Being seriously overweight during pregnancy increases dangers for both mother and unborn child, but little is being done to help obese mums-to-be, says a leading researcher in the field.
Dr Nicola Heslehurst, from Teesside University's Health and Social Care Institute, led a team of academics from the universities of Teesside, Newcastle and Durham looking at the provision of clinical and support services for obese pregnant women.
They found that maternal obesity has more than doubled over the last two decades with one in six pregnant women now facing extra risks to themselves and their babies.
More than half the women who die in pregnancy or childbirth are obese or overweight and being seriously overweight increases the likelihood of conditions such as cardiac disease, diabetes and pre-eclampsia and can be a contributing factor in stillbirth, congenital anomalies and prematurity.
"But very little is being done nationally to support women in achieving a healthy weight before bearing children", says Dr Heslehurst, whose study of births around the country was published in the International Journal of Obesity. "Despite the potential risks, there is no strategic public information campaign."
Her study found wide regional variations for maternal obesity, ranging from just over 13% in London to nearly 22% in the West Midlands.
"Once obese women become pregnant there are still things they can do to minimise the potential for complications for themselves and their babies, such as healthy eating and moderate levels of physical activity," says Dr Heslehurst.
In joint research funded by Public Health North East and published in the journal Midwifery, Nicola's team found improvements to obesity services at North East maternity units over the last four years.
The main advances related to health and safety, such as the provision of more suitable equipment, including sturdier beds and operating tables. However, the lack of services to help mothers tackle their weight problems had still not been addressed, and there was a lack of partnership working between public health and maternity services. No weight gain guidelines were in place, for example.
"Mothers were being told they were putting their babies at risk and were then left to deal with it themselves, largely due to a lack of national guidelines for this type of advice and support for women," says Dr Heslehurst.
The lack of weight management services and weight gain guidance made it difficult for midwives to discuss obesity with women during pregnancy. "Midwives seek to build up a good relationship with women and they struggle to know how to initiate discussion with them about their weight as it is such a sensitive issue," says Dr Heslehurst.
"There is an urgent need for obesity training for midwives and better communication between the public health and maternity services," she says.
Lessons could be learned from the development of smoking cessation services during pregnancy, she suggests. Midwives participating in the study felt that the national drive for smoking cessation with its structured training, support and funding had worked successfully, whereas previous local initiatives without that level of strategic support had failed.
By 2050, two-thirds of adults and one-third of adolescents could face obesity in the US