Pregnancy in severely obese women: the Edinburgh Antenatal Metabolic Clinic

Women who are obese have a greater risk of developing complications during pregnancy, and obesity may also affect the long-term health of the baby.
  • Authors list

    Jane Norman, Rebecca Reynolds, Fiona Denison, Shareen Forbes, Mandy Drake, Yvonne Grieg, Hayley Moir, Kirsten Cliff

This project took place at our Edinburgh centre which operated between 2008 and 2021. 

Women who are obese have a greater risk of developing complications during pregnancy, and obesity may also affect the long-term health of the baby and future generations.

Little is known about the physiological and hormonal changes that occur in very severely obese women (body mass index [BMI] of 40 or higher) during pregnancy and how these changes affect the development of the baby, and subsequent obesity or metabolic risk.

We do not know which advice about weight-management to give these women to ensure the best outcomes for both them and their babies. The Edinburgh Antenatal Metabolic Clinic was established in 2008 to address such questions.

The clinic provides multidisciplinary antenatal care to severely obese pregnant women, including advice about diet and lifestyle.

We are also carrying out a detailed study of the women who attend our clinic to look at their weight gain and change in body composition during pregnancy, and how this affects their babies.

Progress report 2017

More than 400 women have now received antenatal care at the clinic and we have published (and continue to publish) findings from our work. We have already shown that severely obese women who attend our clinic have better clinical outcomes than women who don’t. 

In particular, a recent audit showed that severely obese women cared for by this clinic had a significantly lower rate of stillbirth. They are eight times less likely to have a stillbirth than similarly obese women who do not attend the clinic.

Women who attend the clinic are 8 times less likely to suffer a stillbirth

We have also followed up the babies of almost 200 of our very severely obese women. These babies were significantly heavier and shorter at birth than the babies of normal-weight women, and were still significantly heavier at 6 months of age. This may be related to less breast feeding and the early introduction of solid food, which may affect obesity later in childhood. To look at this, we are assessing the growth of these children (who are now aged between 3 and 7 years) and the development of obesity and any metabolic problems.

Progress report 2018

Our clinic has continued to expand over the years and we now provide evidence based personalised antenatal care to 25-30 women every week. This year we have surveyed women attending the clinic to get feedback from them about their experiences of attending the clinic.

We have also been:

  • focusing on the health of women with gestational diabetes who attend the clinic
  • looking at ways to reduce the time that women spend in sedentary activities
  • exploring how maternal obesity influences the type of anaesthetic women get for caesarean section.

This year we held an ‘MRC Festival Day’ to show-case our work to members of the public. It was really well attended and received excellent feedback. Tommy’s was also visited by Aileen Campbell, MSP and Minister for Public Health and Sport.

The clinic has been used as an exemplar in the development of the first Green- Top Guideline produced by the Royal College of Obstetricians & Gynaecologists to guide management of obesity in pregnancy. Fiona Denison is Chair of this Guideline Development Group, and has been working with a multi-professional group including Rebecca Reynolds to generate the guideline, which is due to be published in October 2018.

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Tommy's funds research across the UK investigating the reasons for pregnancy complications and loss. Maternal and fetal research is underfunded and we need your support to continue. There are many small and large ways you can support us, find out more here.

Timescale: 2008–2015

Summary: 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 monitoring of the mother and baby, personalised advice about healthy eating, and education about the increased risk that obesity causes in pregnancy. We compared the outcomes of pregnancy in about 510 women who attended our specialist clinic with those of 494 women who received standard antenatal care. The women at our clinic had higher risk pregnancies as they were more obese and they were more likely to be having their first pregnancy.

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 less than half of the rate for Scotland overall (4.7 per 1,000 in 2012), and less than a third of the Scottish average for severely obese women (7 per 1,000). 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.

Research paper

Denison FC, MacGregor H, Stirrat LI, et al. Does attendance at a specialist antenatal clinic improve clinical outcomes in women with class III obesity compared with standard care? A retrospective case-note analysis. BMJ Open 2017;7:e015218. doi:10.1136/bmjopen-2016-015218

Tommy’s funds the entirety of this study