Expert Answers: A healthy approach to pregnancy

OBESITY levels among pregnant women have reached epidemic levels, putting the health of their babies at risk, experts say.

The health watchdog NICE has issued new guidelines encouraging women in England to attain a healthy weight before they get pregnant.

It also advises them against eating for two once they conceive.

It says almost half of women of childbearing age are overweight or obese, which could harm their child.

Many women feel they are offered confusing and conflicting advice about their health during pregnancy.

The guidelines from the National Institute for Health and Clinical Excellence are aimed at cutting through that. They discuss weight and exercise before, during and after pregnancy.

If a woman is obese during pregnancy, she has an increased risk of developing serious complications like pre-eclampsia, gestational diabetes, miscarriage and stillbirth. She is also more likely to have a Caesarean section.

NICE also wants local authorities to offer women more opportunities to exercise, at an affordable price, and with crches for their children.

"There's been an exponential increase in obesity among pregnant women," said Professor Lucilla Poston, from King's College, London, who helped develop the guidance.

"It's very worrying, as there are so many potential risks for the mother and her baby."

The National Childbirth Trust welcomed the move to bring clarity to the issue.

Chief executive Belinda Phipps said women were presented with a lot of conflicting advice about exercise.

"It can set a worrying example, by encouraging new mums to embark on drastic weight loss programmes, which are not only unrealistic, but can also be very unhealthy," she said.

Professor Sir Sabaratnam Arulkumaran, president of the Royal College of Obstetricians and Gynaecologists, said he hoped the new guidelines would be actively promoted by the Government.

"We need to support women who are overweight by encouraging them to lead healthier lifestyles.

"This includes providing them with advice on diet, nutrition and exercise.

"These healthy behaviours should occur throughout a woman's lifetime and not just when she is considering starting a family or during pregnancy."

WEIGHT OF EVIDENCE

Obesity is, without doubt, a risk factor in pregnancy, as far as various pregnancy complications are concerned.

These include an increased risk of hypertensive disorders (including pre-eclampsia), gestational diabetes, large babies with consequent difficult delivery, postpartum haemorrhage (PPH) and urinary tract infections.

There is some evidence, albeit inconclusive, that the risk of

thrombosis and thrombo-phlebitis may also be increased.

Being overweight in pregnancy can also have an effect on some of the antinatal scans.

Paul Charlson

GP from Brough

No it is not right, you should not be "eating for two" .

You are quite old for childbirth and if you are overweight your chances of developing diabetes and high blood pressure during pregnancy are higher than average.

I suggest talking to your midwife and seeing a dietician who can properly advise you about the quantity and type of food you should be eating. In regard to your baby you will have a number of tests, some routine for every pregnant mother and some because of your age.

These consist of scans and blood tests aimed at first establishing that both you and your baby are healthy and then to monitor you both to ensure that this remains the case.

Maternity care in the UK, despite the media attention, is uniformly of a high standard so you are in good hands.

Elaine Douglas

A chartered psychologist who specialises in family and child relationships

Your situation is not something that I am an expert on, but I would like to offer you a few thoughts. Firstly, the fact that you are carrying a few more pounds than you would like may not necessarily be a problem in the early stages. However, as the pregnancy develops you may find that the extra weight – plus that of the baby could make things a little uncomfortable for you. This brings me on to your question about eating for two. I know that this was something that used to be regarded as a truth, but I'm not sure that this is how it is perceived these days. Contact a nutritionist (your GP could help on this one). Current thinking is about eating healthily and sensibly, ensuring that you eat a balanced diet and take in the appropriate nutrients to keep you on good form and to ensure that you provide and pass on the right amounts of vitamins etc to your baby. I don't think that you should double your intake of food, but be aware of the right combination of carbohydrates, fats and proteins that make up a healthy regime.

I am aware that when someone has a pregnancy in "later" years there are risks.

Cary Cooper

Professor of Organisational Psychology and Health at Lancaster University

I AM not a medical doctor, so I can't really help you directly much. I am sure, however, that through your ante natal support at the hospital, you can surface your concerns and they will advice you.

Presumably you will be having a scan fairly soon, at which

time you can ask them all the questions that you want answer to.

I would suggest before you go to the hospital that you write a list of the questions that you want to ask the doctor, nurse or midwife, rather than try to remember them on the spot when you might feel anxious or self conscious.

Dr Carol Burniston

Consultant Clinical Child Psychologist

Congratulations on your pregnancy. Ante-natal care is coordinated by your GP and if you haven't already attended your surgery, please do so to arrange the normal checks, scans and booking in to hospital, if that is where you would like to have your baby.

Your doctor will be able to explain that the baby has only small calorie requirements and your body will ensure that the baby's needs are met before your own. It is important to eat healthily, avoid smoking and drinking alcohol and take some gentle exercise. It is possible to have a healthy baby without putting on more weight.

Because of your age, your doctor will be able to offer you extra tests to check that everything is progressing well with your pregnancy. You can discuss these options with them and make any decisions in conjunction with your partner. You will also be offered ante-natal classes where you can meet other expectant women and share your experiences. Some people find support networks such as the National Childbirth Trust (NCT) useful and make long term friends. You can obtain more information from www.nct.org.uk