Watching your Weight in Pregnancy

Pregnant women in the Southern Health and Social Care Trust area are learning how to manage their weight as a result of a project being funded by the Public Health Agency.The 'Watching your Weight in Pregnancy' project, being delivered by the Southern Health and Social Care Trust, got underway in December 2011 to address the rising levels of obesity across the southern area. It also aims to reduce the impact that obesity can have on the health of women and their unborn children during pregnancy and birth.Two pilot programmes are currently underway in the Kilkeel area teaching both antenatal and post natal women that feeling good about yourself and your baby is important during pregnancy.The programmes provide information about managing weight during and after pregnancy and include advice on good nutrition along with opportunities to take part in appropriate physical activities. As part of the project, there have also been training sessions for midwives in the Southern HSC Trust on healthier eating and physical activity during pregnancy.Patricia McStay, Southern Trust Head of Midwifery, explained why there was a need for this project: "Every woman wants a healthy baby and we are supporting the women to improve their own health and wellbeing. We have been seeing increasing numbers of women who are overweight or obese at their first contact with the midwife. We want to support these women to manage their weight gain in pregnancy to reduce the risk of experiencing health complications such as high blood pressure, and diabetes in pregnancy."Angela McComb, Health and Social Wellbeing Improvement Manager, for the PHA, said: "The southern office of the PHA recognised the many risks associated with obesity in pregnancy, both to the mother and her baby, and allocated funding for this pilot project to test out ways in which these health risks can be reduced. "We look forward to seeing the results of the evaluation which will inform the further development of effective approaches to support pregnant women to manage their weight both locally and across Northern Ireland."

Diabetes in pregnancy: are we providing the best care?

This third and final report of the CEMACH national diabetes programme comes at an important time in the national drive to improve services for women with diabetes in pregnancy. The National Service Framework (NSF) for Diabetes requires the NHS to develop, implement and monitor policies that seek to empower and support women with diabetes to optimise the outcomes of their pregnancy. The CEMACH report shows that, whilst progress has been made in improving services for women with diabetes and their babies, there is much still to be done to meet the standards recommended by the NSF. Too many women continue to be poorly prepared for pregnancy in the critical areas of glycaemic control and folic acid supplementation. The report underlines the need for an increased focus on diabetes preconception care services and the development of strategies to educate women with diabetes of childbearing age. The growing proportion of women with type 2 diabetes during pregnancy, many of whom are from minority ethnic groups, presents an additional challenge for health services in developing responsive and accessible services.This CEMACH report has identifi ed several areas of good clinical practice during pregnancy in women with pre-existing diabetes. However, there continue to be areas where there is room for improvement, including antenatal fetal surveillance, glycaemic control during labour and delivery and postnatal diabetes care. The National Institute for Health and Clinical Excellence (NICE) is currently in the fi nal stages of development of its new guideline for the management of diabetes in pregnancy. This guideline, when taken together with the CEMACH report, will provide local health services with an unprecedented wealth of material on which to base their development of improved services for women with diabetes in pregnancy.��

IPH response to Review of Maternity Services in Northern Ireland

IPH responded to the Department of Health, Social Services and Public Safety consultation on a draft maternity strategy for Northern Ireland. The strategy contains a number of proposals, which, if implemented, will significantly change how maternity services are delivered in the future. The draft strategy aims to provide women, professionals, commissioners and policy makers with a clear pathway for maternity services from preconceptual care through to postnatal care.  It places an emphasis on early direct contact with a midwife and a better understanding of the role of the midwife and obstetricians. It sets out clear recommendations for tackling public health issues such as obesity, smoking and alcohol abuse in pregnancy; providing more choice; providing care closer to home and ensuring safe, high quality care tailored to meet the needs of the woman.

Prevalence of chronic conditions – Hypertension

IPH has estimated and forecast clinical diagnosis rates of hypertension among adults for the years 2010, 2015 and 2020. In the Republic of Ireland, the data are based on the Survey of Lifestyle, Attitudes and Nutrition (SLÁN) 2007. The data describe the number of people who report that they have experienced doctor-diagnosed hypertension in the previous 12 months (annual clinical diagnosis). Data are available by age and sex for each Local Health Office of the Health Service Executive (HSE) in the Republic of Ireland. In Northern Ireland, the data is based on the Health and Social Wellbeing Survey 2005/06. The data describe the number of people who report that they have experienced doctor/nurse-diagnosed hypertension at any time in the past (lifetime clinical diagnosis). Data are available by age and sex for each Local Government District in Northern Ireland. Clinical diagnosis rates in the Republic of Ireland relate to the previous 12 months and are not directly comparable with clinical diagnosis rates in Northern Ireland which relate to anytime in the past.   The IPH estimated prevalence per cents may be marginally different to estimated prevalence per cents taken directly from the reference study. There are two reasons for this: 1) The IPH prevalence estimates relate to 2010 while the reference studies relate to earlier years (Northern Ireland Health and Social Wellbeing Survey 2005/06, Survey of Lifestyle, Attitudes and Nutrition 2007, Understanding Society 2009). Although we assume that the risk of the condition in the risk groups do not change over time, the distribution of the number of people in the risk groups in the population changes over time (eg the population ages).  This new distribution of the risk groups in the population means that the risk of the condition is weighted differently to the reference study and this results in a different overall prevalence estimate. 2) The IPH prevalence estimates are based on a statistical model of the reference study. The model includes a number of explanatory variables to predict the risk of the condition. Therefore the model does not include records from the reference study that are missing data on these explanatory variables. A prevalence estimate for a condition taken directly from the reference study would include these records.

Maternal Obesity in the UK: Findings from a national project

In 2008, the Confidential Enquiry into Maternal and Child Health (CEMACH), now known as the Centre for Maternal and Child Enquiries (CMACE), commenced a 3-year UK-wide Obesity in Pregnancy project. The project was initiated in response to a number of factors. At the time, these included: i) growing evidence that obesity is associated with increased morbidity and mortality for both mother and baby, ii) evidence from the CEMACH 'Saving Mothers' Lives' report showed that women with obesity were over-represented among those who died of direct deaths compared to those who died of indirect deaths, 1 iii) unknown national and regional prevalence rates of maternal obesity, and iv) the need for a national clinical guideline for the care of women with obesity in pregnancy.

Saving Mothers' Lives 2003-2005

This, the seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom (UK) enquires into maternal deaths and has a new title, "Saving Mothers' Lives". The change has been made to more accurately reflect the purpose of this, the longest running example of a maternal death review in the world. The Enquiry's aim is to stimulate and promote beneficial clinical actions and health and social service changes that will save yet more mothers' and babies' lives in future. By acting on the recommendations and results contained in the Report, the inequalities in pregnancy outcomes that currently exist between the most advantaged and most vulnerable and excluded mothers and babies in society should reduce, as should the numbers of those who suffer the consequences of severe morbidity.In addition, and perhaps of most importance, all mothers, infants and families will benefit from accessiblematernity services whose staff are proud to provide them with the safest and best possible individualised care that meets all their medical and other needs.