This was one of my midwifery school assignments for our Research Methods class. The assignment was to closely examine a research study and break it down into lay terms. I chose Prediction of uncomplicated pregnancies in obese women: a prospective multicentre study and here it is in hopefully a more readable format:
My Evaluation of a UK Study Used to Predict Complications in Obese Women
As women all over the world are experiencing an increase in obesity, so are expectant mothers. One in four women of reproductive age in the UK are classified as obese, costing the medical system in the UK an estimated 37% more per pregnancy than moms of an normal BMI (Body Mass Index). This is because all obese pregnant women are believed to be at high risk to experience complications over the course of their pregnancies and births. Generally speaking, these women are often attended to through a team of specialists that work together to provide her with highly monitored care. It is now coming to light that these women may be over-managed and, at least some of them, could benefit from a more hands-off approach. The purpose of the study outlined below was to discover which previously perceived risk factors could present in an obese woman and still lead to an uncomplicated pregnancy and birth and how successful were these risk factors at predicting the actual outcome. The purpose of this study was to seek a normal outcome rather than an adverse effect.
From March 2009 to June 2014, researchers examined information collected from 1409 obese women, sixteen years or older, that were pregnant with one child that participated in the UPBEAT trial (stands for UK Pregnancies Better Eating and Activity Trial). The UPBEAT trial was a randomized controlled trial, in other words, some women received diet and physical activity advice while others didn't, and those who didn't receive the advice served as a comparison, or control group. However, researchers were missing blood samples for 27% of the control group. For the purpose of this particular trial, the term obese was in reference to pregnant women weighing 36.4 kilograms more than is considered normal for their height, give or take approximately 5 kilograms. This study did not include mothers that were:
currently using metformin (a diabetes drug); or
had underlying health problems from before they became pregnant (including high blood pressure, diabetes, kidney disease, lupus, various blood disorders, celiac disease, thyroid disease or psychosis).
Various aspects associated with an uncomplicated pregnancy were looked at after the fact to pinpoint how sociodemographic factors (like age, sex, education level, income level, marital status, occupation, religion and ethnicity), whether the mom currently smoked, had previously experienced miscarriage, preeclampsia or gestational diabetes and how many children she had already given birth to. Blood samples were also collected and 19 different biomarkers were analyzed. The study began gathering information from the women in the early second trimester, twice more later in pregnancy, again at delivery and one last collection was taken at 6 months postpartum. The researchers then referenced it back later to whether the mother survived childbirth, the infant was born alive and unharmed, and whether there were less problems during pregnancy and labour, such as gestational diabetes, preeclampsia and large, difficult to deliver babies as a result of gestational diabetes or, conversely, babies that were small for their gestational age.
The women were divided into five groups according to their risk factors and pregnancy outcomes were compared between the groups. Group five consisted of 36% of the women and experienced no complications associated with their prenatal period or delivery. Risk factors of the women that were taken into account and found to not adversely affect the pregnancy and birth outcomes, when considered on their own, were:
having borne more than one child when plasma adiponectin levels were high (low levels of plasma adiponectin are associated with diabetes);
the age of the mother;
systolic blood pressure (referring to the upper number when your blood pressure is taken and is measuring the amount of pressure in your arteries during contraction of your heart muscle); and
HbA1c (how high blood sugar levels were on average over the past approximately 120 days).
The women of the upper fifth group experienced more vaginal births and less gestational diabetes, preeclampsia and other hypertensive disorders, late miscarriage, preterm birth (before 37 weeks gestation), placental abruption (placenta becoming detached from uterus too early), blood clots, and postpartum hemorrhage (above 1000 mL) decreased.
Of the 64% that did experience complications, the leading complication during pregnancy was gestational diabetes and the leading complication during delivery was emergency c-section.
The researchers concluded that blood tests and other measurements can be used to help determine here an obese mom falls in the spectrum of risks. More studies will be done in the future in order to assign appropriate care depending on where a mom falls on that spectrum of risks.
I felt that this was a unique study in that it was focused on determining what perceived factors lead to a normal outcome rather than looking for an adverse outcome. The study was centered around the refreshing idea that some obese women are receiving too much care and, rather than adding more treatments to the mix, as many studies seem to, it was trying to reduce interventions. I felt that it should have included women with pre-existing health conditions. Perhaps that would have skewed the data in a way that the researchers were aiming to avoid, however, my thoughts are that it is increasingly difficult to find someone these days that doesn't already have a diagnosis of at least one of the many conditions that would have disqualified women from participating in the trial. I have a few of those conditions myself, and given that an obese person is already predisposed to health conditions, I'm not sure how transferable the data really is to the general population. So, while I like that the conclusion of the study means less interventions for some women that meet a certain criteria and some are sure to benefit, the impetus was a cost savings initiative funded by National Institute for Health Research in Scotland and I do wonder if the end result might be that women that actually need the care might not receive it or will automatically receive more care than is necessary. I'm not certain the study is applicable to the real world.
Vieira, Matias C., et al. “Prediction of Uncomplicated Pregnancies in Obese Women: a Prospective Multicentre Study.” BMC Medicine, BioMed Central, 3 Nov. 2017, bmcmedicine.biomedcentral.com/articles/10.118/s12916-017-0956-8.