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Learning Objective 1: The learner will be able to discuss complications of pregnancy related to pre-pregnancy obesity.
Learning Objective 2: The learner will be able to compare pre-pregnancy obesity rates for rural-dwelling and urban-dwelling populations.
Introduction: Growing evidence indicates complications of pregnancy increase with severity of maternal obesity. Births in Texas counties, of which more than 70% are rural, account for approximately10% of annual US births. The rural population is noted for health challenges. The purpose of this study was to compare pre-pregnancy obesity rates in urban and rural Texas.
Methods: This is a retrospective cohort design. Data were derived from merged Texas birth and infant death certificates. The population represents women delivering in Texas from 2005 through 2009, inclusive (> 2 million births). Based on pre-pregnancy BMI, we classified the population as underweight, normal-weight, overweight, obese, and super obese. We conducted statistical analyses using SPSS (version 19) and used descriptive statistics to examine pre-pregnancy obesity rates in rural and urban populations.
Results: Analyses revealed that 89.3% of our maternal population resided in urban counties, with 10.7% residing in rural counties. Overall obesity rate was higher among rural residents, however. For urban residents, overweight rates fluctuated around 24.4% from 2005 to 2009 and obesity rates trended upward from 18.8% in 2005 to 21.0 % in 2009. The super-obesity rate in the urban population, which was 0.3% in 2005, increased to 0.4% in 2007 and remained constant for 2008 and 2009. For rural residents, the overweight rate increased from 24.8% in 2005 to 25.2% in 2009. The obesity rate trended upward from 23.5% in 2005 to 26.0 % in 2009 and the super obesity rate rose from 0.4% to 0.5% over the five-year period.
Implications: Pre-pregnancy obesity represents an immense health burden in Texas. Over a five-year period, mothers in the rural population experienced higher prevalence and greater increase in rate of pre-pregnancy obesity than their urban counterparts. Policy efforts should address the urban and rural pre-pregnancy obesity.