Obesity in Pregnancy

Brief ActionPlan applied to obesity in Pregnancy

Obesity and Pregnancy

The study used both qualitative and quantitative data. Qualitative data validated the findings of the quantitative analysis. The research was carried along a set of motivational interview questions. A structural framework known as the UB-PAP (Ultra-brief Personal Action Plan) was applied as the structural framework, and it helped in capturing the qualitative values of the population. The obese pregnant mothers responded to the interview questions and those who scored 7 and above were subjected to a personal action plan. The maternal and infant morbidity and mortality statistics were obtained from the EMR (electronic media records). Other data were sourced from journal articles, the department of Health and Human services, and the state surveillance data on behaviors.

Table of contents

Chapter 1-5

Introduction- -5

Background-5

Aims and Objectives-6

Nature of the Study-7

1.5 Importance of the Study-7

1.6 Research questions-9

1.7 Hypotheses-10

Chapter 2-11

2.1 Research context-11

Chapter 3-12

Literature Review-12

Chapter 4-14

Research Methodology-14

4.1 Sampling-14

4.2 Qualitative and quantitative sampling-15

4.3 the UB-PAP framework questions-18

4.4 Data analysis-19

4.5 Findings-20

4.6 Limitations-21

4.7 Conclusion and Recommendations-21

References -22

Chapter 1 Introduction

1.1Background

The proportion of the population considered to suffer from obesity jumped radically between the 1980s and 2009 (Krauss, Winston, Fletcher, & Grundy, 2000). The obesity outbreak in the United States continues to spread resulting in the growth of America’s biomass percentage. Biomass refers to the product of the population distribution and the average body mass. Maternal obesity is an independent risk factor for possible adverse maternal and fetal morbidity and mortality. Various authors agree that obesity increases the general health problems throughout a woman’s lifetime (Thomson, 2012).

The Healthy people 2010 report from the U.S. Department of Health and Human Services (“Healthy People 2010,” 2008), and statewide surveillance data from the Behavior Risk Factor Surveillance System are few of these reporting systems, and provide the overall obesity trend. Obesity is increasing rapidly among Americans and worldwide populations (Gee, 2004). The health care expenditures in the United States of America continue to rise due to obesity and is approaching 300 billion dollars, yet obesity lingers despite the diet and exercise. United States boasts of the State of the Art health care system, yet limited access to basic health care for the same continues to fail at combating obesity (Kelly, 2006).

The most alarming finding of this study ascertained that the children of these adolescent mothers by age two were at risk of obesity and by age three twelve percent were considered obese. These findings were in keeping with the present day trend of long-term obesity and a two folded increase in maternal obesity (Kelly, 2006).

The population of this study is based in Lowell, MA at the Lowell Community Health Center. The pregnancy demographics and outcomes of this community were last studied in 1989. The population at the time were primarily Cambodian refugees, but now the clinic serve over twenty nine different types of world population, including Portuguese, Burmese, and African ethnicities, some African-American, Hispanic, and Caucasian mixed races. The research by Gee (2004) found that there was an increase in primary cesarean sections, which an operative procedure is done due to the smaller stature of the client and now the large birth size of the infant. There has not been a more recent study at the center ever since.

1.2 Definition of terms

Maternal obesity- the obesity of a pregnant woman

Gestational weight — the weight of an infant at a specific gestational stage

UB-PAP- a motivational interview intervention approach for pregnant, obese women. It stands for Ultra-Brief Action Plan.

Prenatal care- this is the care provided for pregnant women before and during pregnancy.

BMI-this is a simple index of weight for height and is used to classify overweight, underweight, and obesity in adults.

1.3 Aims and Objectives

The study aims to combine the variables and show their correlation. The UB-PAP approach would offer the conventional framework for the study. Kelly (2006) argues that the framework would come in handy in showing the positive improvements achieved in the obesity rate among pregnant, obese adults. The success of the framework would enhance the campaign for other health centers to utilize the tool in their intervention procedures. In short, the research aims to reintroduce a basic health prevention strategy that is cost effective and simple to perform.

1.4 Nature of the study

The intention is to examine the effectiveness of the UB-PAP in the management of the BMI of pregnant, obese women. Through analyzing the behaviors of the women, the study seeks to determine whether the tool has been effective in causing behavior change among pregnant, obese women. The study focuses its analysis on both positive and negative behaviors of the obese pregnant women. The comparison would offer a measure of the achievement realized by the motivational tool (Visser & Atkinson, 2012). The Lowell Community Health Centers is the health centre that acted as the main data source. Data on physical fitness and medical history records were gathered from the centre. The research relied on historical data in order to widen the scope of comparison for the various values of the variables.

The study will also look into the complications associated with obese pregnancies, as well as the risk factors. More clearly, the research will investigate the relationship between obesity and the caeserean procedure. Data for this exercise would be picked from the Lowell Community Health Centre. Another area of importance for this study is the outcomes related to high BMI levels. Through analyzing the negative effects of obesity, the research seeks to trigger the proactiveness of obese pregnant women to seek intervention. Comparing data on obese women and the caesarean procedure attempts reinforced the notion that obesity causes birth complications amongst obese pregnant women. The consolidation of the mentioned data with data from the EMR (Electronic Media Records) helped in the arrival of H2.

Other data sources for this study include records from the United States section for Health and Human services. The “Healthy People 2010 report” provided the statistics. Other data were obtained from statewide surveillance information from the behavior risk factor surveillance system. The system offered a set of past behaviors of the sample population. The research also relied on other secondary sources like publications, books, and practitioners’ records. Through showing the effectiveness of the motivational tool for the pregnant, obese women, the research purposes to close the gap in knowledge on the utilization of the UB-PAP upon maternal obesity.

1.5 Importance of the study

The risk of obesity upon pregnancy, along with the medicalization of prenatal care is prevalent (Hay, 2008). The importance of this study is to centre efforts upon halting further escalation of BMI, by the normalization of pregnancy among the obese pregnant client. Instead of focusing upon clinician desires, the study focuses more on the client. There will be motivation for the client to change their lifestyle and perhaps, maintain BMI, and normal gestational weight goals, throughout the pregnancy and post partum.

Barrier (2000) states that known adverse outcome related to high BMI in pregnancy are hypertension gestational diabetes, pre-term delivery, and induction of labor, increase risk of neonatal death, maternal death, cesarean births, wound infections, hemorrhage, and early spontaneous abortions (Kelly, 2006). This study focuses on preventing the occurrence of complications during the birth process.

The study also explored the lifestyle traits and patterns that expose obese pregnant women to birth complications. The research focused its analysis on investigating how poor nutritional trend, unhealthy lifestyle habits, low motivation for pregnancy visits, and lack of physical exercise expose the life of the expectant mother to labor related complications.

1.6 Research questions

1. How do physical exercise and a healthy diet help to maintain the appropriate gestation weight for pregnant obese mothers with BMI 30Kg/m?

2. What are some of the common traits for pregnant, obese women who experience low motivation for prenatal visits?

3. How can the UB-PAP be designed for pregnant, obese women with low income sources?

4. How does a negative lifestyle promote the progression of high gestational weight amongst pregnant women?

5. How does the “Brief Action Motivational Tool” help in addressing the negative outcomes of obese pregnancies?

6. How does technology aid in preventing gestational weight gain among pregnant women?

7. What has been the effectiveness of the mid-wifery model over the medical care model in the improvement of an obese pregnant client’s condition?

1.7 Hypothesis

The research divided its hypothesis into two statements that helped in the determination of the research design. The two hypotheses statements reflected the nature of the study. The research relied on both qualitative and quantitative data, and this formed the first and the second hypotheses respectively.

H1- the “Brief Action Motivational Tool” is effective in the motivation for obese pregnant women with BMI of 30Kg/m2

H2- Lifestyle determines the progression of obesity among pregnant, obese women.

Chapter 2: Reseach Context

The research comprises of five chapters including, introduction, research context, Literature review, research methodology, and findings and conclusions. The chapters outlined the significance of the study, the intended objectives, the hypotheses statements, justification of the study, the research design, and the findings and conclusions. The examination carried out within the sections of this paper will be important for bridging the gap of knowledge on the use of UB-PAP in the diagnosis of obesity among obese pregnant mothers. It will be particularly helpful in informing the patients and their practitioners in accessing obesity situations (Thomson, 2012).

Chapter 3: Literature review

Originative and current literature on the use of UB-PAP in the management of the gestational weight features in this section. The focus of this paper is the effectiveness of the UB-PAP, but this examination will look at the relationship of the behavior pattern of the obese pregnant women in relation to the respective gestational weight. Books, journal articles, and reports provide a scholarly approach in relation to the problem of the research. Additional material, including conference reports on the risk of obesity and the effectiveness of the UB-PAP tool will feature majorly.

The review focuses on the impact of maternal overweight and obesity. The section covers the behavior of pregnant mothers who are obese, as well as the provision of an intervention plan for the women. A study by Braun (2011) suggested that the rise in the rates of maternal and infant morbidities and mortalities has triggered the curiosity of healthcare providers and researchers. They have strived to ascertain the relationship between gestational weight gains and lifestyle behavior pattern amongst the obese pregnant women (Thomson, 2012). Biomedical studies have forwarded the knowledge on the physical well-being implications obesity and overweight in pregnancy for both mothers and babies like hypertension, hemorrhage, infertility, caesarean delivery and late fetal deaths amongst others.

Little information exists on the psychological and emotional impact of obesity high gestational weights and obesity in pregnancy (Visser & Atkinson, 2012). There is also little information on the how the social context of the obese pregnant women’s lives affects their obesity experiences. In general, the increased focus about obesity and high gestational weight has extended into reproductive health. Evidence exists to suggest that obesity and overweight affect conception. Obesity and overweight lead to reduced infertility and lower success probability for assisted reproduction (Visser & Atkinson, 2012).

Kelly (2006) reveals that pregnancy in women suffering from obesity are commonly complicated than pregnancies among women with normal weights. Pregnancy outcomes decline linearly as the BMI increases from normal to overweight. The list of complications for overweight pregnant mothers is evident (Krauss, Winston, Fletcher, & Grundy, 2000). Hypertension disorders, gestational diabetes, infections, blood clots, and preterm delivery are just some of the few. Pregnant women with high levels of BMI are highly likely to suffer from severe forms of hypertensive constraints.

Evidence exists to suggest that obesity and high gestational weights affect the experiences of labor and delivery (Thomson, 2012). Studies suggest that obese pregnant women are more likely to rely on assisted delivery. This includes the use of forceps in the case of normal delivery, and caesarean section. Various sources have recorded elevated occurrences of the caesarean section amongst obese pregnant mothers. The risk of the caesarean delivery is 50% in women who have recorded high gestational weights (Visser & Atkinson, 2012). The rate doubles in the case of obese pregnant mothers. Positive results arising from caesarean section are likely to be compromised for overweight and obese women. Hefti (2009) continues to argue that women with a BMI higher than 35 are at an enhanced risk of anesthesia-related problems. This includes airway control, constraints in the insertion of regional nerve blocks, and incidences of failed intubation.

Chapter 4: Research methodology

4.1 Sampling and design

This section provides evidence to prove the validity of the research. The section connects the statistics collected to the research questions, and offers a statistical conclusion (Krauss, Winston, Fletcher, & Grundy, 2000). The procedures and rules applied feature in this section. The type of research undertaken was a correlation research. This is because it sought to determine the statistical relationship between the lifestyle behaviors of expectant mothers, and the progression of obesity. More closely, the research sought to investigate how negative behaviors among pregnant women lead to high gestational weight. The research relied on quantitative data.

The choice of quantitative analysis favored the type of research because the phenomenon under investigation could be expressed in numerical form (Clarke, 2010). Some aspects of qualitative analysis came in handy in discovering the underlying desires and motives that determine the lifestyle of pregnant women. in-depth interview questions were applied for this purpose. The questions adhered to the spirit of Motivational Interviewing (MI) and greatly featured the Ultra-Brief Personal Action Plan (UB-PAP) model. The research employed the data collected in enhancing knowledge about the use of the UB-PAP in managing maternal obesity. The respondents were subjected to answering a questionnaire with ten questions. The respondents who involved a group of expectant mothers from the Lowell Community Health Centre responded to the lifestyle questions. Those respondents who scored 7 and above had their personal action plan created.

4.2 Qualitative and quantitative data sampling

Most of the qualitative data was derived from the 10 prenatal visit questions regarding lifestyle changes. The data helped to determine the general trend for pregnant, obese women in respect to behaviors. The qualitative data also helped to determine the economic status of the pregnant, obese women. The qualitative data was also useful in recommending the women suitable for the “Brief Action Motivational Tool.” Those women who scored 7 and above had their own action plan created. The tool involved a well designed procedure that offered guidelines toward behavior change. The framework was developed to offer a comprehensive motivational intervention to promote a series of positive behaviors like a balanced diet, physical activity, regular prenatal visits, and other behaviors that help maintain a safer BMI. The research design flowed from the practical problem of obesity facing pregnant women. The aim of the research was to determine the behavior trend among obese pregnant mothers. This would be followed by an analysis of the effectiveness of the “Brief Action Motivational Tool” in maintaining the BMI of obese pregnant mothers. This study developed a list of research questions that further bring the research problem to the fore. The research problem originated from the need to seek for a practical solution to the complications associated with obese pregnancies. Obesity during pregnancy can present major health complications for the baby and the mother.

The quantitative data was employed in the study to investigate the relationship between the behaviors of obese pregnant women, and their Body Mass Index (BMI). Qualitative data helped to explain the reason behind the behavior pattern of the pregnant, obese women. The research methodology entailed gathering data from both primary and secondary sources.

Data from Gym instructors indicated a poor attendance from obese pregnant clients. They either reflected irregular attendance or halted their attendance completely at some point. The daily attendance sheet provided the attendance information of the overweight pregnant clients. The body mass index of the sample population helped to form the connection between effectiveness of the UB-PAP action and the maternal body weight of the obese pregnant women. The initial weights of the women were measured against their current weights. Current and initial weights are operational defined. Current weight refers to the weight of a pregnant, obese mother, while initial represent the weight of the mother during the first prenatal visit. The difference in the two weights represented the weight gains in pounds for the obese mothers.

The general trend showed by the variation demonstrated that the pregnant, obese women gained more than 20 pounds up to the gestation period. The initial weights of the mothers were determined in the first and second trimester period during the first prenatal visit. The trend showed that the gestational weights of the sample population increased significantly. The increase was way past the stipulated 20 pounds for mothers who weight was abnormal before pregnancy. The weight gains of the mothers were compared against their subsequent level of physical exercise. The sample population was carefully picked. The criteria ensured that the sample was registered with a physical fitness centre. This ensured consistency in the data collection process. It was worthy to note that mothers who showed the greatest irregularity in GYM attendance reflected the most weight gain. The relationship between the weight gain of the obese pregnant mothers and the BMI showed a positive correlation.

The electronic records provided historical data. It offered information on birth outcome variables (infant mortality and morbidity). The data were useful in reinforcing the trend obtained from the GYM attendance and BMI. The proportion of deaths resulting from obesity helped the research to achieve its objective. The deaths resulting from obese pregnancy complications also helped in forming the attitude of the research. Infant morbidity data also played the same role, as well as data from Healthy People 2010 Report from the United States department of Health and Human services.

As mentioned earlier, the qualitative data were extracted from the Motivational Interview (MI) questionnaire. The questions centered on offering a collaborative, client-centered, decision-making approach. The questions offered a non-judgmental attitude. Through permitting the clients to develop their own approach toward the problem, the questions aimed at decreasing levels of ambivalence among the obese pregnant women.

The quantitative data greatly informed the construction of the hypotheses. The data provided a descriptive framework on which the research founded its thesis statements. The general trend of data gathered from the Lowell Community Health Centre, the GYM centers, and the Electronic Media Records suggested a general trend in the two relationships (the effectiveness of UB-PAP and the maternal body weight, and lifestyle behavior patterns and the progression of obesity among pregnant women). The analysis and synthesis of the statistics provided the test for the theses. Qualitative analysis allowed the research to analyze measurable data, this provided for the manipulation of statistical analysis. The level of measurement for this analysis involved a series of ratio data. The quantitative data ranged from BMI adherence, Birth outcomes (infant mortality and morbidities), Post Portum BMI, prenatal visits, and GYM visits. All the measurements corresponded to a specific variable that was of interest to the research. For instance, the GYM records were used to determine the economic status of the sample population. Birth outcome records exposed the extent of the risk to the newly born because of obese pregnancy. At this point, the research assumed a correlation approach. This was crucial for describing the type of connection between the variables. The relationship between the various variables was analyzed.

Qualitative data greatly contributed in determining the relationship the behavior pattern and gestational weight gain of the obese pregnant women. Their response to the motivational interview questions captured their qualitative behavior largely. The obese pregnant women who scored 7 and above were more exposed to the risk. A personal action plan was drafted for them. The questions covered a variety of issues touching on physical exercise, poverty, nutrition, birth complications, motivation, and commitment.

4.3 UB-PAP interview questions

The motivational interview questions were based on the following questions

1. What are some of the diets associated with low calorie content?

2. How does poverty contribute to an unfavorable lifestyle amongst obese pregnant women?

3. How does a regular physical exercise contribute to the balance of calories in the body?

4. What can you do to minimize birth complications associated with obese pregnancies?

5. Do you think it is important to maintain a BMI that is below 22.5-25 kg/m2?

6. What are some of the measures you can undertake to maintain a safe BMI for a safer delivery?

7. Do you think you can achieve the appropriate gestational weight?

8. If the government offered free physical fitness, do you think you can maintain a constant attendance?

9. How would you prefer things to be different?

10. Have you taken measures to lose weight before?

4.4 Analysis

Qualitative analysis was applied in handling the non-numerical data set. The analysis was based on the attributes of the “Brief Action Motivational Tool.” The tool was applied during the pregnancy visits in order to promote favorable behaviors among the obese pregnant mothers. The effectiveness of the framework was ascertained, and the results formed the qualitative data set. The UB-PAP (Ultra-Brief Personal Action Plan) was applied as the motivational tool. The patients with a score of 7 and above qualified for the creation of an individual action plan. Other qualitative data were collected from the statewide surveillance under the behavior risk factor surveillance system.

The research centered its analysis in seeking measures that can be applied to promote a healthy pregnancy. Preeclampsia, urinal tract infection, thrombosis, obstructive sleep apnea, labor complications, and pregnancy loss are some of the negative effects associated with obese pregnancy. The flow of the argument of their research flawed in relation to the thesis statements of the research. The first thesis investigated the relationship between lifestyle behaviors and the progression of obesity among pregnant mothers. The second thesis statement explored the relationship between the effectiveness of “The Brief Action Motivational Tool” and the maternal body weight (BMI) of obese pregnant mothers.

4.5 Findings

This section provides an analysis of data. It provides a link between the statistical context of the research and the literary context through translating the data collected. The research realized a number of findings on the lifestyle of the women in relation to their BMI. Some of the findings made are as follows:

1. Lifestyle is responsible for the extrinsic factors like poverty, low physical activity, and an inferior nutrition. The study discovered that routine physical fitness is not part of the clients’ lifestyle. The lifestyle factors lead to gestational weight gains and a BMI of over 30 Kg/m2.

2. The study also discovered that most of the women portrayed a positive attitude to change. The structural framework was employed in the identification of the obese pregnant women’s readiness for change. This implies that the UB-PAP motivational tool is effective in the management of obesity among pregnant women.

3. Records from the EMR indicated a rising general trend at the Lowell Community Health Centre. The study adopted the finding in order to offer a vivid picture of the adverse effects of obese pregnancies. The maternal and fetal morbidities and mortality records suggested that obese pregnancies could result to deaths. Healthcare costs data from the hospital indicated that the treatment of the vice is expensive.

4. Most women showed a 30% increase in their BMI during the initial stages of prenatal care and two weeks post-partum period. There was a decline in the BMI of some of the clients by more than 20%. The decline was noted after the clients were subjected to the UB-PAP motivational interview framework.

5. The research also discovered that there was an increase in primary caesarean sections. Most women reflected a higher gestational weight as compared to the size of their stature.

6. The low motivation to begin lifestyle changes led to a high gestational weight gain. The UB-PAP tool came in handy in restoring the motivation of the women. The study found that the tool was effective in the management of obese pregnancy.

4.6 Limitations of the study

Time constraints hindered the data collection process. The irregularities of the prenatal care and the individual visits consumed a lot of time, leaving no time for new ventures. The low economic state of the community also hindered the sampling process. At times, the research process halted temporarily because of limited resources. For instance, the poor infrastructure of the locality constrained communication.

The intention was to test the effectiveness of the UB-PAP in motivating obese pregnant women to maintain manageable gestational weights. The study focused on identifying the behavior pattern in the women that needed address using the motivational tool. The research established some considerable degrees of behavioral change in the women at the end of the motivation program. Nevertheless, the issue of the effectiveness of the UB-PAP needs further research. An application of longitudinal data would lead to further findings. The research recommends an increase in providing input in the physical exercise program for obese women. Expectant obese mothers could get more information on exercise from the ACOG (American College of Obstetrics and Gynecology) website.

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