Shared learning database

Dartford & Gravesham NHS Trust
Published date:
December 2012

A 10 week community based health intervention programme, aimed at obese pregnant women with a body mass index of 30kg/m2. This programme offers advice in accordance with the National Institute of Health and Clinical Excellence guidance (PH27, 2010).

This example was updated in March 2016.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

Its primary aim is to restrict gestational weight gain to within Institute of Medicine guidelines for obese pregnant women, 7-9kg, (IOM 2009), reducing the associated risks of excessive weight gain in pregnancy to mother and baby and also lifelong obesity related risks. It also aims to insure that obese pregnant women are aware of the risks of obesity to their current and future health and that of their baby. This is achieved by assessing women's existing knowledge related to obesity and its health risks and building on their knowledge with evidence based advice on diet, exercise and healthy lifestyle in accordance with the National Institute of Health and Clinical Excellence guidance (NICE PH27, 2010). 

Reasons for implementing your project

National obesity rates among pregnant women have more than doubled from 1990 to 2007 from 10% to 24% CMACE & RCOG 2010,CMACE 2011. This upward trend will continue if no action is taken (Office of National Statistics 2010). Statistics from our local Darent Valley Hospital reflect these increasing rates but more worryingly present figures that are above the national average. Nationally 3.3% of women booking for maternity care have a BMI of 35kg/m2 and 1.09% have a BMI of 40kg/m2 compared to local rates of 4.7% and 1.93% respectively (CMACE 2009). Local figures for 2012 indicate that rates have risen further to 6% and 3% respectively. In 2013, for the first time since 2003, our local data shows a substantial decrease, figures had almost halved from 2012.

Pregnancy Plus has been running for 4 years and we would hope that it has positively affected these figures. Our aim is to investigate this further.

Local feedback from the Obesity in Pregnancy Project (CMACE 2009) identified that 48% of the local obese pregnant population are category 4 deprived, compared to 24% of the general pregnant population. This reflects the higher than average local obesity rates as deprivation is closely associated with obesity (WHO 2000). This implies that the probable cause of obesity is lack of education regarding a healthy diet and exercise.

Obesity in pregnancy greatly increases mortality and morbidity rates for mother and baby. Safe management of complications in pregnancy and labour is complex and expensive. Yet in the UK emphasis is placed on management of the problem rather than its prevention. Another limitation is the lack of UK guidance on recommended gestational weight gain. This failure to commit makes it difficult for clinicians caring for obese pregnant women to put structures in place to support pregnant women to maintain or lose weight during pregnancy. These are the only guidelines that specify recommended gestational weight gain for pregnant women according to their BMI when booking for antenatal care. 

How did you implement the project

We set up this programme in 2009, prior to the publication of the NICE guidelines on obesity in pregnancy. We now utilise these guidelines to support and guide the information given to the women regarding diet and exercise in pregnancy and lifelong. It reinforced the credibility of the programme.

Through a process of constant evaluation in collaboration with the women who attend the programme and the implementation of NICE guidance we now have a programme tailored to the individualised needs of this particular client group. This has been a process of shared learning between facilitating midwives and the women attending the programme.

Recommendation 2
The programme promotes the NICE guidance and recommendations on diet and physical activity. It encourages women to incorporate exercise into everyday activities. This has been encouraged by providing pedometers for the women that attend. It acknowledges that weight loss programmes are not appropriate in pregnancy and aims to support women in the maintenance of a healthy gestational weight gain based on the recommendations of the American Institute of Medicine guidance.

Recommendation 3
The programme extends in to the postnatal period and offers advice based on NICE guidance.

Health visitors participate in the post-natal session to support seamless and ongoingcare and advice.

Recommendation 4
The programme reinforces NICE guidance regarding the importance of maintaining a healthy life style for the whole family and lifelong.

Recommendation 5
The programme offers antenatal and postnatal women aquanatal classes at a local leisure centre.

The 1 year pilot study incurred a total cost of £4,699.94. This included equipment, administration and staff costs. The 8 week programme is now run 3 times a year in four areas across the Trust and costs £2,500 per annum per area. 

Key findings

This is a new service and we are currently collecting data that will positively support the programme. This data includes weekly weights/gestational weight gain, postnatal weight loss, mode of delivery, pregnancy outcomes, method of feeding etc. Analysis of the raw data indicates that the majority of women that attend the programme maintain a gestational weight gain within the recommendations of the IOM. These women are also more likely to breast feed. A comparative retrospective study of obese pregnant women that attended pregnancy plus in 2014 and those that did not attend revealed that 86% of women who attended Pregnancy Plus breast fed compared to 55% who did not attend.

Key learning points

Setting up this service was initially challenging due to the lack of British guidance regarding gestational weight gain and the lack of specific recommendations for the maintenance of a healthy lifestyle for obese pregnant women.

We would strongly advise that before undertaking a project such as this that the project manager should undertake a systematic review of current literature related to the subject. This was a useful tool in identifying the subject matter for the programme itself.

To facilitate the sharing of good practice and to support organisations that wish to set up similar services we run annual innovation in practice study days at our hospital. These include workshops that will address potential problems of setting up this and other innovative services. 

Contact details

Michele Ahluwalia & Karen George
Community Midwifery Team Leaders
Dartford & Gravesham NHS Trust

Primary care
Is the example industry-sponsored in any way?