Maternal obesity soars to record level in Scotland

The increasing trend was seen across all maternal age groups and levels of deprivation, according to a report by Public Health Scotland.

Obesity Action Scotland said the findings were concerning given that maternal weight has an impact on children.

The charity said: "Today's report offers yet more evidence that we need stronger action in helping improve population weight."

Studies have shown that if a woman is overweight while pregnant, her baby is more likely to be heavier and the health risks continue into childhood, with a higher risk of developing insulin resistance, high blood pressure and high cholesterol.

Obesity in pregnancy is associated with an increased risk of serious adverse outcomes, including miscarriage, congenital conditions, maternal blood clots, gestational diabetes9, postpartum haemorrhage and neonatal death.

There is also a higher caesarean section rate and a lower breastfeeding rate compared to those with a healthy BMI.

Scotland has higher rates for both elective and emergency caesarean than England or Wales.

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For live single births in Scotland, the percentage of normal vaginal deliveries has fallen steadily from 75.9% in 1975/76 to 50.2% in 2021/22, which is the lowest recorded proportion in the reported period.

More than one in three (37.6%)  babies were delivered by caesarean section, the highest proportion seen and ranged from 23.5% in women under 20 to 55.4% in women aged 40 and over. 

The proportion increases slightly with decreasing deprivation, 36.3% in the poorest areas compared to 39.7% in the most affluent.

High birth weight also carries risks and can be associated with maternal obesity and excessive weight gain during pregnancy.

In 2021/22, 12.9% of babies had a birthweight of 4000g or more (roughly 9lbs)  up from around 8% in the mid-1970s.

Age and deprivation continues to be a factor in maternal health, the study authors said.

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The proportion who were overweight or obese ranged from 40.8% in women under 20 to 61.6% among those aged 40 and over and was highest (61.1% in the poorest areas.

The report also found that maternal age has continued to steadily rise with 59% of women aged 30 years or older at the time of giving birth, which is the highest proportion since reporting began.

Having a baby at an older age is associated with a number of adverse outcomes for both mother and baby including a greater risk of premature birth, stillbirth, caesarean section and higher neonatal mortality.

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In 2021/22 the proportion of women giving birth who were aged 35 years and over was the highest recorded at 24.7% and the proportion aged under 20 was the lowest seem at 2.3%.

While older women are more likely to have a caesarean section, the report said there was an increasing tendency for this method of delivery across all age groups.

Deprivation continued to influence the health of pregnant women and babies across Scotland.

Women from poorer areas were generally more likely to have a first birth at a younger age, be overweight or obese, to deliver their babies early and to have a low birthweight baby compared to those from less deprived areas.

A greater than average proportion of African (67.2%) and Caribbean and Black (70.4%) women giving birth were overweight or obese.

However, women giving birth from these ethnic groups were also more likely to be living in the most deprived areas (48.6% and 45.5% respectively).

More births continued to occur among women from the most deprived areas and this theme has not changed markedly over time.

In 2021/22, 6.5% of single babies and 69.3% of twins or triplets were born preterm, or before 37 weeks. They were more likely in women under 20 and those over 40, who are more likely to have multiple births due to intervention such as IVF (in vitro fertilisation".

Babies who are both preterm and small for their gestational age are at particular risk of short and long-term health problems.

The study said a "complex response" was required to tackle rising obesity levels across the general population but in particular among deprived communities.

It said: "Affordability and availability of healthy food in local communities, access to active transport links and physical activity opportunities are all factors that influence the healthy weight of individuals in the population but extend beyond the sphere of Health Services.

"It is crucial to target a variety of factors that may disproportionately disadvantage more deprived populations in terms of access to healthy environments."

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