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Multi-disciplinary care needed to manage obesity in pregnancy, says RCOG

Weight management advice and support required before, during and after pregnancy from primary care to maternity services

Caroline White

Friday, 23 November 2018

Obese women should be supported to lose weight before, during and after pregnancies to ensure the healthiest possible outcome for mother and baby, says new clinical guidance published by the Royal College of Obstetricians and Gynaecologists (RCOG).

Specialist weight management advice and support is needed from primary care to maternity services, it says.

Obesity is now one of the most common health risk factors in pregnancy. Latest UK figures show that around 22% of pregnant women are obese while 28% are overweight.

Obesity can boost the risk of complications for both mother and baby, including miscarriage, stillbirth, pre-eclampsia, gestational diabetes and postpartum haemorrhage – the most common cause of maternal death directly related to pregnancy in the UK.

The overall likelihood of a miscarriage in early pregnancy is one in five (20%), but rises to one in four with a BMI of 30 or above. The overall likelihood of stillbirth in the UK is one in every 200 births, this rises to one in 100 with a BMI of 30 or above.

And babies whose mothers are obese also run a heightened risk of congenital abnormalities, pre-term birth, and becoming obese and diabetic in later life.

But these risks can be minimised with the care and support outlined in the new guidance.

Key recommendations include:

  • Women with a BMI of 30 and above should lose weight before becoming pregnant and between pregnancies.
  • Women should be weighed and offered advice on weight and lifestyle in primary care, such as during pre-conception counselling and appointments about contraception
  • A structured weight-loss programme and referral to a dietician or an appropriately trained healthcare professional are worth considering. 
  • For women unable to lose weight before pregnancy, a consultation to advise of the increased risks of complications, and dietetic advice from a trained healthcare professional should be provided early in the pregnancy.
“Pregnancy provides an opportunity for healthcare professionals to connect with women at a time when they are generally more concerned about their health. By making healthy changes to their diet and exercise, women who are obese may limit the amount of extra weight they gain during pregnancy,” said Professor Fiona Denison, chair of Translational Obstetrics at the University of Edinburgh and lead author of the guideline*.

“Losing weight by dieting or taking weight loss drugs is not recommended as this may harm the health of the unborn baby,” she added.

The guidelines state that although being obese is itself not a reason to be admitted to a consultant-led unit, women who are obese are more likely to require an induction of labour, emergency caesarean birth, or a vaginal birth that requires a medical intervention.

The additional care that can be provided promptly in a consultant-led unit must be discussed with each woman so that she can make an informed choice about her planned place of birth, says the guidance.

This requires a multi-disciplinary, individualised approach, and may need to involve consultations with an obstetrician, anaesthetist, and midwife. Women who are obese may also experience difficulty in breastfeeding and may need additional support.

Dr Daghni Rajasingam, consultant obstetrician and RCOG spokesperson, commented: “Pregnant women who are overweight or obese have increasingly more complex health needs. It is crucial that healthcare services – from primary care to maternity services – offer specialist weight management advice and support for women planning a pregnancy, or who are pregnant.”

Dr Max Davie, officer for health promotion for the Royal College of Paediatrics and Child Health added: “Overweight parents are much more likely to have overweight children, and they as a family are more likely to suffer from life changing conditions such as type 2 diabetes. That’s why it is crucial there are support services available for anyone wanting to manage their weight, especially couples wanting to start or expand their family.

“With cuts to public health spending we know that providing these services is becoming increasingly difficult so we hope that the publication of [this] new guidance acts as the catalyst needed to reverse these cuts.”

*Denison FC, et al on behalf of the Royal College of Obstetricians and Gynaecologists. Care of Women with Obesity in Pregnancy. Green-top Guideline No. 72. BJOG 2018; DOI:10.1111/1471-05386.000:1-45.

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