The Relationship Between Basal Metabolic Index (BMI) and Hypertension Amongst Pregnant Women in Bishop Shanahan Specialist Hospital, Nsukka
CHAPTER ONE
General objective
To determine and compare the incidence and severity of Hypertension in pregnant women with Basal metabolic index BMI i.e. > 30 and those with normal BMI (18.5-24.9) during caesarean section under spinal anaesthesia.
Specific objectives
- To determine the incidence of Hypertension in the pregnant within the two
- To compare the types and volumes of intravenous fluids used in both groups
- To determine and compare the type and amount of vasopressors in both groups
CHAPTER TWO
LITERATURE REVIEW
Conceptual review
Concept of BMI
The human body is divided into fat free mass and body fat (Insel and Roth, 2002). The fat free mass composed of all body’s non-fat tissues such as bones, water, muscles, teeth and connective tissues (Insel and Roth, 2002). Body fat composes of essential and non-essential fats. Essential fats are crucial for normal body functioning such as provision of warmth, and carrying out metabolic activities. They make up 3% and 12% of the total body weight in men and women respectively (Insel and Roth, 2002). Non-essential fat exists within adipose tissues located below the skin and around major organs. Adiposity of non-essential fats results from a long-term energy surplus in the body where energy intake exceeds energy expenditure. Excess non-essential fat in the body is what causes BMI (Sharkey, 1997).
Prevalence of obesity
Global Trend of BMI
Prevalence of obesity is increasing at an alarming rate all over the world (WHO, 2006). It is estimated that by 2010 the number of overweight and obese students across European Union will be set to top 26 million 6.4 million of them being obese (International Obesity Taskforce, 1996). Number of Overweight and obese in Europe is rising by 1.3 million a year (Schokker, Visscher, VanBaak & Seidell, 2007).
In the ten years period from 1985 to 1995, in Australia, there was a high increase in the proportion of students who were either overweight but not obese, or obese (Magarey, Boulton & Daniel, 2001). Table 2.1 shows the percentage increase of BMI among Australian students in ten years period.
CHAPTER THREE
RESEARCH METHODOLOGY
Study population
The study population was all women of childbearing age undergoing caesarean section in Nsukka Hospital during the study period.
Study Design
This was a comparative cross sectional study.
CHAPTER FOUR
RESULTS
A total of 150 mothers undergoing caesarean section conducted under spinal anaesthesia at Nsukka Hospital were recruited during the study.
The average age of the patients was 28.2 years (SD 5.95) with a range between 16 and 47 years. The modal age group was between 25 and 29 years containing 54 (36%) of the patients (Figure 1). There were 40 (26.7%) patients in the second most frequent age group of patients aged less than 25 years.
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATION
The prevalence of obesity in Enugu has been on the rise from 39% in 2003 to 41% in 2009. In females of child bearing age (15-45 years) the prevalence of obesity stands at 23% countrywide.
Maternal obesity has been shown to be associated with more co- morbidities, increased caesarean delivery and significant risks for both the mother and child.
Obesity has been reported as a risk factor for Hypertension in women undergoing caesarean section under regional anaesthesia.
Hypertension is one of the most common complications of spinal anaesthesia with an incidence of 15% to 33% in the general population. In obstetric patients, Hypertension has a higher incidence of 20-100% and may be associated with maternal and foetal complications ranging from an increased incidence of nausea and vomiting to foetal hypoxia due to changes in utero-placental blood flow with consequent foetal acidosis.
Conclusion
- The study showed a higher prevalence of Hypertension in obese parturient women with anaverage blood pressure reduction by 0.6% from the baseline level for each unit increase in
- Therewas no significant difference in the volumes used intra-op between the two
- Ephedrine was mainly used to correct Hypertension with higher doses required in obesepatients due to the higher severity of Hypertension in the
Recommendations
- All pregnant women should have their pre-pregnancy or first trimester weight recorded and BMI
- Special consideration should be made in this group (obese paturients) of patients in the Nsukka Hospital spinal anaesthesia protocol currently in use.
Recommendations for Policies
Policies on sports and physical education should be corrected or restated so that they incorporate criteria for all students of all ages in sports and health related activities. The policy statement should provide an open room for parents, guardians and stakeholders in education to debate on how to develop students’s interests towards physical activities, sports and development of good sportsmanship.
Education policies should also put sports and leisure activities as a compulsory component of education, since they have an important attribute in development of the whole human body. Leisure activities and exercises are very important component in development of the child’s physical, mental and intellectual characteristics (Rowland, 1990). Therefore, policies on education should view physical education and sports as a foundation stone towards students with good body health and minds, together with well developed intellectual and physical capabilities.
Policies on health and human welfare should focus on development of the generation that is free from cardiovascular diseases and other chronic diseases, which are byproducts of BMI. Since childhood obesity persists to adulthood, policies should focus on elimination of the problem at the childhood age. Treatment of diseases resulting from BMI is reported to be expensive. Thus effort should be done to control the problem among school students.
Recommendations for Further Research
A more advanced method to study the impact of BMI on pregnant women’s behaviours and outcomes need to be explored. Such method may include conducting a longitudinal study that will help to get systematic progress of overweight and obese students.
Another study can be done to investigate the mechanism that makes overweight and obese students to underperform in academics. This can involve serological or neurological analysis to determine the impacts that BMI press on overall child’s body make-up.
A study to identify the type of exercises that can effectively work out BMI among school students within a limited range of time is needed. For this case, an experimental study with effective diet management between the experimental group and control group is suggested.
REFERENCES
- David J. Birnbach andIngrid M. Browne. Anesthesia for Obstetrics. In: Miller RD, Miller’s Anesthesia. 6th edition. USA: Elsevier Churchill Livingstone; 2005. p. 2307-2308
- Mbochi RW, Kuria E, Kimiywe J, Ochola S, Steyn NP. Predictors of overweight andobesity in adult women in Enugu Province, Nigeria. BMC Public Health. 2012;12:823.
- int,.’WHO | Obesity And Overweight’. N.p., 2015.
- NJSebire et al, Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London, International Journal of Obesity (2001) 25, 1175–1182
- Warwick NganKee, Prevention of maternal Hypertension after regional anaesthesia for caesarean section, Current Opinion in Anaesthesiology 2010, 23:304–309
- Fattah et al, Maternal weight and body composition in the first trimester, ActaObstetriciaetGynecologica. 2010; 89: 952–955
- Pregnancy in patients with obesity or morbid obesity: Obstetric and Anesthetic complications; Bariatric Times. 2010;7: 9-13
- GarabedEknoyan Adolphe Quetelet (1796–1874)—the average man and indices of obesity Nephrol Dal Transplant (2008) 23 47-51
- M. Prentice and S. A. Jebb, Beyond body mass index, The International Association for the Study of Obesity. Obesity reviews 2001; 2, 141–147
- Fernando Souza Nani and Marcelo Luis Abramides Torres; Correlation between the BodyMass Index (BMI) of Pregnant Women and the Development of Hypertension after Spinal Anesthesia for Cesarean SectionRevistaBrasileira de Anestesiologia 21 Vol. 61, No 1, January-February, 2011.
- Rasmussen K, Yaktine A. Weight gain during pregnancy. Washington, DC: NationalAcademies Press;
- Crane JM, White J, Murphy P, et al. The effect of gestational weight gain by body massindex on maternal and neonatal J ObstetGynaecol Can. 2009; 31(1):28–35