As with many other noncommunicable diseases (NCDs), obesity has been on the rise globally for several years with potentially dire consequences for maternal health. The proportion of women of reproductive age who are obese ranges from 3% to 74% across low- and middle-income countries (LMICs), and the highest burden tends to be in middle-income countries.
Insight into obesity and maternal health
Jamaica is one such setting that is experiencing a growing number of maternal deaths due to NCDs and other non-obstetric causes. While the country has seen a slow decline in maternal deaths, “Indirect causes account for an increasing proportion of these deaths,” said Lovney Kanguru, lead author of a recent population based study examining the consequences of overweight and obesity for Jamaican women of reproductive age. Kanguru and colleagues noted that this trend is occurring despite high uptake of maternal health care services, including antenatal visits, skilled birth attendance, postnatal care and immunization coverage. According to Kanguru, “This has spurred local efforts towards understanding indirect causes, which appear to be driven by the increasing prevalence of NCDs in the island.”
Their study found that 63% of women in Jamaica between the ages of 15 and 49 were obese. Among this population of women, roughly 6% were diabetic, 19% had a hypertensive disorder and 3% were both diabetic and hypertensive. Diabetes and hypertension are known risk factors for maternal morbidity and mortality, and in these cases, obesity may be classified as an indirect cause posing risks to maternal health.
Additionally, the research showed that one in every ten women who died during or after childbirth had been overweight or obese, the majority of whom had also developed complications such as hypertension, circulatory/cardiovascular disorders and diabetes. Despite evidence that obese women face greater health risks than non-obese women, community perception of obesity varied—which may pose challenges to maternal mortality measurement. As Kanguru illuminated, “It became apparent during the fieldwork for this study that medical practitioners and the wider community did not see overweight or obesity as a ‘disease’—and being overweight was sometimes regarded as a sign of good health—so the condition is likely to be left out as a reported contributing cause of death.”
Reversing the trend
The authors call for more research on maternal overweight and obesity in LMICs. As Kanguru illustrated, “The data available in Jamaica clearly do not provide a full picture of the problem and the relationship of obesity with childbearing. Maternal health needs to be explored further with primary studies and better data from routine sources.” Calculating body mass index (BMI) based on height and weight rather than clinical assessments or judgments and incorporating BMI into routine antenatal records are also important steps to improve measurement and address this issue.
Furthermore, the study calls for lifestyle and preventative interventions to promote healthy weight before, during and after pregnancy. This entails addressing the underlying social attitudes and values in culturally-sensitive ways. As Kanguru stated, “Exploring strategies to change diets traditionally suited to high physical labour to one which better accommodates the current sedentary occupations of women, targeting adolescent girls and [changing] attitudes regarding obesity as a sign of prosperity is crucial as these may be context-specific and are not necessarily transferable from high- to low- or middle-income settings.”
Read the full paper, “The burden of obesity in women of reproductive age and in pregnancy in a middle-income setting: A population based study from Jamaica,” in the MHTF-PLOS collection on NCDs and maternal health.
Explore other posts from the Maternal Health Task Force’s blog series, “Noncommunicable Diseases and Maternal Health.”
Is your work related to NCDs and maternal health? We want to hear from you!