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ATTITUDES TO OBESITY IN PREGNANCY AISHA ALZOUEBI, PENELOPE LAW AND SOTIRIOS SARAVELOS

HILLINGDON HOSPITAL AND IMPERIAL NHS TRUST

Background

The prevalence of obesity is rising. The WorldHealth Organization estimates that more than 1billion people are overweight, with 300 millionmeeting the criteria for obesity. Rates of obesity in pregnancy are rising across the UK with over 20% of women being classed as obese (BMI>30) and 1 in every 1,000 being classed as having extreme obesity (BMI >50).Maternal obesity is associated with infertility, gestational diabetes, pregnancy induced hypertension and pre-eclampsia, thrombo-embolism, fetal anomalies, macrosomia, caesarean sections, prolonged labour, neonatal death and postpartum anemia. Consequently obesity during pregnancy is related to higher overall health care expenditures, measured by length of stay after delivery and use of other services.Overweight women of childbearing age should be informed of the risks associated with pregnancy and receive appropriate dietary counselling. These women should be screened for hypertension and carbohydrate intolerance and encouraged to perform physical activity. Stable, pre-pregnancy weight loss in obese women markedly reduces the occurrence of maternal complications during pregnancy.This highlights the importance of pre-conceptual advice, the setting up of specialist clinics in order to cater to this high risk population.

Objectives

Questionnaires were sent out to 100 midwives and 100 obstetricians. The questionnaire asked about words used, counselling and attitudes to pregnant women with BMIs of greater 30. The questionnaire also focused on the health professional’s training on obesity during pregnancy. The questionnaire was also devised to assess the knowledge of obstetricians and midwives of the current NICE guidance on weight management before, during and after pregnancy (July 2010).

The following areas of the NICE guidelines were assessed:• Appropriate assessment and classification of body weight• Recognising the psychosocial implications of obesity• Appropriate counselling of obese women regarding maintaining a healthy diet during pregnancy• A healthy diet would include eating breakfast, cutting out fizzy drinks, fatty foods and regular exercise• Knowledge of effective weight loss programmes • Familiarity with tailoring weight loss programmes according to the individual while identifying barriers to change• The role of the multidisciplinary team approach to managing obesity in pregnancy

Results

There was a 73% response rate. 61% of health professionals felt uncomfortable telling a patient that she was overweight or obese. Only 2% of doctors had seen patients for pre-conceptual advice.

Conclusions

References

Obstetricians and Antenatal clinic midwives were unprepared for talking to women about their weight. Unfortunately old myths about diet and exercise were being offered to patients. Very little training had been given to these health professionals. It was noted that there are an increasing number of patients attending antenatal clinics whom have had bariatric surgery. Managing these patients within a multi-disciplinary team is critical in order to reduce the morbidity and mortality rate of this high risk group. Increasing the confidence and skills of staff in offering service innovations to eligible women is a major challenge to be met if new models of care are to be successful in addressing overweight and obesity in pregnancy¹.

1. Davis DL, Raymond JE, Clements V, Adams C, Mollart LJ, Teate AJ, Foureur MJ, Addressing obesity in pregnancy: The design and feasibility of an innovative intervention in NSW, Australia. Women Birth. 2011 Sep 172. Weight management before, during and after pregnancy, NICE, July 2010

Methods

To find out the understanding and attitudes of obstetricians and midwives towards overweight and obese pregnant women and their management.

Prevalence of obesity in females aged 16-44 years

Figure 1

Data from the UK National Obesity Observatory

Recommendations

•All women with a BMI of greater than 30, whom plan on conceiving should be referred to a specialist antenatal clinic.•This clinic should provide pre-conceptual advice.•It should include the following health professionals; Obstetrician, Midwife, Dietician and Counsellor /Psychologist.•This clinic should also be offered to postnatal women with a BMI of 30, who plan on conceiving again.•Formal training should be given to doctors and midwives. This can be a formal course or E-learning packages

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