Maternal weight and the obesogenic environment in Nova Scotia Sara Kirk, Louise Parker, Trevor Dummer, Linda Dodds, Tarra Penney

“…today’s principal neglected public health problem...” (WHO, 1997) “…one of the most important medical and public health problems of our time..." (Prof. Philip James, IOTF Chairman) “…given the prevalence of childhood obesity, and given its contribution to many diseases, this is the first generation that may not live as long as their parents…” (Dr. Kellie Leitch) The obesity time bomb

Obesity rates, by province and sex, 2004

Overweight and obesity rates: children and youth, by province, 2004

So, what happened?

Pregnancy and post-partum: an ideal time for intervention Obese mothers are at a high risk for many complications Children with obese parents are themselves more likely to be obese as adults Supportive programming for mothers is key to obesity prevention

No national surveillance system that routinely measures pregnancy weight in Canada Canadian Perinatal Surveillance system (CPSS) collects 27 health outcomes but not BMI of the mother The pregnant population in Canada

Provincial level population-based, computerized database with information on pregnancy outcomes Maternal/newborn data available for every pregnancy of > 20 weeks gestation, with a birth weight of 500g or more Data on self-reported pre-pregnancy weights from 1988 The Atlee Perinatal Database

To describe the temporal, socio-economic and demographic trends in normal weight and obese pregnant women in Nova Scotia Part of a larger study investigating the influence of the obesogenic environment on maternal body weight Objective

Self-reported pre-pregnancy weights on women in NS ( ) 172,373 deliveries (2108 multiple births) normal weight = kg moderately obese = kg severely obese > 120 kg Analyses to look at trends in maternal body weight by: Time Age Parity SES Urban/rural Methods

Non obese (55-75kg) n=94,655 Moderately obese (90-120kg) n=12,882 pSeverely Obese (>120kg) n=1,216 p Maternal age (yrs, mean, SD) 28.5 (5.4)28.6 (4.9)< (4.8)<0.001 Primiparous (n,%)42,715 (45.1)5,359 (41.8)< (41.1)<0.01 Low SES (n,%)18,653 (20.3)3,089 (24.8)< (27.2)<0.001 Rural (n,%)35,193 (37.2)5271 (41.1)< (41.3)<0.01 Weight gain (kg, mean SD) 15.4 (6.0)11.5 (6.7)< (6.8)<0.001 Subject characteristics

8.6 kg increase

Number of deliveries to women with pre- pregnancy weight >120kg

Maternal obesity: A provincial problem

Summary of results Obese women: were slightly older were of lower SES gained less weight during pregnancy were more likely to live in rural areas

Conclusions Maternal weights have increased dramatically over the last 20 years in Nova Scotia Deliveries in severely obese women have more than tripled since 1988 These trends have implications for population health and health care delivery Maternal and child health Staffing Resources

What next? In-depth exploration of the influence of the obesogenic environment on maternal body weight Investigation of maternal obesity in the context of the child Recommendations for family-centred management and prevention

Acknowledgements IWK Health Centre funding (Tarra Penney and Trevor Dummer) Reproductive Care Program of Nova Scotia (data access)