Does an antenatal educational programme decrease adverse pregnancy outcomes among obese pregnant women? A feasibility study in Kurdistan Region of Iraq.

Maternal obesity is associated with a wide range of health risks for the mother and newborn (Poston et al, 2011). Investigations and research about the incidence of obesity during pregnancy and its outcomes has not previously been investigated in the Kurdistan region of Iraq. The aim of this study was to explore the appropriateness of an educational programme for obese women and its influence on pregnancy outcomes with a view to undertaking a larger randomised controlled trial and obese women‘s perceived benefits of the programme. Ethical approval to conduct the study was obtained from De Montfort University Research Ethics Committee and local health care and education provider institutions. 293 pregnant women agreed to take part in the study from three health centres in a large city in the Kurdistan region of Iraq. Obese women (BMI 30 or above) were randomised to one of two groups; 96 women agreed to take part in an antenatal education programme (intervention group), 98 did not take part in the intervention (control group) and 99 women were of normal weight (BMI 18.5-24.99) and did not take part in any education programme (baseline group). Quantitative and qualitative data was collected The key findings showed that there was no statistically significant difference among the groups regarding; pregnancy induced hypertension (PIH), gestational age at onset of labour (GA), labour outcomes and neonatal outcomes. In relation to Gestational Diabetes Mellitus GDM, findings indicated that the prevalence of GDM was reduced among those obese women who received the educational programme compared to the control and baseline groups. In addition, obese women (intervention) had gained lower weight gain than women in control group but it was not statistically significant. However, the common themes which emerged in qualitative arm related to; antenatal educational strategies; problems of transferring an educational programme from one country to another, the socio-cultural context of health education programmes, weight management, and medicalization of birth in Kurdistan region. This research found that the antenatal education programme appeared to make only a small difference to pregnancy outcomes. One factor which may have affected the results of this study was the diminishing attendance rate among women who were part of the education programme; less than 10% of women attending all six sessions and the majority of women attending 2-3 sessions. The reasons for the diminishing attendance are discussed in the thesis and highlight the importance of developing future maternity health education programmes that are culturally appropriate to the society they are part of; taking account of the perceived role of pregnant women in that culture, the style and format of health education and the place of the health professional in that society. A larger RCT comparing intervention group of obese pregnant women with nonintervention group is feasible, acceptable and recommended. However, prior to progressing to a large scale study, a thorough planning stage is necessary which considers cultural practices and educational strategies. The understandings gained from this research will be transferable to other research within similar settings.