Maternal obesity

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  • Previous studies have found that adverse effects of maternal employment on child obesity are limited to mothers with higher education and earnings. Explanations for this have centered on differences between the childhood nutritional and exercise environments provided by non-parental caregivers versus by the mothers.

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  • For the 57th Nestlé Pediatric Nutrition Workshop, which took place in May 2005 at Half Moon Bay, San Francisco, the topic ‘Primary Prevention by Nutrition Intervention in Infancy and Childhood’ was chosen. Early nutrition seems to be involved in the mechanism of control, especially taking into account the role of protein and long-chain polyunsaturated fatty acids (LCPUFAs). It seems that the new generation of infant formulas already takes those findings into consideration. We would like to thank the two chairmen, Prof. Hugh Sampson and Prof.

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  • The Working Group believes that, in addition to making a meaningful contribution to the diet, foods marketed to children should also be those with minimal quantities of nutrients that could have a negative impact on health and weight. Nutrition Principle B therefore proposes targets for limiting the amount of sodium, saturated fat, trans fat, and added sugars. In selecting the four specific nutrients, the Working Group is again drawing from recommendations from the 2010 DGA.

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  • The government aims for 100% enrollment as part of the MDG targets for 2015, with girls' enrollment share being 50%. Various obstacles to achieving this goal exist, such as lack of school facilities, in particular girls' schools in rural areas. The problem is even greater for girls' secondary schools, which are very few and scattered. Insecurity, combined with distance and lack of transport, prevents especially girls from accessing school facilities.

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  • Despite the standard definitions noted above, accurate identification of the causes of maternal deaths is not always possible. It can be a challenge for medical certifiers to attribute correctly cause of death to direct or indirect maternal causes, or to accidental or incidental events, particularly in settings where deliveries mostly occur at home. While several countries apply the ICD-10 in civil registration systems, the identification and classification of causes of death during pregnancy, childbirth and the puerperium remain inconsistent across countries.

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  • In 2012, WHO published the Application of ICD-10 to deaths during pregnancy, childbirth and the puerperium: ICD Maternal Mortality (ICD-MM), to guide countries to reduce errors in coding maternal deaths and to improve the attribution of cause of maternal death (10). The ICD-MM is to be used together with the three ICD-10 volumes. For example, the ICD-MM clarifies that the coding of maternal deaths among HIV-positive women may be due to: Obstetric causes: such as haemorrhage or hypertensive disorders in pregnancy – these should be identified as direct maternal deaths.

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  • These studies are diverse, depending on the definition of maternal mortality used, the sources considered (death certificates, other vital event certificates, medical records, questionnaires or autopsy reports) and the way maternal deaths are identified (record linkage or assessment from experts). In addition, the system of reporting causes of death to a civil registry differs from one country to another, depending on the death certificate forms, the type of certifiers and the coding practice.

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  • In recent years a number of factors have had a significant impact on the capacity of maternity services and midwives to deliver quality care. Many more women and families are recognised as having complex physical and social needs including women and families living in poverty; migrant women who do not speak English as a first language; teenage mothers; women who are misusing drugs and alcohol; women who are obese and those who have long-term conditions such as diabetes. In addition the average age of first birth is now 29.4 years compared with 28.

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  • Parents and children need a framework for care which provides continuity from pre-pregnancy, through pregnancy and childbirth, to the early years of life. A comprehensive approach to early life is needed which builds on existing programmes to ensure our children get the best start in life8. Midwives have a key role in ensuring that their contribution integrates with the roles of other professionals and agencies working in collaboration with maternity services.

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  • It has been documented, for example, that high maternal pre-pregnancy weight and excessive weight gain during pregnancy are often associated with adverse pregnancy outcomes, including greater risks of gestational diabetes, childbirth complications, caesarean sections, hypertension and pre-eclampsia, and post-partum obesity. Women with severe (morbid) obesity are more likely to experience even poorer outcomes such as stillbirths or neonatal deaths.

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  • Nutrient deficiencies were reported in infants born to women who underwent procedures that resulted in malabsorption, as well as women who did not take prenatal vitamins or had difficulty with their own nutrition (i.e., from chronic vomiting). Literature suggests that gastric bypass and laparoscopic adjustable band procedures confer only minimal, if any, increased risk of nutritional or congenital problems if supplemental vitamins are taken and maternal nutrition is otherwise adequate. Biliopancreatic diversion has an appreciable risk for nutritional problems in some patients.

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  • Weight loss procedures are being performed more frequently to treat morbid obesity, with a six-fold increase over a recent 7-year time span; almost half of patients are women of reproductive age. The level of evidence on fertility, contraception, and pregnancy outcomes is limited primarily to case series and case reports. The evidence suggests that fertility improves after bariatric surgical procedures; however, data are too sparse to reach definite conclusions about the degree of improvement in fertility that is achieved.

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