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Obesity and Socioeconomic Disparities

Rethinking Causes and Perinatal Care

Jevitt, Cecilia M., PhD, CNM, FACNM

The Journal of Perinatal & Neonatal Nursing: April/June 2019 - Volume 33 - Issue 2 - p 126–135
doi: 10.1097/JPN.0000000000000400
Feature Articles: Continuing Education
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Obesity affects more than 35% of women aged 20 to 39 years in the United States. This article summarizes recent research that reconceptualizes obesity as adipose disease associated with smoking; socio-economic disparities in employment, education, healthcare access, food quality, and availability; and environmental toxins, ultimately altering microbiomes and epigenetics. Individual prenatal care of women with obesity includes early testing for diabetes, counseling on epigenetic diets, advice supporting weight gain within national guidelines, and vigilance for signs of hypertensive disorders of pregnancy. Intrapartum care includes mechanical cervical ripening measures, patience with prolonged labor, and uterotonic medication readiness in the event of postpartum hemorrhage. Postpartum care includes thrombus risk amelioration through early ambulation, use of compression stockings, and anticoagulation. Delays in lactogenesis II can be offset by measures to support early breastfeeding. Sociopolitical action by nurses at national, state, and community levels to reduce population disparities in racism, education, and employment; reduce pollution from obesogenic chemicals; and improve food quality and distribution policies is likely to have the broadest impact in future obesity reductions and prevention.

The University of British Columbia, Faculty of Medicine, Midwifery Program, Vancouver, British Columbia, Canada.

Corresponding Author: Cecilia M. Jevitt, PhD, CNM, FACNM, The University of British Columbia, Faculty of Medicine, Midwifery Program, Apt 505, 5988 Gray Ave, Vancouver, British Columbia, V6S 0K4, Canada (cecilia.jevitt@ubc.ca).

Disclosure: The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Each author has indicated that he or she has met the journal's requirements for Authorship.

Submitted for publication: October 15, 2018; accepted for publication: January 28, 2019.

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