Sizing up problems for obese mums-to-be
PREGNANCY is one of nature’s miracles, a time when your body will go through all kinds of changes, among them putting on a few pounds. But often, it’s not just your tummy that will grow: many women can look forward to expanding hips, bums and thighs too.
But while blossoming is one thing, carrying around kilos of excess weight is another, and recently there are growing concerns for obese mothers-to-be.
A woman with a body mass index (BMI) higher than 30 - for example, a 5ft-4ins-tall woman weighing 12-and-a-half stone - is classified as obese, and a report published this week by the Confidential Enquiry into Maternal and Child Health (CEMACH) warned that women in this category are putting themselves and their babies at risk of complications that could lead to death.
Though maternal deaths in this country are rare, the figures make for stark reading: more than half of women who die in pregnancy or shortly after giving birth are overweight or obese.
Not only that, but obese mothers-to-be are more likely to suffer miscarriage, stillbirth and early labour than women whose weight is within the normal healthy range when they are pregnant. They are also more at risk of heart disease, miscarriage, diabetes, infections and thromboembolism, where clots block a blood vessel.
“Obesity in the Lothians is an increasing problem and 20 per cent of antenatal women are obese,” says Dr Fiona Denison, clinical lecturer in obstetrics and gynaecology at the University of Edinburgh.
“As well as the health worries, providing care for these women during pregnancy can be challenging. Scanning, taking their blood pressure and even monitoring the baby’s heartbeat can be problematic.
“And when it comes to giving birth, there are safety issues, for example giving a section to an overweight woman is technically much harder.”
But Fiona is keen to stress that she does not want to make women feel guilty. “We are here to support women,” she says, “not to make them feel like it is their fault.
“All midwives are experienced in looking after women of all weights, and very overweight women will be given extra monitoring and can get extra information and advice on subjects such as their diet.”
Next year, a clinic for overweight mothers-to-be will be set up in Edinburgh. The Metabolic Clinic at Edinburgh Royal Infirmary’s Simpson Centre for Reproductive Health will open at Easter and treat up to 200 women each year who are found to be obese when they visit their midwife for their first pregnancy check at around ten-to-12 weeks.
It will be run by Andrew Calder, professor of obstetrics and gynaecology and head of reproductive and developmental sciences at Edinburgh University, and Fiona will be one of the research team. The team will include specialists from a range of disciplines including anaesthetists, dieticians and scanners.
The information gained from the patients will be used to monitor the effects of obesity on mothers and babies. Fiona says: “Being overweight worsens pregnancy outcomes, but we don’t fully understand why, and that is what we want to look at.”
Another problem in this sensitive area is that mothers-to-be are advised not to lose weight during pregnancy.
She says: “All women put on weight during pregnancy, and what we would recommend is not that overweight women suddenly lose lots of weight, but that they limit the amount they put on over the nine months.”
Edinburgh nutritionist Emma Conroy advises: “The simplest thing to do to stop putting on more weight is to avoid processed sugar, which has no nutritional value and encourages weight gain. Eat fresh, natural foods. I wouldn’t advise choosing low-fat, diet products as some fats are needed to enable you to absorb nutrients.”
And there are plenty of tips to follow to boost your health while pregnant. Emma explains: “Research has found that by optimising nutritional intake, the incidence of foetal deformities drops from the national rate of 6 per cent to 0.47 per cent and the incidence of miscarriage drops from 25 per cent to 3.5 per cent.
“Oily fish would be perfect but unfortunately it often contains industrial pollutants. Essential fats are in great demand to build the baby’s brain, and the mother can be left short, causing post natal depression, so I’d advise taking a good-quality fish oil supplement throughout pregnancy.
“Fresh fruit and vegetables are as important as ever to provide antioxidants. Antioxidants mop up the free radicals that can damage developing cells.
“Vegetarians need to take extra care, as they may miss out on vital nutrients like vitamins A, D and B12. Steer clear of soya, too, because of its phyo-oestrogen content. The hormones we are exposed to in the womb affect us all our lives, and soya consumption has been linked to infertility and genital deformities.”
Emma adds: “Vitamin supplements are strongly advisable, and take extra if expecting twins. The link between spina bifida and low folic acid is just one example of how nutrients dictate pregnancy outcomes, and remember that the 400mcg advised by the government is difficult to get from diet alone, even a very healthy diet.”
Emma Conroy runs Edinburgh Nutrition on Waverley Place, 0131-557 2921. WHAT TO PUT ON AND KEEP OFF THE MENU
PREGNANT women are advised to eat healthily from the main food groups: carbohydrates such as bread and pasta; five portions of fruit and vegetables a day; meat, fish and alternative proteins such as eggs, beans and pulses; and dairy products including milk, cheese and yoghurt. Include plenty of iron-rich foods including dark green vegetables such as broccoli, watercress, spinach and kale.
Avoid soft cheeses such as brie, liver, pate, raw and undercooked eggs.
It is also important to keep up your fluid levels.
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