The association between socioeconomic factors, obesity and obstetric outcomes in two different regions in new south Wales (NSW) Australia

Background. The two university teaching hospitals studied are on the eastern seaboard of Australia. The Royal North Shore Hospital (RNSH) is in the large urban area of Northern Sydney Region (NSR) and John Hunter Hospital (JHH) is in the main regional city of the Hunter Region (HR). Both are major teaching hospitals in the NSW public health service. There are very clear socioeconomic differences between the two regions. The HR has significantly higher unemployment (5.8% vs. 2.7%), lower weekly average income ($767 vs. $1325), more single parent households (12% vs. 6%) and fewer overseas born Australian (10% vs. 38%). Data were analysed for rates of maternal obesity and obstetric outcomes for the two hospitals Results. 3,100 women at RNSH and 3082 at JHH were assessed from a computerised patient database. There was a 10kg mean weight (+SE) difference (RNSH, 62+0.4Kgs; JHH 72+0.2Kgs; P=0.0000) with a significantly larger number at JHH >100Kgs (260 vs. 49) (P=0.000). For those women >100Kgs at JHH there was a decrease in spontaneous labour and increase in operative delivery and gestational diabetes. These were not seen in the RNSH women >100kgs. Conclusion and Impact. As seen in other publications there are increased interventions and complications such as gestational diabetes, operative delivery, perinatal mortality and depression in women whose pregnancies are complicated by obesity. Obesity combined with socio-economic factors of disadvantage has implications for the health of women and their children. These findings require new approaches to integrated individual and population based public health care that effectively improves health of both women and children in all localities. This will require a combination of the clinical skills of health practitioners with locality based epidemiological data, preventative medicine and health promotion both within hospitals and stretching to the broader community health and education systems.