Preconception health behaviours among women with obesity in Northern Ireland: an analysis of a national maternity dataset 2011-2021

Abstract

Living with obesity can give rise to unique reproductive challenges and compromise preconception health, defined as the overall health of non-pregnant individuals of childbearing age (15–49 years). Folic acid supplementation is a key preconception health behaviour, and women with obesity are recommended a higher dose (5 mg/day) to reduce the risk of fetal complications. This study aimed to explore 1)trends in Body Mass Index (BMI) in the preconception and early pregnancy period in Northern Ireland (NI), and 2) the prevalence of folic acid supplementation across BMI categories. Anonymised national data routinely collected in the Northern Ireland Maternity System (NIMATS) dataset were accessed. Multiple linear regressions explored trends in BMI between January2011 and December 2021 and χ2 tests explored associations between BMI categories and self-reported folic acid supplementation between December 2014 and December 2021.The analyses included a total of 255117 pregnancies, with missing data addressed per variable. The percentage of women entering pregnancy with a healthy BMI decreased between 2011and 2021 (48.65%, n = 12144, and 39.55%, n = 4316, respectively),while the percentage of women with obesity increased over the same period (18.11%, n = 4520, and 27.36%, n = 2986, respectively). Regression models exploring BMI trends were statistically significant (p < 0.001) in both the unadjusted model and the model adjusted for age, deprivation and number of previous births, suggesting an average increase of ~1 unit of BMI per calendar year in women entering pregnancy. In the whole sample, folic acid supplementation was mostly initiated after conception (59.03%, n = 86319), with only 33.01%(n = 48267) and 4.53% (n = 6628) of pregnancies being supplemented with 400 mcg and 5 mg before conception, respectively. Among women living with obesity, the recommended preconception supplementation of 5 mg of folic acid was low (8.74%, n = 2990). A further 23.87% (n = 8168) of pregnancies from women with obesity were supplemented with 400 mcg of folic acid before conception. Overall, analyses demonstrated an increased number of women entering pregnancy with an elevated BMI and suboptimal preconception folic acid supplementation, particularly at the recommended dosage for women with obesity. This study highlights the need to optimise preconception health in NI, including among women living with obesity.

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Identifiers

ORCID for Emma H. Cassinelli: orcid.org/0000-0001-8778-0801

ORCID for Danielle A.J.M Schoenaker: orcid.org/0000-0002-7652-990X

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