Safeguarding against maternal obesity

Abstract

British Journal of Midwifery • october 2012 • Vol 20, No 10 Earlier this month, the BJM held another successful study day designed to offer concentrated educational updates for busy midwives. This particular programme focused on the issue of obesity and nutrition in pregnancy. The health implications of maternal obesity for both the mother and baby are well known, yet the incidence of obesity in the UK is still alarmingly high. Just over a quarter of adults were classified as obese in 2010 (Body Mass Index >30kg/ m2) (NHS Information Centre, 2012). This has an enormous monetary impact on the already strained NHS. David Cameron, Prime Minister said: ‘[obesity] already costs our NHS a staggering £4 billion a year. But within 4 years, that figure is expected to rise to £6.3 billion.’ The question is, what can we do about this? In this issue of BJM, Helen Williams explores the value of antenatal interventions (p698) in the second of two articles discussing whether midwives are missing a health promotion opportunity. Helen concludes that despite the wealth of evidence on maternal obesity, there is a definite gap in the research on optimal weight gain during pregnancy. In the UK, there are no guidelines for this and so it is very difficult for midwives to provide evidence-based advice. The only guidance available is the one from the US developed by the Institute of Medicine (2009); however, evidence behind it is lacking. The National Institute for Health and Clinical Excellence (NICE) (2010) clearly state that weight loss during pregnancy should be avoided. But with many women presenting as obese at the time of booking, is raising awareness then already too late? It is worth noting, however, that there are still many women who, at booking, are not overweight and so nutrition guidance and health promotion at this point may help safeguard against obesity in future pregnancies. It is estimated that about 50% of normal-weight women and 65% of overweight or obese women gain too much weight during pregnancy, which is associated with high postpartum weight retention, long-term obesity, and a range of adverse maternal and fetal outcomes. The ‘eating for two myth’ needs dispelling and women should be informed early on that they only need to consume about 200 extra calories in the third trimester. In today’s climate of increasing obesity and rising birth rates, the need for evidence-based guidelines and advice becomes ever more pressing and surely must be driven from practice. BJM