Obstetrician and Gynecologist’s Perspectives on the Definition and Management of Obesity in Pregnancy

• Author / Creator

  Stafford, Shawna M

• Introduction: Obesity is a complex disease affecting increasing numbers of reproductive aged
  women. Despite ongoing research efforts, many knowledge gaps remain when caring for
  women with obesity in pregnancy. Currently, there is no clearly defined, comprehensive
  standard of care for pregnant women with obesity. Consequently, obstetricians and gynecologists (OBGYNs) have developed different approaches. In this study, how the management of women with obesity differs from that of normal weight patients was explored. Another aim was to gain a better understanding of how OBGYNs define obesity, as there is currently no consensus definition.

  Methods: A mixed methods approach was used. Qualitative concept maps were generated
  through individual in-depth mapping sessions with seven OBGYNs and analyzed
  thematically. Major themes informed survey development. The resultant survey was
  distributed to OBs in Edmonton (n=58). Responses were entered into a Research Electronic
  Data Capture Database (REDCap) and descriptive statistics performed. Finally, semi-structured interviews with residents in obstetrics and gynecology were conducted until saturation about the current working definition and ideal definition of obesity in pregnancy. Ethics approval was obtained.

  Results/Conclusions: Obstetrics and Gynecology residents and staff physicians relied on varying subjective measures to classify patients as having obesity or not. They defined and appreciated risk secondary to obesity at different Body Mass Index (BMI) points. While they found it useful, BMI was not routinely used and on its own was felt to be insufficient to define obesity. Clinicians prefer a definition of obesity that incorporates a more comprehensive picture of patient health and wellbeing. This could include medical comorbidities and specific barriers to care that may provide insight into weight distribution. Establishing a consensus definition and classification of obesity in pregnancy would allow for more standardized care plans to be developed.
  
  Limited professional education opportunities, lack of specific counseling tools, time constraints, and negative bias toward women with obesity in pregnancy all act as barriers to providing evidence-based care to women with obesity. Education strategies addressing these barriers will help empower obstetrical care providers to become champions of weight management in the future. Current guidelines do not address many of the areas physicians identify as challenging and important in the care of women with obesity in pregnancy. Revision of national guidelines should incorporate those areas OBGYNs deem most crucial to providing high level care.

• Subjects / Keywords

  • pregnancy
  • qualitative
  • obesity
  • mixed methods
  • obstetrics

• Graduation date

  Fall 2019

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-rrwm-3413

• License

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