Weighing up the issue

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by Jolene Cargill, Newsnet Scotland’s Social Affairs Editor

It is estimated that one in four pregnant mothers in the UK is obese.  The alarming rise in obesity in mothers mirrors obesity in the population as a whole, particularly in Scotland, where we are second only to the US.  But are health services getting to grips with this major public health issue?

If you look at physical resources the answer is resoundingly, no.  Most hospital units don’t have the full complement of equipment to deal with obese pregnant mothers.  Equipment such as blood pressure cuffs and operating tables and beds all need to be bigger to cope with bigger mothers.  And reports show that basic equipment is not universally available for the care of obese women across the UK.

Together with the increase in prevalence of obesity, this has huge implications for maternity service provision.  And evidence suggests that not only is obesity per se increasing, but the degree of obesity among those who are already obese is also rising. Doctors and midwives can’t provide optimal care with the wrong equipment.

But its not just infrastructure that is lacking. In news reports in the last week it was suggested that parents who are obese allow their children to be overweight to validate their lifestyle. Whether you agree with that or not, its clear that the key to changing behaviour is to address attitudes. Professionals need more iinformation about how to manage obesity during pregnancy.

The National Institute of Clinical Excellence produced a guideline in 2010 and baby charity Tommy’s have produced a free guide with dietary and exercise advice. Jane Brewin, Chief Executive Officer of Tommy’s said,

“A set of guidelines to ensure women receive optimal care and support is a step in the right direction as mitigating the impact of obesity on mums and their babies is one of our most important health challenges.”

The charity set up the first specialist service working with obese mothers in Scotland at a clinic in Edinburgh. Professor Jane Norman, lead doctor in the antenatal metabolic unit at the Edinburgh Royal Infirmary, said,

“We know the worst possible outcomes of obesity in pregnancy; stillbirth, diabetes, pre eclampsia and the risk of cesarian is two to three times higher.  But we are still learning how best to manage obesity in pregnancy and how to engage with overweight and obese mothers.”

Ticking timebomb

The statistics are unsettling.  Babies who have an obese mother are five times more likely to die and they are at increased risk of being too big or too small.  If the baby is too big they are more likely to have birth injuries. They are also at increased risk of diabetes and cardiovascular disease and there is a clear link between being obese at birth and the child developing obesity later in life.

Reports into maternal deaths have highlighted obesity as a factor in increasing numbers of maternal deaths in the UK.  Between 2003 and 2005, twenty seven per cent of the women who died were classified as obese.

Dr Norman said, “If the mum is obese during pregnancy, there is a strong risk it’s transmitted through the generations.  But we don’t fully understand why this happens.”

The Edinburgh unit will follow children long-term to assess growth and development of obesity and any metabolic problems.

At the multi disciplinary clinic obese pregnant women get practical advice and support on healthy eating and exercise. There are over eighty women who regularly attend the clinic and last year the NHS opened another unit offering support in Lanarkshire. Dr Norman said it’s a constant challenge to tackle misinformation, “People are affected by what’s around them.  For example we still have to tackle the ‘eating for two’ myth.”

“We advise women not to gain excessive weight but losing weight is not a good thing either so we encourage women to maintain their weight.  The risk of dieting during pregnancy is a worry.  Our dietician comes to the clinic and advises on what they should eat, how to change their diet for the better.”

Lasting change

The role of the clinic is to help women make changes to their lifestyle that they can manage after the baby is born.  “Even if you put a baby who had an obese mother on a perfect diet, they will probably still be obese.  So if we wait until after the baby is born – it’s too late for the child” said Dr Norman.

So far the clinic has been successful in limiting weight gain during pregnancy among the majority of severely obese women.  And researchers are now carrying out a clinical trial to test a drug used to treat diabetes in pregnancy.  Edinburgh is the lead centre and trials are also underway at Liverpool, Sheffield and Birmingham.  Dr Norman said, “If trying to get women to manage their diet and exercise doesn’t work then a safe drug could be an alternative approach.”

But doesn’t this send the wrong message to women, promising yet another quick fix solution to a long term problem?  Dr Norman says, “Many health professionals have a tension in talking to women about their weight because they don’t want to be seen to be critical.”

“There must be a sympathetic dialogue where you say to the mother, you are obese and increasing your risk of this condition but here is what we can offer if you are keen to do it.  But even if you approach in the right way, people don’t always welcome it.”

Breaking the cycle

Suzanne Richardson is six months pregnant with her second child. At sixteen and a half stone (105kg) Suzanne is extremely self conscious about her appearance but says she was happy to get advice after raising the issue of her weight with the midwife.

“I brought it up and asked for help.  I think if they had told me I had a problem I might have been embarrassed or even offended but I would still have wanted to make changes.”

Since going to see the dietician the only weight the 27 year old has gained is the weight of the baby. During her first pregnancy with three year old son Scott, Suzanne says her weight was a constant strain resulting in severe back pains.

The former hairdresser who lives in Carnwath, Lanarkshire, said she first got into bad eating habits at work.  “I got into terrible habits eating rubbish at work, for quickness.”  And a bad diet was compounded with depression.

“It was a shock when I found out I was pregnant again.  Everything kind of happened at once.  I got depressed and most of the time how I looked made me feel worse.”

Now she feels more confident that she can break the vicious cycle and make long term changes to her lifestyle with ongoing support.  “Before I was pregnant again I was trying all kinds of dieting fads, meal replacement programmes, ‘skinny water’ and appetite suppressants.  And I was neurotic about it, constantly checking my weight on the scales.  Now I leave the weighing to the dietician and I am eating the sensible way.”

“I used to never eat breakfast but now stick to eating little and often and I have cut back on quick fixes like crisps.  Instead of fizzy drinks I will eat a bit of fruit.  I will definitely keep going to the dietician for advice after the birth.  It was really hard at first but it makes all the difference having somebody there to give you that kick start.”

Initially, the advice Suzanne received from the dietician and midwife shocked her but she says she was surprised by mothers who have turned down the chance to get dietary advice.  “I found out about the risks and it was frightening.  You have to sit down and think seriously about how much you are putting you and the baby at risk.  If you have the chance of getting a helping hand you should take it.”

Suzanne wants to get back to a more healthy weight for her self esteem and her family’s quality of life.  “I want to be able to do more with my kids, not just sit at the side and watch them play but have the energy to join in so we can all enjoy our time together.”