الفهرس 
SIGNIFICANCE OF THE STUDY
Maternal ObesityOnly 14 pages are availabe for public view
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Abstract
Maternal obesity is defined as a BMI ≥ 30 kg/m2 at the
first booking appointment. Excessive gestational weight
gain is independently and strongly associated with macrosomia,
particularly among overweight and obese women, which leads
to adverse maternal and neonatal outcomes such as pre
eclampsia, seizures, hypoglycemia, failed induction, prolonged
labor, caesarean birth, birth trauma, birth asphyxia, and
increased risk of perinatal mortality. Moreover, there is a
positive association between gestational weight and postpartum
weight retention.
The aim of this study was to evaluate the effect of
nutritional program for improving obesity on maternal health
through assessing maternal knowledge about obesity during
pregnancy, assessing maternal practices related to their
nutritional lifestyle to determine their needs, designing and
implementing nutritional program according to the class of
obesity, evaluating the effect of the program on the mother &
neonatal health.
The study was carried out Maternal and Child Health
(MCH) centers at El- Giza and EL-Moneab areas using a
controlled quasi-experimental design with pre- post assessment.
The sample consisted of a study group of 50 obese pregnant
women in the first trimester of pregnancy who received the
educational progrem and a control group of 50 similar women under routine care. The data collection tools consisted of an
interview questionnaire form assessing women’s socio
demographic data, obstetric and medical history, current
pregnancy details, knowledge assessment and practices, and a
food frequency intake sheet; and a physical assessment and
follow up sheet to record initial and follow up visits,
assessment covering ANC visits data, follow-up complaints,
diagnosed problems, weight, and fetal heart rate (FHR), and
pregnancy outcomes. A pilot study was conducted on ten obese
pregnant women and the tools were finalized accordingly. The
work was carried out through assessment (pretest), planning,
implementation, and evaluation (posttest) phases lasting from
May 2013 to May 2014.
The main study results were as follows:
Women in the study and control groups had similar
socio- demographic with 25-35 years, and having basic
education, and not working, 78% and 74% respectively.
The obstetric history was similar in the two groups, with
mean gravity of 3, similar mean parity of 2. The majority
had previous abortion, 56% and 44% respectively.
All women in the study and control groups had a history
before and during current pregnancy, with similar obesity
grades, and the majority were having chronic disease.
All women in both groups had antenatal care (ANC)
during current pregnancy, mostly since the first trimester Women’s knowledge in both groups was low before the
progrem; it showed statistically significant improvement
in the study group, compared with the control group
(P<0.001) after the progrem.
The pre – progrem positive practices towards diet,
exercise, and rest were low in both groups, with
statistically significant improvements after the progrem
only in the study group.
Before the progrem, salt intake was higher among
women in the study group (P=0.001), while the intake of
juices was higher in the control group.
At the post – progrem phase, the study group had higher
intake of cereals (P=0.01), dairies (P<0.001), vegetables
and fruits (P=0.002) and lower intake of carbohydrates
(P<0.001), caffeine (P<0.001), and juice (P<0.001),
Meanwhile, the intake of carbohydrates and fat was
higher among women in the control group, P<0.001 and
P=0.001 respectively.
In the follow up, the frequency of intake of various food
groups was higher among women in control group except
for vegetables and fruits which were higher in the study
group (P<0.001).
Thought pregnancy. The frequency of intake of
carbohydrates group showed a decreasing trend in study
group, whereas the control group the control group
demonstrates an increasing trend with statistically
significant difference between the two groups. The frequency intake of dairies and protein groups was
increased in both groups.
At the second post – progrem visit, more women in the
control group had hypertension and gestational diabetes
(P= 0.02).
At the third post – progrem visit, women in the control
group hadhigher weight (P=0.004), hypertension and
gestational diabetes (P=0.02).
At the fourth post – progrem visit, they additionally had
more headache. They also had additionally more
hydromnios (P<0.001) malpresentation, and abnormal
FHR at the fifth post progrem. This continued to the
sixth, seventh, and eight post progrem visit.
Concerning body weight women in the study group had
significantly lowered body weight throughout follow –up
visits.
Concerning maternal outcomes, women in the control
had significantly higher rates of fetal distress (P<0.001),
abnormal uterine contractions (P<0.001), perineal
lacerations (P=0.004), and post partum hemorrhage
(P=0.001).
As for fetal outcomes, study group had better Apgar
scores at the first (P<0.001) and fifth (P=0.01) minutes,
with less NICU admissions (P<0.001).
Women, knowledge had significant positive correlation
with their education at all phases, and with income of study group at the post – progrem phase (r=0.337),
practices related to lifestyle had significant negative
correlation with age at the pre- progrem phase
(r= - 0.252), and with parity of study group women at the
post – progrem phase (r= -0.305).
In conclusion, obese pregnant women have deficient
knowledge and practices regarding diet. Exercise and rest
during pregnancy. The nutritional program is effective in
improving their knowledge, practices related to lifestyle, with
improvement in the complaints and problems during
pregnancy, lower body weight throughout follow-up visits, and
better maternal and fetal outcomes.
Base on the study findings, it is recommended that the
developed nutritional program be made available at ANC
centers, and the nurses in these centers should exert more
efforts in educating pregnant obese women regarding healthy
diet during pregnancy, with the help of dietitians, Obese
pregnant women need early progrem to avoid excessive weight
gain, with screening programs for pregnancy associated
complications as pregnancy induced hypertension and diabetes.
The study should be replicated using a control clinical
trial designs to provide results at a higher level of evidence.