Objective To gain a detailed understanding of healthcare professionals' perceptions of the impact that caring for obese pregnant women has on maternity services.Design Qualitative interview study using purposeful sampling and face-to-face interviews.Setting Sixteen maternity units in NHS Trusts in the North East Government Office Region of England, UK.Sample Thirty-three maternity and obstetric healthcare professionals with personal experience of managing the care of obese pregnant women.Methods Semi-structured interviews with healthcare professionals representing each maternity unit in the region. Transcripts were analysed using systematic content analysis.Main outcome measures Views on the impact maternal obesity has on maternity services, the facilities required to care for obese mothers in pregnancy, and existing services directed towards maternal obesity.Results Five dominant themes relating to service delivery emerged; booking appointments, equipment, care requirements, complications and restrictions, and current and future management of care. Many of the issues identified were associated with managing the care of obese women in pregnancy safely, resources and cost issues to be able to do this, multidisciplinary care requirements because of coexisting morbidities when the mother is obese, and restricted care options and patient choice.Conclusions Healthcare professionals in the North East of England feel that maternal obesity has a major impact on services and resource, on the health of both the mother and child, and on the psychological wellbeing of the mother.

Receptors for 1,25 dihydroxyvitamin D3 [1,25-(OH)2D3] have been reported in breast tissue; however, the presence of multiple binding sites and limited availability of human tumor tissue have precluded complete biochemical characterization of the receptor in breast cancer. In the present study, binding proteins for 1,25-(OH)2D3 in breast tumor tissue were analyzed using a rat model of breast cancer. Breast tumors were induced in adult female rats with the carcinogen nitrosomethylurea. Such tumors previously have been shown to possess high levels of estrogen receptors and are estrogen dependent. Binding proteins for 1,25-(OH)2D3 in 0.3 M KCl extracts of tumor tissue were analyzed on sucrose density gradients. Two binding proteins were detected: one sedimenting at 5-6 S representing binding of 1,25-(OH)2D3 to the 25 hydroxyvitamin D3 (25OHD3) binding protein and a second moiety sedimenting, like the rat intestinal receptor, at 3.3 S. Binding of the dihydroxy metabolite to the faster sedimenting protein could be eliminated by inclusion of radioinert 25OHD3 in the incubation medium. Receptor content of rat breast tumor was investigated using an hydroxylapatite assay by incubating tumor extracts with a saturating concentration of 1,25-(OH)2-[3H]D3, plus unlabeled 25OHD3 to eliminate binding of the hormone to the 5-6 S species. Scatchard analysis of 1,25-(OH)2D3 binding to the tumor extracts yielded an apparent dissociation constant (Kd) of 0.33 nM. In summary, breast tumors induced in rats by nitrosomethylurea were shown to contain high affinity 1,25-(OH)2D3 receptors with properties very similar to those reported for the receptor in other mammalian target organs. The presence of receptors for 1,25-(OH)2D3 in these rat breast tumors implies that the tissue is potentially responsive to the hormone.

Introduction International evidence shows that Asians have increased diabetes risk at a lower body mass index (BMI) than European Whites.1 UK guidance for routine gestational diabetes screening does not consider this BMI difference in risk. A proportion of high risk Asian women are therefore unscreened for diabetes in pregnancy, and potentially wrongly assigned to low risk care leading to inequalities. This study describes trends in first trimester obesity using the WHO BMI criteria for Asians. Methods Retrospective epidemiological study using data from 34 maternity units in England between 1995 and 2007. Obesity classification was BMI >27.5 kg/m2 for Asians, and >30 kg/m2 for all other ethnic groups. χ2 analyses were used for trends over time. Logistic regression for odds of first trimester obesity among ethnic groups adjusted for maternal age, parity, deprivation and employment. Results Black and South Asian women have a significantly higher incidence of first trimester obesity compared with White women, and this is increasing at a more rapid rate over time in Black women. The proportion of South Asian women classified as obese doubled from 10.6% to 20.5% when using the WHO criteria for Asians compared with the general population BMI. Following adjustment for population demographics, Pakistani women had the highest odds of first trimester obesity (OR 2.19, 95% CI 2.08 to 2.31). Conclusion Current gestational diabetes screening in the UK excludes half of the South Asian population at high risk. There should be further consideration of ethnic groups when defining the BMI categories to be used when developing clinical guidelines and services.

No abstract