Antenatal Weight Management
Ailsa Millen
Healthy Lifestyle Midwife
A Big Problem?
 One fifth of pregnant women in the UK are
obese.
 Maternal obesity has become one of the most
commonly occurring risk factors in obstetric
practice.
 Obesity has overtaken smoking as the biggest
threat to women during pregnancy.
The Future
 By 2050 it is estimated that 50% of all women will
be obese and obesity-related diseases will cost the
NHS an extra £45.5 billion per year.
 It is increasingly recognised that pregnancy and
early years are the intervention opportunities most
likely to impact on the obesity epidemic.
The Deadly facts
 Obesity in pregnancy is associated with a higher
risk of morbidity and maternal death.
 The Confidential enquiry into Maternal and Child
Health (2007) found that over half of mothers who
died in pregnancy, childbirth or within 42 days of
childbirth, were either overweight or obese.
Risks of obesity during pregnancy
GESTATIONAL
DIABETES
MISCARRIAGE
PREMATURE
LABOUR
HYPERTENSIVE
DISORDERS
THROMBO
EMBOLIC
DISORDERS
OBESITY
PREECLAMPSIA
BIRTH
COMPLICATIONS
ABNORMALIITES
P/N
INFECTION
HAEMORRHAGE
Risks to the infant
PRE-TERM
BIRTH
MACROSOMIA
LATE
FETAL
DEATH
OBESITY
CLEFT LIP
&
PALATE
NEONATAL
HYPOGLYCAEMIA
SHOULDER
DYSTOCIA
CONGENITAL
ABNORMALITIES
Impact on the NHS
 Increased need for specialized equipment
Higher levels of care requirements
Increased costs
Increase in maternal complications
Implications for the infant
Intrapartum Care
 Specialist furniture
 Difficulty in gaining venous access
 Difficulty in blood pressure monitoring
 Difficulty in monitoring the fetal heart
 Difficulty in performing vaginal examinations and
fetal blood sampling
 Increased incidence of failure to progress
 Increase in instrumental deliveries and LSCS
 Increased risk of shoulder dystocia
 Anaesthetic problems
 Increased risk of infection, haemorrhage &
thrombosis
Findings locally
 1 in 3 of women who book at Lincoln County Hospital have
a BMI>30.
 Increase in the number of women with BMI>40 and
BMI>50.
 Asked to carry out an audit in 2009 regarding outcomes of
women with BMI 30-40.
 Results were shocking!
Audit Results
 Small sample of 30 women with BMI 30-40 (control group
of 30 women with BMI 20-25).
 50% (15%) had induction of labour (IOL).
 IOL for raised BP 87% (0).
 Emergency LSCS 24% (4%).
 Normal birth 66% (81%).
 Raised BP 64% (4%).
 Pre eclampsia 34% (4%).
Audit Results Cont’d
 Stillbirth 4% (0)
 Antenatal haemorrhage 17% (11%).
 Post partum haemorrhage 17% (4%).
 Difficult to scan/monitor 67% (0).
 Premature labour 20% (4%).
 Baby >4000g 13% (4%).
 Baby <2500g 13% (8%).
Weight Management in Pregnancy
 Dieting is not recommended!
 Excessive weight gain needs to be prevented.
 Ensure a nutritionally adequate diet.
 Moderate exercise on a regular basis unless
contraindicated.
 Currently in the UK there are no National Guidelines for
weight gain in pregnancy.
 We use the USA Institute of Medicine recommendations
which state a weight gain of 5-9kg for women with a booking
BMI >30.
New Service in Lincoln
Bumps
&
Beyond
Service in Lincoln BMI>35
 Extra A/N appointment with dedicated Consultant at 14
weeks also see Healthy Lifestyle Midwife ensures relevant
prescriptions and appointments are organised.
 Seen seven times throughout pregnancy at one-one
appointments and once post-natally.
 Sessions on nutrition, exercise, food labelling, shopping,
behaviour change, goals etc.
 Pilot in Lincoln, will be rolled out across the county.
Any Questions?
4-7 Year Old Weight Management Service
• Pilot project covering 3 areas: Spalding, Skegness &
Coastal and Gainsborough.
• Over-riding aim of the programme is to ensure that all
children within these areas have a healthy weight by
being physically active and eating healthily.
• Programme designed by Phoenix Weight Management
Team.
4-7 Year Old Weight Management Service
4-7 ‘s – Meet the Family!
Amy the Aubergine
Broccoli Spears
4-7 Year Old Weight Management Service
Chill & Lee
Paul the Pineapple
4-7 Year Old Weight Management Service
Sammy Strawberry
Lincolnshire Obesity Rates 2009/10
School
Year
Weighed
Obese
2009-2010
Overweight
2009-2010
Healthy Weight
2009-2010
Reception
724 children
(10.8%)
1007 children
(15%)
4954 children
(74%)
1024 children
(15.5%)
4328 children
(65%)
(England 9.8%)
Year 6
1298 children
(19.5%)
(England 18.7%)
4-7 Year Old Weight Management Service
• Children identified by NCMP measurements.
• Parent and child invited to attend the one year
programme consisting of 12 weekly sessions, first and
last being on a one to one basis.
• Remaining 10 sessions held in groups.
• Follow up sessions every 3 months.
4-7 Year Old Weight Management Service
• Different topics each week.
• Healthy Eating, food groups, shopping.
• Portion size, lunch boxes, snacks.
• Being active, reducing amount of ‘screen time’.
• Topic based activities for parent and child to take part
in.
• Interactive sessions.
4-7’s Activity
• In Gainsborough a qualified fitness instructor will
facilitate the activities for the children.
• They have already done a lot of work with schools
using the framework of ABC (agility, balance and coordination) with activities.
• Family vouchers towards roller skating, swimming etc.
• Possibility of some free ‘boot camp’ days for the
children in the summer holidays.
4-7 Year Old Weight Management Service
• Very early days!
• Watch this space!
Bye for
now!!