Hindawi

Journal of Nutrition and Metabolism

Volume 2021, Article ID 6188847, 10 pages
[Link]

Research Article
Study of the Prevalence of Obesity and Its Association with
Maternal and Neonatal Characteristics and Morbidity Profile in a
Population of Moroccan Pregnant Women

Fatima Taoudi,1 Fatima Zahra Laamiri ,2 Fatima Barich ,3,4 Nadia Hasswane,1
Hassan Aguenaou,3 and Amina Barkat1
1
Mother and Child Couple Health and Nutrition Research Team, FMP de Rabat, Mohammed V University, Rabat, Morocco
2
Hassan First University, Higher Institute of Health Sciences of Settat, Health Sciences and Technology Laboratory,
Settat, Morocco
3
Joint Unit of Nutrition and Food Research, CNESTEN–Ibn Tofaιl University–URAC 39,
Regional Designated Center for Nutrition (AFRA/IAEA), Rabat, Morocco
4
Higher Institutes of Nursing Professions and Health Techniques, Rabat, Morocco

Correspondence should be addressed to Fatima Zahra Laamiri; fatilamir1970@[Link]

Received 29 June 2021; Revised 18 November 2021; Accepted 26 November 2021; Published 14 December 2021

Academic Editor: Elsa Lamy

Copyright © 2021 Fatima Taoudi et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Obesity is a real public health problem whose prevalence continues to increase throughout the world. It affects all age groups
and does not spare pregnant women. This work aims to determine the prevalence of obesity and to study its association with
maternal and neonatal characteristics and the morbidity profile of pregnancy. This is a descriptive and cross-sectional study
carried out in the maternity ward of the prefectural hospital center called “Sidi Lahcen” in Témara, Morocco, over a 12-month
period. Maternal and neonatal data are collected through a preestablished questionnaire, and anthropometric parameters were
recorded. 390 participants, aged between 18 and 43 years, were included in this study, with a prevalence of overweight and
obesity of 34.9% and 41%, respectively. Correlation results revealed that the prevalence of overweight and obesity was
significantly elevated in women over 25 years (p < 0.001). The rate of caesarean section was four times higher in obese women
compared to women of normal weight (53.8% versus 12.8%; p � 0.018). The over-term was significantly high in the obese group
compared to the nonobese group (33.8% versus 20.2%; p � 0.013). A statistically significant positive correlation was found
between gestational body mass index and newborn birth weight (r � 0.29; p < 0.001) as well as a high prevalence of macrosomia
in newborns of comparatively obese women compared to newborns of nonobese women (17.6% versus 9.6%; p � 0.041). The
correlation analysis with the morbidity profile showed a significantly high preponderance of gestational diabetes, anemia, and
toxemia of pregnancy in the obese group compared to the normal group (p < 0.001). This study clearly demonstrated that
obesity during pregnancy is associated with higher risks of maternal and neonatal complications, the management of which
places a burden on the health system as well as families. These data reinforce the need to improve antenatal care for the
prevention of obesity and its preventable complications.

1. Introduction In 2016, more than 1.9 billion adults (18 years and older)
were overweight. Of this total, more than 650 million were
Obesity has been considered by the WHO as a global epi- obese [3]. Today globally, overweight and obesity are linked
demic since 1998. It is a real public health problem. Its global to more deaths than underweight.
prevalence has almost tripled over the past four decades and There are more obese than underweight people in all
continues to rise in developed and developing countries regions except parts of sub-Saharan Africa and Asia [3].
[1, 2]. Obesity leads to serious health consequences, in particular
2 Journal of Nutrition and Metabolism

by the increase in cardiovascular diseases, type 2 diabetes, 2.3. Inclusion and Exclusion Criteria. We included in this
musculoarticular disorders, and a few cancers (breast, en- study all parturients with a physiological pregnancy who
dometrium, and colon), but also through moral harm as a gave birth in this hospital during the study period and who
result of the discrimination it entails [4, 5]. agreed to participate in our survey.
Since obesity does not spare pregnant women, it is an The study excludes women who do not know their weight
obstetric risk as well as antenatal factor prepartum or before pregnancy. Similarly, women who had a serious com-
postpartum, both on the fetal and the maternal side [6, 7]. plication of childbirth, women with a mental pathology,
It is responsible for a large number of maternal and fetal women who do not consent, and women with whom the
complications. Obese patients have three times more in- pretest was performed were excluded from the study.
fertility problems than normal weight women [7], in ad-
dition to a significant increase in the rate of abortions before
20 weeks of amenorrhea (SA), regardless of the mode of 2.4. Sampling Method. The sampling method used in this
conception in patients [8]. study is of the probability type. The survey was carried out on
In addition, overweight and obese women are prone to all the women who gave birth in the maternity ward of the
gestational diabetes, preeclampsia, and genital and urinary Sidi Lahcen regional prefectural hospital in Témara of the
tract infections [9]. During work, obesity is associated with prefectural hospital center “Sidi Lahcen” in Témara. Based
lengthening the duration of the first stage and a significant on the Lorenz formula developed by Cochran and Ardilly
decrease in uterine contractility [10, 11]. [20, 21], n � t2 × p × (1 – p)/m2, where t � 1.96, and based on a
As for postpartum complications, overweight or obese regional prevalence of 14.4% [22] and an accuracy of 5%, a
women are at risk of hemorrhage from delivery and massive minimum population of 189 are required to obtain statis-
postpartum hemorrhage [9]. Furthermore, weight gain tically representative data. In this work, we recruited a global
during pregnancy accounts for 20–35% of long-term sample of 390 pregnant women.
changes in maternal weight [12].
This cannot be a burden on the health system associated
with higher levels of postpartum maternal weight retention 2.5. Data Collection Methods. Data collection is carried out
and an unwanted cardiometabolic risk profile in the off- by a face-to-face interview with the women via a pre-
spring [13, 14]. established questionnaire tested and validated by experts in
For fetal complications, newborns with obese mothers perinatal care (research team in health and nutrition of the
more often suffer from neonatal distress, meconium inha- mother and child couple, Faculty of Medicine and Pharmacy
lation, and neonatal death [15]. They are about twice as likely of Rabat, Mohammed V Rabat University).
to have fetal macrosomia [9, 16]. The investigation explored several aspects, including the
In Morocco, the prevalence of obesity is high among following:
women. Indeed, obesity was detected in 20% (18.9–21.1) of (a) Demographic and socioeconomic data (age of
respondents, three times more common in women 29% mothers, marital status, place of residence, level of
(27.4–30.6) compared to men 11.0% (9.5–12.6) (MS, 2018) [17]. education, occupation of mother and head of
In addition, numerous studies have shown a strong household, monthly income, etc.).
influence of socioeconomic status on obesity, especially in
women, causing changes in their behaviors that alter their (b) Medical and obstetric history (chronic pathology,
energy intake and energy expenditure and therefore affect history of diabetes, number of pregnancies, number of
their body fat storage [18, 19]. abortions, neonatal death). In addition, the study was
However, studies of obesity during pregnancy are few, supplemented by means of the obstetrical file which
while obesity in pregnant women poses many obstetric and made it possible (blood glucose, complete blood count
perinatal problems. (CBC)), monitoring of the pregnancy, the number of
In this context, our present work proposes to determine prenatal consultations, and gestational age.
the prevalence of obesity and to study its association with (c) Maternal anthropometric data.
maternal and neonatal characteristics and the morbidity Women in the study were chosen based on
profile of pregnancy. knowledge of their pregestational weight. Then the
anthropometric data were collected on admission,
namely,
2. Materials and Methods
Weight: the weight of the women is taken with a
2.1. Type of Study. This is a cross-sectional descriptive study portable scale, scale of the type SECA, maximum
that was carried out at the maternity ward of the prefectural load 150 kg, and minimum load 10 kg. The reading
hospital center “Sidi Lahcen” in Témara, Morocco, over a 12- is made to within 0.5 kg.
month period from October 2018 to September 2019. The women are weighed with the least amount of
clothing possible, in a standing position, well
straight, the arms in the extension of the body. The
2.2. Study Population. The study concerned a population of scale is calibrated regularly and is calibrated several
pregnant women who gave birth in this maternity ward. times during each session.
Journal of Nutrition and Metabolism 3

Waist: it has been taken with the help of a grad- of the distribution of quantitative variables. Thus, the quan-
uated height up to 2 m. The women are measured titative variables with symmetrical distribution (age of
barefoot, the heels joined, the arms extended along mothers, gestational body mass index, and gestational age)
the body, the heels, the shoulders, and the buttocks were expressed as mean and standard deviation. Quantitative
touching the height. The lower edge of the orbits of variables with asymmetric distribution (birth weight of the
their eyes in the plane of Frankfurt. newborn) are expressed as median and quartile. Qualitative
The reading is done to within 0.1 cm. Women are variables are expressed in numbers and corresponding per-
asked to remove their scarf before performing this centages. The study of the association between corpulence and
measurement. maternal and neonatal parameters was carried out by the
Calculation of BMI: the gestational body mass Pearson khi2 test or the exact Fisher test. Pearson’s correlation
index of parturients was calculated by dividing was used to study the association between gestational body
weight over height squared. Then, the women were mass index and birth weight. A threshold of p < 0.05 was
further subdivided according to WHO recom- considered significant for all analyses performed.
mendations into four BMI groups: (1) the un-
derweight group (BMI < 18.5 kg/m2), (2) the
3. Results
normal group (18.5 ≤ BMI < 25), (3) the over-
weight group (25 ≤ IMC < 30), and (4) the obese 3.1. Sociodemographic Profile of Women Surveyed. In this
group (BMI ≥ 30 kg/m2) [20]. study, 390 parturients were surveyed when they were ad-
(d). Neonatal data are as follows: mitted in the maternity ward of the Sidi Lahcen prefectural
hospital in Témara, Morocco. Analysis in Table 1 showed
Anthropometric measurements in newborns: that the age of women varied from 18 to 43 years with an
Weight: the measurement is made using a average of 29.69 ± 5.8 years and a preponderance of the 25 to
calibrated flail scale with a maximum capacity of 34 age group (47.4%).
20 kg and a minimum load of 500 g. The scale is The distribution by place of residence was statistically
calibrated before each weighing. The weight of similar. In contrast, the distribution by level of education
newborns is taken from birth, after the first care was dominated by illiterate women with a proportion of
following the birth. The child is naked, lying on the 48.5%. The distribution of women according to their
scale carrier, and its weight is determined when the spouse’s income, the occupational situation, and medical
scale is in balance. coverage shows on the one hand that 57.7% had low income
Apgar score: and on the other hand that the majority of women were
The Apgar score is a simple method for quickly inactive (91.8%) and more than half (59.5%) were without
assessing the health and vital signs of a newborn medical coverage. In addition, the majority use oral con-
baby. It teaches us about the adaptation of the traception (67.4%).
newborn to ectopic life. It was designed by Dr.
Virginia Apgar in 1952 [23], with five criteria,
namely, appearance (skin coloring), pulse (heart 3.2. Anthropometric Data and Medical and Obstetric History
activity), grimace (reactivity to stimuli), activity of Pregnant Women. Analysis of anthropometric parameters
(muscle tone), and breathing (frequency and re- (Table 2) showed that the average BMI of our population was
spiratory efforts). 28.44 ± 4.79 kg/m2, with a preponderance of overweight and
The Apgar score must be established in the first, fifth, and obesity prevalent at 34.9% and 41%, respectively. Analysis of
tenth minutes. When you have a score ≥7, this is a normal the results in relation to the obstetric history of the women
newborn. showed that the majority of women were multiparous and
An Apgar score of less than seven should lead to ap- had no history of abortion (75.4%) and fetal death (93.1%).
propriate management, because it doubles the risk of pre- Of those with a medical history, 22.3% had a family history
mature death [24]. of diabetes, 3.6% had chronic conditions such as high blood
pressure, and 3.6% had chronic conditions such as high
blood pressure, epilepsy, and thyroid problems.
2.6. Ethical Consideration. The study protocol was approved Moreover, the majority of women (97.2%) had a follow-
by the Ethics Board of the Faculty of Medicine and Phar- up pregnancy either in the public sector (57%), in the private
macy, Mohammed V University in Rabat, Morocco (Ethical sector (21.1%), or in both (21.9%). In addition, 69.5% of
Approval number 69 delivered on 31 January 2017). Before women had at least 4 prenatal consultations, and 28.5% of
data collection, invited participants were informed about the women received iron supplementation during pregnancy.
study objectives and methods, and both oral and written
consent were obtained from all who were recruited.
3.3. Maternal and Neonatal Data. Analysis of maternal data
(Table 3) revealed that the average gestational age of
2.7. Statistical Analysis. The statistical analysis was conducted pregnant women in amenorrhea weeks was 39.53 ± 1.56.
using the SPSS epidemiological software (SPSS version 13.0). Cesarean delivery affected 20% of our parturients. Regarding
The Kolmogorov Smirnov test was used to study the normality the neonatal data, we found that macrosomia affected 15.6%
4 Journal of Nutrition and Metabolism

Table 1: Sociodemographic characteristics among pregnant women.

Characteristics Pregnant women N � 390 95% confidence interval (CI)
Age groups (years)
Less than 25 108(27.7) 23.1–32.1
25 to 34 185(47.4) 42.6–52.6
35 and more 97(24.9) 20.5–29.2
Area of residence
Urban 210(53.8) 48.5–59.2
Rural 180(46.2) 40.8–51.5
Level of education
Illiterate 189(48.5) 43.3–53.3
Primary or koranic school 72(18.5) 14.6–22.8
Primary 65(16.7) 13.1–20.6
Secondary 52(13.3) 10–16.7
Higher education 12(3.1) 1.5–4.9
Occupation of women
House wife 358(91.8) 89.2–94.6
Employed 32(8.2) 5.4–10.8
Occupation of the household head
Without job 36(9.2) 6.2–12.3
With job 302(77.4) 73.3–81.5
Retired 52(13.3) 10–16.7
Medical coverage
No 232(59.5) 54.6–64.1
Yes 158(40.5) 35.9–45.4
Contraception
No 116(29.7) 25.1–34.4
Oral contraception 263(67.4) 63.1–72.1
IUD 10(2.6) 1.3–4.4
Others 1(0.3) 0.0–0.8
Pregnancy monitoring
No 11(2.8) 1.3–4.6
Yes 379(97.2) 95.4–98.7
Note: values are expressed as number and percentage. IUD: intrauterine device.

of newborns and that the Apgar score at 5 min was less than In relation to the association between BMI and neonatal
7 in the majority of newborns (71.5%). data, our results revealed, on the one hand, a statistically
significant positive correlation between gestational body mass
index and birth weight (r � 0.29; p < 0.001) and, on the other
3.4. Study of the Association between Body Size and Maternal
hand, a prevalence of macrosomia in obese women compared
and Neonatal Parameters. Table 4 showed the correlation
to nonobese women (17.6% versus 9.6%; p � 0.041).
between body size and maternal and neonatal parameters.
Analysis of the results revealed that the overall preva-
lence of obesity was significantly higher (p < 0.001) among 3.5. Pregnancy Morbidity Profile and Its Association with Body
women aged over 35 years (53.6%) compared to women Size of the Parturients. Our study also explored the pa-
aged 25 to 35 years (45.4%) and women under 25 (22.2%). thologies that occurred during pregnancy. Overall analysis
On the other hand, no statistically significant differences of the results (Figure 1) showed that 90/390 (23.1%) had at
were observed among female respondents (mother’s work, least one morbidity whose profile was dominated by anemia
educational attainment, and area of residence). (58.89%) followed by gestational diabetes (35.56%) and fi-
Regarding obstetric parameters, the prevalence of obe- nally gravid toxemia (5.56%). Analysis of the morbidity
sity was significantly high in multiparous women compared profile by body size showed that the percentages of women
to first-time women (51% versus 30%; p � 0.026). with gestational diabetes, anemia, and gravid toxemia were
In addition, the rate of caesarean sections was four times significantly elevated in the overweight and obese group
higher in obese women compared to normal weight women compared to the normal group. This difference was statis-
(53.8% versus 12.8%) and statistically significant tically significant (p < 0.001).
(p � 0.018). Similarly, the prevalence of obesity and over-
weight was significantly high among women with multiple 4. Discussion
abortions (p � 0.041).
Furthermore, the prevalence of women who exceeded The present work proposes to determine the prevalence of
the term was significantly high in the obese group compared obesity and to study its association with maternal and
to the nonobese group (33.8% versus 20.2%; p � 0.013). neonatal characteristics as well as the morbidity profile of
Journal of Nutrition and Metabolism 5

Table 2: Population distribution of female participants by anthropometric information and medical and obstetric history α: values are
expressed as number and percentage.
Characteristics Pregnant women N � 390 95% confidence interval (CI)
BMIα tranche
Underweight 3(0.8) 0.1–1.8
Normal 91(23.3) 19.5–27.7
Overweight 136(34.9) 30.3–39.5
Obesity 160(41) 36.2–45.9
Chronic pathologyα
No 376(96.4) 94.4–98.2
Yes 14(3.6) 1.8–5.6
History of diabetesα
No 303(77.7) 73.6–81.8
Yes 87(22.3) 18.2–26.4
Gravidity/parityα
1 pregnancy 90(23.1) 19–27.7
2 pregnancies 153(39.2) 34.6–44.1
3 pregnancies 147(37.7) 32.6–42.3
Previous abortionα
Neither 294(75.4) 70.8–79.7
1 abortion 71(18.2) 14.4–22.3
2 abortions 21((5.4) 3.1–7.7
3 abortions 4(1) 0.3–2.1
Neonatal deathα
No 363(93.1) 90.1–95.4
Yes 27(6 .9) 4.6–9.5
Prenatal consultationα
Less than 4 CP 119(30.5) 25.9–35.6
4 or more CPs 271(69.5) 64.4–74.1
Iron supplementationα
No 279(71.5) 67.2–76.2
Yes 111(28.5) 23.8–32.8
Note: BMI: underweight: BMI < 18.5 kg/m2; normal: 18.5 ≤ BMI < 25 kg/m2; overweight: 25 ≤ BMI < 30 kg/m2; obesity: BMI ≥ 30 kg/m2. CP: prenatal
consultation.

Table 3: Birth history and neonatal characteristics.

Characteristics Pregnant women N � 390 95% confidence interval (CI)
Gestational ageβ 39.53 ± 1.56 39.37–39.68
Mode of deliveryα
Vaginal 312(80) 75.4–83.8
Caesarean section 78(20) 16.2–24.6
Instrumentationα
No 279(84.0) 80.1–88.0
Episiotomy 41(12.3) 9–16
Ventouse 12(3.6) 1.5–5.7
Sexα
Female 194(49.7) 45.1–55.1
Male 196(50.3) 44.9–54.9
Weight (g)ɣ 3400[3100–3800] 3400–3450
Weight band
Hypotrophy 15(3.8) 2.3–5.9
Normal 314(80.5) 76.7–84.6
Macrosomia 61(15.6) 12.1–19
Apgarα at 5 min
Apgar < 7 279(71.5) 67.2–76.2
Apgar ≥ 7 111(28.5) 23.8–32.8
Deathα
No 379(97.2) 95.4–98.7
Yes 11(2.8) 1.3–4.6
Note: α values are expressed as number and percentage. β values are expressed as mean and standard deviation. ɣ values are expressed as median and quartile.
6 Journal of Nutrition and Metabolism

Table 4: Distribution of female partners by sociodemographic, obstetric, and body size parameters.
Pregnant women N � 390
Variables
Underweight n � 3 Normal n � 91 Overweight n � 136 Obese n � 160 p∗
Age (year)
<25 2(1.9) 31(28.7) 51(47.2) 24(22.2)
25 à 35 0(0) 44(23.8) 57(30.8) 84(45.4) <0.001
≥35 1(1.0) 16(16.5) 28(28.9) 52(53.6)
Area of residence
Urban 2(1) 50(23.8) 73(34.8) 85(40.5)
0.982
Rural 1(0.6) 41(22.8) 63(35) 75(41.7)
Level of education
Illiterate 2(0) 55(21.1) 85(32.6) 119(45.6)
Primary or koranic school 1(1.5) 16(24.6) 28(43.1) 20(30.8) 0.132
Secondary or higher education 0(0) 20(31.3) 23(35.9) 21(32.8)
Occupation of women
House wife 3(0.8) 84(23.5) 125(34.9) 146(40.8)
0.978
Employed 0(0) 7(21.9) 11(34.4) 14(43.8)
Parity
Primiparous 0(0) 29(32.2) 34(37.8) 27(30)
Second screen 2(1.3) 34(22.2) 59(38.6) 58(37.9) 0.026
Multiparous҂ 1(0.7) 28(19) 43(29.3) 75(51)
Mode of delivery
Low channel 2(0.6) 81(26) 111(35.6) 118(37.8)
0.018
Caesarean section 1(1.3) 10(12.8) 25(32.1) 42(53.8)
Previous abortion
No abortion 1(0.3) 77(26.2) 106(36.1) 110(37.4)
1 abortion 2(2.8) 11(15.5) 20(28.2) 38(53.5)
0.041
2 abortions 0(0) 3(14.3) 9(42.9) 9(42.9)
3 abortions 0(0) 0(0) 1(25.0) 3(75.0)
Note: values are expressed in terms of number and percentage. ∗ Fisher’s exact test. A p value < 0.05 is considered significant. ҂: (Babinski A, Kerenyi T, Torok
O, Grazi V, Lapinski RH, Berkowitz RL. Perinatal outcome in grand and great grand multiparity: effect of parity on obstetric risk factors. Am J Obstet Gynecol
1999; 181(3):669–74). The multiparous is a woman whose parity is between 2 and 5.

25 p*<0.001

20

15
number

25,56%
23,33%
10
18,89%

14,44%
5
8,89%

2,22% 2,22%
1,11% 1,11%
0
Pregnancy toxemia anemia Gestationnel diabetes
pathology during pregnancy

BMI Group

Underweight Overweight
normal obese
Figure 1: Distribution of parturients by body mass index and morbidity profile. Note: underweight: BMI < 18.5 kg/m2; normal:
18.5 ≤ BMI < 25 kg/m2; overweight: 25 ≤ BMI < 30 kg/m2; obese: BMI ≥ 30 kg/m2. ∗ Fisher’s exact test. A value of p < 0.05 is considered
significant.
Journal of Nutrition and Metabolism 7

pregnancy in the region of Témara, Morocco, an area with a group of normal weight women (95% CI [1.01–1.46]), and a
high prevalence of obesity [22]. 3.5 times greater risk of recurrent miscarriage (95% CI
The results showed that overweight and obesity are a [1.03–12.01]) [41]. This complication is attributed to insulin
problem in the study population with respective prevalence resistance traditionally encountered in obese patients as
of 34.9% and 41%. These results are controversial with those well as polycystic ovary syndrome frequently encountered
reported in France and Canada with respective prevalence of in this female population. Thus, this risk is likely to increase
23.5%, 7%, and 23%, 36% [25, 26]. Gestational weight gain with the degree of obesity [42].
remains an independent risk factor for the health of the For neonatal criteria, the Apgar score at 5 min was less
mother and her child in the short and long term [27]. In- than 7 in 3/4 of the newborns or (71.5%). This same result
deed, it is associated with increased rates of gestational has been demonstrated in many international studies
hypertension, gestational diabetes, caesarean delivery, and [15, 43, 44], which reported a higher incidence of newborns
macrosomia [6]. with Apgar less than 7–5 min in the overweight female
It is accompanied by an increase in maternal adipocytic population (Class I with 18% and Class II with 19%)
stores, often contributing to the maintenance of postpartum compared to the rest of the population (6.9%). One would
overweight and increasing the risk of subsequent obesity and think that the frequency of fetal suffering during labor would
type 2 diabetes [12, 28]. Similarly, excessive weight gain be increased in overweight women. Similarly, a positive and
influences the development of obesity in children in the statistically significant mean correlation (r � 0.20, p < 0.001)
short and long term [28, 29]. The study of the correlation was found between obesity and newborn weight. This is
between body shape and maternal parameters showed that consistent with several studies that have reported that obese
the prevalence of overweight and obesity is higher in women women are about twice as likely to give birth to newborns
over 25 years of age with a statistically significant difference with macrosomia [9, 16, 45]. This creates a risk of weight
(p < 0.001, Table 4). These results are similar to those re- gain in adulthood [46].
ported in a study of Swedish Ghanaian and Nigerian women Obesity as a morbidity factor has also been exploited in
[30–32]. Similarly, these findings corroborate with the this work. Indeed, our study showed that the prevalence of
findings of Garabedian et al. which reported that obesity is pregnant toxemia and gestational diabetes was significantly
affecting more and more young women [33]. This explains higher in obese women compared to normal weight women
its increasing prevalence among pregnant women [34]. In (p < 0.001, Figure 1). This has been demonstrated by pre-
fact, this can also be explained by the accumulation of fat vious studies [47, 48]. Therefore, testing in women with risk
during pregnancy [35]. factors early in pregnancy is recommended [49].
A correlation was also observed between corpulence and Gestational diabetes is diagnosed in 1–3% of pregnancies
the education level of the participants. Indeed, 45.6% of and 17% of obese women [50]. Excess adipose tissue is
illiterate women were obese and 32.6% were overweight responsible for an overproduction of adipokines, an im-
(Table 4), while those with higher or secondary education portant part of which is involved in the inflammation
had a lower rate of obesity and overweight. Although the phenomenon. It is these same adipokines that are respon-
difference in our sample was not statistically significant, our sible for the metabolic imbalances that cause the compli-
results corroborate with the literature that considers edu- cations of obesity (insulin resistance, type 2 diabetes,
cated women to be at lower risk of obesity because they are atherosclerosis, and arterial hypertension) [50, 51]. Several
more aware of its risks [18, 36, 37]. As for parity, a significant studies have concluded that toxemia is increased in obese
correlation was observed with overweight (p � 0.026, Ta- pregnant women [52, 53]. In this sense, our results cor-
ble 4). This finding is similar to that found in the study by roborate with the comments of these authors in that the
Ducarme et al. [25] which reported significant values pregnant toxemia was significantly higher in the overweight
(p < 0.001), with prevalence of overweight and obesity of and obese group compared to the normal group. Obesity is
33.1% and 35.1%, respectively. indeed strongly associated with hyperlipidemia, which, by
The impact of obesity on both gestational age and the direct or indirect mechanism, damages the endothelial cells
course of delivery was also raised in our study. Indeed, the causing vasoconstriction and platelet aggregation, contrib-
study demonstrated a significant correlation between obesity uting to the preeclampsia process [54].
and overdue pregnancy. The impact of obesity on both ges- Regarding anemia, our study showed that the overall
tational age and delivery patterns was also raised in our study. prevalence was 58.89% with a statistically significant pre-
Indeed, the study showed a significant correlation between ponderance in overweight group. Our results remain less
obesity, postterm pregnancy, and caesarean section, and these alarming than those reported in neighboring Arab Maghreb
results are similar to results reported by other authors countries such as Tunisia and Mauritania with prevalence of
[15, 31, 38]. In the same sense, other studies have shown that 41% and 53.1%, respectively [55, 56]. Anemia remains a
the increase in caesarean sections is proportional to the size, global public health problem with prevalence of 38% in
even in the absence of maternal pathology [39, 40]. Similarly, pregnant women [57]. It is a global target to reduce anemia
study participants with a history of abortion were obese, which in women of reproductive age by 50% by 2025 [58]. This
is statistically significant (p � 0.041, Table 4). Our results could be done through prenatal surveillance and other re-
remain similar to a randomized study by Lashen and Fear search exploring the nutritional profile of pregnant women
which reported that obese women had a 1.2 times greater in general and obese women in particular. This component
risk of first trimester pregnancy loss compared to a control was not explored in the present study.
8 Journal of Nutrition and Metabolism

5. Conclusion [8] M. Metwally, K. Ong, W. Ledger, and T. Li, “Does high

body mass index increase the risk of miscarriage after
The prevalence of overweight and obesity in our population spontaneous and assisted conception? A meta-analysis of
is 34.9% and 41%, respectively. Our study has clearly the evidence,” Fertility and Sterility, vol. 90, no. 3,
demonstrated that obesity is responsible for obstetrical and pp. 714–726, 2008.
neonatal complications, the management of which consti- [9] N. Sebire, M. Jolly, J. Harris et al., “Maternal obesity and
tutes a burden for both the health system and the families. pregnancy outcome: a study of 287 213 pregnancies in
London,” International Journal of Obesity, vol. 25, no. 8,
These data reinforce the need to improve antenatal care for
pp. 1175–1182, 2001.
the prevention of obesity and its avoidable complications. [10] C. Hamon, S. Fanello, L. Catala, and E. Parot, “Conséquences
de l’obésité maternelle sur le déroulement du travail et l’ac-
Data Availability couchement à l’exclusion des autres pathologies pouvant
modifier la prise en charge obstétricale,” Journal de Gyne-
Access to data is restricted in order to respect the rights of cologie Obstetrique et Biologie de la Reproduction, vol. 34,
third parties and the confidentiality of participants. pp. 1109–1114 31, 2005.
[11] M. I. Cedergren, “Non-elective caesarean delivery due to
Conflicts of Interest ineffective uterine contractility or due to obstructed labour in
relation to maternal body mass index,” European Journal of
The authors declare that they have no conflicts of interest. Obstetrics & Gynecology and Reproductive Biology, vol. 145,
no. 2, pp. 163–166, 2009.
Authors’ Contributions [12] E. P. Gunderson, “Childbearing and obesity in women: weight
before, during, and after pregnancy,” Obstetrics & Gynecology
Fatima Taoudi and Fatima Zahra Laamiri contributed Clinics of North America, vol. 36, no. 2, pp. 317–ix, 2009.
equally in this manuscript. The design and review of the [13] R. Gaillard, E. A. P. Steegers, L. Duijts et al., “Childhood
cardiometabolic outcomes of maternal obesity during preg-
literature of this study were performed by F. Taoudi, F. Z.
nancy,” Hypertension, vol. 63, no. 4, pp. 683–691, 2014.
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F. Taoudi and F. Z. Laamiri. The writing of the manuscript prenatal, perinatal, and postnatal overnutrition: a review,”
was performed by F. Taoudi, F. Z. Laamiri, F. Barich, Seminars in Reproductive Medicine, vol. 29, no. 3,
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Acknowledgments vol. 103, no. 2, pp. 219–224, 2004.
[16] A. M. Siega-Riz, M. Viswanathan, M. K. Moos et al., “A
The authors thank all the participants for their contribution. systematic review of outcomes of maternal weight gain
according to the Institute of Medicine recommendations:
birthweight, fetal growth, and postpartum weight retention,”
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