‘Urgent action’ needed on maternal obesity, doctors warn

Maternal obesity is an urgent and growing public health concern in the UK that requires more action, the Royal College of Physicians (RCP) has warned.

Support for women’s health before during and after pregnancy must be given greater priority to address the fact that one in four pregnant women in England is now living with obesity, a report concluded.

Obesity in pregnancy is linked to far higher rates of gestational diabetes, pre-eclampsia, caesarean birth and postpartum haemorrhage, the RCP noted.

And rates of maternal obesity are highest in the most deprived communities, reinforcing existing health inequalities.

The report pointed to data from the 2021-24 MBRRACE-UK Confidential Enquiry into Maternal Deaths which found that 64% of women who died during pregnancy or within six weeks of birth were living with overweight or obesity.

Rising rates of maternal obesity are increasing pressure on maternity services and contributing to avoidable harm, the RCP said.

And it cited emerging evidence showing a link between maternal obesity and the subsequent increased risk of cardiometabolic disease in children as well as other adverse health outcomes later in life, ‘compounding inequalities across generations’, it said.

Addressing the issue will need a system-wide approach that starts with tackling the wider determinants of health including transforming food systems and strengthening prevention to prevent obesity in the first place, the report said.

But it will also require improved interconnection between maternity services, weight management services and primary care, it continued.

Compassionate and inclusive obesity care should be embedded into healthcare training as well as better data and surveillance to monitor maternal and infant outcomes related to obesity, it added.

There also needs to be research on the safety and long-term impacts of obesity treatments in pregnancy, it said.

Given that access to IVF in England is restricted to women with a BMI of less than 30 kg/m2, access to weight loss drugs has been proposed as a priority for women needing to lose weight to access fertility treatment, the RCP noted.

Yet weight re-gain upon discontinuation of obesity medicines with corresponding increased risk of maternal complications during pregnancy is a concern, the report found.

The RCP stressed that obesity should be seen as a chronic, systemic illness, shaped by health inequalities, genetic influences, ethnicity, social and commercial factors, stigma, mental health and the environments people live in.

Dr Kath McCullough, special adviser on obesity at the Royal College of Physicians, said: ‘Maternal obesity is one of the clearest signs that we need to tackle the root causes of obesity and weight gain, recognising the benefits not only for pregnancy but also women’s health and future generations.

‘We need bold, joined-up action across the system – from food policy and education to healthcare services, professional training and research to better prevent obesity in the first place and better support women living with obesity in the pre- and postnatal periods.’

Dr Anita Banerjee, obstetric physician added that too often, women arrive in pregnancy already at risk, ‘having had little support beforehand to address the factors affecting their health’.

‘By the time they are pregnant, opportunities for preventing obesity and the risks associated with it have already been missed.

‘This is why action before, during and after pregnancy matters so much. If we want safer pregnancies and healthier babies, and a healthier society, we need to prioritise women’s health long before they reach a maternity unit.’