Pregnancy care and birth outcomes for women with moderate to super-extreme obesity Valerie J. Slavin a,b, *, Jennifer Fenwick a,b , Jenny Gamble a a School of Nursing and Midwifery and Maternity and Family Unit, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, University Drive, Meadowbrook, Qld 4131, Australia b Queensland Health, Gold Coast Hospital, 108 Nerang Street, Southport, Qld 4215, Australia 1. Introduction Obesity, defined as a body mass index (BMI) of 30 kg/m 2 or more is a global public health problem in developed nations. Almost a decade ago the World Health Organisation (WHO) reported that obesity had reached epidemic proportions, with more than one billion adults overweight; at least 300 million of them clinically obese. 1 Obesity is a major contributor to the global burden of chronic disease and disability due to an association with co-morbidities including type two diabetes, cardiovascular disease and stroke. 1 Obesity in childbearing women is increasingly recognised as a key risk factor for adverse outcomes for both women and their babies. 2 Pregnancy related complications include increased risk of gestational diabetes, hypertensive disease, thromboembolism, stillbirth, induction of labour (IOL) and caesarean section (CS). As a result of the obesity epidemic in the childbearing population, maternity systems and care providers are under increasing pressure to provide additional resources to accommo- date the range of complications that arise from maternal obesity. Adding to the challenge of planning and providing quality services is the increasing number of women in the extremely obese category (defined as BMI  40). 3,4 There remains little evidence about the prevalence and outcomes for women with a BMI beyond 40 largely because perinatal data collections generally group all women with either a BMI over 30 or 40 together. As such there is limited understanding of the health service needs of this group of childbearing women. There is however emerging work describing the prevalence and outcomes of women with a new class of obesity, termed by some, super obese, morbid obese or extremely obese, defined as BMI greater or equal to 50. 4–6 Since there is currently no standard agreed terms to describe subgroups beyond BMI 40, this paper will define the subgroups as moderately obese Women and Birth 26 (2013) 179–184 A R T I C L E I N F O Article history: Received 4 February 2013 Received in revised form 16 April 2013 Accepted 2 May 2013 Keywords: Pregnancy Body mass index Morbid obesity Caesarean section Diabetes gestational A B S T R A C T Purpose: To describe the health service utilisation and birth outcomes of pregnant women with moderate to super-extreme obesity. Background: Maternal obesity is increasingly recognised as a key risk factor for adverse outcomes for both women and their babies. Little is known about the service utilisation and perinatal outcomes of women with obesity beyond a body mass index of 40. Method: Women with a self-reported pre-pregnancy BMI of 40 or more, who had received care and birthed a baby at the study site between 1 January 2009 and 31 December 2010. Clinical audit was used to identify the health service utilisation and birth outcomes of these women. Results: 153 women had a BMI of 40 or more. Women saw 6 different health professionals during pregnancy (1–16). Most of their visits were with a medical practitioner, often with limited experience, and almost all women only saw a midwife once at their booking visit (n = 150, 98.0%). While the majority of women experienced a normal pregnancy, free from any complications, almost half the women in this study experienced a caesarean section (n = 74, 48.4%). Conclusion: Clinical audit has been useful in providing additional information which suggests current maternity care provision is not meeting the needs of this group of women. The model of antenatal care provision may be a mediating factor in the birth outcomes experienced by obese women. The development of effective, targeted antenatal care, designed to meet the needs of these women is recommended. ß 2013 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved. * Corresponding author at: 45 Harmsworth Road, Pacific Pines, Qld 4211, Australia. Tel.: +61 07 5580 0409. E-mail address: v.slavin@griffith.edu.au (V.J. Slavin). Contents lists available at SciVerse ScienceDirect Women and Birth jo u rn al h om ep age: w ww.els evier.c o m/lo c ate/wo mb i 1871-5192/$ – see front matter ß 2013 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved. http://dx.doi.org/10.1016/j.wombi.2013.05.001