Tommy’s Metabolic Antenatal Clinic

The Tommy’s Metabolic Clinic at The Royal Infirmary of Edinburgh supports pregnant women with severe obesity. The clinic follows high risk pregnancies very carefully, detecting potentially life-threatening problems early so they can offer timely intervention, personalised treatment and careful monitoring of the pregnancy.

Our Edinburgh Metabolic Antenatal Clinic is home to specialists in pregnancy care and diabetes, as well as midwives and a specialist dietician. Care offered to women who are very severely obese (BMI over 40) includes frequent check-ups of mothers and babies, as well as personalised advice about healthy eating and lifestyle.

The clinic uses specialist equipment such as Tanita scales, that allow clinicians to measure women's weight and body composition at each visit. The team also use larger cuffs to accurately measure blood pressure, have access to extra-large support stockings for thromboprophylaxis and screen for diabetes.

Obese women are more likely to have a complicated pregnancy with poorer outcomes. Risk of stillbirth is more than double that of non-obese pregnant women, affecting 1 in 100 pregnancies, compared to 1 in 225 for non-obese women.

The clinic follows high risk pregnancies very carefully, detecting potentially life-threatening problems early so they can offer timely intervention, personalised treatment and careful monitoring of the pregnancy.

Obese women who attend our specialist clinic are 8 times less likely to have a stillbirth than those who attend a standard maternity ward.

What happens at the clinic?

Our specialist researchers and clinicians have developed a specialist care pathway for helping obese women have healthy pregnancies:

  • At their first clinic visit, patients are reviewed by a dietician and given personalised healthy eating dietary advice and advice to maintain their weight during pregnancy.
  • For uncomplicated pregnancies, women are usually reviewed at the clinic 4 times. At these visits, women will have fetal growth scans and meet with the interdisciplinary team. Women with extra risk factors such as gestational diabetes are seen as often as every 1 to 2 weeks.
  • Women are also screened for gestational diabetes with a fasting glucose test at less than 20 weeks' gestation, and a 75g oral glucose tolerance test at 24-28 weeks' gestation.

Women attending the clinic will continue to see their community midwife to provide continuity of care during and after pregnancy.

Referral information

Women who are very severely obese (have a BMI of over 40) can be referred to the metabolic clinic by their GP, midwife or obstetrician, referrals can only be accepted from the Lothian region.

Care timeline

12-16 weeks into pregnancy: Initial visit, personalised pregnancy plan, dietetic review, screen for diabetes

28 weeks into pregnancy: Glucose tolerance test, review risk

30 weeks into pregnancy: Growth scan, anaesthetic review, delivery plan, review risk

36 weeks into pregnancy: Growth scan, review of delivery plan if indicated, post-dates plan in required, postnatal weight-management and contraception discussion

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