1. Introduction
Obesity, a multifaceted non-communicable disease, results from a complex interplay of genetic, environmental, hormonal, behavioral, and socioeconomic factors [
1,
2]. Obesity presents significant threats, amplifying morbidity and mortality rates among affected populations [
2]. Dramatically, in the past 20 years, the prevalence of obesity among women of reproductive age has grown significantly as a serious threat to public health over the last few years [
3]. Consequently, the World Health Organization (WHO) has nominated obesity as one of the most important threats to human health, defining it as an excessive amount of body fat accumulation and further separating it into three classes according to increasing body mass index (BMI) levels: class I (BMI 30–34.9), class II (BMI 35–39.9), and class III (BMI ≥ 40) [
1]. Moreover, obesity is linked to most chronic conditions like type 2 diabetes, hypertension, and cardiovascular disease, collectively contributing to heightened mortality rates [
2,
4]. Extensive systematic reviews underscore the escalating obesity rates globally, showing an increase in obesity prevalence regardless of geographic location, ethnicity, or socioeconomic status [
5]. While obesity rates have risen across demographics, studies indicate a notably higher prevalence among women and older age groups [
5].
According to the World Health Organization (WHO) report from 2016, more than 1.9 billion adults were overweight, and one-third of them were classified as obese. This demonstrates a substantial rise in obesity compared to 1975 when the global obesity rate was much lower. The report also highlights that the surge in obesity has been particularly prominent among younger populations, with a specific emphasis on women of childbearing age [
6]. The World Health Organization (WHO) has projected that by 2025, the number of adults affected by obesity will continue to increase. It is estimated that 2.7 billion adults will be overweight, with over 1 billion adults classified as obese. Additionally, 177 million adults are expected to be severely affected by obesity [
7].
For instance, in the United States, obesity prevalence among women aged 20–39 surged from 28.4% to 34.0% by 2021. Similarly, Sweden reported a 16% increase, Hong Kong saw a 30% rise, and Canada experienced an 82% surge from 1997 to 2009. France witnessed an increase from 8.3% to 15% over the same period [
8]. In Europe, the WHO estimates reveal that more than 50% of men and women are overweight, with 23% of women classified as obese [
1]. Southeast Asia reports 14% overweight and 3% obese individuals, while in Africa and Southeast Asia, the prevalence of obesity in women is twice that of men [
1]. The WHO stated that the overweight and obesity prevalence in KSA is 68.2% (women 69.2% and men 67.5%) and 33.7% (women 39.5% and men 29.5%), respectively [
9].
The substantial prevalence of obesity among women of reproductive age carries profound public health implications, particularly concerning adverse effects on pregnancy outcomes. This not only affects women and their offspring but also strains healthcare systems, necessitating heightened healthcare provisions ranging from in vitro fertilization (IVF) to extended antenatal care, cesarean deliveries, and prolonged hospital stays [
2,
7,
9]. Research indicates that the escalating obesity prevalence contributes to heightened incidences of gestational diabetes and macrosomia [
10].
Despite the seriousness of this issue, limited research has been undertaken in the Kingdom of Saudi Arabia to assess the prevalence and effects of obesity on pregnancy and neonatal outcomes among pregnant women. This highlights the fundamental importance of the outcomes obtained, offering critical insights into the incidence and consequences among pregnant women. The timely identification of obesity-related complications by nurses and healthcare providers can aid in reducing maternal and birth outcome morbidity and mortality rates, mitigating both short-term and long-term adverse consequences for both mother and fetus. Hence, this study assumes paramount significance in elucidating the effects of obesity on maternal and neonatal outcomes within the context of pregnant women. Therefore, this study aimed to assess the prevalence of obesity among pregnant women and to determine its impact on pregnancy and neonatal outcomes in Saudi Arabia.
2. Materials and Methods
2.1. Study Design and Setting
A retrospective cross-sectional study design was employed to investigate maternal and fetal outcomes among women with obesity during pregnancy in Saudi Arabia. The study was conducted at the obstetrical and gynecological department within King Fahad National Guard Hospital, King Abdulaziz Medical City, the Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.
2.2. Study Sample
A purposive sampling technique was employed, encompassing all admissions from the commencement of 2021 to the conclusion of the same year. The selection focused on pregnant women exhibiting a high body mass index (BMI) during the third trimester, adhering to specific inclusion and exclusion criteria. These women were identified through medical records at King Fahad National Guard Hospital in Riyadh. The inclusion criteria were defined as follows: (1) residence in Saudi Arabia, (2) age between 18 and 40 years, (3) current pregnancy, (4) carrying a single fetus, and (5) BMI of 30 and above during the third trimester. Exclusion criteria encompassed pregnant women with psychiatric or mental health conditions and those with chronic medical diseases such as diabetes and hypertension. The exclusion of these pregnant women from the study was because of the fact that managing chronic or mental health conditions during pregnancy involves a complex interplay of various factors, including medication, therapy, and support systems. This additional layer of complexity could introduce confounding variables that may complicate the interpretation of the study results.
2.3. Recruitment
From the total cohort of 8426 pregnant women who delivered at King Fahad National Guard Hospital in Riyadh in 2021, 3416 were identified as having obesity. Among this subset, 341 pregnant women fulfilled the inclusion criteria and were enrolled in the current study. Data encompassing maternal and fetal clinical outcomes were collected utilizing the hospital’s data registry system, known as “Best Care”, covering the period from the inception to the culmination of 2021. The structured questionnaire employed by the researchers facilitated the compilation of maternal and neonatal outcomes extracted from the “Best Care” data-based registration system within the Obstetrics and Gynecology departments of the hospital.
2.4. Tools of Data Collection
A structure data extraction tool was used to collect sociodemographic characteristics, obstetric history, maternal outcomes, and neonatal outcomes. This tool was developed by the authors after an extensive literature review. The questionnaire’s face and content validity were assessed by three expert PhD faculty members in obstetrics and gynecology nursing, ensuring clarity, comprehensiveness, and applicability.
The first part of the questionnaire was demographic data, which included data such as maternal age, weight, height, BMI (BMI: calculated based on the current body weight in kg and height in cm), education status, and residency.
The second part of the questionnaire was obstetrical history, which included data such as gestational age, gravidity, parity, abortion, and mode of previous delivery.
The third part of the questionnaire was the maternal outcomes, which included data such as gestational diabetes, preeclampsia, eclampsia, anemia, premature rupture of membrane, preterm delivery, cesarean section, postpartum complications, intensive care unit admission, and maternal length of stay.
The fourth part of the questionnaire was the neonatal outcomes, which included data such as gestational age, sex of the baby, baby condition, birth weight, 1st minute APGAR score, 5th minute APGAR score, and neonatal intensive care unit admission.
2.5. Administrative Approval and Ethical Considerations
Official permissions from the relevant authorities at the study setting were obtained. Ethical approval was secured from the research unit at the College of Nursing at King Saud bin Abdulaziz for Health Sciences and the Institutional Review Board Committee (IRB) with IRB approval number IRB/0913/22 at King Abdullah International Medical Research Center (KAIMRC). Research ethics and hospital protocols were stringently followed to maintain the confidentiality of all patient data.
This study was conducted retrospectively, and due to the nature of the data collection, obtaining individual consent from participants was not feasible. Therefore, a waiver of consent was granted by the Institutional Review Board of KAIMRC for the use of de-identified data. All data analyzed in this study were anonymized to ensure confidentiality and privacy.
2.6. Statistical Analysis
Data analysis was performed using SPSS version 22 for Windows. Descriptive statistics, including percentages, means, frequency counts, and standard deviations, were used to describe sample characteristics. The chi-square test was applied for analyzing categorical and ordinal data, while bivariate correlation (Pearson’s test) assessed the association between sample demographic data, obstetrical history, and the effects of obesity among pregnant women.
3. Results
A total of 341 pregnant women were included in this study. As shown in
Table 1, the mean age of the sample was 30.499 ± 5.236 years. In addition, 56.9% of the sample had a high school education level. The maternal height of the sample was 157.478 ± 7.468. Additionally, the maternal current weight of the sample was 89.771 ± 12.244. Moreover, the maternal pre-pregnancy weight of the sample was 82.094 ± 10.284. Additionally, 73.0% of the sample’s residents were urban. Finally, 44.3% of the sample’s BMI were in obesity class II.
As depicted in
Table 1, over 95% of the sample had a gestational age above 36 weeks. Furthermore, 58.4% reported gravidities ranging from 0 to 3. In the same vein, 71.6% had a number of parties totaling between 0 and 3. Additionally, the sample showed that 60.7% had experienced zero abortions and the rest had at least one abortion, and the predominant mode of previous delivery, accounting for 83.6%, was spontaneous vaginal delivery.
The total number of women with normal body weight was 5010 out of 8426 women (59.5%), while the total number of women with obesity was 3416 out of 8426 women (40.5%).
As shown in
Table 2, a total of 41.6% of the study sample had gestational diabetes. In addition, 26.7% of the study sample had cesarean section delivery. Additionally, 39.9% of the study samples had postpartum complications. The other complications were less than 10%.
As shown in
Table 3, among the study sample (92.1%), the fetal gestational age was term delivery: 37 to 40 weeks. In addition, 7.9% had preterm births. Additionally, 9.7% of the study sample had a low birth weight. Moreover, 26.1% of the study sample were admitted to the NICU. Finally, 17.3% had causes of NICU admission of respiratory distress.
As shown in
Table 4, there was a statistically significant relationship between the classes of obesity and seven items of maternal outcome characteristics, including gestational diabetes (chi (ꭓ
2) test) (
p = 0.00), anemia (chi (ꭓ
2) test) (
p = 0.048), cesarean section (chi (ꭓ
2) test) (
p = 0.050), reason for CS (chi (ꭓ
2) test) (
p = 0.039), postpartum complications (chi (ꭓ
2) test) (
p = 0.00), types of postpartum complications (
p = 0.001), and maternal length of stay in hospital (Pearson’s test) (
p = 0.039).
As illustrated in
Table 5, there was a statistically significant relationship between classes of obesity categories and two items of fetal outcome characteristics, including birth weight (Pearson’s test) (
p = 0.00) and first minute APGAR score (Pearson’s test) (
p = 0.041).
As shown in
Table 6, there was a statistically significant relationship between classes of obesity categories and two items of obstetrical variable characteristics, including gravidity (Pearson’s test) (
p = 0.00) and parity (Pearson’s test) (
p = 0.00).
5. Conclusions
Maternal obesity significantly impacts both immediate and long-term health outcomes for mothers and newborns, leading to complications such as gestational diabetes, anemia, and an increased likelihood of cesarean section deliveries. Recognizing the complexity of these challenges, our collective efforts in research, education, and clinical practice are crucial for developing effective preventive measures and interventions. To address the unique context of Saudi Arabia, targeted educational programs focusing on BMI control, dietary adjustments, and lifestyle modifications are recommended.