Population estimates, consequences, and risk factors of obesity among pregnant and postpartum women in India: Results from a national survey and policy recommendations

Abstract

Objective To examine prevalence, risk factors, and consequences of maternal obesity; and provide evidence on current policies and programs to manage maternal obesity in India. Methods This is a mixed‐methods study. We analyzed the National Family Health Survey (NFHS)‐4 data (2015–16) to estimate the prevalence and risk factors of obesity, followed by a desk review of literature and stakeholder mapping with interviews to develop policy guidance. Results National prevalence of obesity (defined by WHO as body mass index ≥25) was comparable among pregnant (12%) and postpartum women (13%) ≥20 years of age. A high prevalence of obesity (>40%) was observed in over 30 districts in multiple states. Older maternal age, urban residence, increasing wealth quintile, and secondary education were associated with increased odds of obesity among pregnant and postpartum women; higher education increased odds among postpartum women only (OR 1.90; 95% CI, 1.44–2.52). Dietary variables were not associated with obesity. Several implementation challenges across healthcare system blocks were observed at policy level. Conclusion Overall prevalence of obesity in India during and after pregnancy is high, with huge variation across districts. Policy and programs must be state‐specific focusing on prevention, screening, and management of obesity among pregnant and postpartum women.

Impact of pregnancy on long‐term health: Advances in postpregnancy care—An opportunity to improve long‐term maternal health

“…Suboptimal nutrition and obesity are conditions that affect all women globally, spanning from high-to low-and middle-income countries. [7][8][9] The postpregnancy period presents a unique opportunity to improve maternal long-term health. Pregnancy complications can be reviewed and management plans devised to arrange follow-up to ensure that women can avail of early identification of chronic diseases such as glucose intolerance and type 2 diabetes, and cardiovascular diseases such as hypertension, ischaemic heart disease, and stroke.…”

“…It is estimated that one‐third of the world's population suffers from malnutrition, whether it be thinness or obesity or micronutrient deficiencies. Suboptimal nutrition and obesity are conditions that affect all women globally, spanning from high‐ to low‐ and middle‐income countries 7–9 …”

Addressing the gaps in nutritional care before and during pregnancy

“…In the USA, evidence suggests that obesity prevalence in women aged 20–39 is at least 31 % and may be over 61 % in women with low incomes (49) . In some regions of India, over 40 % of women may have obesity as defined by body mass index (BMI) ≥30 kg/m2 (50) . Globally, obesity prevalence is rising and is estimated to be >20 % in all women by 2025 (51,52) .…”

“…A nutrition checklist that facilitates standardised nutrition assessment could support non-nutrition healthcare providers in maternity services to address nutrition as part of their routine clinical care. A similar approach has been taken in India where their government along with the UN children's fund (UNICEF) and other colleagues, has launched a treatment algorithm with checklist points to guide healthcare providers in addressing key aspects of antenatal care, including diet and weight (50) . Other regions may have locally developed tools to support nutrition assessment and feedback.…”

Mid-upper arm circumference in pregnant women and birth weight in newborns as substitute for skinfold thickness: findings from the MAASTHI cohort study, India

“…Maternal obesity rates are disproportionately higher in Low-Middle income countries (LMICs) as India and can have adverse health outcomes for mothers and children. In India, Chopra et al analyzed the National Family and Health Survey-4 (NFHS-4) data and reported obesity among 12 % of pregnant women 20 years and above, with as high as above 40 % high in over 30 districts in multiple states [ 8 ]. Similarly, in children of South Asia, the overall prevalence of overweight and obese children was reported as 1.91 and 0.89 %, respectively [ 9 ].…”