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Pregnancy and body mass index (BMI) An information guide

Pregnancy and body mass index (BMI) Key messages • the majority of overweight women have a straightforward pregnancy & birth • women with a high BMI are at a higher risk of complications during pregnancy and labour • enjoy a normal healthy diet and keep your weight gain to a minimum • keep active and take regular, moderate intensity exercise • take the higher dose of 5mgs of folic acid for the first 12 weeks of pregnancy • take Healthy Start Vitamins or vitamin D supplements throughout pregnancy • choose the most appropriate place to give birth • breastfeeding your baby can aid weight loss • reducing your weight by 6lbs between pregnancies can reduce your chances of gestational diabetes in your next pregnancy by 50% Why is BMI particularly important in pregnancy? Your BMI is the relationship between your height and weight and is used by health professionals to determine whether you have a healthy weight in pregnancy. Recording your BMI will make sure that you get the most appropriate care during your pregnancy. This information is about the extra care you will be offered during your pregnancy and how we can minimize the risk of complications in this and any future pregnancy. Be assured, you will not be judged for being overweight and you will be given all the support that you need. Your midwife will refer you to the consultant team to discuss and agree a plan of care. If your consultant team identify additional risk factors you may be prescribed 75mg of aspirin daily, but do not take aspirin unless advised to do so. 2

Most women who are overweight have a straightforward pregnancy and birth and deliver healthy babies. However, being overweight increases the chance of miscarriage, gestational diabetes, pre-eclampsia, labour complications, health problems for the baby and stillbirth. The higher the BMI, the greater the risk of complications. If you have a BMI of less than 35 and no other complications you can choose to have your baby in hospital, at home or in the birth centre. The amount of weight gain in pregnancy can vary. Only some of it is due to increased body fat – your baby, placenta, amniotic fluid and increases in maternal blood and fluid retention all contribute. However, if your BMI is over 30 you will be encouraged to not to have excessive weight gain and you will be offered a referral to a community weight management programme. Dieting or trying to lose weight in pregnancy is not recommended but eating a well balanced diet and being active can improve the wellbeing of you and your baby. Ask your midwife about healthy eating in pregnancy, and search healthy diet in pregnancy on NHS Choices www.nhs.uk Exercise Daily Moderate intensity physical activity such as swimming or brisk walking for at least 15 to 30 minutes a day is beneficial and will not harm you or your baby. If you exercised regularly before pregnancy you should be able to continue with no adverse effects. If you have not exercised before then you should begin with no more than 15 minutes of continuous exercise three times per week, increasing gradually to daily 30 minute sessions. Vitamin Supplements It is recommended that you take a high dose folic acid supplement of 5mg (milligrams) daily for the first 12 weeks of pregnancy to 3

reduce the risk of neural tube defects. A daily supplement of 10mcg (micrograms) of vitamin D taken throughout your pregnancy is also recommended to keep your bones healthy and to provide your baby with enough vitamin D for the first few months of life. Ask your midwife about Healthy Start Vitamin supplements or visit www.healthystart.nhs.uk. If you are not eligible for Healthy Start 10mcg vitamin D tablets can be purchased from various commercial outlets. Checking the position and size of your baby If you have a high BMI it can be difficult to feel the size or position of the baby accurately and it may be necessary to have additional scans to check the growth of your baby. All women are offered two scans in their pregnancy to check the baby’s major organs, size and physical characteristics. If there is a lot of excess body fat around the tummy ultrasound scan pictures can be unclear. This can limit the ability to identify any problems and to see how well the baby is growing. Labour It is worth remembering that most women have straightforward births. However, women who have a high BMI may experience more difficulties in labour. We know that women who have a high BMI are at an increased likelihood of having:• an induced labour • a longer labour • a caesarean section • difficulties in hearing the baby’s heartbeat • bigger babies and difficulties delivering the baby’s shoulders • heavy bleeding immediately after birth • problems having epidurals and drips inserted • a repeat caesarean section • a baby who has breathing difficulties after birth.

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Care in labour It may be difficult to hear the baby’s heartbeat clearly so it may be necessary to monitor the baby’s heartbeat continuously using an electronic fetal heart monitor. The midwife may also prefer to fix a fetal scalp electrode to the baby’s head if it is difficult to monitor the baby’s heartbeat. You will be given a Ranitidine tablet regularly in labour to reduce the acid content of your stomach which is a precaution in case a caesarean section is needed. We would advise you not to use the birthing pool if your BMI is over 35 at booking. This is to minimise the risk to yourself and your baby. If your BMI is over 40, you will have been measured for compression stocking which we advise you to wear during your labour and until you are fully mobile after the birth. This is to help prevent blood clots forming in your legs. If you have a BMI over 40, an anaesthetist will review your hospital notes and either send you information or an appointment to assess you and discuss the birth options including pain relief in labour. Epidurals and pain relief If you have a BMI over 40, you may be referred to an anaesthetist at booking. Your midwife will discuss all methods of pain relief with you before your birth, for more information on what is available ask your midwife for the Pain Relief in Labour information leaflet. Having a raised BMI means you are at slightly higher risk of needing a caesarean birth, in which case it is safer to have an epidural than a general anaesthetic.

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BMI and your health after baby is born We encourage you to get mobile as soon as possible after the birth, drink plenty of fluids and continue to wear compression stockings if they have been prescribed. It may also be necessary to give you heparin (blood thinning) injections for a few days to prevent blood clots in your legs or chest. You may be asked to continue with these when you go home; you will be shown how to give the injections yourself. For women needing a caesarean section there is an increased likelihood of developing a wound infection because it is difficult to keep the wound clean and dry. You should wear loose, comfortable clothes and cotton underwear. After your daily bath or shower carefully pat the wound dry by using your own clean towel. Lift up the skin folds over the wound and use a mirror, if necessary to check the stitch line for changes. Your midwife will give you advice on wound hygiene and how you can help prevent infection. Smoking is harmful and can prevent your wound from healing. Even one cigarette reduces the blood flow and oxygen to the skin, preventing vital nutrients from being absorbed and therefore increasing the risk of a wound infection. Some women may experience more problems breast-feeding. It can be more difficult to get yourself and the baby into a comfortable position. It is very important to have skin to skin contact with your baby immediately following birth and be assured that with good support and perseverance you will normally succeed. Make the most of the breast-feeding support on the postnatal ward and in your local community and remember that breast-feeding can help weight loss due to an increased metabolic rate.

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UUrinary incontinence Some women may experience problems with bladder weakness during and after pregnancy. It is important that you do your pelvic floor exercises during your pregnancy and after the birth of your baby. Discuss this with your midwife. Further information and support There are many postnatal groups to help you once you have had your baby. Your midwife will be able to give you more information about these. There is also help available to support you in losing weight and starting exercise. Your GP, health visitor and practice nurse will be able to advise you, and don’t forget the commercial slimming clubs. Remember, in addition to the immediate health benefits, reducing your weight by just 6lbs between pregnancies can reduce your chances of gestational diabetes by 50%. You may also find the following websites helpful: www.nhs.uk www.healthychoices.co.uk www.healthystart.nhs.uk www.rcog.org.uk Why your weight matters during pregnancy and after birth Acknowledgement: Adapted from the Oxford Radcliffe Hospitals NHS Trust Pregnancy and Body Mass Index (BMI) Leaflet 2010, with their kind permission.

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If English is not your frst language and you need help, please contact the Ethnic Health Team on 0161 627 8770

Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu 0161 627 8770

For general enquiries please contact the Patient Advice and Liaison Service (PALS) on 0161 604 5897 For enquiries regarding clinic appointments, clinical care and treatment please contact 0161 624 0420 and the Switchboard Operator will put you through to the correct department / service Date of publication: June 2012 Date of review: April 2014 Date of next review: April 2017 Ref: PI_WC_756 © The Pennine Acute Hospitals NHS Trust

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