Obesity prevalence in a cohort of women in early pregnancy from a neighbourhood perspective

A register based study on 94,323 primiparous pregnant women in 586 Swedish neighbourhoods during the years 1992-2001. Multilevel technique was used to regress obesity prevalence on socioeconomic individual-level variables and the neighbourhood economic status. Five hundred and eighty-six neighbourhoods in the three major cities of Sweden, Stockholm, G？teborg and Malm？, during 1992-2001, were included. The majority of neighbourhoods had a population of 4 000-10 000 inhabitants.Seven per cent of the variation in obesity prevalence was at the neighbourhood level and the odds of being obese were almost doubled in poor areas.Our findings supports a community approach in the prevention of obesity in general and thus also in pregnant women.Overweight is a predominant health problem worldwide and is today regarded as one of the most important health threats [1]. This epidemic is especially pronounced in young people, including women of reproductive age. A Swedish study reported a six-fold increase since 1980-81 in obesity prevalence in women 16 to 34 years of age [2]. Further, an overview by Guelinckx et al reported obesity prevalence in pregnant women from different countries ranging from 1.8% to 25.3% [3]. Four recent systematic reviews summarise foetal and maternal negative consequences of obesity during pregnancy [3-6]. Maternal risks include gestational diabetes, hypertension and pre-eclampsia, increased incidence of operative delivery, postpartum haemorrhage, and anaesthetic risks, as well as infective and thromboembolic complications, while foetal risks include miscarriage, neural tube defects, macrosomia, and stillbirth.As a consequence, a number of intervention programmes to prevent or control obesity during pregnancy have been developed, and several of these programmes have adopted a community approach [6]. Even if no conclusive evidence of the effects is currently at hand, the community approach implicates a more narrow focus on the close environment. Accordingly