Women’s Knowledge About risk of excessive Gestational Weight Gain Risks at Selected Maternal and Child Health Centers at Minia District

Introduction

Excess weight is increasingly growing in all age groups worldwide, especially in countries with low and medium incomes. Given the association with negative short- and long-term maternal and child outcomes, pre-pregnancy obesity (body mass index, BMI 30 kg/m2), excessive gestational weight gain (GWG) and post-partum weight retention (PPWR) are seen as new public health challenges. Such findings include, later in life, obstetric or neonatal complications, obesity, type 2 diabetes (T2D) and cardiovascular diseases (CVD). Several adverse pregnancy effects are associated with excessive gestational weight gain (GWG).Obesity is more common, the occurrence of complications associated with being overweight during pregnancy, such as increased rates of hypertensive pregnancy disorders, foetal macrosomia, and caesarean birth rates, is growing, with more women entering pregnancy today with an elevated body mass index (BMI) (Kominiarek et al., 2017).

Guidelines for gaining weight from the Institute of Medicine (IOM) are widely accepted and endorsed by the American College of Obstetricians and Gynecologists (ACOG) and other professional organizations around the world. Lower weight gain ranges for women with higher pre-pregnancy BMI are recommended by the IOM weight gain guidelines, which were revised in June 2009 but are still close to those published in 1990. Many epidemiological evidence suggest that women who gain outside of them have better perinatal results than women who gain within these guidelines. Preterm delivery, gestational diabetes, caesarean birth, low birth weight, macrosomia, neonatal morbidity, and postpartum weight retention are outcomes associated with weight gain outside of the guidelines. New research has also shown a link between higher maternal weight gain and childhood obesity (Olson et al., 2013).

Excessive gestational weight gain can lead to a lifetime of unhealthy mother and baby weight (The recorded incidence of high gestational age (LGA) neonates was 31 percent in a study of 180 obese pregnant women with BMI > 40 kg/m2).Other results noted that offspring born to mothers who acquired unnecessary pregnancy weight had a higher risk of being overweight or obese (27% to 73%) opposed to offspring whom mothers acquired ample weight. Throughout infancy and into adulthood, these macrosomic infants may experience obesity, with greater risks of getting diabetes, heart disease or other metabolic disorders (Parikh et al, 2017).

Pregnancy excess weight is linked with an increased incidence of pregnancy complications; an increased risk of postpartum problems may also be associated with it. In women with normal BMI, an increase in BMI during pregnancy was related to increase of 0.4 percentage points in postpartum infection rates, and an increase in more than one group of BMI was associated with an increase of 3.2 percentage points. The related rises were 2.2 percentage points and 1.2 percentage points for females who were overweight (Thangaratinam et al., 2014).

Measures to reduce excessive gestational weight gains tend to be successful, but the findings have been modest and the results are substantially heterogeneous. A recent study showed that obese women who engaged in dietary and lifestyle intervention gained less kg than women who managed (Skouteris et al., 2019).

Public health nurses urge all pregnant women to consume nutritious food, with focus on mother and baby benefits. What to eat and how much to eat during pregnancy are advised. Discuss physical activity for all pregnant females as well. Women are encouraged to stay active as it will support her and her baby and aid her after birth with weight loss. Before increasing this exercise to 30 minutes every day of the week, moderate physical activity is prescribed three days a week in 15 minute bursts (National Institute for Health and Care Excellence, 2015).

Significance of the study:

The Eastern Mediterranean Region, including Egypt, excessive weight gain is drastically increasing. The prevalence of obesity and obesity in this area ranges from 74% to 86% among women and 69% to 77% among men (World Health Organization, 2015), in addition, women between the ages 25-64 years had a 41 percent prevalence of obesity as the obesity of Egyptian adult women (BMI ≥30 kg/m2) and extreme obesity (BMI ≥35 kg/m2) increased from the twelfth and tenth highest in the world, it was found that the mean BMI of reproductive aged women increased from 26.31 to 29.2 in a study focused on Egyptian Demographic and Health Surveys. Moreover, the Egyptian Demographic and Health Survey found that during pregnancy, about 66 percent of married females aged 25-29 experienced excessive weight gain.

Egypt has the fifth highest number of obese women in the world over the age of fifteen, according to the World Health Organization. 75% of Egyptian females, over the age of 30, are estimated to be overweight or obese. Increased perinatal risk is associated with maternal obesity and excess gestational weight gain (GWG).In order to evaluate women's awareness of excessive gestational weight gain risks at Selected Maternal and Child Health Centers in Minia District, this study raises the risks for mothers and infants as Cesessrian section, obstructed labour, gestational diabetes, pregnancy induced hypertension.

Aim of the study

The current study aims to assess women’s knowledge about risk of excessive gestational weight gain risks at selected maternal and child health centers at Minia district

Research Questions:

The study will answer the following questions:

• What is the level of knowledge regarding excessive weight gain during pregnancy?
• Is there is a relationship between women' knowledge of excessive weight gain during pregnancy and selected demographic characteristics

Subjects and methods

Research design:

A descriptive study design was utilized.

Setting

The study was conducted at Maternal and child Health centers (MCH) at Matay and Samalut centers. This setting was selected by random methods by putting all centers at Minia governorate in one ball then randomly selected two centers. These centres provide a variety of programmes, including mandatory vaccinations, family planning, antenatal and postnatal care, and antenatal and postnatal care for women who visit MCH centres for family planning and antenatal care. The city of Matay is an Minia city affiliated to the Minia Governorate, located in the north of the Minya Governorate, bordered on the north by the Bani Mazar Center, and on the south by the Samalut Center, and 41 km away from the city of Minya, the governorate's capital. The city of Samalut is one of the centers of Minya Governorate, which is located 25 km north of Minia. 

Sample: A convenient sample of 332 pregnant women attending antenatal care units at Samalout and matay health centers (180 cases from Samalout and 152 case from matay) according to inclusion criteria. All age group, cooperative, women with or without complication, women's with multiple pregnancy, women's diagnosed with diabetes mellitus, hypertension, renal disease, cardiac disease, thyroid, and hyperemesis gravidarum.

Tools:

Tool I: interviewing Questionnaire:-

The investigator created an interviewing questionnaire to collect data, which is divided into two parts:

Part I: personal Characteristics, It consists of (11) items including: Data related to women such as age, residence, educational status, working status, parity, gestational age , weight, height and  BMI. Medical and Obstetric history (Nomber of gravid a, Nomber of delivery, Nomber of abortion, pregnancy spacing, complication during pregnancy.

-          From Q1 to Q 8 assessed the demographic data of the studied subjects such as age,  level of education , working status, No of delivery, gestational age, weight, height and body mass index

-          From Q9 to Q 13 assessed the medical and obstetric history of the studied subjects such as No of pregnancies, No of deliveries, No of abortion, birth spacing between each pregnancy and complication during pregnancy.

Part II: knowledge of women regarding maternal nutrition during pregnancy, It includes (15) questions to assess of woman knowledge about nutrition during pregnancy. It consisted of two option yes or no option. From Q14 to Q 28.

Tool II : Knowledge Assessment Tool of weight gain during pregnancy: It consists of (30) inquires to assess of woman knowledge about weight gain , risks for mother and baby, Women’s knowledge  about safe and effective management of weight gain in pregnancy with response (Yes, No)( Phelan et al., 2014).

The Questionnaire was developed by investigator after reviewing national, international literature, textbook and magazines to assess pregnant women knowledge about excessive weight gain during pregnancy and its risks,  the instrument consists of fifteen statements: The format of the all-statements included the  (Yes, No ) .

Scoring System:-

For knowledge outcomes, correct responses will be scored as (One), while incorrect and ''don’t know'' responses will be scored as (Zero). The total knowledge scores will 45. Scores ≤ 22.5 (50%) will classified as unsatisfactory level of knowledge, scores > 22.5 (50%) will classified as satisfactory level of knowledge

Validity of Content:

The validity of the data collection methods, such as an interviewing questionnaire and an awareness assessment method for weight gain during pregnancy was tested by five experts in community health nursing, community medicine, and obstetric nursing. Content coverage, item order, consistency, relevance, applicability, wording, duration, style, and overall appearance were all assessed. Minor changes, such as rephrasing and rearrangement of certain sentences, were made in response to expert feedback and suggestions.

Reliability

The Cronbach's alpha coefficient was used to test the interview questionnaire's internal accuracy. A Cronbach's alpha coefficient of 0.00 means there is no reliability, while a coefficient of 1.00 means there is perfect reliability. A reliability coefficient of 0.70, on the other hand, is sufficient. Cronbach’s alpha for reliability testing was performed for interviewing questionnaire was 0.78 and knowledge assessment tool of weight gain during pregnancy was 0.813.

Pilot Study

A pilot study was conducted before starting data collection on 10% of pregnant women who were excluded from the sample. The tools were administered to 30 pregnant women in MCH centers at Matay and Samalout centers after obtaining permission from the MCH centers authority. The aim of pilot study was to test the clarity of the tools and to estimate the time required to fill the sheets which was 20-30 minute according to the needed explanation. Based on the result of pilot study, the necessary modification in the sheets was done.

Ethical Concern

The ethics and study committee of Minia University's Faculty of Nursing gave their written approval. To gain their cooperation, oral consent was obtained from each participant after describing the purpose and objectives of the research. For the sake of privacy and confidentiality, each evaluation sheet was coded and the subjects' names were not printed on the sheets. Subjects had the option to withdraw from the study at any time.

Study Procedure

The Dean of the Faculty of Nursing at Minia University granted permission to conduct the research. Following ethical committee approval at Minia University's Faculty of Nursing, an official letter from the directors of MCH Centers at Matay and Samalout was obtained for data collection. This letter included a brief description of the study's goals, as well as a request for permission.

In 2019, the investigator created data collection methods after conducting an exhaustive analysis of applicable national and international literature. Five experts in the field of nursing from Minia University's faculty of nursing and faculty of medicine updated the study tools in order to assess their material validity and feasibility. The required modifications included rephrasing and rearrangements of some sentences. Prior to data collection, a pilot study of thirty pregnant women was performed, with those who were not included in the study being omitted.

From August 2019 to January 2020, the investigator visited MCH centres twice a week (on Saturdays and Tuesdays) to recruit the study sample. According to inclusion criteria, all pregnant women who visited an antenatal care unit at an MCH centers for antenatal care services (6:8 women per week) were chosen. The average number of interview subjects per day was four, and the average time spent on each was about 20-30 minutes, depending on the individual's response.

After obtaining oral consent from each participant pregnant woman and describing the purpose and goals of the study to gain their cooperation, the pregnant women were interviewed. The questionnaire was introduced for the pregnant women to fill out, unless the participant was unable to read or write, in which case the investigator filled it out. The investigator read the questions to the participant and recorded their exact responses. Participants were given the opportunity to ask questions and receive explanations.

Statistical analysis

The statistical package for social science (SPSS) version 20 was used to collect, tabulate, and analyse the data. Numbers and percentages were used to represent descriptive data. The mean and standard deviation were used to present quantitative data. The Chi square test was used to see if there was a connection between two qualitative variables or if there was a difference between two or more proportions. Correlation was calculated between knowledge, birth spacing. Pregnancy complication using Pearson correlation test. Probability (p-value) equal to or less than 0.05 was considered significant in tests of relationships

Results

Table (1). Distribution of Study sample Regarding to their demographic characteristics (n=332)

Table (1) shows that, 30.7% of study subject their age ranged from 20-24 years with a mean age 32.5 ± 0.939, while 10.2% of them their age ranged from 35-39 years. In addition 81% of ware house wives. Their educational level revealed that 41% of women are illiterate and 40 % had preparatory education and 19% had university.

Table (2). Distribution of study sample regarding to their anthropometric measurement (n=332)

Table (2) illustrates that,half 50 % of study subjects women their body weight ranged from 50 to 70 kg, the mean body weight was73.8 ± 11.7 kg. Regarding the mean height of study subjects was164.2± 11.7 cm. The body mass index of study subjects ranged from 25 to -<30 in 60.5% of study subjects with a mean 30.494 ± 4.323.

Table (3). Distribution of study sample regarding their mdical and obstetric history (n=332)

Table (3) shows that, 41.3% of study subjects hade one pregnancy and 9% hade three pregnancies. Regarding their Number of deliveries 70.5% have one delivery, 19.3% have two delivery and 10.2% hade more than three deliveries. Regarding number of abortion 70.8% have no abortion but 29.2% have one abortion. Regarding age of gestation 39.8% have 24 to 34week, 29.5% have 35 to 36 week and 10.2% have 37 to 41weeksof gestation. Regarding complication during pregnancy 60.6% of study subjects have no complication, 19% have preeclmpcia, and 10.2% have gestational diabetes.

Table (4). Distribution of study subjects regarding their knowledge about weight gain during pegnancy (n=332).

Table (4) illustrates that, knowledge about weight gain during pregnancy 79.2 % of study subjects reported no weight gain during pregnancy should not increase, 89.8% answered no about increase in weight about 5-9 kg, 70.5% answered no about increase in weight about 11.5-161 kg and 58% answered no about increase in weight about 16.5-18 kg.  

Table (5); Distribution of Study Sample regarding their Knowledge about the safe and effective way to gain weight during pregnancy (n=332).

Table (6) illustrates that, Knowledge about safe and effective way to gain weight during pregnancy, all study subjects reported they should take multiple meals, 60.2%reported no two meals, 10.2% remove fats from meets, 89.5% stop eating after 8 pm at night during pregnancy, 60.2% reported no regarding to eat a little cake and chocolate. In addition 81.0%, 70.5%, 79.5%, 91.0%, 91.3%, 58.7% respectively of study subjects answered no regarding the following drink a lot of fruit juice, eat a lot of fruits and vegetables, eat a little fast food, eat a little fried food, eat foods that contain less carbohydrates and eat organic meals respectively.

Table (6).Distribution of Study Subjects regarding their Knowledge regarding Women' risks ( n=332) .

Table (6) illustrates that, Knowledge regardingwomen'risks 89.5%of study subjects answered yes regarding to gestational diabetes, preeclampsia, and high blood pressure during pregnancy are common women risks. While 89.8% of study subjects answered no regarding preterm labor as risk, 79.5% and 58.7% also said no about obesity and shoulder dystocia as women risks.

Table (7).Distribution of Study Subjects regarding their Knowledge regarding Child's risks (n=332) .

Table (7) illustrates that, Knowledge regarding child risks 89.5%of study subjects answered yes regarding to increase gestational weight above normal, a dead child, and lower pregnancy life than normal but 69% of study subjects answered yes about childhood obesity as child risks and 80.7% as congenital anomalies

Figure (1) Distribution of study sample regarding their Source of Getting Information (n=332)

Figure (1) illustrates that, 41% of study subjects obtained their information regarding excessive weight gain during pregnancy from their families as their mothers, and grand-mothers, while 27% from more than one sources, 15% get information from social media as T.V and 6 % of women obtained their information from Magazine and Newspaper.

Table (8): Correlation between overall scores of women knowledge and Pregnancy complication (n=332)

Table (8): reveals that there is no statistically significant correlation between pregnant women knowledge and pregnancy complication.

Table (9): Relation between knowledge of study sample and their some demographic variables (n=332).

     Significant at (p-value <0.01)

Table (9): point's relation between knowledge of study sample and their some demographic variables wasa positive statistically significant relationship between knowledge score and age and education p value 0.000 and 0.03 respectively