Obesity in pregnancy

Weight gain in pregnancy varies and depends on the woman’s weight before pregnancy. Most women put on 10–12.5kg (22–28lb) over the whole of their pregnancy. Too much weight gain can affect health and increase blood pressure. But, equally, it’s important that pregnant women do not diet.

Women who are overweight or obese before they conceive have an increased risk of complications during pregnancy and birth, which poses health risks for both mother and baby in the long term. There is evidence that maternal obesity is linked to health inequalities, particularly socio-economic deprivation, inequalities within ethnic groups and poor access to maternity services.

Women who are obese during pregnancy should be supported to adopt healthy eating and participate in moderate physical activity.

Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight

The Route Map Towards Healthy Weight sets out early years as a key target group. To give children the best start in life, early life interventions need to begin before and during pregnancy and continue through infancy, in early years settings such as nurseries and child minders, and at school. The early years offer the best opportunity to put in place healthy behaviours around food and physical activity which will be sustained into adulthood. Central to this is the involvement of families, and every opportunity must be taken by all involved to shape and deliver services using health professionals and the third sector in a way which best provide support.

The rise in the number of women who are obese during pregnancy gives cause for concern due to the risks that obesity poses to the health of both the mother and infant, as well as its influence on long term adult health. Maternal obesity can have an adverse effect on birth weight which, in turn, may affect risk of obesity later in life.

In infancy there is evidence that breastfed babies show slower growth rates which may contribute to the reduced risk of obesity later in life shown by breastfed babies. Infants who gain weight rapidly in the first two years of life are more likely to be overweight later in childhood. There is also evidence to suggest that infants who are weaned onto solid foods at an early age (before 15 weeks) are more likely to be overweight later in childhood.
The map sets out the following actions to encourage healthy behaviours around food and physical activity in the early years by:

  • Promoting positive environments for children and families through all aspects of planning, regeneration and transport policies.
  • Implementing the Maternal and Infant Nutrition Strategy.
  • Continuing to develop and roll out the Getting It Right For Every Child change management programme for services affecting children and young people, founded on wellbeing indicators including healthy and active that encourage attention to diet and activity.
  • Investing to ensure that all pregnant women, and women who have children aged under four, who are eligible for Healthy Start are aware of, and apply for the Healthy Start vouchers.
  • Investing to ensure that more babies are breastfed, and for longer.
  • Investing to support pregnant women and new mothers to develop healthy lifestyle behaviours, for example through the key elements of parenting programmes and community capacity building in The Early Years Framework.
  • Investing to support parents’ knowledge about how they feed themselves and their babies particularly when babies make the transition onto solid foods.
  • Investing in a programme of education and support for health professionals on maternal and infant nutrition to provide the best quality information and support to all women about how they feed themselves and their babies.
  • Investing in communications aimed at women of childbearing age (pre-conception) about the relationship between maternal obesity and adverse outcomes in pregnancy.
  • Ensuring that the guidance set out in Nutritional Guidance for Early Years is implemented across all services for children between 1-5 years old, regardless of the providers of those services.
  • Supporting the third sector to increase opportunities for play through our investment in Inspiring Scotland's Go Play Programme.
  • Ensuring that nurseries and other childcare facilities minimise sedentary activities during playtime, and provide regular opportunities for enjoyable active play and structured physical activity session.

The Centre for Maternal and Child Enquiries (CMACE) and the Royal College of Obstetricians and Gynaecologists (RCOG) produced joint guidelines on the care of women with obesity before, during and after pregnancy in England. The guidance includes standards of service provision for local maternity units and addresses many of the needs stated above as trusts and maternity units will now have evidence-based national guidelines to ensure that obese mothers-to-be are given appropriate care and treatment during pregnancy.

Upcoming publications on obesity and weight gain in pregnancy

NICE Public Health Guidance on weight gain in pregnancy will be published in August 2010 and you can view the consultation documents. NHS Health Scotland will produce a Scottish Perspective on the NICE guidance in November 2010.

The Scottish Perspective on NICE Public Health Guidance 11 gives recommendations to improve the nutrition of breastfeeding mothers and children in low income households. Recommendation 6 focusses on obesity.

Recommendation 6 (obesity)

Target population

Pregnant women who have a pre-pregnancy body mass index (BMI) over 30, and those with a BMI over 30 who have a baby or who may become pregnant.

Who should take action?

Obstetricians, gynaecologists, GPs, midwives, health visitors, nurses, dietitians, those working in contraceptive services or on weight management programmes (commercial or voluntary).

What action should they take?

Actions should be taken which are appropriate to professional group. Inform women who have a BMI over 30 about the increased risks this BMI poses to themselves and their babies and encourage them to lose weight before becoming pregnant or after pregnancy.

Provide a structured programme that:

  • Addresses the reasons why women may find it difficult to lose weight, particularly after pregnancy
  • Is tailored to the needs of an individual or group
  • Combines advice on healthy eating and physical exercise (advising them to take a brisk walk or other moderate exercise for at least 30 minutes at least five days a week)
  • Identifies and addresses individual barriers to change
  • Provides ongoing support over a sufficient period of time to allow for sustained lifestyle changes

Health professionals should refer pregnant women with a BMI over 30 to a dietitian for assessment and advice on healthy eating and exercise. Weight loss during pregnancy should not be advised.

Health professionals should advise breastfeeding women that losing weight by eating healthily and taking regular exercise will not affect the quantity or quality of their milk.

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