'I Am Not Going, So You're Doing It': Management of Pregnant People With High BMI at Rural Hospitals in British Columbia: A Mixed Methods Analysis.
Kathrin Stoll, Jude Kornelsen, Stephanie Lin and 2 others
PMID 41398901WHAT IT FOUND
Adverse maternal-newborn outcome scores were higher for underweight and high-BMI groups, but BMI was not clearly linked to them at rural British Columbia hospitals.
Local birth rates fell as BMI rose, and providers described applying BMI transfer rules differently, with some patients refusing referral.
Key findings
01Local birth rates decreased as BMI increased, from 72.7% for normal BMI to 34.9% for BMI 40 or higher.
02Adverse maternal-newborn outcome scores were higher for underweight and BMI 30 or over groups, but the study did not find clear associations.
03Providers described two themes: challenging BMI cut-offs and the impact of BMI cut-offs on patients, including some patients refusing referral.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 3257 (72.9%) of 4468 births had a pre-pregnancy BMI recorded. Three of the ten RSON hospitals were not included in the administrative data because they joined after the data request. The hospital-level analysis excluded home births, unknown place of birth, and twin or triplet pregnancies. The qualitative part used healthcare providers and administrators, not patients, so the patient perspective was missing. BMI itself is a contested measure, and the authors note it is not an indicator of health. The adverse outcome analysis did not find clear associations, so it cannot show whether BMI increases risk at these hospitals.
Declared interests
The RSON evaluation was funded by the BC Joint Standing Committee on Rural Issues and the Rural Coordination Center of BC. The authors state that access to data was subject to approval and that inferences, opinions, and conclusions are theirs, not the Data Steward's.
The easy way to misread this
Do not read the lack of a clear BMI-adverse outcome link as proof that high BMI is safe at rural hospitals. The study was observational, BMI was not recorded for all births, and it did not test whether keeping high-BMI patients local is safe.