Maternal obesity in the UK - Public Health Agency

1 Centre for Maternal and Child Enquiries Improving the Health of mothers, babies and children Maternal obesity in the UK: findings from a national project 2010 . United Kingdom changing Living with diabetes isn't easy. It takes discipline, control and support from the people around you. At Novo Nordisk, we the future want to be your partner in living well with diabetes. of diabetes We know that we are not simply treating diabetes. We are helping real people live better lives. We understand that diabetes is just a part of who you are not what defines you. This understanding is behind every decision or action we take, and fuels our passion for changing the perception, treatment and future of diabetes for good.

2 At Novo Nordisk, we are Changing Diabetes . Corporate Affairs UK/Ireland UK/DB/1010/0359 October 2010 . Maternal obesity in the UK: findings from a national project 2010 . United Kingdom i CMACE Mission statement Our aim is to improve the Health of mothers, babies and children by carrying out confidential enquiries and other related work on a UK-wide basis and by widely disseminating the results. Please cite this work as: Centre for Maternal and Child Enquiries (CMACE). Maternal obesity in the UK: Findings from a national project. London: CMACE, 2010 . Disclaimers This work was undertaken by the Centre for Maternal and Child Enquiries (CMACE) as part of the CEMACH. programme. The work was funded by the National Patient Safety Agency ; the Department of Health , Social Services and Public Safety of Northern Ireland; NHS Quality Improvement Scotland (QIS); and the Channel Islands and Isle of Man.

3 The views expressed in this publication are those of CMACE and not those of the funding bodies. The recommendations contained in this report represent the view of CMACE and the obesity in Pregnancy project External Advisory Group, which was arrived at after a careful consideration of the available evidence. The recommendations do not override healthcare professionals' individual responsibility to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. Advertisements published in this document are not endorsed or supported in any way by CMACE, the authors or reviewers of this document. They are included as a way of supporting the work of CMACE and reducing the cost of the report.

4 Published December 2010 . CMACE, Chiltern Court, 188 Baker Street, London, NW1 5SD. Tel: 020 7486 1191 Fax: 020 7486 6226. Email: Website: Designed and produced by ie Marketing, Bristol. Tel: 0117 923 2235. Printed by Henry Ling Ltd, at the Dorset Press, Dorchester, DT1 1HD. ISBN: 978-0-9558055-4-7. ii Contents vi vii viii xiii 1. Key findings and 1. Key 1. Prevalence of Class II, Class III and super-morbid obesity in 1. Socio-demographic 1. Clinical 2. Poor pregnancy 3. Preconception 3. Clinical care during 4. Clinical care during labour and 5. Postpartum care and 5. Facilities and equipment in maternity 6. Key 6. 2. 17. 17. Aims and objectives of the national 18. Improving services and 18.

5 3. 19. Consensus 19. Searching the scientific 19. Stakeholder 19. Multidisciplinary consensus standards 20. Consensus 20. Survey of maternity 22. 22. Development of the survey 22. Pilot of survey 23. Administration of survey 23. 23. An observational study of mothers with a BMI 35 and their 23. 23. Development of the data collection 24. Pilot of data collection 24. Data collection 24. 24. Clinical 26. 26. Development of the data collection 26. iii Pilot of data collection 27. Data collection 27. 27. Developing 28. 4. Maternity services for women with 31. 31. Service 31. Preconception care and 31. Provision of information for 32. Measuring and recording height, weight and body mass 32.

6 Risk assessment during 32. 33. Local 33. Equipment and 34. Education of healthcare 35. 36. 5. Prevalence of Class II, Class III and super-morbid obesity in 37. UK national 37. Prevalence of obesity in the UK nations and Crown 38. Prevalence of obesity by Strategic Health Authorities (England).. 39. Prevalence of obesity identified in the first 40. 40. 6. Maternal obesity : Socio-demographics, clinical characteristics and pregnancy 43. Socio-demographic 43. Maternal weight and body mass 43. Social 44. 44. 45. Clinical 45. 45. Pregnancy-related 46. Gestational weight 47. Onset of 48. Place of 49. Mode of 50. 51. Length of stay in 52. Maternal 52. Maternal 52. Postpartum 53. Pregnancy 55.

7 Live births, stillbirths and early neonatal 55. Gestational 57. iv Fetal congenital 57. Neonatal unit 58. Large for gestational age and small for gestational 58. Feeding 59. factors for pregnancy-related complications and outcomes among women with 60. Maternal body mass 60. Maternal 61. Maternal 61. Maternal 62. Maternal gestational weight 62. 63. 7. Standards of care for women with Class II and Class III Maternal 65. Preconception care and 65. Measuring and recording height, weight and body mass 67. Provision of information for 68. Risk assessment during 68. 69. Antenatal 70. Postnatal 71. Maternal surveillance and 74. Planning labour and 75. Care during 76. 80. Postnatal care and follow-up after 80.

8 81. 8. 83. 86. Index of 93. Index of 94. APPENDIX A: Stakeholder organisations consulted during February 95. APPENDIX B: Members of the Consensus Standards Group by 96. APPENDIX C. Process for developing the standards of care for women with 97. APPENDIX D: Levels and grades of 98. APPENDIX E: Standards of care for women with obesity in 99. APPENDIX F: CMACE obesity and maternity services 102. APPENDIX G: CMACE obesity in pregnancy audit notification 109. APPENDIX H: CMACE obesity in pregnancy audit APPENDIX I: Contributors to the CMACE obesity in Pregnancy 120. v Acknowledgements Editor Professor Ian Greer Executive Pro-Vice-Chancellor, Faculty of Health & Life Sciences, University of Liverpool.

9 Chair of the National Advisory Committee for CMACE. Lead author Dr Kate Fitzsimons Senior Research Fellow, CMACE. Other author Amy Sullivan Researcher, CMACE. With special thanks to: The unit co-ordinators, clinicians and staff throughout England, Wales, Northern Ireland, Scotland, Channel Islands, and the Isle of Man, without whose commitment and continued support we would not have had the data to enable us to produce this report. All personnel in CMACE regional offices and affiliated offices involved in the collection and validation of all data provided for this report (See Appendix I). The CMACE obesity Working Group: Dr Kate Fitzsimons, Senior Research Fellow; Alison Miller, Programme Director and Midwifery Lead; Rachael Davey, R&D Projects and Research Assistant; Julie Maddocks, West Midlands, North West and Wales Regional Manager.

10 R. ichard Congdon, CMACE Chief Executive; Shona Golightly, CMACE R&D Director; Dr Imogen Stephens, CMACE Clinical Director; Amy Sullivan, CMACE Researcher; Anna Springett, CMACE Senior data analyst; James Hammond, CMACE Database development and IT officer; Clara Haken, CMACE Project Midwife; and all other staff at CMACE Central Office for their support and advice during the development of this report. D. r Jo Modder (formerly CMACE Clinical Director of Obstetrics), for providing clinical input for the project from its conception through to April 2010 . The National Patient Safety Agency (NPSA) and the Department of Health , Social Services and Public Safety of Northern Ireland, the States of Jersey and Guernsey, the Isle of Man, and NHS Quality Improvement Scotland (NHS QIS) for funding this work.