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  • Proceedings of the Nutrition Society, Volume 70, Issue 4
  • November 2011, pp. 439-449

Identifying ‘at risk’ women and the impact of maternal obesity on National Health Service maternity services

  • Nicola Heslehurst (a1)
  • DOI:
  • Published online: 22 August 2011

Obesity is a public health concern worldwide, arising from multifaceted and complex causes that relate to individual choice and lifestyle, and the influences of wider society. In addition to a long-standing focus on both childhood and adult obesity, there has been more recent concern relating to maternal obesity. This review explores the published evidence relating to maternal obesity incidence and associated inequalities, the impact of obesity on maternity services, and associated guidelines. Epidemiological data comprising three national maternal obesity datasets within the UK have identified a significant increase in maternal obesity in recent years, and reflect broad socio-demographic inequalities particularly deprivation, ethnicity and unemployment. Obese pregnancies present increased risk of complications that require more resource intensive antenatal and perinatal care, such as caesarean deliveries, gestational diabetes, haemorrhage, infections and congenital anomalies. Healthcare professionals also face difficulties when managing the care of women in pregnancy as obesity is an emotive and stigmatising topic. There is a lack of good-quality evidence for effective interventions to tackle maternal obesity. Recently published national guidelines for the clinical management and weight management of maternal obesity offer advice for professionals, but acknowledge the limitations of the evidence base. The consequence of these difficulties is an absence of support services available for women. Further evaluative research is thus required to assess the effectiveness of interventions with women before, during and after pregnancy. Qualitative work with women will also be needed to help inform the development of more sensitive risk communication and women-centred services.

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Corresponding author
Corresponding author: Dr Nicola Heslehurst, fax +44 1642 342758, email
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30.N Heslehurst , J Rankin , JR Wilkinson (2010) A nationally representative study of maternal obesity in England, UK: trends in incidence and demographic inequalities in 619 323 births, 1989–2007. Int J Obes 34, 420428.

31.M Knight , JJ Kurinczuk , P Spark (2010) Extreme obesity in pregnancy in the United Kingdom. Obstet Gynecol 115, 989997.

34.MG Kanagalingam , NG Forouhi , IA Greer (2005) Changes in booking body mass index over a decade: retrospective analysis from a Glasgow Maternity Hospital. BJOG 112, 14311433.

42.N Heslehurst , H Simpson , LJ Ells (2008) The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev 9, 635683.

43.AS Poobalan , LS Aucott , T Gurung (2008) Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women – systematic review and meta-analysis of cohort studies. Obes Rev 10, 2835.

44.KJ Stothard , PWG Tennant , R Bell (2009) Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 301, 636650.

45.J Rankin , P Tennant , K Stothard (2010) Maternal obesity and congenital anomaly risk: a cohort study. Int J Obes 34, 13711380.

46.MR Torloni , AP Betran , S Daher (2009) Maternal BMI and preterm birth: a systematic review of the literature with meta-analysis. J Matern Fetal Neonatal Med 22, 957970.

48.E Oken (2009) Maternal and child obesity: the causal link. Obstet Gynecol Clin North Am 36, 361377.

55.MM Rogge , M Greenwald & A Golden (2004) Obesity, stigma, and civilised oppression. Adv Nurs Sci 27, 301315.

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