judith

PY - 2012/12/18

Y1 - 2012/12/18

N2 - Background: Asians are at increased risk of morbidity at a lower body mass index (BMI) than European Whites, particularly relating to metabolic risk. UK maternal obesity guidelines use general population BMI criteria to define obesity, which do not represent the risk of morbidity among Asian populations. This study compares incidence of first trimester obesity using Asian-specific and general population BMI criteria.Method: A retrospective epidemiological study of 502,474 births between 1995 and 2007, from 34 maternity units across England. Data analyses included a comparison of trends over time between ethnic groups using Asian-specific and general population BMI criteria. Logistic regression estimated odds ratios for first trimester obesity among ethnic groups following adjustment for population demographics.Results: Black and South Asian women have a higher incidence of first trimester obesity compared with White women. This is most pronounced for Pakistani women following adjustment for population structure (OR 2.19, 95% C.I. 2.08, 2.31). There is a twofold increase in the proportion of South Asian women classified as obese when using the Asian-specific BMI criteria rather than general population BMI criteria. The incidence of obesity among Black women is increasing at the most rapid rate over time (p=0.01).Conclusion: The twofold increase in maternal obesity among South Asians when using Asian-specific BMI criteria highlights inequalities among pregnant women. A large proportion of South Asian women are potentially being wrongly assigned to low risk care using current UK guidelines to classify obesity and determine care requirements. Further research is required to identify if there is any improvement in pregnancy outcomes if Asian-specific BMI criteria are utilised in the clinical management of maternal obesity to ensure the best quality of care is provided for women irrespective of ethnicity.

AB - Background: Asians are at increased risk of morbidity at a lower body mass index (BMI) than European Whites, particularly relating to metabolic risk. UK maternal obesity guidelines use general population BMI criteria to define obesity, which do not represent the risk of morbidity among Asian populations. This study compares incidence of first trimester obesity using Asian-specific and general population BMI criteria.Method: A retrospective epidemiological study of 502,474 births between 1995 and 2007, from 34 maternity units across England. Data analyses included a comparison of trends over time between ethnic groups using Asian-specific and general population BMI criteria. Logistic regression estimated odds ratios for first trimester obesity among ethnic groups following adjustment for population demographics.Results: Black and South Asian women have a higher incidence of first trimester obesity compared with White women. This is most pronounced for Pakistani women following adjustment for population structure (OR 2.19, 95% C.I. 2.08, 2.31). There is a twofold increase in the proportion of South Asian women classified as obese when using the Asian-specific BMI criteria rather than general population BMI criteria. The incidence of obesity among Black women is increasing at the most rapid rate over time (p=0.01).Conclusion: The twofold increase in maternal obesity among South Asians when using Asian-specific BMI criteria highlights inequalities among pregnant women. A large proportion of South Asian women are potentially being wrongly assigned to low risk care using current UK guidelines to classify obesity and determine care requirements. Further research is required to identify if there is any improvement in pregnancy outcomes if Asian-specific BMI criteria are utilised in the clinical management of maternal obesity to ensure the best quality of care is provided for women irrespective of ethnicity.

KW - Obesity

KW - Pregnancy

KW - Epidemiology

KW - Inequalities

KW - Ethnic group

KW - Asian

KW - Guidelines

KW - Body Mass Index (BMI)

KW - GESTATIONAL DIABETES-MELLITUS

KW - PREGNANCY OUTCOMES

KW - INSULIN-RESISTANCE

KW - IMPACT

KW - WOMEN

KW - RISK

KW - METAANALYSIS

KW - POPULATIONS

KW - OVERWEIGHT

KW - DELIVERY

U2 - 10.1186/1471-2393-12-156

DO - 10.1186/1471-2393-12-156

M3 - Article

SN - 1471-2393

VL - 12

JO - BMC Pregnancy and Childbirth

JF - BMC Pregnancy and Childbirth

M1 - 156

ER -