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Published: Thursday, March 24, 2011 - 12:59

It is now universally accepted that obesity in pregnancy poses significant dangers for both mother and child. Yet, evidence on the ground shows that help for the obese pregnant mother is patchy or close to non-existent in many maternity units in the UK according to research findings by a team led by  Dr Nicola Heslehurst  from Teesside University's Health and Social Care Institute. The research was carried out by a team of academics from the universities of Teesside, Newcastle and Durham looking at the provision of clinical and support services for obese pregnant women. The findings were published in the International Journal of Obesity.

They found that maternal obesity has more than doubled over the last two decades with one in six pregnant women now facing extra risks to themselves and their babies.

According to the two most recent triennial maternal mortality reports, more than half the women who die in pregnancy or childbirth are obese or overweight.  Moreover, being seriously overweight increases the likelihood of conditions such as cardiac disease, diabetes and pre-eclampsia and can be a contributing factor in stillbirth, congenital anomalies and prematurity.

Weight before conception

"But very little is being done nationally to support women in achieving a healthy weight before bearing children", says Dr Heslehurst. Her study found wide regional variations for maternal obesity, ranging from just over 13% in London to nearly 22% in the West Midlands.

"Once obese women become pregnant there are still things they can do to minimise the potential for complications for themselves and their babies, such as healthy eating and moderate levels of physical activity," says Dr Heslehurst.

"Mothers were being told they were putting their babies at risk and were then left to deal with it themselves, largely due to a lack of national guidelines for this type of advice and support for women," says Dr Heslehurst.

Weight management services

The lack of weight management services and weight gain guidance made it difficult for midwives to discuss obesity with women during pregnancy. "Midwives seek to build up a good relationship with women and they struggle to know how to initiate discussion with them about their weight as it is such a sensitive issue," says Dr Heslehurst.

"There is an urgent need for obesity training for midwives and better communication between the public health and maternity services," she says.

Lessons could be learned from the development of smoking cessation services during pregnancy, she suggests. Midwives participating in the study felt that the national drive for smoking cessation with its structured training, support and funding had worked successfully, whereas previous local initiatives without that level of strategic support had failed.

The study and its findings will come as no surprise for many practitioners in the field. However, opinions expressed are arguably contentious at some levels. Public health education about the overall health risks of obesity is active. Dr Heslehurst’s observation that “very little is done nationally to help women achieve a healthy weight before bearing children” is clearly overlooking the fact that more than half of all pregnancies in the UK are unplanned. There is no question, however, that a more active and streamlined approach on tackling issues related to obesity in pregnancy is needed and urgently. As these results show, this will include investment in education, personnel and equipment.


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Management of obesity in pregnancy remains a major concern

By Dr Joe Kabyemela, MD