National Institute for Health and Clinical Excellence (NICE)
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New NICE guidance on weight management before, during and after 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 NICE on dietary and physical activity interventions for weight management before, during and after pregnancy.
The aim of this 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. Health professionals can help women to understand the health risks of being overweight or obese during pregnancy and the importance of achieving a healthy weight prior to pregnancy, but also advise them not to try to lose weight while they are pregnant.
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 obese1 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; they should understand that weight loss after birth takes time and that physical activity and gradual weight loss will not affect their ability to breastfeed. Losing weight gradually can actually help women maintain a healthy weight in the long-term.
"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. The aim of developing this new guidance is to provide health professionals with clear recommendations to help them support women during this important time."
The new guidance will be aimed at GPs, obstetricians, midwives, health visitors, dietitians, community pharmacists and all those working in antenatal and postnatal services and children’s centres. The recommendations cover four key areas: preparing for pregnancy; pregnant women and women who may become pregnant - particularly those with a BMI over 30kg/m2; and supporting women following childbirth. Recommendations include:
- Preparing for pregnancy: 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. This should include information on the increased health risks their weight poses to themselves and would pose to their unborn child.
- Pregnant women: Explain to women with a BMI of 30 or more how this poses a risk, both to their health and the health of the unborn child. Explain 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 dietitian or appropriately trained health professional for assessment and personalised advice on healthy eating and how to be physically active. Encourage them to lose weight after pregnancy.
- Supporting women after childbirth: 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. Advice on healthy eating and physical activity should be tailored to the woman’s circumstances. For example, it should take into account the demands of caring for a baby and any other children, how tired she is and any health problems she may have (such as pelvic floor muscle weakness or backache).
- 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 older children as well as those with babies. Where possible, affordable childcare (for example, a creche) should be provided and provision made for women who wish to breastfeed.
- Women with a BMI of 30 or more after childbirth: Offer a structured weight-loss programme or, if more appropriate, offer a referral to a dietitian or an appropriately trained health professional. They will provide a personalised assessment, advice about diet and physical activity and advice on behaviour change strategies such as goal setting. 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 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 emphasised 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."
Professor Annie Anderson, Professor of Food Choice, Centre for Public Health Nutrition Research, University of Dundee and guidance developer said: "Obesity prevention and management is a key health issue for most women of childbearing age. Many health professionals are asked to provide guidance on weight management during pregnancy and in the post partum period but have been unsure what to advise. This guidance provides an evidence-based framework for what should be recommended about diet and physical activity during the maternal journey. Dispelling the myth of “eating for two”, highlighting the importance of being physically active during pregnancy and encouraging weight loss after pregnancy is the cornerstone of this guidance."
Dr Tracey Sach, member of the Public Health Interventions Advisory Committee at NICE and guidance developer said: "Pregnancy is a special time for women, when they are most aware of their weight and face important issues for the health and well being of themselves and their baby.
"Having recently had a baby myself, this guidance was pertinent to my experiences both during and after pregnancy. During pregnancy it was not uncommon to hear I should be ‘eating for two’ and that I should stop cycling. However, neither is necessary and this guidance aims to dispel these common myths.
"After having my son, I was aware that my own readiness to deal with the issue of weight changed over time. The guidance is not prescriptive about when women can seek support, women who may need support should be able to seek it when they are ready."
Professor Steve Field, Chairman of the Royal College of General Practitioners said: "GPs and GP Practices have a crucial role in maternity care that begins pre-conception, and continues right through to postnatal support, advice and care. The GP is there to support the patient and their family.
"There is much conflicting information, particularly in the media, about what constitutes a healthy weight for a woman during and after pregnancy, and I welcome any guidance that can offer prospective and new mothers comprehensive direction and clarity.
"The RCGP recognises that truly women-centred maternity care can only be delivered with clear guidance and with full collaboration and communication between GPs and our colleagues across the maternity team, including midwives, obstetricians and health visitors.
"This new guidance will help clinicians across the board in providing women with the support they need to make healthy decisions about their weight, both for themselves and for the health of their baby."
Louise Silverton, Deputy General Secretary of the Royal College of Midwives, said: "There is a real need to address the issue of obesity, and this new guidance shows this is particularly important for pregnant women. The growing volume of evidence shows that the health of a mother with obesity is further compromised by the pregnancy, also impacting the health of her unborn baby. Midwives are ideally placed to assist women in developing healthy lifestyles during pregnancy and during the postnatal period.
"As a result of the increase in obesity among pregnant women, midwives are, (on top of the continuing baby boom) dealing with more complex births. These women need to see a midwife as early as possible in their pregnancy. They need more time to spend with a midwife to help and advise them as well as involving the wider health care team."
Jane Brewin, Chief Executive of baby charity Tommy's, said: "The number of pregnant women who are overweight and obese is rising at an alarming rate in the UK and we know that, during pregnancy, obesity increases the risks of health complications for the mother and poses long-term health risks for the baby. A set of guidelines to ensure all women receive optimal care and support is a step in the right direction, as mitigating the impact of obesity on mums and their babies is one of our most important health challenges."
Notes to Editors
About the guidance
1. The new guidance will be available on the NICE website from 28 July 2010: http://guidance.nice.org.uk/PH27
2. 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.
3. In adults, a BMI of 25 to 29.9 means that person is considered to be overweight, and a BMI of 30 or above means that person is considered to be obese.
4. About half of women of childbearing age are either overweight (BMI 25-29.9 kg/m²) or obese (BMI greater than or equal to 30 kg/m²)2 and approximately 16% of women in England are obese at the start of pregnancy 3.
5. 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 death4. An obese woman is also more likely to have an induced or longer labour, instrumental delivery, caesarean section or postpartum haemorrhage5.
There are also practical implications for the birth. Obese women may experience reduced choices about where and how they give birth. There may also be restrictions on home births and the use of birthing pools.
6. 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 life6.
7. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
8. NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
1 The NHS Information Centre (2008) Health survey for England 2006: CVD and risk factors adults, obesity and risk factors children. London: The NHS Information Centre
2 The NHS Information Centre (2008) Health survey for England 2006: CVD and risk factors adults, obesity and risk factors children. London: The NHS Information Centre
3 Heslehurst N, Rankin J, Wilkinson JR et al. (2010) A nationally representative study of maternal obesity in England, UK: trends in incidence and demographic inequalities in 619 323 births, 1989-2007. International Journal of Obesity 34: 420-8
4 Centre for Maternal and Child Enquires and the Royal College of Obstetricians and Gynaecologists (2010) Joint guideline - Management of women with obesity in pregnancy. London: CMACE/ Centre for Maternal and Child Enquires and the Royal College of Obstetricians and Gynaecologists
5 Yu CKU, Teoh TG, Robinson S (2006) Obesity in pregnancy. British Journal of Obstetrics and Gynaecology 113: 1117-25
6 Ramachenderan J, Bradford J, McLean M (2008) Maternal obesity and pregnancy complications: a review. Australian and New Zealand Journal of Obstetrics and Gynaecology 48: 228-35