Challenge pregnant women to manage their weight, NICE saysBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4107 (Published 28 July 2010) Cite this as: BMJ 2010;341:c4107
Myths about pregnancy and weight—such as that pregnant women need to “eat for two”—need to be challenged by GPs, midwives, and other healthcare workers, says new guidance from the UK National Institute for Health and Clinical Excellence (NICE).
Obese women and their unborn babies face serious health risks, including a raised risk of miscarriage, stillbirth, pre-eclampsia, and gestational diabetes, it says. Women need reliable information on how to manage their weight before, during, and after their pregnancy.
The team that produced the guidance says that healthcare professionals such as GPs and midwives don’t routinely provide this advice and that many healthcare professionals are unsure about how to tackle the question of weight in pregnancy or what advice to give.
Lucilla Poston, professor of maternal and fetal health at King’s College London, who helped develop the guidance, said that some midwives might be “unwilling to talk about obesity” and might need advice about how to broach the subject. But she said the advice in the guidance didn’t require special training to deliver, because it was “sound yet simple lifestyle advice.”
“The problem is the time required to deliver [the advice],” she said. “We do say people can suggest a referral to other health professionals, such as dietitians.”
However, in some areas, dietitians are “overwhelmed” with referrals of women who are pregnant and obese, she admitted. “There is a resource implication,” she added.
Professor Poston emphasised the importance of measuring body mass index and offering advice before a woman becomes pregnant and also after she gives birth.
“Even modest weight retention after pregnancy is now known to increase the risk of problems in the next pregnancy,” she pointed out.
Healthcare professionals are advised that women who are obese (BMI ≥30) and already pregnant should not be advised to adopt a weight loss diet as the safety of such diets is not established and some women might be tempted to try a dangerous crash diet. Instead women should be encouraged to eat a healthy and balanced diet and to become or remain physically active.
Professor Poston said that the lifestyle guidance was aimed at reducing the risk of gestational diabetes, which she said was “probably underdiagnosed,” because not all hospitals routinely offer oral glucose tolerance tests to women with a BMI of >30. She said that the advice to eat foods high in complex carbohydrates and to keep active would help reduce glucose intolerance.
Weight loss after giving birth should be slow and steady, and women should not feel pressured into losing weight immediately, the guidance says. Healthcare professionals should take advantage of the 6-8 week postnatal check to discuss the woman’s weight but should accept that many women won’t feel able to start a weight loss programme at that stage.
Professor Poston said it might be “at least six months” before a woman was able to commit to a weight loss programme but that when she was ready the issue should be taken seriously.
Cite this as: BMJ 2010;341:c4107
Dietary Interventions and Physical Activity Interventions for Weight Management Before, During and After Pregnancy is at http://guidance.nice.org.uk/PH27.