An unhealthy growth curve

Obesity is the root of numerous health risks, from heart disease to cancer. But obseity can also be life-threatening to pregnant women and has major repercussions for the health service as Alison Utley reports.

Obesity is set to overtake smoking as the greatest cause of premature loss of life. So it comes as no surprise that maternal obesity is also on the increase, leading to more serious complications throughout pregnancy. The Confidential Enquiry into Maternal and Child Health, for instance, reported that 35% of all maternal deaths in 2000-02 were in obese women.

Until recently there was an absence of national, regional or local statistics on the extent of maternal obesity, making planning and budgeting for health services very difficult. But now research carried out by the University of Teesside shows that the problem is particularly acute in the North East and is putting a strain on health services there.

As a result, maternity services in the region are tackling obesity as a priority. Lead researcher Nicola Heslehurst, from the School of Health & Social Care, said the research team was alerted to the growing problem by anecdotal evidence from midwives and other staff in maternity units in the region who were extremely concerned about the apparent increase in numbers of women who are obese at the start of their pregnancy.

‘Doctors and midwives in the region have expressed concerns about the increase in complications that can arise when mums are obese’, she said. ‘One of the problems is that sometimes you can't see the ultrasound scan of the baby properly in obese pregnant women and this can lead to clinical problems as well as being upsetting for the parents who are not able to see a picture of their baby.’

The researchers carried out interviews with all the maternity units in the North East. They found there were more obese mothers encountering problems during their pregnancies. This impacted significantly on the antenatal care requirements.

Diabetes and high blood pressure were common complications. But other difficulties arose from the additional procedures needed to monitor and manage obese patient care. One interviewee said:

‘The excess layers of fat make it more difficult to palpate to determine fetal lie when the mother is obese, and there are difficulties when doing ultrasound scans and listening to the fetal heart. During labour it is more difficult to pick up the contractions and fetal heart rate, and this can lead to misinterpretation of what is being picked up, which determines the outcome. For example the labour might be misinterpreted as being abnormal which could lead to an unnecessary change in the plan of action, caesarean etc.’

Another highlighted practical complications stemming from obesity. Obese women tend to stay longer in hospital, typically five days, because they’re more likely to develop pre-eclampsia, or complications with wound healing and wound infections after surgery.

Many of the complications and restrictions addressed by the health-care professionals were significant throughout the entire pregnancy, the researchers discovered. Reduced mobility also added to the risk factors and required more frequent administering of pain relief. Difficulties with lifting and handling for staff were also highlighted, along with the difficulty of administering pain relief and analgesia.

Professor Carolyn Summerbell, head of the University of Teesside's Centre for Food, Physical Activity and Obesity, said, ‘We're not trying to blame or stigmatise obese pregnant mums and we would certainly not recommend that they go on crash diets. But our initial findings show reasons for concern, and there is a lack of weight management guidance and support readily available for obese pregnant mothers’.

The research uncovered a series of implications for maternity services, including:

• need for stronger equipment such as delivery beds to support heavy-weight mums
• reduced patient choice and discouraging home births
• more referrals to consultants rather than midwifery-led care
• ruling out the use of birthing pools or alternative delivery methods
• an increase in caesarean sections.

Professor John Wilkinson, Director of the North East Public Health Observatory, said, ‘We knew there was a problem with childhood obesity and with older adults but maternal obesity is something that has crept up on us. We had some evidence and were aware that heavier women were coming in to book a pregnancy, but we needed some hard evidence’.

Until the late 1980s the height and weight of pregnant women was regularly monitored, he added. ‘This became unfashionable in recent years as it was felt this caused unnecessary concern and worry to women who had gained a couple of extra pounds. But the study now recommends that a routine system of monitoring the height and body weight of pregnant mothers is extended to all maternity units.’

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