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

OBESITY

GESTATIONALDIABETES

MISCARRIAGE

HYPERTENSIVEDISORDERS

PRE-ECLAMPSIA

ABNORMALIITES

HAEMORRHAGE

P/NINFECTION

BIRTHCOMPLICATIONS

THROMBOEMBOLIC

DISORDERS

PREMATURELABOUR

Risks to the infant

OBESITY

PRE-TERMBIRTH

MACROSOMIA

CLEFT LIP&

PALATE

CONGENITALABNORMALITIESSHOULDER

DYSTOCIA

NEONATALHYPOGLYCAEMIA

LATEFETALDEATH

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 YearWeighed

Obese2009-2010

Overweight2009-2010

Healthy Weight2009-2010

Reception 724 children (10.8%)

(England 9.8%)

1007 children(15%)

4954 children (74%)

Year 6 1298 children(19.5%)

(England 18.7%)

1024 children(15.5%)

4328 children (65%)

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 co-ordination) 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!!