Maternal Obesity Rates Increasing in Scotland

The percentage of women in Scotland starting their pregnancy with a BMI in the obesity category has increased significantly in recent years and is now at an alarming rate of 25%. This is worrying not only due to the potential harmful health effects in mothers, but also due to the consequent potential lifelong adverse effects in children.

What is maternal obesity and what are the risks?

Maternal obesity is categorised as having a BMI of 30+ during pregnancy and is correlated with an increased risk of many adverse effects and outcomes¹. Pregnant women with overweight and obesity are at a higher risk of multiple health complications such as gestational diabetes, pre-eclampsia, and hypertension¹.

Babies born from mothers with overweight and obesity are also 2-3 times more likely to be of a high birth weight (categorised as being 9lb or over). This increased birth weight consequently leads to an elevated risk of type 2 diabetes, hypertension, and overweight and obesity later in life for these babies².

Maternal obesity is also associated with a greater risk of miscarriage, death during labour, and stillbirth. Obesity during pregnancy also puts mothers at a higher chance of delivery through caesarean section – which is associated with many of its own risks and complications².

A study published by the British Medical Journal estimated that pregnancy in women with overweight and obesity costs the NHS up to 37% more than pregnancy in women of a healthy weight³.

How prevalent is maternal obesity in Scotland?

The most recent report on ‘Births in Scottish Hospitals’ published by Public Health Scotland in November 2020 has revealed that, of the women who delivered babies in Scottish hospitals in 2019/20, 25% had obesity⁵. Maternal obesity rates in Scotland have increased from 20.7% in 2011 to 25.0% in 2020⁵.

The European Perinatal Health Report 2015 revealed that Scotland is recording alarmingly high levels of maternal obesities in comparison to other European countries – with the second worst rate of maternal obesity in European countries in 2015⁶. At that time, Scotland was second only to Wales and, outwith UK countries, the next nearest rate was Germany at 14.9%. Since this European report, rates in Scotland have continued to increase.

Which groups are most affected?

Rates of maternal obesity are closely associated with social and economic inequalities in Scotland. Women from areas of high levels of deprivation and those over the age of 40 are the greatest affected by maternal obesity².

There is a significant gap in the prevalence of obesity during pregnancy depending on levels of deprivation (as categorised by the Scottish Index of Multiple Deprivation)². In 2020, women living in the areas of the highest levels of deprivation experienced 13% higher rates of maternal obesity than those living in the areas of the lowest levels of deprivation⁵.

As shown below, those individuals living in the most deprived areas have had consistently higher levels of maternal overweight and obesity than those living in the least deprived areas since 2011⁵.

The widening of the health gap, as demonstrated above, highlights the importance of addressing health inequalities with powerful and effective interventions. Socioeconomic status cannot continue to impact the health outcomes of pregnant women and babies in Scotland. 

What are the steps to tackle this?

It is not medically recommended to lose weight whilst pregnant, and therefore prevention strategies are key in order to reduce the number of women in Scotland who fall pregnant whilst experiencing a BMI in the overweight or obesity categories.

Some potential strategies which are specifically aimed at mothers and infants include:

• Continuing to implement the Maternal and Infant Nutrition Strategy – a Scottish Government framework which aims to improve the nutrition of pregnant women and infants through education of medical professionals and members of the public, education and support including breastfeeding, and practical provision of support services.
• A greater awareness and understanding of the risks of maternal obesity².
• Provision of the Best Start Food Card – this is a card provided to those who are eligible and require some extra income-related support. The card functions like a normal credit/debit card and can be used to purchase the following items free of charge: milk; fresh, frozen, and tinned fruit and vegetables; fresh, dried, and tinned pulses; and infant formula milk. The Best Start Food Card is part of the wider Best Start Grant – whose aim is to make fresh and healthy food available to everybody, regardless of their socio-economic status - and is a step in reducing food-based health inequalities in Scotland.

On a whole population level, the current prevention strategies which Obesity Action Scotland recommend – focussing on the promotion of a healthy food environment - have the ability to provide benefits to individuals of all ages and sectors of the country, therefore promoting a healthy weight to all.

References:

1. Doi, L., Williams, A.J., Marryat, L. and Frank, J. (2020). Cohort study of high maternal body mass index and the risk of adverse pregnancy and delivery outcomes in Scotland. BMJ Open, 10(2), p.e026168.
2. Maternity and Early Years (2013). Obesity in pregnancy - Maternal and Early Years. [online] www.maternal-and-early-years.org.uk. Available at: http://www.maternal-and-early-years.org.uk/obesity-in-pregnancy [Accessed 9 Dec. 2020].
3. ‌Morgan, K.L., Rahman, M.A., Macey, S., Atkinson, M.D., Hill, R.A., Khanom, A., Paranjothy, S., Husain, M.J. and Brophy, S.T. (2014). Obesity in pregnancy: a retrospective prevalence-based study on health service utilisation and costs on the NHS. BMJ Open, [online] 4(2), p.e003983. Available at: https://bmjopen.bmj.com/content/4/2/e003983 [Accessed 8 Dec. 2020].
4. ‌Euro Peristat (2013). European Perinatal Health Report 2010. Available at: https://www.europeristat.com/reports/european-perinatal-health-report-2010.html. [Accessed 9 Dec. 2020].
5. Public Health Scotland (2020). Births in Scottish Hospitals. [online] Available at: https://beta.isdscotland.org/find-publications-and-data/population-health/births-and-maternity/births-in-scottish-hospitals/ [Accessed 8 Dec. 2020].
6. Euro Peristat (2018). European Perinatal Health Report 2015. [online] Available at: https://www.europeristat.com/index.php/reports/european-perinatal-health-report-2015.html [Accessed 9 Dec. 2020].