Antonovsky A The salutogenic model as a theory to guide health promotion. Health Promot Int. 1996; 11:(1)11-18

Baker J Developing a care pathway for obese women in pregnancy and beyond. British Journal of Midwifery. 2011; 19:(10)623-43

Berg M Midwifery relationships with childbearing women at increased risk, 2nd edn. In: Kirkham M Basingstoke: Palgrave MacMillian; 2010

Boney C, Verma A, Tucker R, Vohar B Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005; 115:(3)e290-6

Catalano P Management of obesity in pregnancy. Obstet Gynecol. 2007; 109:(2 Pt 1)419-33

Cedergren M Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet. 2006; 93:(3)269-74

Unit feedback from the CMACE Obesity in Pregnancy: women with a BMI ≥35.London: CMACE; 2009

Claesson IM, Brynhildsen J, Cedergren M, Jeppsson A, Sydsjö A, Josefsson A Weight gain restriction during pregnancy is safe for both the mother and neonate. Acta Obstet Gynecol Scand. 2009; 88:(10)1158-62

Day-Stirk F, Palmer L The RCM virtual institute for birth: promoting normality. RCM Midwives. 2003; 6:(2)64-5

Denison F, Chiswick C Symposium 1: Consequences of obesity and overweight during pregnancy. Improving pregnancy outcome in obese women. Proceedings of the Nutrition Society. 2011; 70:457-64

Denison FC, Price J, Graham C, Wild S, Liston WA Maternal obesity, length of gestation, risk of postdates pregnancy and spontaneous onset of labour at term. BJOG. 2008; 115:(6)720-5

Denison FC, Norwood P, Bhattacharya S, Duffy A, Mahmood T, Morris C, Raja EA, Norman JE, Lee AJ, Scotland G Association between maternal body mass index during pregnancy, short-term morbidity, and increased health service costs: a population-based study. BJOG. 2014; 121:(1)72-81

London: DH; 2007

Dodd JM, Crowther CA, Robinson JS Dietary and lifestyle interventions to limit weight gain during pregnancy for obese or overweight women: a systematic review. Acta Obstet Gynecol Scand. 2008; 87:(7)702-6

Downe S Defining normal birth. MIDIRS Midwif Digest. 2001; 11:S31-3

Guelinckx I, Devlieger R, Mullie P, Vansant G Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Am J Clin Nutr. 2010; 91:(2)373-80

Health and Social Care Information Centre. 2010. (accessed 7 September 2015)

Health and Social Care Information Centre. 2011. (accessed 7 September 2015)

Health and Social Care Information Centre. 2014. (accessed 18 September 2015)

Heslehurst N, Simpson H, Ells L, Rankin J, Wilkinson J, Lang R, Brown TJ, Summerbell CD The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev. 2008; 9:(6)635-83

Holloway I, Wheeler S, 3rd edn. Chichester: Wiley-Blackwell; 2010

Hui A, Back L, Ludwig S, Gardiner P, Sevenhuysen G, Dean H, Sellers E, McGavock J, Morris M, Bruce S, Murray R, Shen GX Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial. BJOG. 2012; 119:(1)70-7

Jevitt C Obesity related lactation problems. In: Richens Y, Lavander T London: Quay Books; 2010

Keely A, Gunning M, Denison F Maternal obesity in pregnancy: Women's understanding of risks. British Journal of Midwifery. 2011; 19:(6)364-69

Kirkham M, 2nd edn. Basingstoke: Palgrave MacMillian; 2010

Knight M, Kenyon S, Brocklehurst P, Neilson J, Shakespeare J, Kurinczuk JJOxford: National Perinatal Epidemiology Unit; 2014

Kristensen J, Vestergaard M, Wisborg K, Kesmodel U, Secher NJ Pre-pregnancy weight and the risk of stillbirth and neonatal death. BJOG. 2005; 112:(4)403-8

Lewis GLondon: Confidential Enquiry into Maternal and Child Health; 2007

Lewis GLondon: Confidential Enquiry into Maternal and Child Health; 2011

Lindholm ES, Norman M, Kilander CP, Altman D Weight control program for obese pregnant women. Acta Obstet Gynecol Scand. 2010; 89:(6)840-3

Modder J, Fitzsimons KJLondon: Centre for Maternal and Child Enquiries and Royal Collage of Obstetricians and Gynaecologists; 2010

Nascimento SL, Surita FG, Parpinelli MÂ, Siani S, Pinto e Silva JL The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: a randomised clinical trial. BJOG. 2011; 118:(12)1455-63

National Institute for Health and Care Excellence. Weight management before during and after pregnancy. 2010. (accessed 7 September 2015)

NHS Choices. How much weight will I put on during my pregnancy?. 2011. (accessed 7 September 2015)

NHS Litigation Authority. Clinical Negligence Scheme for Trusts: Maternity Clinical Risk Management Standards Version 1, 2013/14. 2013. (accessed 7 September 2015)

Nyman VM, Prebensen AK, Flensner GE Obese women's experiences of encounters with midwives and physicians during pregnancy and childbirth. Midwifery. 2008; 26:(4)424-9

Poobalan AS, Aucott LS, Gurung T, Smith WC, Bhattacharya S Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women systematic review and meta-analysis of cohort studies. Obes Rev. 2009; 10:(1)28-35

Quinlivan J, Julania S, Lam L Antenatal dietary interventions in obese pregnant women to restrict gestational weight gain to Institute of Medicine recommendations: a meta-analysis. Obstet Gynecol. 2011; 118:(6)1395-401

Richens Y, Lavander TLondon: Quay Books; 2010

Scott-Pillai R, Spence D, Cardwell CR, Hunter A, Holmes VA The impact of body mass index on maternal and neonatal outcomes: a retrospective study in a UK obstetric population, 2004-2011. BJOG. 2013; 120:(8)932-9

Streubert H, Carpenter D, 5th edn. London: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011

Tsukamoto H, Fukuoka H, Inoue K, Koyasu M, Nagai Y, Takimoto H Restricting weight gain during pregnancy in Japan: a controversial factor in reducing perinatal complications. Eur J Obstet Gynecol Reprod Biol. 2007; 133:(1)53-9

Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jørgensen JS The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care. 2011; 34:(12)2502-7

Geneva: WHO; 1995

World Health Organization. Trade, foreign policy, diplomacy and health: Public Health. 2013. (accessed 7 September 2015)

Supporting the individual needs of obese pregnant women: Effects of risk-management processes

02 October 2015
13 min read
Volume 23 · Issue 10


Obesity is the UK's most prevalent antenatal comorbidity, and reducing rates of maternal obesity and risk management of complications in pregnancy and labour is a priority for the NHS. The emphasis on managing maternal obesity-related risks, rather than dealing with the causes of long-term obesity, is short-sighted and fails to consider the needs of the individual woman. This process of risk management is fuelled by the maternity services' costly litigation insurance that presents measures to manage obesity-related risks, leading to bureaucratic shaping of maternity services. This limits the choices for this group of women by standardising care rather than facilitating their individual needs. This article explores an alternative long-term strategy called Pregnancy Plus that facilitates the management of risk alongside supporting the needs of individual obese pregnant women, offering choice and equal access to maternity services while maintaining the safety of the women and their babies. Pregnancy Plus is an award-winning multi-intervention health education and weight maintenance programme that has presented promising outcomes to date. It utilises a salutogenic approach to health education and care-planning for obese pregnant women and adopts the principles of the US Institute of Medicine guidelines for the maintenance of gestational weight-gain in obese women.

Rates of obesity worldwide have doubled in the past 30 years (World Health Organization (WHO), 2013) and obesity in the UK is reaching epidemic levels. The Health and Social Care Information Centre (HSCIC, 2014) reported that over 60% of adults and 30.6% of children in England were classed as overweight or obese in 2012. Rates of maternal obesity in the UK saw an increase from 10% in 1990 to 30% in 2014 (Denison et al, 2014) and obesity-related maternal and infant deaths have mirrored this, with reported obesity-related maternal deaths of 23% in 2007 increasing to 49% in 2011 (Lewis, 2007; 2011). The negative impact of obesity on health, particularly in the childbearing population, should not be underestimated—obesity is now the UK's most prevalent antenatal comorbidity (HSCIC, 2010; 2011).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

  • Monthly email newsletter