CMACE Release: National Enquiry Into Maternal Obesity - Implications For Women, Babies And The NHS

The Centre for Maternal and Child Enquiries (CMACE) releases its report Maternal obesity in the UK: Findings from a national project today after its three-year UK-wide national enquiry into Obesity in Pregnancy.


This major national study, which collected information from every maternity unit in the UK, has revealed for the first time the prevalence of severe maternal obesity (body mass index 35+) in the UK. The report also details the complications and consequences of obesity during pregnancy, and outlines the implications for the care of obese pregnant women.


This study found that around 5% of the UK maternity population were severely obese. In real terms, this equates to around 38,478 (1 in 20) pregnant women each year, and, with growing levels of obesity in the general population, this number is expected to increase. Wales was found to have the highest rate (6.5%, 1 in every 15 pregnant women) of severe maternal obesity in the UK. In England, the region with the highest rate was East of England (6.2%, 1 in every 16 pregnant women), while London had the lowest rates (3.5%, 1 in every 29 pregnant women).


The report highlighted that pregnancy outcomes for severely obese women are poorer when compared to the general population. The study found that the stillbirth rate in women with a BMI 35+ (8.6 per 1000 singleton births) was twice as high as the overall national stillbirth rate (3.9/1000 singleton births), and that the risk of stillbirth increases with increasing obesity. Also, in women with a BMI 35+, stillbirths occurring during labour and birth were three times higher than the overall national rate in England, Wales and Northern Ireland.


The risks of obesity in pregnancy extend to the mother too. Pregnant women, and especially obese pregnant women, are more at risk of developing venous thromboembolism (VTE), which is a potentially fatal condition that involves a blood clot forming in a vein which may break away, travel through the circulatory system and obstruct a blood vessel. The CMACE study revealed how VTE risk was poorly documented for obese pregnant women at their first antenatal appointment and fewer than 50% of the women at moderate or high risk of VTE were offered treatment to prevent the condition. For those women who did receive treatment antenatally, the prescribed doses were considered to be insufficient for their body weight, according to current guidelines published by the Royal College of Obstetricians and Gynaecologists (RCOG). Similar findings were found for postnatal treatment for the prevention of VTE, with only 55% of eligible women being prescribed the appropriate medication. These findings highlight that improvements in this area are required to reduce the risk of VTE in obese women during and after pregnancy.















The CMACE report also revealed that obese women have an increased risk of medical conditions both before and during pregnancy. Thirty-eight per cent of women in the study had at least one medical condition diagnosed prior to and/or during pregnancy. The most common conditions were gestational diabetes and pregnancy induced hypertension, which affect 8-9% of women with a BMI 35+; these conditions affect approximately 2-2.5% of women in the general maternity population. The presence of medical conditions increases the risk of complications for both the mother and baby, and increased surveillance and medical intervention are therefore required.


Only 55% of women with a BMI 35+ gave birth naturally. The caesarean section rate for singleton babies was 37%, which is 1.5 times higher than the rate in the general maternity population. In addition, severely obese women were at least four times more likely to suffer from postpartum haemorrhage within 24 hours of birth than women in the general maternity population.


The CMACE study also identified gaps in anaesthetic care for obese women. According to current joint CMACE/RCOG guidance, women with a BMI ?‰?40 (morbidly obese) should receive an antenatal consultation with an obstetric anaesthetist so that potential problems can be identified and an anaesthetic management plan for labour and delivery can be made. Only 45% of eligible women had such a plan.


A set of ten key recommendations has been developed by CMACE in response to the findings in the report. The purpose of providing these recommendations is to highlight areas requiring better clinical practice. The general points are:



- Better preconception care and advice is needed for women with overweight and obese BMIs. The joint CMACE/RCOG guideline on managing women with obesity in pregnancy, issued in March 2010, notes that women of childbearing age with a BMI 30+ should be provided with good information and advice on the risks of obesity during pregnancy and childbirth; and they should be supported to lose weight before conception and in the postnatal period. Pre-pregnancy counselling must also include taking an accurate height and weight measurement for a BMI calculation to identify women who may be at further risk or require additional services or care.


- Women with obesity have an increased risk of pregnancy complications such as gestational diabetes and pre-eclampsia. CMACE recommends that surveillance and screening according to existing guidelines occur so that referrals for specialist care can be made early in pregnancy.


- Women with a BMI 40+ should have a consultation with an obstetric anaesthetist, as recommended by the joint CMACE/RCOG guideline on obesity in pregnancy, so that potential problems such as venous access can be identified before the birth.


Professor James Walker, Chair of CMACE said, "The numbers of obese mothers are on the rise and this group of women require specialist care since they are more susceptible to illnesses and complications. So far, there hasn't been a UK-wide study on the extent of the problem but we now have very good data on how these women are cared for and the areas where improvements are urgently needed".


Dr Imogen Stephens, CMACE Clinical Director said, "This CMACE report shows that much more needs to be done in the NHS to deal with the growing numbers of obese pregnant women. We have already shown in our previous survey how specialist equipment such as wheelchairs, trolleys and beds are needed to care for this unique group of women. The findings from this new study show that the risks of clinical intervention increase with increasing levels of obesity and that specialist obstetric care is needed. All this requires improved, and better integrated, care for these women".


Dr Tony Falconer, President of the Royal College if Obstetricians and Gynaecologists (RCOG) said, "Pregnant women who are obese need to know about the associated risks for them and their baby and must be supported to lose weight before they embark on pregnancy. This will involve counselling and advice from a range of healthcare professionals including GPs, midwives, maternity support workers and nutritionists.


When a woman finds out she is pregnant, she tends to adopt positive behaviours to ensure that she is as healthy as she can possibly be and this includes sensible eating and lower alcohol consumption. However, we need to think about being more proactive by encouraging and enabling women to lead healthier lives before they fall pregnant and after giving birth so that they take a more long-term approach to being healthy".


Professor Cathy Warwick, General Secretary of the Royal College of Midwives, said "Our own research backs up these recommendations. Women have told us that they are not getting the level of care that they should from maternity services.


"There is no doubt that being obese and pregnant can leave women open to more problems in pregnancy than non- obese women. However with high quality care these problems can be identified and treated and women can have a very positive experience of pregnancy and birth. It is therefore crucial that midwives and other health professionals work together to ensure that these women get the best possible care, support and advice. Many women have told the RCM that one of the big barriers to this is that there are simply not enough midwives to spend time with them especially in the antenatal period.


"There is also a much wider and long-term public health message here. There is a real need to reduce obesity in the population as a whole, tackling the issue before women become pregnant."


Notes


The research lead for this project and author of the report is Dr Kate Fitzsimons (Senior Research Fellow, CMACE). The editor of the report is Professor Ian Greer (Executive Pro-Vice-Chancellor, Faculty of Health & Life Sciences, University of Liverpool; Chair of the National Advisory Committee for CMACE).


To view Maternal obesity in the UK: Findings from a national project, please click here. The launch of the report accompanies the CMACE conference 'Obesity in Pregnancy: Improving care and effecting change'. To view the conference programme, click here.


This new report follows the publication of the CMACE survey on NHS maternity provision to obese women and the joint CMACE/RCOG clinical guideline 'Management of Women with Obesity in Pregnancy' in March this year.


Body mass index (BMI) offers a useful measure of obesity and is a simple index of weight-for-height used to classify underweight, overweight and obesity in adults. BMI is calculated by dividing a person's weight in kilograms by the square of their height in metres (kg/m2). The table below shows a widely accepted classification published by both the World Health Organization and the National Institute for Health and Clinical Excellence (NICE). This report focused on women with a BMI 35+ (severely obese) in pregnancy. A woman with a height of 5ft 5" and a weight of 15 stone would have a BMI of 35.


BMI (kg/m2) Classification

Condom Promotion Campaigns In Sub-Saharan Africa Have Been Successful

There has been a substantial rise in the use of condoms reported by young, sexually active, single women in sub-Saharan Africa, according to an Article in this week's issue of The Lancet. The study found that most women who reported using a condom stated pregnancy avoidance as their reason. The authors therefore suggest that condoms may be promoted more effectively if the emphasis was on pregnancy prevention rather than prevention of sexually transmitted disease.



John Cleland (London School of Hygiene and Tropical Medicine, UK) and Mohamed Ali (WHO) assessed trends in sexual abstinence, contraception, and condom use by single women aged 15-24 years in 18 African countries. They used data from comparable surveys involving 132 800 women in total. The researchers found that between 1993 and 2001, the proportion of women declaring themselves virgins rose significantly in seven of the 18 countries and fell significantly in six. On average, abstinence over the 3 months preceding the survey increased from 43.8% to 49.2% in the 18 countries. For women who reported having sex in the 3 months preceding the survey, use of any contraceptive method rose slightly from an average of 32.6% to 36.5%. Use of non-barrier methods (mainly contraceptive pills) changed little, whereas use of periodic abstinence fell slightly. Use of condoms rose substantially during the study period, from an average of 5.3% to 18.8%. This rise was significant in 13 of the 18 countries. In the most recent surveys from these 13 countries, 60% of the women said they were using condoms for pregnancy prevention.



Professor Cleland concludes: "The finding that condoms have now become the dominant method of contraception is to be welcomed because of their dual protection against HIV transmission and pregnancy - A young woman might find it easier to negotiate use of condoms with a partner for prevention of pregnancy than for protection against HIV transmission. Therefore, we suggest that condoms might be promoted more effectively if the emphasis was on pregnancy prevention rather than prevention of sexually transmitted disease."







Contact: Joe Santangelo


Lancet

Non Communicable Diseases: The World's Number One Killer For Women

Non-communicable diseases (NCDs), including cancer, cardiovascular disease, chronic respiratory disease and diabetes, are the world's number one killer causing 60% of deaths globally. A staggering 35 million people die from NCDs, of which 18 million are women. These diseases represent a major threat to women's health, increasingly impacting on women in developing countries in their most productive years. To voice their outrage at the international neglect of these silent killers, the NCD Alliance convened a high-profile side event on women and NCDs at the United Nation's 55th Commission on the Status of Women.


The panel session, "Non-communicable diseases: A neglected dimension of women's health and development" called for the global health and development community to focus their attention on the impact of NCDs on women, particularly in low and middle income countries. High profile panelists included Ann Keeling, CEO of the International Diabetes Federation and Chair of the NCD Alliance Steering Committee, Sania Nishtar, Founder and President of NGO think tank Heartfile, Patricia Lambert, Director of the International Legal Consortium at the Campaign for Tobacco-Free Kids and Vice President of the International Network of Women Against Tobacco, and Vivien Tsu, Associate Director of the Reproductive Health global program at PATH.


During this event the panel discussed the unique vulnerability of girls and women to the socioeconomic determinants and risk factors of NCDs; the impact of NCDs on the health and socio-economic position throughout the lifecycle; and the importance of women's empowerment for the prevention of the global NCD epidemic. The session also focused on the UN High-Level Summit on NCDs in September 2011, and the opportunity it presents for securing commitments for the biggest killer of women worldwide. Failure to act now on NCDs will undermine development gains made to date on the Millennium Development Goals (MDGs 4 & 5), including progress on women's empowerment.


This event also marked the official launch of the landmark publication "Non-communicable diseases: A priority for women's health and development". This publication is the first to focus on the specific needs and challenges of girls and women at risk of, or living with NCDs. It aims to draw attention to these diseases and key risks factors particularly tobacco control as a priority for women's health and development, stimulate policy dialogue in the run-up to the UN Summit on NCDs in September.


Concluding the afternoon, Ann Keeling, NCD Alliance, called for a unified approach to the NCD epidemic "By pooling our collective expertise and strengths in a coordinated movement to make NCDs a priority for women's health and development, we will inspire a new level of commitment that will benefit the millions of girls and women worldwide".


Source:

World Heart Federation

Women's Rights Factor Into Election Campaigns For Congress, Pa. Governor

As campaigns get under way for elections this spring and fall, many media outlets are examining the policy positions of incumbents and their challengers, including where they stand on reproductive rights and related issues. The following summarizes recent media coverage of races in Pennsylvania and New York.

~ Sen. Arlen Specter (D-Pa.): Specter, who switched his party affiliation from Republican to Democrat in 2009, faces election challenges from both the left and the right, the New York Times reports. Rep. Joe Sestak (D-Pa.), a two-term House member, is challenging Specter in the state's Democratic primary, set for May. While Sestak "has lagged behind [Specter] in the polls and raised only half the money the senator has," several progressives back Sestak's candidacy, and his presence in the primary "has driven Specter to the left," the Times reports. As he campaigns for re-election, Specter "has to be careful not to alienate Democratic women, who support him for backing abortion rights despite what they view as his demeaning treatment of [Anita Hill] two decades ago in Clarence Thomas' Supreme Court confirmation hearings," the Times writes. That issue re-emerged last week when Specter told Rep. Michele Bachmann (R-Minn.) to "act like a lady" after she repeatedly interrupted him in a radio interview. Specter later apologized for the remark. If he survives the Democratic primary, Specter will face former Rep. Patrick Toomey (R-Pa.), whom Specter narrowly defeated six years ago in a Republican primary (Seelye, New York Times, 1/27).

~ Rep. Carolyn Maloney (D-N.Y.): Reshma Saujani, a hedge fund lawyer, has launched a campaign against Maloney in the Democratic primary, to the dismay of some New York state feminists who have long backed Maloney "for her work on mammograms, equal pay, reproductive rights and violence against women," the New York Times reports. Marilyn Fitterman, a former state president of the National Organization for Women, wrote in an e-mail message to Sujani that she should drop her challenge to Maloney "if you care anything about women's rights." Former vice presidential candidate and Rep. Geraldine Ferraro (D-N.Y.) also encouraged Saujani not to run, saying, "She's ending her political career before it starts." Ferraro added, "That's not a threat, it's a statement of fact. You don't, if you're a Democrat, challenge an incumbent Democrat who has a position of power to get things done just because you feel like this is something you want to do." According to the Times, Maloney considered a primary challenge against Sen. Kirsten Gillibrand (D-N.Y.) but decided against a bid (Halbfinger, New York Times, 1/27).














~ Former Rep. Joe Hoeffel (D-Pa.): Hoeffel officially launched his gubernatorial bid on Tuesday after first declaring his candidacy on Facebook in September 2009, the AP/Lebanon Daily News reports (Jackson, AP/Lebanon Daily News, 1/26). Hoeffel appeared with former NARAL Pro-Choice America President Kate Michelman on Tuesday at a campaign event in Philadelphia, where she said Hoeffel was the only gubernatorial candidate who would protect women's rights. Hoeffel told the audience, "I stand with all of the women of this state," adding, "You have a constitutional right to privacy that, as governor, I will protect and defend." Hoeffel will compete against three opponents running for the Democratic nomination: state Auditor Jack Wagner, Scranton Mayor Chris Doherty and Allegheny County Executive Dan Onorato. Wagner describes himself as an opponent of current abortion law, while Doherty calls himself "pro-choice, without exception." Oronato said that he personally opposes the procedure but would not work to change state law. Hoeffel has said that, if elected, he would try to amend Pennsylvania's Abortion Control Act of 1981 to end certain abortion restrictions (Infield, Philadelphia Inquirer, 1/27).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2010 The Advisory Board Company. All rights reserved.

FDA Issues Warning To Breast Pump Maker

FDA last month sent a warning letter to a breast pump manufacturer, telling company officials that they should have investigated complaints from women who said the "Comfort Select" pumps electrically shocked them, the Wall Street Journal reports.

FDA found manufacturing violations at two of Evenflo's Ohio plants during inspections in January and February. Evenflo failed to "review and evaluate all complaints," according to FDA, and also failed to "establish medical device reporting procedures." Eighteen of 37 complaints about the products -- including at least three from women who say they were shocked while using the pumps -- were not investigated by the company. An Evenflo spokesperson said that the company is working with FDA to address the agency's concerns (Corbett Dooren, Wall Street Journal, 9/15).


Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.