Is Obesity an Independent Barrier to Obtaining Prenatal Care?

Lisa D. Levine; Ellen J. Landsberger; Peter S. Bernstein; Cynthia Chazotte; Sindhu K. Srinivas

doi:10.1055/s-0032-1326984

American Journal of Perinatology, Table of Contents

Am J Perinatol 2013; 30(05): 401-406
DOI: 10.1055/s-0032-1326984

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is Obesity an Independent Barrier to Obtaining Prenatal Care?

Authors

Lisa D. Levine

¹Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program, Philadelphia, Pennsylvania
Ellen J. Landsberger

²Department of Clinical Obstetrics and Gynecology, Jack D. Weiler Hospital of the Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Peter S. Bernstein

²Department of Clinical Obstetrics and Gynecology, Jack D. Weiler Hospital of the Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Cynthia Chazotte

²Department of Clinical Obstetrics and Gynecology, Jack D. Weiler Hospital of the Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
Sindhu K. Srinivas

¹Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program, Philadelphia, Pennsylvania

Abstract

Objective Obesity is a demonstrated barrier to obtaining health care. Its impact on obtaining prenatal care (PNC) is unknown. Our objective was to determine if obesity is an independent barrier to accessing early and adequate PNC.

Study Design We performed a retrospective cohort study of women who initiated PNC and delivered at our institution in 2005. Body mass index (BMI) was categorized by World Health Organization guidelines: underweight (<18.5 kg/m²), normal weight (18.5 to 24.9 kg/m²), overweight (25.0 to 29.9 kg/m²), and obese (≥30 kg/m²). Maternal history and delivery information were obtained through chart abstraction. Differences in gestational age at first visit (GA-1) and adequate PNC were evaluated by BMI category. Data were compared using χ² and nonparametric analyses.

Results Overall, 410 women were evaluated. The median GA-1 was 11.1 weeks and 69% had adequate PNC. There was no difference in GA-1 or adequate PNC by BMI category (p = 0.17 and p = 0.66, respectively). When BMI groups were dichotomized into obese and nonobese women, there was no difference in GA-1 or adequate PNC (p = 0.41).

Conclusion In our population, obesity is not an independent barrier to receiving early and adequate PNC. Future work is warranted in evaluating the association between obesity and PNC and the perceived barriers to obtaining care.

Keywords

obesity - access - adequate prenatal care

Full Text

References

References
1 Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723-1727
2 Center for Disease Control and Prevention. Overweight and obesity. Available at: http://www.cdc.gov/obesity/index.html . Accessed September 2011
3 World Health Organization. Obesity and overweight. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/ . Accessed March 2012
4 Østbye T, Taylor Jr DH, Yancy Jr WS, Krause KM. Associations between obesity and receipt of screening mammography, Papanicolaou tests, and influenza vaccination: results from the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study. Am J Public Health 2005; 95: 1623-1630
5 Wee CC, McCarthy EP, Davis RB, Phillips RS. Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care?. Ann Intern Med 2000; 132: 697-704
6 Quesenberry Jr CP, Caan B, Jacobson A. Obesity, health services use, and health care costs among members of a health maintenance organization. Arch Intern Med 1998; 158: 466-472
7 Chu SY, Callaghan WM, Kim SY , et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care 2007; 30: 2070-2076
8 O'Brien TE, Ray JG, Chan WS. Maternal body mass index and the risk of preeclampsia: a systematic overview. Epidemiology 2003; 14: 368-374
9 Durnwald CP, Ehrenberg HM, Mercer BM. The impact of maternal obesity and weight gain on vaginal birth after cesarean section success. Am J Obstet Gynecol 2004; 191: 954-957
10 Cnattingius S, Bergström R, Lipworth L, Kramer MS. Prepregnancy weight and the risk of adverse pregnancy outcomes. N Engl J Med 1998; 338: 147-152
11 Institute of Medicine of the National Academies. Weight gain during pregnancy: reexamining the guidelines. May 28, 2009. Available at: http://www.iom.edu/pregnancyweightgain . Accessed September 2011
12 Lia-Hoagberg B, Rode P, Skovholt CJ , et al. Barriers and motivators to prenatal care among low-income women. Soc Sci Med 1990; 30: 487-495
13 Chu SY, Bachman DJ, Callaghan WM , et al. Association between obesity during pregnancy and increased use of health care. N Engl J Med 2008; 358: 1444-1453
14 Phelan S. Pregnancy: a “teachable moment” for weight control and obesity prevention. Am J Obstet Gynecol 2010; 202: 135 , e1–e8
15 Kotelchuck M. An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994; 84: 1414-1420
16 Dawson DA. Ethnic differences in female overweight: data from the 1985 National Health Interview Survey. Am J Public Health 1988; 78: 1326-1329
17 New York City Department of Health and Mental Hygiene. Obesity in the South Bronx: a look across generations. Available at: http://www.nyc.gov/html/doh/downloads/pdf/dpho/dpho-bronx-obesity.pdf . Accessed September 4, 2012
18 Fox P, Yamaguchi C. Body image change in pregnancy: a comparison of normal weight and overweight primigravidas. Birth 1997; 24: 35-40
19 HealthyPeople.gov. Maternal, infant, and child health objectives. Available at: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26 . Accessed March 16, 2012