A weighty issue for mums-to-be

TOO often, the headlines only tell us of the dangers of the obesity epidemic facing Britain – that it puts us at increased risk of illnesses such as heart disease, stroke, diabetes and certain types of cancer.

So, if you ask the average person in the street what their body mass index is, the likelihood is that they will have no idea. Yet worryingly, many people’s body mass index – which is calculated from their height and weight – will place them as overweight or obese.

We are constantly warned of rising obesity levels in children. Yet the impact of obesity in expectant mothers and their unborn children is something that has not attracted as much attention until now.

Last week, the Confidential Inquiry into Maternal and Child Health published a report echoing concerns that are felt by many clinicians.

While overall levels of maternal death in the UK are low, obese pregnant women are four or five times more likely to die during pregnancy than those of normal weight.

This is not a problem that is going to go away. Recent figures tell us that more than one in two women in Scotland are now either overweight or obese, with one in four falling into the more serious obese category.

However, the headlines alone – such as “Obesity blamed as more mothers die in childbirth” – do not tell the whole story.

There is much we do not know about the exact impact of obesity on pregnancy and childbirth and this is something that we are aiming to address with the Tommy’s Research Centre at the University of Edinburgh. The centre, which is due to open in April next year under the directorship of Andrew Calder, Professor of Obstetrics and Gynaecology, will be based at the University’s Queen’s Medical Research Institute at the new Royal Infirmary.

A key focus of its work will be looking at ways of alleviating the risks and problems caused by maternal obesity.

The Tommy’s Research Centre at Edinburgh will follow a number of expectant mothers – both those who are obese and those of a normal weight – throughout their pregnancies.

The aim of this clinic will be to find out how and why maternal weight affects pregnancy outcome. Provision of appropriate dietary advice and weight management programmes will be crucial. Medically, it is not advisable to tell an obese woman to lose weight during pregnancy. However, women who are already obese are likely to put on more weight during pregnancy than other expectant mothers.

It serves no purpose to point the finger of blame and there are wider social issues to take into consideration. Pregnant women from economically disadvantaged backgrounds are more likely to be obese than more affluent women.

Any intervention and support therefore needs to be tailored to an individual woman’s needs and circumstances. We are keen to explore how the dispersal of fat stores in the expectant mother affects the child.

We know that babies of women who develop diabetes during pregnancy are more likely to accumulate fat stores around some of their vital organs as they develop in the womb.

We do not know what role the distribution of the mother’s own fat stores plays in this,

but we do know that babies born to obese mothers are also four times more likely to be obese themselves by the age of four.

While lifestyle is likely to have a major role, the way these babies develop within the womb may also contribute to the increased risk of childhood obesity.

Research at the Edinburgh Centre will complement the work at the two existing Tommy’s Research Centres in London and Manchester whose research is focused on preventing pregnancy complications including premature birth, miscarriage and stillbirth.

The fact that these complications are more likely to occur in obese women coupled with the rise in rates of maternal obesity serves to emphasise the importance of the research we will be undertaking at the Tommy’s Research Centre.

DR FIONA DENISON -Dr Fiona Denison is a clinical lecturer in obstetrics and gynaecology at Edinburgh University.

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