Should the UK Introduce Recommendations for Weight-Gain during Pregnancy - Case Study Example

SHOULD THE UK INTRODUCE RECOMMENDATIONS FOR WEIGHT-GAIN DURING PREGNANCY? DISCUSS THE EVIDENCE BASE FOR YOUR CONCLUSION By of the Class Name of the Professor Name of the School City, State 20 February 2015 Introduction The gestational period for women in the society requires critical attention to ensure the health and safety for both the mother and the unborn child. Biologically, it is normal for women to add weight during pregnancy. This is however different in different women. Depending on their height and weight before pregnancy, it contributes to the differences of weight gain among women, which could have detrimental effect to their health wellbeing. Realizing the risks involved, there raised concerns to what should be the recommended weight gain ranges during pregnancy. First, women should be educated that bodies respond differently along the gestational period. According to Nice, other than the increment of body fat, “the unborn child, placenta, amniotic fluid and increases in maternal blood and fluid volume all contribute” to the extra weight gain during pregnancy (2010). To enable women obtain optimal weight gain, the UK should introduce recommendations for weight gain during pregnancy. This will assist pregnant mothers and medical care providers monitor and regulate any development. Pattern of excessive gestational weight gain (GWG) in UK despite antenatal care The UK lacks a formal guideline for pregnancy weight gain. It has left women to rely on medical advice from their caregivers and clinicians among other approved medical professionals to establish what is appropriate for their pregnancy. Despite the dietary, physical involvement and personalized medical advice, majority of women have still ended up gaining more or less than their bodies require. Most women in the UK lack appropriate and specific information to help them regulate their weight gain. Therefore, they will consume based on myths and ignore the necessary activities to end up acquiring unhealthy weight. While few consider medical advice for their regulated weight, majority women especially those who are obese disregard or are unaware of the potential implications of their weight gain during pregnancy. A survey conducted by Leslie, Gibson and Hankey between 2009 and 2010 June showed that increasingly pregnant women beyond a BMI of 25 (overweight and obese) were unconcerned about their potential weight gain during pregnancy, with their attitude reflecting lack of awareness of potential effect to the them and their infants (2013). Despite the medical advice, they still fail to acknowledge that excessive weight gain is an issue. Others find it offensive when their midwives measure their weight when delivering care. Insufficiency of UK’s system and Scarcity of resources UK’s reliability on encouraging healthy pre-pregnancy BMI and other medical advice express some reluctance compared to other western nations whom have gone ahead to adopt WHO’s recommendations as provided through IOM guidelines. Hector and Hebden clarify lack of UK’s evidence based guidelines to inform pregnant women of the recommended ranges of GWG and compare their strategy to widely adopted IOM guidelines customized for country’s needs (2013). Unfortunately, while a healthy BMI is considered one between 20 and 25, majority of the pregnant and pre-pregnant women in the UK are those who register a BMI above 25. Based on a systematic review of clinical trials, Oteng-Ntim et al stated that approximately 24 percent of the women at a “reproductive age were already obese: rates of obesity in pregnancy had doubled to approximately 20 percent in UK” and its prevalence was still increasing by end of 2011 (2012). It is necessary to admit that most pregnant women may not have regular care depending on their social-economic status, meaning even the minimal care and advice offered by the medical practitioners may not be accessible to them. With appropriate open recommendations for GWG in the UK, most pregnant women would benefit to help them monitor and regulate their weight gain. This could be adjusted to meet UK’s health needs in antenatal care and enable women to keep check of their weight despite their geographical location and inaccessibility to the care. Prevention of labor complications due to excessive weight gain Unaware of the recommended weight gain that pregnant women should gain, they risk exposing themselves and their babies to unhealthy complications during pregnancy. Most women in the UK fail to plan their pregnancy; as a result, they lack the opportunity to prepare (loosing or adding weight), which is important for their pregnancy. Due to this, most conceive with an already established overweight or obesity. By either negatively continuing or altering their lifestyle activities and consumption, they end up with excessive weight gain that often trigger pregnancy complications. Research indicates that a proportionate number of women with a normal, overweight and obese BMI who gained more than adequate weight did experience pregnancy complications in one their tri-semesters. According to Arrowsmith, Wray and Quenby, their survey on pregnant women after induction of labor (IOL) for prolonged pregnancy indicated that more obese women 24.8 than 18 percent for normal weight women were associated with increased rates of caesarean section delivery (2011). Uncontrolled weight to obesity levels among pregnant women is known to often cause their pro-longed pregnancies. PPH and excessive GWG The UK is among the developed countries where overweight and obesity have become norms their prevalence has increased considerably since the 90s. Even with the enforcement of healthy pre-pregnancy BMI in the UK, there is varying data on pregnant women across Wales, Scotland and England who record high levels of BMI. Some, factoring out any sickness register over 35 BMI ranges and 40 or beyond in special cases. This is a risk exposure to primary postpartum hemorrhage (PPH) that has contributed to numerous maternal deaths in the UK and the rest of the world. Loss of blood occurs after delivery via the vaginal track or caesarean section operations. The divergence is the amount of blood that women of adequate and excessive weight gain loose in within the 24 hour period after blood. Finding from a 3 years obesity pregnancy project across UK by CMACE revealed that women with a BMI of over 35, accumulated to percentage of 37.5 of the 5065 samples women were reported to suffer from PPH (blood loss of over 500 ml with 24 hours of delivery) (2010). Primary Postpartum Hemorrhage among samples obese women with a BMI of over 34.9 in UK (CMACE, 2010, p.53). Macrosomia, Dystocia issue and increased GWG With introduction of recommended GWG, pregnant women and professionals in antenatal care would be seeking to regulate weight on weekly/monthly basis to prevent situations of dystocia associated with high weight and growth of the fetus size. While most physicians tend to anticipate occurrence of dystocia, there are potential connections of excess maternal GWG, the fetus size and dystocia conditions. Birth of large babies for overweight and obese mothers than normal mothers is known to be highly probably around the world. Though obesity is highly, no doubt that excessive maternal weight gain is significant cause of Macrosomia, where fetus may grow to weigh over 4000 grams. This could occur in both diabetic and non-diabetic women. From an Irish study investigating the outcomes of excessive GWG, Viswanathan et al found that “the case-control investigation indicated higher gestational weight gain during pregnancy was a significant predictor of shoulder dystocia (OR, 2.0; 95% CI, 1.6–2.2; P = 0.015), where the results suggested a positive predictive value of 1 percent for shoulder dystocia when gestational weight gain was12 kg or greater” (2008). It is definitely a consistent issue with UK pregnancies that contributes to the differential rate of growth of the child’s trunk and head. Some women add approximately 20 Kgs during pregnancy an average of around 35 lb from their normal or overweight level only to cause mild or severe shoulder dystocia during deliveries. O’leary does recommend determination of minimal weight gain among pregnant women of different BMI to achieve the optimal weight gain, prevent macrosomia and dystocia cases (2009). Gestational Diabetes mellitus During the pregnancy, mothers’ bodies are known to develop resistance to insulin. As a result of the hormonal influence, the mother’s body cells become more resistant to insulin as the pregnancy period increases in the late tri-semesters. The effect is its obstruction to the supply of glucose in the blood. Considering the weight of pregnant women before their pregnancy, those who weight overweight or obese could trigger are at high risks of GDM. Apparently, the beta-cell dysfunction combined with reduced insulin sensitivity contributes to abnormal GDM among established overweight and obese prior to the pregnancy. With resistance of insulin due to high glucose retention in the blood, the maternal weight gain is accelerated, and contributes to other complications like macrosomia and large for gestational age infants. Based on Diabetes facts and statistics in UK, GDM affects approximately 5 percent of all pregnancies, which is a substantial number, indicating its high risks among over 24.9 BMI patients and a 7 percent lifetime risks of developing type II diabetes after GDM (Diabetes.org, 2014). Patients are advised to monitor their glucose level, which may go well with exercises and weight control during pregnancy. Though weight loss during pregnancy is difficult and not advisable, with recommended ranges of weight gain, obstetrics and GDM patients can be in a position to monitor and manage weight Hypertensive disorder The cases of diastolic blood pressure beyond 90 mm Hg is a risk that most obstetrical have to deal with during patient care visits to avoid child and mother’s risks. It still remains scientifically unclear how weight gain cause hypertension for pregnant women. However, in treatment and regulation of the disorder interventions of gestational weight gain are recommended (Macdonald-Wallis et al, 2013). Based on various researches, increased blood pressure has been associated with GWG at least in the first half of the pregnancy period. Cases of gestational hypertension occurring after mid pregnancies and pre-eclampsia are reported distributed among women who gain excessive weight in the UK. According to Mushambi and Williamson, in UK’s history, gestational hypertensive diseases nearly cause 18.6 percent of maternal deaths, affecting 10.6 percent of pregnant women, 5.8 and 0.4 percent from primigravidas, and secundagravid women respectively, where the women were characterized by excessive weight gain and oedema conditions (1996). Some women have demonstrated high blood pressure levels during their mid pregnancy after rapid increase of their weight within a month. Others hypertension occur after an excessive GWG during the first term of pregnancy. Stillbirth and uncontrolled GWG Prior pregnancy high BMI for women has been associated with the cause of still births in the UK. Like any other high income country, the few percentage of overweight and obese women tend to gain excessive additional weight during pregnancy, contributing to high rates of BMI. By 2012, England already recorded approximately 50 percent of adult women beyond normal weight as 32 and 25 percent as overweight and obese respectively. With unregulated additional weight gain during pregnancy, BMI progressively increases enhances the risks of still birth. In comparison to other countries, the UK demonstrates similar risk factor of women from deprived groups in terms of socioeconomic status, but also admits that maternal weight and obesity among women of child bearing age are potential factors that could be modified to prevent stillbirth situations (Flenady et al, 2011). Weight gain resulting to diabetes, hypertension and obesity among other complications may trigger fetal complications like slow growth and dysfunctions that cause stillbirth. Increase in fat and fat free mass, though a part of the anabolic processes in pregnancy is linked to GWG and conditions of postpartum weight retention (PWR). An American observational study for women who adhered to IOM recommendations on weight gains demonstrated they had high probability of better maternal outcome as limited cases of PWR than those who gained excess or less weight (2010). Similarly, with adoption of recommended GWG and its implementation by pregnant mothers, they can assist to prevent lifelong consequences to children arising from heredity outcomes like childhood obesity. Conclusion There are apparent many benefits for the UK, its obstetric population and the children to be born upon introduction of recommendations for weight gain. It has cost the UK millions of Euros in ensuring maternal and children’s health which could have been regulated with implementation and adherence of specific recommended guideline. One, the current system in the UK fails to avail sufficient information to pregnant mother to openly regulate their weight. Similarly, the number their system is not fully effective as the number of women getting into pregnancy with obese and over weights is still considerably substantial. Finally, there are potential maternal diseases and complications than can better be prevented or controlled from causing severe effects during pregnancy, delivery time or in future of a child’s or maternal life through strict adherence of weight recommendation to monitor their health. References Arrowsmith, S., Wray, S. and Quenby, S., 2011.Maternal Obesity and Labour Complications following Induction of Labour in Prolonged Pregnancy. BJOG. 2011, 118(5): 578–588. [online] Available at:[Accessed 20 February 2015]. CMACE, 2010. Maternal Obesity in the UK: Findings from a National Project. [pdf] Available at: [Accessed 20 February 2015]. Diabetes.org, 2014. Diabetes: Facts and Stats. [pdf] Available at: [Accessed 20 February 2015]. Flenady,V., Middleton,P., Smith, G.C., Duke,W., Erwich,J.J., Khong, T.Y., Neilson, J., Ezzati, M., Koopmans,L., Ellwood,D., Fretts, R. and Frøen, J.F. 2011. Still Births 5. [pdf] Available at:[Accessed 20 February 2015]. 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