Maternal and perinatal outcome in obese pregnant patients

© 2009 Informa plcIntroduction. Obesity represents a rapidly emerging epidemic amongst pregnant patients in South Australia, in particular in Adelaide's Northern suburbs, one of the poorest urban areas in Australia. The aim of the current study was to prepare a comprehensive overview of maternal and perinatal outcome in overweight, obese and morbidly obese pregnant patients. Material and methods. Retrospective review of women with singleton pregnancies delivering in the first 6 months of 2006; 100 with normal BMI (group I: BMI 19.1-25 kg/m2), 100 overweight (group II: BMI 25.1-30 kg/m2), 110 obese (group III: BMI 30.1-40 kg/m2) and 60 morbidly obese women (group IV: BMI >40 kg/m2) were identified with access to complete medical records. Outcome measures included booking demographics, booking blood pressures, glucose challenge and glucose tolerance results, hypertensive complications, pre-existing and gestational diabetes, instrumental deliveries, caesarean deliveries, blood loss, birth weights, Apgar scores, post-partum complications and psychological problems. Results. Women in group II, III and IV were characterised by higher systolic booking blood pressure (mean differences: 3.92, 9.94 and 9.84 respectively for group II, III and IV) and higher diastolic booking blood pressures (mean differences 3.02, 6.92 and 9.22 respectively). As a combined group II-IV, women were at increased risk for pre-existing morbidity (OR 2.33) and requiring medication (OR 2.13). Pregnancy hypertension occurred significantly more in group III and IV with OR 2.38 and 3.75. Women without pre-existing hypertension were also found to be at increased risk to develop gestational hypertension only if they belonged to group IV (OR 3.69). Women in group III and IV are at increased risk at gestational diabetes with OR 8.82 and 27.38. Women in group III and IV are less likely to have a spontaneous onset of labour with ORs of 2.18 and 3.51 for not having spontaneous onset of labour. Induction of labour occurred more often in group IV (OR 3.17). Requirement of instrumental deliveries or lower segment caesarean section occurred more often in group II, III and IV with OR 2.20, 3.28 and 5.47 respectively. Significant more blood loss was found in group III and IV with mean differences of 135.42 and 207.94 ml compared with group I. The birthweight in group III and IV are significantly higher with mean differences of 104.86 and 324.94 g. Macrosomia occurred more often in group IV (OR 4.04). Women in group III and IV had a longer overall hospital stay with mean differences of 0.58 and 1.09 days. Mental health issues were more common in group II, III and IV with OR 3.16, 3.53 and 4.17 respectively. Conclusion. These South Australian data from a socio-economically deprived area in Adelaide's Northern suburbs confirm that obesity during pregnancy represents a major risk for adverse outcome for patients with a whole spectrum of adverse pregnancy outcomes; obesity represents a major challenge for health care providers.Claire Schrauwers and Gus Dekke

Donor and Recipient Perspectives on Anonymity in Kidney Donation From Live Donors: A Multicenter Survey Study

Background: Maintaining anonymity is a requirement in the Netherlands and Sweden for kidney donation from live donors in the context of nondirected (or unspecified) and paired exchange (or specified indirect) donation. Despite this policy, some donors and recipients express the desire to know one another. Little empirical evidence informs the debate on anonymity. This study explored the experiences, preferences, and attitudes of donors and recipients toward anonymity. Study Design: Retrospective observational multicenter study using both qualitative and quantitative methods. Setting & Participants: 414 participants from Dutch and Swedish transplantation centers who received or donated a kidney anonymously (nondirected or paired exchange) completed a questionnaire about anonymity. Participation was a median of 31 months after surgery. Factors: Country of residence, donor/recipient status, transplant type, time since surgery. Outcomes: Experiences, preferences, and attitudes toward anonymity. Results: Most participants were satisfied with their experience of anonymity before and aftersurgery. A minority would have liked to have met the other party before (donors, 7%; recipients, 15%) or after (donors, 22%; recipients, 31%) surgery. Significantly more recipients than donors wanted to meet the other party. Most study participants were open to meeting the other party if the desire was mutual (donors, 58%; recipients, 60%). Donors agree significantly more with the principle of anonymity before and after surgery than recipients. Donors and recipients thought that if both parties agreed, it should be permissible to meet before or after surgery. There were few associations between country or time since surgery and experiences or attitudes. The pros and cons of anonymity reported by participants were clustered into relational and emotional, ethical, and practical and logistical domains. Limitations: The relatively low response rate of recipients may have reduced generalizability. Recall bias was possible given the time lag between transplantation and data collection. Conclusions: This exploratory study illustrated that although donors and recipients were usually satisfied with anonymity, the majority viewed a strict policy on anonymity as unnecessary. These results may inform policy and education on anonymit

Shaping a 'New Manggarai': Struggles over culture and tradition in an Eastern Indonesian regency

10.1111/j.1467-8373.2005.00287.xAsia Pacific Viewpoint463323-33