Impact of maternal obesity on the NHS

A new study reveals the true costs of the increase in maternal obesity and how it is impinging on service delivery in the NHS

It was carried out by The Centre for Food, Physical Activity and Obesity Research at the University of Teesside with 33 healthcare professionals based in the North East of England recruited for the study.

The results are published in this month's BJOG: An International Journal of Obstetrics and Gynaecology.

Previous studies have concentrated on the effects of obesity on pregnant women and the subsequent public health risks.

The findings of this study uncover 5 recurrent themes relating to maternal obesity: booking appointments, equipment, care requirements, complications and restrictions and current and future management of care. The main points are summarised below.

Obese patients require specialised equipment for surgical deliveries including theatre tables and scales. Other equipment such as specially modified ward beds, chairs and wheelchairs are required. The costs of these, though considered less-expensive, are cumulative.

More guidance is required in antenatal and postnatal care provision as obese women have higher levels of maternal morbidity and a higher dependency on care. The risks involved include misdiagnosing conditions such as high blood pressure and determining fetal size. There is more demand for one-to-one specialist care, specifically, for a consultant obstetrician to be available at the time of birth rather than a registrar. All those interviewed also agreed that multidisciplinary care (MCD) is needed, with dietetic and physiotherapy services working with maternity units when caring for an obese patient. Given these extra demands, there are further implications on waiting times and staff resources.

Obesity results in problems for the mother throughout the antenatal period. Common problems include deep vein thromboses (DVT), incontinence, diabetes and pre-eclampsia. Problems extend into the labour stage such as the need for increase pain relief and reduced mobility for women during labour. Complications during delivery for the baby include fetal distress and birth trauma. Postnatal problems for obese mothers include increased support for breastfeeding, and a higher rate of infection because of the slower rate of healing in obese women.

Maternal obesity also reduces patient choice. There are restrictions for pool and, in some cases, home births. Given the higher incidence of emergency interventions, emergency caesareans are usually carried out for obese patients.

Better and more consistent maternal nutrition guidelines are needed. Pregnant women that are obese need to be informed about the appropriate weight gain and made aware about the issues surrounding their condition and how to manage the potential risks to mother and baby if weight is not controlled.

Healthcare professionals agreed that consistency of tone is required in the way obese women are communicated to given the difficulties and emotions involved. There is a need to strike a balance between providing information and doing it sensitively so patient dignity is maintained. Similarly, obese mothers need to realise that they must take responsibility by managing their body weight sensibly.

Lead researcher Nicola Heslehurst 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 getting extremely concerned about the apparent increase in the number of women who were 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. 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"

Professor Carolyn Summerbell, who heads up the University of Teesside's Centre for Food, Physical Activity and Obesity Research, said: "We're not trying to blame or stigmatize obese pregnant mothers and we would certainly not recommend that overweight mums-to-be go on crash diets. But our initial findings show reasons for concern with obese pregnant mothers, and there is a lack of weight management guidance and support readily available for them".

Prof. John Wilkinson said "Until the late 1980s the height and weight of pregnant women was regularly monitored. But 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 our study recommends that a routine system of monitoring the height and body weight of pregnant mothers is extended to all maternity units. This will allow comparisons between different social groups, ages and whether the mothers were having their first child and whether they were in employment. It will also enable us to judge the effectiveness of health promotion activities aimed at pregnant mothers."

Dr Judith Rankin, Associate Director of the Regional Maternity Survey Office (RMSO) and a partner in the study, said: "This research will help to inform the NHS about the changes needed to the way service delivery is carried out and how the information is collected."

Professor Philip Steer, editor-in-chief of BJOG said, "Over the years, the obesity problem has slowly crept up on us and now has the potential to assume epidemic proportions if we are not careful."

"Based on the findings of this piece of research, we know the economic and social impacts of maternal obesity. Action is needed to ensure that the problem is dealt with immediately, with the sensitivities of all involved carefully considered. Much forward planning and co-ordination is required and public education campaigns should focus on a healthy lifestyle agenda, starting in our primary schools. We need to nip this in the bud or maternity services will suffer as a result."