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Abstract Maternal obesity is defined as a BMI ≥ 30 kg/m2 at the first booking appointment. Excessive gestational weight gain is independently and strongly associated with macrosomia, particularly among overweight and obese women, which leads to adverse maternal and neonatal outcomes such as pre eclampsia, seizures, hypoglycemia, failed induction, prolonged labor, caesarean birth, birth trauma, birth asphyxia, and increased risk of perinatal mortality. Moreover, there is a positive association between gestational weight and postpartum weight retention. The aim of this study was to evaluate the effect of nutritional program for improving obesity on maternal health through assessing maternal knowledge about obesity during pregnancy, assessing maternal practices related to their nutritional lifestyle to determine their needs, designing and implementing nutritional program according to the class of obesity, evaluating the effect of the program on the mother & neonatal health. The study was carried out Maternal and Child Health (MCH) centers at El- Giza and EL-Moneab areas using a controlled quasi-experimental design with pre- post assessment. The sample consisted of a study group of 50 obese pregnant women in the first trimester of pregnancy who received the educational progrem and a control group of 50 similar women under routine care. The data collection tools consisted of an interview questionnaire form assessing women’s socio demographic data, obstetric and medical history, current pregnancy details, knowledge assessment and practices, and a food frequency intake sheet; and a physical assessment and follow up sheet to record initial and follow up visits, assessment covering ANC visits data, follow-up complaints, diagnosed problems, weight, and fetal heart rate (FHR), and pregnancy outcomes. A pilot study was conducted on ten obese pregnant women and the tools were finalized accordingly. The work was carried out through assessment (pretest), planning, implementation, and evaluation (posttest) phases lasting from May 2013 to May 2014. The main study results were as follows: Women in the study and control groups had similar socio- demographic with 25-35 years, and having basic education, and not working, 78% and 74% respectively. The obstetric history was similar in the two groups, with mean gravity of 3, similar mean parity of 2. The majority had previous abortion, 56% and 44% respectively. All women in the study and control groups had a history before and during current pregnancy, with similar obesity grades, and the majority were having chronic disease. All women in both groups had antenatal care (ANC) during current pregnancy, mostly since the first trimester Women’s knowledge in both groups was low before the progrem; it showed statistically significant improvement in the study group, compared with the control group (P<0.001) after the progrem. The pre – progrem positive practices towards diet, exercise, and rest were low in both groups, with statistically significant improvements after the progrem only in the study group. Before the progrem, salt intake was higher among women in the study group (P=0.001), while the intake of juices was higher in the control group. At the post – progrem phase, the study group had higher intake of cereals (P=0.01), dairies (P<0.001), vegetables and fruits (P=0.002) and lower intake of carbohydrates (P<0.001), caffeine (P<0.001), and juice (P<0.001), Meanwhile, the intake of carbohydrates and fat was higher among women in the control group, P<0.001 and P=0.001 respectively. In the follow up, the frequency of intake of various food groups was higher among women in control group except for vegetables and fruits which were higher in the study group (P<0.001). Thought pregnancy. The frequency of intake of carbohydrates group showed a decreasing trend in study group, whereas the control group the control group demonstrates an increasing trend with statistically significant difference between the two groups. The frequency intake of dairies and protein groups was increased in both groups. At the second post – progrem visit, more women in the control group had hypertension and gestational diabetes (P= 0.02). At the third post – progrem visit, women in the control group hadhigher weight (P=0.004), hypertension and gestational diabetes (P=0.02). At the fourth post – progrem visit, they additionally had more headache. They also had additionally more hydromnios (P<0.001) malpresentation, and abnormal FHR at the fifth post progrem. This continued to the sixth, seventh, and eight post progrem visit. Concerning body weight women in the study group had significantly lowered body weight throughout follow –up visits. Concerning maternal outcomes, women in the control had significantly higher rates of fetal distress (P<0.001), abnormal uterine contractions (P<0.001), perineal lacerations (P=0.004), and post partum hemorrhage (P=0.001). As for fetal outcomes, study group had better Apgar scores at the first (P<0.001) and fifth (P=0.01) minutes, with less NICU admissions (P<0.001). Women, knowledge had significant positive correlation with their education at all phases, and with income of study group at the post – progrem phase (r=0.337), practices related to lifestyle had significant negative correlation with age at the pre- progrem phase (r= - 0.252), and with parity of study group women at the post – progrem phase (r= -0.305). In conclusion, obese pregnant women have deficient knowledge and practices regarding diet. Exercise and rest during pregnancy. The nutritional program is effective in improving their knowledge, practices related to lifestyle, with improvement in the complaints and problems during pregnancy, lower body weight throughout follow-up visits, and better maternal and fetal outcomes. Base on the study findings, it is recommended that the developed nutritional program be made available at ANC centers, and the nurses in these centers should exert more efforts in educating pregnant obese women regarding healthy diet during pregnancy, with the help of dietitians, Obese pregnant women need early progrem to avoid excessive weight gain, with screening programs for pregnancy associated complications as pregnancy induced hypertension and diabetes. The study should be replicated using a control clinical trial designs to provide results at a higher level of evidence. |