A Cross Sectional Study on Awareness of Risk Factors of Maternal Obesity among Women in a Tertiary Care Hospital in Chennai, Tamil Nadu, India

Background: There has been a rise in prevalence of obesity all around the world. Obesity during pregnancy has various adverse outcomes on both the child and mother. Maternal affects include pregnancy induced hypertension, gestational Diabetes, pre-eclampsia and foetal outcomes includes macrosomia, pre term birth and obstructed labour. Aim: Of this study is to assess the knowledge and awareness of complications of obesity during pregnancy among women. Materials and Methods: This is a cross sectional descriptive questionnaire study conducted among 384 women attending the out-patient’s department of obstetrics and gynaecology during a time period of January 2021 to June 2021. Results: Average level of awareness was found among the participants. 53.3% women were aware and 46.6% participants were not aware of the adverse effects of maternal obesity. Conclusion: In this study, it was observed that half of the participants were unaware, hence perinatal counselling and awareness camps needs to be conducted to raise the awareness and knowledge levels among general population for a healthier society.


INTRODUCTION
There has been an increasing prevalence of maternal obesity across the world, which has become a major health concern [1]. Maternal obesity is said to have both maternal and foetal complications. In case of mothers, it causes various complications during their pregnancy such as hypertension, preeclampsia and gestational diabetes [2]. If there is excessive weight gain during pregnancy and postpartum retention of weight gain, it results in higher chances of having obesity later on in life and having further complications [3]. It has also been noted that the relationship between poor lactation performance and high body mass index is of high concern because of the increase in incidence of obesity among young females [4]. A lot of studies, from various populations, it has been reported that there is a very strong relationship between low rates of lactation, early termination of lactation and maternal overweight [4]. It has also been noted from various studies that obesity in early childhood leads to severe adult obesity [5]. And hence childhood obesity is considered as the recent epidemic because of the emergence of these junk foods and fast lifestyle.
Adequate lifestyle interventions which includebehaviouralcounselling related to importance of healthy diet and physical exercise has always shown positive outcome in controlling gestational weight gain [6].
This study was conducted in order to increase the awareness of people in rural areas of southern part of India about maternal obesity and its various complications.

MATERIALS AND METHODS
A cross sectional study was conducted among antenatal women attending the outpatient department of obstetrics and gynaecology in a tertiary care hospital in Chennai, Tamil Nadu during a time period of January 2021 to June 2021. All the women predominantly belonging to an age group of 18 to 50 years. Sample size was calculated based on a study done by Nneka et al, which showed that 40.2% of study participants were aware of complications of obesity in pregnancy [7]. Using the formula 4pq/d 2 and considering 5% allowable error, the sample size was calculated to be 384. The study was conducted after obtaining a written informed consent in their native language, Tamil. All women who gave consent was interviewed personally in the OP room. Women who belonged to third trimester and who were anxious about the study and who did not give consent for the study was excluded from this study.
This study is a cross sectional survey which had two questionnaires. Part 1 included a pre tested and structured questionnaire consisting of their sociodemographic details (age, religion, type of family, education, occupation, total number of family members, per capita income, socioeconomic class and parity) and part 2 consists of a structured and validated questionnaire to assess the knowledge, awareness and perception about complications of maternal obesity [8]. The questionnaire was translated into native language and explained well to the participants before collection of data.
The data entry was done in Microsoft Excel Sheet and data was analysed using SPSS software version 22. Frequencies and percentages were calculated. Chi square test was done to find association Table 1 summarizes participants awareness and knowledge about complications of maternal obesity. 205(53.3%) and women are aware of the same and 179(46.6%) participants where found to be unaware of the term obesity and its adverse effects.

RESULTS
Tables 2,3,4 summarized the association of socioeconomic class, education levels and parity with the knowledge and awareness of obesity during pregnancy and its adverse outcomes.

DISCUSSION
Maternal obesity increases the risk of adverse outcomes for both mother and the child [9]. In various studies conducted in the Middle eastern countries it was observed that more than half of its participants where obese /overweight and it might be due to poor knowledge about maternal obesity and its adverse outcomes [10,11]. In a study conducted in Saudi Arabia 68.5% mothers had poor awareness about maternal obesity whereas in our study 46.6% women were not aware of adverse outcomes of maternal obesity [9]. Lack of knowledge and awareness can most likely to be due to the low education level among women. As in our study it shows women who at least completed secondary education or have a professional degree are more likely to be more aware of complications of maternal obesity than those who are illiterate or who had only primary education. This is similar to the result obtained by Dekker et al. [12].
The various maternal outcomes of obesity during pregnancy are increased risk of pregnancy induced hypertension, gestational diabetes and more chances of having a caesarean section. Post-dated baby, macrosomia, low APGAR score and prolonged hospitalisation are the various effects of maternal obesity on the babies [13]. In a study which was conducted in Scotland it was reported that obesity during pregnancy was associated with an increased risk of developing type 2 Diabetes Mellitus among offspring [14]. There was a strong association between increased chances of developing childhood obesity and obesity during pregnancy [15]. Even though all the previously mentioned studies reported various adverse outcomes of maternal obesity not much studies were conducted on awareness of the general population about the same. In our study 46.6% women reported that they were not aware of maternal obesity and its complications and the associated factors involved are educational qualification, socioeconomic class and the parity of the mother. This result was somewhat similar to the results obtained in a study conducted in Saudi wherein participants with at least a bachelor's degree were more aware than the rest of participants hence proving the direct relationship between level of knowledge and education.
A better counselling and awareness of these adverse effects can motivate women to maintain appropriate BMI and improve the perinatal outcome.
Strengths of this study was its large sample size and it helped in assessing the awareness levels in a wide range of women. What do you think about chance of developing diabetes mellitus at young age if mother is diagnosed with mother is diagnosed with maternal obesity?  Limitations of this study-more research in diverse locations nationwide is required to confirm the findings. The result obtained in our result varies from other studies maybe because of sociocultural differences.

CONCLUSION
The level of knowledge among women about complications of obesity during pregnancy in a sub urban area in south India was not found to be satisfactory. Hence health workers need to be trained to conduct awareness camps especially in the rural areas for all women of reproductive age group. Perinatal counselling also plays a very important role in improving knowledge among women. These awareness programs and counselling are very much the need of the hour because of increase in incidences of maternal obesity and and its awareness levels are quite low in the society.

CONSENT
All women who gave consent was interviewed personally in the OP room.

ETHICAL CLEARANCE
The study was approved by institutional ethics committee of Saveetha Medical College, Chennai, Tamil Nadu.