- Lucilla Poston, head of division of women’s health, King’s College London,
- Lucy C Chappell, clinical senior lecturer in maternal and fetal medicine
- 1Women’s Health Academic Centre, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, UK
Obesity in pregnant women has considerable resource implications, with increased odds of caesarean or instrumental delivery, haemorrhage, infection, longer duration of hospital stay, and need for neonatal intensive care.1 At a time when more than half the women of reproductive age in the United Kingdom are overweight or obese,2 any analysis of weight management interventions in pregnancy is timely and welcome. In the linked paper (doi:10.1136/bmj.e2088), Thangaratinam and colleagues present a comprehensive and well conducted meta-analysis of studies that have tried to improve maternal weight and obstetric outcomes through dietary and lifestyle interventions across the body mass index (BMI) range.3 However, many of the included studies are of small size and limited quality. The authors conclude that interventions can improve some outcomes for the mother and baby and that dietary advice, rather than advice on physical activity, is most effective. Importantly, there was no evidence of harm.
Internationally, the guidelines for weight management in pregnancy vary. Because the US Institute of Medicine (IOM) recommends limits for gestational weight gain (table⇓),4 most published intervention studies focus mainly on this parameter. In the UK, however, the National Institute for Health and Clinical Excellence (NICE) guidelines for weight management in pregnancy do not advise regular weighing of pregnant women beyond their first visit because evidence for an effective intervention to improve clinical outcomes in a UK population has been lacking.5