Obesity among Obstetrical Patients Seeking Care in a Safety Net Hospital: The Impact of Adverse Childhood Events

To determine the prevalence of obesity among a cohort of pregnant patients with high compared with low adverse childhood events scores.

The study was part of a large study of adverse childhood events among pregnant women seeking care in a safety net hospital from June 2022 to June 2023. The patients were seen in a variety of settings (a routine prenatal clinic, a high-risk clinic, an antepartum testing unit, an obstetrical ultrasound unit, and a labor and delivery suite). They were randomly approached and asked to complete a previously validated questionnaire for their Adverse Childhood Experience score (ACE score). Their body mass index (BMI) on their first visit was recorded. BMI was categorized as overweight (BMI > 25), class I obesity (BMI > 30), class II obesity (BMI > 35), and class III obesity (BMI > 40). This study was approved by the Valleywise Institutional Review Board.

Three hundred and forty-nine patients were approached and 320 agreed to complete the questionnaire. Eighty percent of patients had an initial prenatal visit BMI >25 and 62% had an initial BMI that was categorized as obese. Patients with a high ACEs score were more likely to have a BMI in the obese category compared with those in the low-risk group with an odds ratio of 1.34 (95% CI [0.7907-2.2798], p = 0.275).

Maternal obesity is a well-known risk factor for numerous adverse obstetrical and neonatal outcomes. While the CDC reported a national prepregnancy obesity rate of 29.0% in 2019, our patients were 2.14 times more likely to be obese. Obesity was more prevalent in women with high ACEs scores. Safety net hospitals should be cognizant of marked increase in obesity in their obstetrical patients, especially those with high ACEs scores, and develop interventions that incorporate trauma-informed care.