Does specialist care reduce the number of stillbirths in obese women?

Rebecca Reynolds, Fiona Denison, Jane Norman

Care of severely obese women at Tommy's specialist antenatal metabolic clinic reduces the number of stillbirths eight times

This research study is complete

The specialist multidisciplinary Antenatal Metabolic Clinic established with the help of Tommy’s in 2008 has now looked after more than 1,000 severely obese women throughout their pregnancies. This care includes regular and frequent check-ups of the mother and baby, personalised advice about healthy eating, and education about the increased risks that obesity causes in pregnancy. In 2015, we compared around 510 women who attended our specialist clinic with 494 women who received standard antenatal care. The women at our clinic had higher risk pregnancies as they were more obese and were also more likely to be having their first pregnancy.

We found that women who received specialised care in our clinic were 8 times less likely to have a stillbirth.

We found that women who received specialised care were 8 times less likely to have a stillbirth.The rate of stillbirths was 2 per 1,000 deliveries, which is lower the rate for Scotland overall (3.2 per 1,000 in 2015), and less than a third of the Scottish average for severely obese women (7 per 1,000). There were no stillbirths at all in the clinic over 2016. Women attending the clinic were less likely to have a baby of low birthweight (less than 2.5 kg). They were also more likely to be tested for diabetes, allowing the condition and the pregnancy to be managed appropriately if it is diagnosed. This study shows that this level of extra care for severely obese women reduces the risk of stillbirth. 

Impact

The success of the metabolic antenatal clinic prompted us to open the our new “Lothian preterm birth clinic” in October 2016, the first of its type in Scotland. Again, research studies are embedded into the evidence based antenatal care we provide to women and their babies. Our formal opening in 2018 was attended by Scottish Cabinet Secretary for Health Shona Robison. Since our first patient attended in October 2016, around 240 women have been referred to the clinic.

Research paper

Fiona C Denison, Heather MacGregor, Laura I Stirrat, Kerrie Stevenson, Jane E Norman, Rebecca M Reynolds (2017) Does attendance at a specialist antenatal clinic improve clinical outcomes in women with class III obesity compared with standard care? A retrospective casenote analysis. Published 2017 in BMJ open DOI:10.1136/bmjopen-2016-015218

Timing

2016-2017


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Funding

Tommy's funded the set-up of the clinic and continues to support the staff and research taking place there

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