RCP warns maternal obesity is an urgent and growing threat to women and babies

In its new RCP view on maternal health and obesity, the Royal College of Physicians calls for urgent action across the whole system to support women’s health before, during and after pregnancy, highlighting that one in four pregnant women in England is now living with obesity.

Obesity in pregnancy is linked to far higher rates of gestational diabetes, pre-eclampsia, caesarean birth and postpartum haemorrhage. Rates of maternal obesity are highest in the most deprived communities, reinforcing existing health inequalities.

These risks can be fatal: the 2021–24 MBRRACE-UK Confidential Enquiry into Maternal Deaths reported that 64% of women who died during pregnancy or within six weeks of birth were living with overweight or obesity.

The RCP has warned that rising rates of maternal obesity are increasing pressure on maternity services and contributing to avoidable harm. Emerging evidence shows an association between maternal obesity and the increased risk to their children of cardiometabolic disease and other adverse health outcomes later in life, compounding inequalities across generations.

The College’s new policy briefing calls for coordinated, system-wide action across seven areas:

• tackling the wider determinants: transforming food systems and strengthening prevention to prevent obesity in the first place
• improving pre-pregnancy education, considering the impact of obesity on reproductive health 
• embedding compassionate and inclusive obesity care into healthcare training
• improved interconnection between maternity services, weight management services and primary care
• tackling inequalities through targeted local action
• strengthening data and surveillance to monitor maternal and infant outcomes related to obesity
• investing in research on the safety and long-term impacts of obesity treatments in pregnancy.

The RCP recognises obesity as a chronic, systemic illness, shaped by health inequalities, genetic influences, ethnicity, social and commercial factors, stigma, mental health and the environments people live in.

Dr Kath McCullough, RCP special adviser on obesity, said: “Maternal obesity is one of the clearest signs that we need to tackle the root causes of obesity and weight gain, recognising the benefits not only for pregnancy but also women’s health and future generations. We know that obesity is driven by inequality, poverty and environments that make healthy choices harder every day.

“We need bold, joined-up action across the system - from food policy and education to healthcare services, professional training and research to better prevent obesity in the first place and better support women living with obesity in the pre- and postnatal periods. Getting this right would transform outcomes for families and deliver lasting benefits for the NHS.”

Dr Anita Banerjee, obstetric physician and RCP censor, said: “Too often, women arrive in pregnancy already at risk, having had little support beforehand to address the factors affecting their health. By the time they are pregnant, opportunities for preventing obesity and the risks associated with it have already been missed.

“This is why action before, during and after pregnancy matters so much. If we want safer pregnancies and healthier babies, and a healthier society, we need to prioritise women’s health long before they reach a maternity unit. Prevention is better than treatment.”

Dr Alison Wright, president of the Royal College of Obstetricians and Gynaecologists (RCOG) said: “We were delighted to contribute to this vital work led by the Royal College of Physicians and fully support this holistic, integrated approach to care. Stigmatisation of women and their weight remains an issue, which is exacerbated by health inequalities. This must be replaced by the provision of accessible, non-judgemental, evidence-based information support and care, before, during and after pregnancy.

“The RCOG has developed clinical guidance to support clinicians in caring for pregnant women with obesity, which can increase the risk of pregnancy complications, the likelihood of intervention during labour and conditions such as gestational diabetes and pre-eclampsia. We must see maternity services appropriately resourced, with the right staffing levels, training and facilities to care for women with increasingly complex pregnancies.”