Weight management guidance for pregnancy

Women should be encouraged to achieve a healthy weight before they become pregnant and advised that there is no need to ‘eat for two’ when pregnant. These are just two of the recommendations included in new public health guidance published by the National Institute for Health and Clinical Excellence (NICE) on dietary and physical activity interventions for weight management before, during and after pregnancy.

The guidance was developed by a team of experts including Dr Debra Bick, Professor of Evidence Based Midwifery Practice, Florence Nightingale School of Nursing & Midwifery at King’s College London, and Professor Lucilla Poston, Director of the Maternal and Fetal Research Unit and Head of the Division of Reproduction and Endocrinology, also of King’s.

The aim of the new guidance is to help health professionals support women who are pregnant or who are planning a pregnancy, and mothers who have had a baby in the last 2 years.

Professor Debra Bick, Professor of Evidence Based Midwifery Practice and guidance developer said: ‘The new guidelines will be very important for midwives, health visitors and other members of the healthcare team who are ideally placed to advise women on healthy eating before, during and after their pregnancy.

'Obesity is now a major health risk for many women and their babies, but it is a risk that can be reduced if appropriate measures are taken. The guidance emphasises that healthy eating is important even before planning pregnancy and some of the ‘myths’ around food intake during and after pregnancy, such as ‘eating for two’, need to be countered.’

Professor Lucilla Poston, Professor of Maternal and Fetal Health, King’s College London and guidance developer said: ‘The increasing prevalence of obesity amongst pregnant women in the UK is very worrying as there are so many potential risks for the mother and her baby. This timely guidance provides sound, yet simple lifestyle advice which can help health professionals support obese women to optimise their health, and their baby’s too.

‘It is also emphasises how important it is to think about BMI and weight management before pregnancy and after delivery – indeed even modest weight retention after pregnancy is now known to increase the risk of problems in the next pregnancy. Increased awareness of all these important issues will represent a major breakthrough in improvement of maternity care.’

The new guidance will be aimed at GPs, obstetricians, midwives, health visitors, dieticians, community pharmacists and all those working in antenatal and postnatal services and children’s centres.

Recommendations include:

• Health professionals should use any appropriate opportunity to provide women with a BMI of 30 or more with information about the health benefits for themselves and their baby of losing weight before becoming pregnant, and how their obesity poses a risk, both to their own and their unborn child’s health once they become pregnant.
• Explain to women with a BMI of 30 or more that they should not try to reduce this risk by dieting while pregnant and that the risk will be managed by the health professionals caring for them during their pregnancy. These women should also be offered a referral to a dietician or appropriately trained health professional for assessment and personalised advice on healthy eating and how to be physically active.
• Provide clear, tailored, consistent, up-to-date and timely advice about how to lose weight safely after childbirth. Ensure women have a realistic expectation of the time it will take to lose weight gained during pregnancy.
• Local authority leisure and community services should offer women with babies and children the opportunity to take part in a range of physical or recreational activities. This could include swimming, organised walks, cycling or dancing. Activities need to be affordable and available at times that are suitable for women with children.
• Women with a BMI of 30 or more after childbirth should be offered a structured weight-loss programme or, if more appropriate, a referral to a dietician or an appropriately trained health professional. Women who are not yet ready to lose weight should be provided with information about where they can get support when they are ready.

Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE said: ‘This new guidance is about helping health professionals to help women have a healthy pregnancy – it’s not about preaching to women. About half of women of childbearing age are either overweight or obese and although obese women can have healthy babies, the evidence does suggest that there are more risks associated with pregnancies in women who have a BMI of over 30 when they become pregnant.

‘It’s also important that women do not feel pressurised into rapid weight loss or crash diets after pregnancy. At the moment health professionals do not generally give women information about the risks of obesity during pregnancy and the importance of weight management before or after pregnancy. We want all women to be supported before, during and after they have children so that both they and their babies have the healthiest outcome possible.’

Women who are obese before getting pregnant face an increased risk of complications during pregnancy and childbirth. These include the risk of impaired glucose tolerance and gestational diabetes, miscarriage, pre-eclampsia, thromboembolism and maternal death.

Babies born to obese women face several health risks. These include a higher risk of fetal death, stillbirth, congenital abnormality, shoulder dystocia where one of the baby’s shoulders becomes stuck. There is also a risk of the baby being too large for their gestational age (macrosomia) which may increase the likelihood of obesity in childhood and later life.

Notes to editors:

The new guidance will be available on the NICE website from today: http://guidance.nice.org.uk/PH27. These recommendations will complement existing NICE guidance on obesity, maternal and child nutrition, antenatal care, postnatal care, physical activity, behaviour change, antenatal and postnatal mental health and diabetes in pregnancy.