Healthy Weight in Pregnancy

1. Merryn Anderson Healthy Weight in Pregnancy

2. Summary • Why healthy weight in pregnancy is important • The situation nationally and in Cornwall • Moving forward

3. Healthy weight in pregnancy • Reduce fertility1 • Risk for mother and foetus during pregnancy2 • Risk of illness in later life3 • NICE guidelines4

4. Nationally

5. Women aged 16-446

6. Cornwall

7. Moving forward • Pre-pregnancy • Pregnancy • Post-natal

8. Pre-pregnancy Everyone presenting to primary care with BMI >25 People presenting with subfertility and BMI > 29.9 Adult Obesity pathway

9. Pregnancy-booking clinic All women at booking clinic • Consents women • Highlights relevant diet and exercise chapters in ‘The Pregnancy Book’ • Signposts Healthy Lifestyle in Pregnancy service and children’s centres

10. Pregnancy – 12 week scan All women to have an accurate BMI recorded at the 12 week scan BMI >30 BMI <30 Midwife to give ‘Obesity in Pregnancy’ leaflet • Universal advice • Signpost to website • Give option for self referral to Healthy Lifestyle in Pregnancy • If not opted out contacted by specialist midwife with the Healthy Lifestyle in Pregnancy to receive individualised plan • Behaviour change advice • Healthy eating/exercise • Information about services available • Create personal goals and agree follow up plan • Invitation to Obesity in Pregnancy Group • If BMI >40 to be seen by specialist as part of the anaesthetic review clinic Follow up phone-call, text, internet as agreed in individual plan

11. Post-natal Based on BMI recorded at the 12 week scan BMI >30 BMI <30 Midwife to review progress and give individualised information on: • Exercise advice (RCOG guidelines) • Behaviour change advice • Healthy living pack/website access • Breast feeding • If BMI >35 options to include invitation to weight matters course • Slimming world/weight watchers • Universal advice • Signpost to website Follow up at 3 and 6 months post-natal

12. Summary • Why healthy weight in pregnancy is important • The situation nationally and in Cornwall • Moving forward

13. Any suggestions?Anyquestions?

14. References • Jan Willem van der Steeg; PieternelSteures; Marinus J.C. Eijkemans; J. Dik F. Habbema; Peter G.A. Hompes; Jan M. Burggraaff; G. Jur E. Oosterhuis; Patrick M.M. Bossuyt; Fulco van der Veen; Ben W.J. Mol. Obesity Affects Spontaneous Pregnancy Chances in Subfertile, Ovulatory Women. Human Reproduction. 2007;Vol 23:324-328 • Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118 (Suppl. 1):1–203. • Department of Health: Obesity 2011. Available from http://www.dh.gov.uk/health/category/policy-areas/public-health/obesity-healthy-living/ [Accessed 23/4/12]

15. Weight management before, during and after pregnancy: Dietary interventions and physical activity interventions for weight management before, during and after pregnancy. National Institute of Clinical Excellence 2010. Available from http://guidance.nice.org.uk/PHG/Wave18/3 [Accessed 23/4/12] • Centre for Maternal and Child Enquiries (CMACE). Maternal obesity in the UK:Findings from a national project. London: CMACE, 2010 • The Health and Social Care Information Centre. The health survey for England 2007: latest trends. London: The Health and Social Care Information Centre; 2008