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Obesity in the UK maternity services is the biggest issue faced today, with complications in labour causing concern as well as added costs on the National Health Service (NHS) (Ziauddeen & Alwan, 2019). In the past decade, obesity in pregnant women has doubled from around 22% in 2010 to 44% in 2018 (Desk, 2019). It is of interest to the group because the group would like to gain more knowledge of current healthcare issues in preparation for university. Obesity is defined as having a greater body mass index (BMI) than or equal to 30 (World Health Organisation (WHO), 2020). Turning now to look at how obesity is defined, a BMI is measured using a person's weight and height, the statuses range from seriously underweight to obese where health may be seriously affected due to the build-up of fat on the body (World Health Organisation (WHO), 2020; Fitzsimons, Modder, & Greer, 2009). Although BMI calculations are globally accepted, research shows that many professional athletes have a BMI over 30, due to muscle mass pushing them into the obese category, even though they are physically fit and healthy (Chen, 2016). The higher the BMI the greater the risk of complications during pregnancy.
Common complications in pregnancy for obese women to name a few include Miscarriages, a high BMI increases the risk to 25% (NHS Choices, 2019a; Fitzsimons, Modder, & Greer, 2009). Three times more likely of getting gestational diabetes, often including consultant-led care and a greater risk of having a bigger baby. With high blood pressure and pre-eclampsia, the chance of pre-eclampsia is 2 to 4 times higher than in women whose BMI is below 25 (Fitzsimons, Modder, & Greer, 2009). Blood clots, there is a greater chance of blood clots during pregnancy for any woman, however, with a BMI of 25 or above the chance of blood clots is increased further. Shoulder dystocia, an increased risk of the baby's shoulder becoming stuck during delivery and post-partum haemorrhage, an increased risk of heavier bleeding after the birth (NHS Choices, 2019a; Fitzsimons, Modder, & Greer, 2009).
The solution to the problem lies within the public health sector, and the critical time for action to be taken is before pregnancy occurs (Ziauddeen & Alwan, 2019). As 1 in 5 women in Wales are classed as obese at the first midwifery appointment (Siddall, 2020). Although, it could be argued that the responsibility lies with the expectant mother. Midwives expressed difficulties in communicating with clients about their weight, given that obesity is a sensitive subject (Furness et al., 2011). However, it could be argued that midwives should be trained to deal with sensitive situations as set out in the Standards for competence for registered midwives (NMC, 2016).
Let us now consider the amount of weight a pregnant woman should gain during pregnancy. (NHS, 2018) suggests although this varies considerably, most pregnant women gain between 10kg and 12.5kg. However, the recommendations for weight gain are universal failing to include individual risk factors (Kirkpatrick, 2013). The myth “eat for two when pregnant” is still around (Tommy’s. 2017). Head of prevention, claimed that “the “eating for two” myth has been around for years, but it is very unhelpful. Eating healthily and consuming healthy portion sizes are important before, during and after pregnancy to increase the chances of conceiving naturally, reduce the risk of pregnancy and birth-related complications and stave off health problems like Type 2 diabetes and heart and circulatory disease in the long-term” (Tommy’s. 2017).
In the first six months, pregnant women do not need to eat any extra calories, it is only in the third trimester that an extra 200 calories a day should be consumed (Tommy’s. 2017). Nevertheless, the media still use eating for two (Tesco, 2020). The National Charity Partnership (NCP) survey showed that more than 1 in 3 pregnant women think they need to eat 300 or more extra calories every day, and 61% think they need to start eating the extra calories in the first or second trimester, therefore, the media could be aiding the issue with false advertisement. Although mothers carrying multiple babies or a large foetus need more energy to sustain them, this results in a higher metabolism causing nutrition and energy to be consumed faster (Nair, 2018). Turning now to look at sugar levels in foods, and a study carried out by the National Nutrient Database (USDA), it can be seen that the food categories with the highest sugar contents are the labelled fat-free, low fat, light and reduced-calorie foods (Nguyen, Lin, & Heidenreich, 2016). This information on such food items could be seen as misleading and women buying such items to maintain their weight, are possibly gaining weight. The writers looked at the importance of exercise in pregnancy and found that it is highly important and has many benefits including the prevention of excessive weight gain. However, in pregnancy dieting is not something recommended for overall body weight, it is recommended to eat a balanced healthy diet to maintain a steady and healthy weight.
This is to ensure that there are no effects on the baby’s health and weight (NHS choices, 2012). Women must be aware of the importance of dieting as it states it can affect the baby’s weight as well as mothers. Diet during pregnancy can affect many factors, therefore it is important to be aware of the appropriate diet for all pregnant women (NHS Choices, 2012). A balanced mixture of foods is essential, it is important to have a high intake of fruit and vegetables. It is also recommended that women have a bare minimum of foods that contain high levels of fat and sugar (NHS Choices, 2012). The importance that women are aware of appropriate food intake and the levels of fat and sugar intake that are recognised as unhealthy (NHS Choices, 2019a). In 2012 a study was carried out to compare prices of healthy and unhealthy foods (NHS Choices, 2014). Per 1,000Kcal in healthy foods, the price increased significantly compared to unhealthy food. Reaching an increase of 17 pence per item, unhealthy food only increased by 7 pence per item (NHS Choices). The NHS website shows that healthier food prices have increased more than double compared to the price of unhealthy foods. This study could argue that the price of food affects people's choices of food (NHS Choices, 2014).
Especially in Wales where they have the highest rate of obese pregnant women with a percentage of 6.5%, which is the equivalent to 1 in every 5 women (Ziauddeen & Alwan, 2019). This could be due to inequalities and the fact Wales has the highest percentage of 23% of people living in poverty, the highest in the UK (Seneddresearch, 2018). Research shows that 28.4% of women in the higher deprivation areas were obese compared to 14.4% in the lower deprivation areas (Public Health England, 2019). Although it can be seen that the issues obesity cause are negative in pregnancy, resulting in long-term health issues that are increasing at an alarming rate and by 2025 20% of women will be obese (The Lancet, 2016). Study shows the root cause of the problem has not been effectively managed and different approaches have had little effect in solving the issue (Kirkpatrick, 2013).
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