Saving Mothers' Lives: - Public Health Agency for Northern Ireland

Pre-pregnancy counselling and weight loss, together with wider public health messages about optimum
weight should help to reduce the number of obese women who become pregnant.
There are currently no national statistics on the prevalence of maternal obesity and only limited information
regarding the provision of maternity services for obese women in the UK 28 . Whilst there are National
Institute for Health and Clinical Excellence (NICE) guidelines for the management of obesity in children and
adults 13 , there is no specifi c guideline for the management of obesity in pregnancy; a key recommendation
in this Report.
CEMACH is developing a national programme on obesity in pregnancy to commence in 2008, which
will include a survey of the provision of maternity services for obese women, development of consensus
standards, information on national and regional prevalence fi gures and pregnancy outcomes, and an audit
of clinical care. The UK Obstetric Surveillance System (UKOSS) is also planning to collect information on
the most morbidly obese pregnant women.
Smoking
The 2005 Infant Feeding Survey 29 found that 33% of all women in the United Kingdom smoked at some
time in the year before or during pregnancy. These included 16% who smoked before pregnancy but gave
up, mainly on confi rmation of pregnancy and 17% who smoked throughout pregnancy. This was a slight
decrease from 2000 when 35% smoked at some time in the year before pregnancy and 20% smoked
during pregnancy.
The percentage who smoked at some time in the year before pregnancy ranged from 20% of women in
managerial and professional occupations to 48% of those in routine and manual occupations and 35% of
those who had never worked. Linked to this were differences by age. The percentage of women smoking
before or during pregnancy ranged from 68% of women aged under 20 to 21% of those aged 35 or over.
A smoking history was not documented for 67% of the women who died which makes further analysis of
the increased contribution of smoking in pregnancy to maternal mortality impossible. It also highlights the
need for better awareness amongst health professionals as well as better record keeping.
Vulnerability
Ethnicity
The ethnic groups of all women who died were reported to the Enquiry, but the ethnic group of mothers in
general is recorded only in England and not in the other countries of the United Kingdom. Since 1995, ethnic
group information has been recorded in the Hospital Maternity Episode Statistics (HES) System for England, but
coverage is still not complete. By the fi nancial year 2004-05, ethnic group was recorded for 75% of deliveries in
England for the years covered by this Report. A comparison of maternity HES data for 2000-01 with data about
children under the age of one recorded in the 2001 census showed that the ethnic group distribution in HES
delivery data was broadly comparable as long as maternities to women whose ethnic group was not stated are
grouped with those to women whose ethnic group was recorded as White30 . Maternity HES data for the fi nancial
years 2003-04 and 2004-05 have been grossed up to the total numbers of registered maternities in England in
the 2003-05 triennium to produce the estimated maternities in Table 1.18. These have been used to produce
estimated mortality rates and relative risks by ethnic group for England.
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