The implications of obesity as it relates to pregnancy and childbirth are many. Obese women may have health issues that predate conception, such as having a greater chance of high blood pressure and heart attack. BBC News has reported today the findings of the Centre for Maternal and Child Enquiries (CMACE) that obese women are under-served by the NHS hospital ante-natal and maternity units.
Obesity is the next step up on Body Mass Index (BMI) charts from "overweight," having a score of 30 - 32; morbidly obese at 33 and upward. Once pregnant, an obese woman present a higher than average health risk to herself and to her fetus, including gestational diabetes, pre-eclampsia and stillbirths. However, there are financial implications too, as they require hospitals to cater to special needs, including extra-wide operating tables, beds and staff on hand. According to CMACE findings, only half of the 320 units examined regularly assessed the extra support and services and equipment an obese woman may need.
Obesity is a growing health problem in the UK, as 20% of pregnant women are said to be obese. This brings up the issue of self-determination, confused by the right and ability of a national health service to control their use of public funds.
- Is obesity a personal issue or a nation-wide trend?
- Is obesity so common now that it is considered a medical condition?
- Can the NHS effectively turn the trend around by stepping up and offering more information, guidance and treatment for obesity beginning in adolescence?
- Would earlier monitoring and treatment, as above, be more cost-effective than special treatment for obese women in pregnancy?
- Assuming that a pregnant woman has the right to be treated for maternity under the NHS regardless of her size and weight, could she be simultaneously required to enroll in a nutritional and fitness program in order to lose some of the weight?
- Should the onus of responsibility for a woman's pregnancy health rest with her, her GP or the Ante-Natal supervisory team at the hospital? By two of these, or all three?
Obesity is not a new issue, relative to maternity. In January, I wrote about guidelines suggested by the European Society of Human Reproduction and Embryology (ESHRE) that would have fertility clinics turning down obese women for IVF if they refused to make positive lifestyle choices in regard to weight (also alcohol and cigarette smoking). This topic didn't seem to get much press attention or many comments on social media like Twitter, or on my blog. However, combined with the CMACE findings, it presents a picture of obesity in the female population of the UK and far-reaching effects:
- Elevated levels of childhood obesity, due to overeating and under-exercising;
- eating as a lifestyle choice (social gathering, entertainment, boredom), rather than from a nutritional perspective;
- earlier onset of menstruation than in previous generations;
- a lack of education, during adolescence and young adulthood on the health benefits of achieving a weight in the "normal" BMI range;
- higher-than-ideal weight beginning in young adulthood due to poor eating habits;
- a fast-food culture that has overtaken family meals around the breakfast or dinner table;
- ignorance of the detrimental effects obesity could have on them and their baby;
- inadequate supervision of a woman's weight gain during pregnancy (It's been many years, however, I distinctly remember asking why I wasn't weighed in the ante-natal clinic. I was told it was no longer policy to weigh pregnant women after the first intake.);
- Inadequate measures and/or equipment in hospital to cope with problems related to a pregnant woman's obesity; and
- no follow-up with a woman after her baby's birth to ensure that she lose that extra weight before trying to conceive again.
In a country that does not have a national health service, it would be almost, if not totally, impossible to create a nationwide scheme to reverse the ever-growing trend toward obesity. Since the UK is under that system, it seems like new measures should be put in place now. We know that the onset of menstruation is linked to a girl's weight. A girl needs to have reached what is called the critical weight, approximately 45kg (101 pounds), before menstruating begins. Girls who are moderately obese, start menstruating earlier. That mothers are on alert these days for their daughter's first period, beginning at age 9/10 (School Year 5 in the UK), is indicative of the average girl's weight reaching 45kg earlier in her life.
Were GP surgeries to provide girls of age 8 or 9 years and their mothers with access to workshops, leaflets of information about their bodies and imminent changes they will experience, suggestions of healthy weight ranges, a balanced diet and the benefits of exercise, it could reduce the number of girls entering teen years and obesity simultaneously.
It's not such a radical idea. We already get reminders from the local Health Authority of the vaccinations that are directed specifically to higher than average incidents of particular diseases in a particular area. If cost is the issue (and when isn't it?), I have a few thoughts:
- institute the program through the health visitor scheme, inviting every girl in the patient database in for a group talk every year or two;
- send trained health workers into primary and secondary schools, rather than using the teachers; and
- perhaps most radical:
- when a female patient notifies her GP of her pregnancy, she should be weighed at the surgery.
- Her ante-natal care should then include a nutritional plan appropriate to both her BMI and her pregnancy and help with implementing it.
- Supervision - If she is weighed at every ante-natal appointment, someone at the surgery can help her keep her weight gain to a minimum.
- She should be offered some sort of behavioural therapy, whether CBT, NLP or other coaching or counseling help.
- The GP should then notify the hospital ante-natal department of the need for special measures as applicable.
Even a small, positive change could make a difference within the generation of women who are of child-bearing age right now, but certainly within the generation of girls being born now.
While I will admit that being overweight or obese and being pregnant obviously pose significant risks, I hate the way that if a women is even slightly overweight and infertile, Dr's immediately ten to go down the route of "oh if you lose weight you should be able to get knocked up easily", the two are not directly linked to each other. Sure being overweight doesn't help with fertility but I know plenty of overweight and obese women who have gotten knocked up and had healthy pregnancies no problem.
This is of course a no brainer, but you should be as healthy as possible when contemplating a pregnancy.
In regards to turning down obese women for IVF unless they agree to make changes to their lifestyle. Not all weight issues are because you shove too much food in your gob, some are actually genetic. And the BMI that dictates whats considered overweight and obese isn't an accurate portrayl in my opinion. The All Blacks were recently measured via the BMI and there were a fair few of them that were considered not only overweight but obese!! And it's very obvious that they are not.
ICLW
#101
http://thegalwho.wordpress.com/
Posted by: Rach | March 21, 2010 at 03:32 AM
Another great article as usual. Happy march iclw.
Posted by: Wishing4One | March 21, 2010 at 10:24 AM
Fabulous article. Although, I am not 'overweight' (as I have huge thighs from speedskating) my BMI is labeled as 'overweight', but I take any advice about the weight and conception seriously.
Liddy from
No. 144: the unfair struggle (male-factor, speedskating, life)
Posted by: Liddy | March 21, 2010 at 03:25 PM
Hi Liddy,
As I have struggled with my weight for a long time, I don't make judgments about anyone else's. I understand how difficult it is for some people to maintain a healthy weight, whether because of bad habits, or what food represents to some people.
What I look for in anyone TTC, is how badly do you want that baby? If it's more important than anything else, it's more important than eating big quantities, or particular foods. There are a few pieces to the puzzle. Self-awareness, honesty with yourself (not meaning "you"), commitment and action. People who do things that they know are bad for them, lack the honesty and commitment. With TTC, they have to decide whether they have the commitment to conceiving a healthy baby, and being healthy enough themselves to take care of that baby.
Thanks for commenting. Having watched Olympic speedskating on TV, I am in awe of what you do. It's a great sport.
Lisa
Posted by: Lisa | March 27, 2010 at 10:19 AM