Pregnancy

Pregnancy

This section aims to provide you with information about nutrition and physical activity in pregnancy.
Obesity in pregnancy has been recognised as a significant risk factor for both the mother and the child. The Confidential Enquiry into Maternal and Child Health (CEMACH) state that “The magnitude of risk means that obesity represents one of the greatest and growing overall threats to the childbearing population of the UK” (Centre for Maternal and Child Enquiries, 2007).
The Public Health Wales Reproductive and Early Years pathfinder project was set up to explore how Public Health Wales can:
  • Add value to public health activity in Wales by bringing focus and leadership to an important area of health gain;
  • Draw upon and help coordinate existing expertise and functions across Wales including Public Health Wales itself, academia, and other health partners and agencies.
In January 2012 the project published a progress report for phase one of the project. Appendix two: Reproductive and Early Years Evidence for Interventions (as of October 2011)includes an indicator for maternal obesity, it’s background, evidence for interventions, interventions in place, surveillance and references.

European Food Information Council ‘Weight Issues Associated with Pregnancy’ gives a good overview of the topic area.

Policy and Strategy

Welsh Government (2011) A strategic vision for maternity services in Wales sets out the Minister’s expectations of the NHS in delivering safe, sustainable and high quality maternity services, and highlights three priorities for NHS Wales to focus on:
  • Organising maternity care to meet the needs of women and their babies
  • Protecting and improving the health and well-being of mothers and their babies
  • Ensuring pregnancy and childbirth is a safe, fulfilling, life-enhancing experience.
The guidance emphasises that it is important to help women lose weight before they are having a baby and that dieting during pregnancy is not recommended. Furthermore it states that:
  • there is no need to ‘eat for two’ or drink full-fat milk
  • moderate-intensity physical activity will not harm the mother or baby
  • there are no formal evidence-based guidelines from the UK Government or professional bodies on what constitutes appropriate weight gain during pregnancy.
Centre for Maternal and Child Enquiries /Royal College of Obstetricians and Gynaecologists (2010) Joint Guideline Management of women with obesity in pregnancy – Local maternity services may wish to implement these standards for all women with maternal obesity. They include that “Links with existing public health services for effective weight management should be made at local levels, and pathways for referral into these services incorporated into local maternity guidelines for preconception, antenatal and postnatal care.”
Royal College of Obstetricians and Gynaecologists (2006) Exercise in Pregnancy Statement Number 4 – This statement has been designed to aid women and their care providers as they discuss the relative merits of aerobic and strength-conditioning exercise in pregnancy and the postpartum period.

Data, Research and Surveys

The Centre for Maternal and Child Enquiries released results from a survey on NHS maternity provision for obese women and published guidelines in March 2010.
Key findings include
  • The majority of maternity units routinely provide care to women with obesity
  • 124 (44%) maternity units did not have local guidelines for the care and management of women with obesity
  • Patient information about maternal obesity should be developed. 49 (18%) maternity units currently provide printed information for women.
Maternal obesity (defined as obesity during pregnancy) is significantly more likely to occur in older women and those who live in areas of high deprivation. The National Obesity Observatory (NOO) (England) have developed detailed information on the public health aspects of maternal obesity including the epidemiology of maternal obesity; the effects of maternal obesity on maternal health and child health; and the evidence and guidance on maternal obesity. For more information please visit the NOO website.
Thangaratinam, S., Rogozinska, E., Jolly, K. Et al (2012) Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. British Medical Journal 344:e2088
The research into nutritional programming (or the ‘foetal origins of disease’ as it is sometimes known) is growing rapidly. The nutritional conditions that exist while a baby is developing in the mother’s womb, and the nutrition it receives during infancy, affect a person’s development and future health. This seems to be especially true for some chronic diseases such as heart disease and diabetes. It is thought that there are critical periods during pregnancy and infancy where ‘nutritional programming’ occurs.
For more information –
Harding, J.E. (2001). The nutritional basis of the foetal origins of nutritional disease. International Journal of Epidemiology 30 (1) 15-23.
Barker D.J. (1997) Fetal nutrition and cardiovascular disease in later life. British Medical Bulletin 53 96–108.
The Barker Theory – A Public Health Overview by Dr David Barker
European Food Information Council (EUFIC) Nutritional programming – mother’s diet and baby’s health

Healthy Eating and Lifestyle in Pregnancy (HELP) Study
The Healthy Eating and Lifestyle in Pregnancy (HELP) study is a large multicentre randomised controlled trial which aims to assess whether a weight management intervention for obese pregnant women, which targets physical activity and healthy eating, is effective in reducing women’s BMI at 12 months from giving birth. The study is being run by the South East Wales Trials Unit (SEWTU) in Cardiff University. The HELP trial was developed from a pilot study conducted and funded within Cardiff and Vale University Health Board working in collaboration with Slimming World.

There is an identified need for effective interventions that assist pregnant women in managing their diet and activity levels. A small prospective study by Swansea University, using mixed methods, has been published looking at the feasibility and acceptability of a newly devised intervention programme called ‘Eat Well Keep Active’; an intervention programme delivered to 20 women early in their pregnancy.

Campaigns

Go Folic!

Go Folic! calls on all women who might become pregnant to take folic acid each day, as recommended by the NHS to help prevent birth defects such as spina bifida.
This campaign is led by SHINE (Spina Bifida, Hydrocephalus, Information, Networking, and Equality) and the Scottish Spina Bifida Association.

Nutrition and Physical Activity Initiatives

Healthy Start is a UK-wide government scheme to improve the health of low-income pregnant women and families with young children on benefits and tax credits. It provides a great opportunity for health professionals and others working with pregnant women and families to offer encouragement, information and advice on issues such as healthy eating, breastfeeding and vitamins. Free vouchers every week to spend on milk, plain, fresh and frozen fruit and vegetables, and infant formula milk are available to those that are eligible.
National Institute for Health and Clinical Excellence (NICE) Shared Learning Database – ‘The Monday Clinic’ – Implementing a maternal obesity service, Doncaster and Bassetlaw Hospitals NHS Foundation Trust. A midwifery-led service which encourages obese, pregnant women to make positive healthy lifestyle changes in the antenatal period, which would be sustainable after the birth.

Key Resources

The Pregnancy and Baby section on the NHS Direct Wales website provides information aimed at the public around diet in pregnancy, foods to avoid and exercise in pregnancy. An alternative source of information is the British Nutrition Foundation Nutrition for baby section of the website.
Public Health Action Support Team (PHAST) developed an interactive resource to support Primary Care Trusts (PCTs) in England to develop, implement, and evaluate effective obesity care pathways in November 2010. The new resources, commissioned by the Regional Public Health Group for London (RPHG), focus on adults, child and maternal obesity. The support package is intended as a practical and concise resource to help those working at a local level who are responsible for developing and reviewing obesity pathways, and commissioning associated weight management services.
British Dietetic Association (2011) Fact Sheet Healthy Eating During Pregnancy
Royal College of Obstetricians and Gynaecologists (2006) Recreational Exercise and Pregnancy Information for You
Food Standards Agency (2002) Eating while you are pregnant
Food Standards Agency (2002) Thinking of having a baby

Useful Links