1. Merryn Anderson

2. Summary Why healthy weight in pregnancy is important The situation nationally and in Cornwall Moving forward

3. Healthy weight in pregnancy Reduce fertility 1 Risk for mother and foetus during pregnancy 2 Risk of illness in later life 3 NICE guidelines 4

4. Nationally BMIPrevalence 5 >354.99% >402.01% >500.19%

5. Women aged 16-44 6

6. Cornwall BMIPrevalence 30-3511.1% 36-403.5% >400.8%

7. Moving forward Pre-pregnancy Pregnancy Post-natal

8. Pre-pregnancy Everyone presenting to primary care with BMI >25 Adult Obesity pathway People presenting with subfertility and BMI > 29.9

9. Pregnancy-booking clinic Consents women Highlights relevant diet and exercise chapters in The Pregnancy Book Signposts Healthy Lifestyle in Pregnancy service and childrens centres All women at booking clinic

10. Pregnancy – 12 week scan All women to have an accurate BMI recorded at the 12 week scan BMI <30 Universal advice Signpost to website Give option for self referral to Healthy Lifestyle in Pregnancy Midwife to give Obesity in Pregnancy leaflet Follow up phone-call, text, internet as agreed in individual plan If not opted out contacted by specialist midwife with the Healthy Lifestyle in Pregnancy to receive individualised plan Behaviour change advice Healthy eating/exercise Information about services available Create personal goals and agree follow up plan Invitation to Obesity in Pregnancy Group If BMI >40 to be seen by specialist as part of the anaesthetic review clinic BMI >30

11. Post-natal Based on BMI recorded at the 12 week scan Midwife to review progress and give individualised information on: Exercise advice (RCOG guidelines) Behaviour change advice Healthy living pack/website access Breast feeding If BMI >35 options to include invitation to weight matters course Slimming world/weight watchers BMI >30BMI <30 Follow up at 3 and 6 months post-natal Universal advice Signpost to website

12. Summary Why healthy weight in pregnancy is important The situation nationally and in Cornwall Moving forward

13. Any suggestions? Any questions?

14. References 1. Jan Willem van der Steeg; Pieternel Steures; Marinus J.C. Eijkemans; J. Dik F. Habbema; Peter G.A. Hompes; Jan M. Burggraaff; G. Jur E. Oosterhuis; Patrick M.M. Bossuyt; Fulco van der Veen; Ben W.J. Mol. Obesity Affects Spontaneous Pregnancy Chances in Subfertile, Ovulatory Women. Human Reproduction. 2007;Vol 23:324-328 2. Centre for Maternal and Child Enquiries (CMACE). Saving Mothers Lives: reviewing maternal deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118 (Suppl. 1):1–203. 3. Department of Health: Obesity 2011. Available from http://www.dh.gov.uk/health/category/policy- areas/public-health/obesity-healthy-living/ [Accessed 23/4/12] http://www.dh.gov.uk/health/category/policy- areas/public-health/obesity-healthy-living/

15. 4. Weight management before, during and after pregnancy: Dietary interventions and physical activity interventions for weight management before, during and after pregnancy. National Institute of Clinical Excellence 2010. Available from http://guidance.nice.org.uk/PHG/Wave18/3 [Accessed 23/4/12] http://guidance.nice.org.uk/PHG/Wave18/3 5. Centre for Maternal and Child Enquiries (CMACE). Maternal obesity in the UK:Findings from a national project. London: CMACE, 2010 6. The Health and Social Care Information Centre. The health survey for England 2007: latest trends. London: The Health and Social Care Information Centre; 2008