ACOG Updates Guidelines on Prenatal Obesity, Exercise

Troy Brown, RN

December 28, 2015

Two new guidelines from the American College of Obstetrics and Gynecology (ACOG) emphasize the need for exercise during pregnancy and the post-postpartum period to prevent or correct maternal weight issues.

Practice Bulletin Number 156, "Obesity in Pregnancy," and Committee Opinion Number 650, "Physical Activity and Exercise During Pregnancy and the Postpartum Period," appear in the December issue of Obstetrics & Gynecology. Together, the documents address the clinical management of overweight and obese women before and during pregnancy, and the need for women to exercise regularly to prevent or correct overweight or obesity.

More than half of all women of childbearing age in the United States are overweight or obese, the group writes, and obesity in pregnancy is associated with significant and extensive risks for both the mother and her fetus.

Even Small Preconception Weight Loss Improves Pregnancy Outcomes

"Optimal control of obesity begins before conception," the practice bulletin authors write. "Weight loss before pregnancy, achieved by surgical or nonsurgical methods, has been shown to be the most effective intervention to improve medical comorbidities. Obese women who have even small weight reductions before pregnancy may have improved pregnancy outcomes."

Lead author Patrick M. Catalano, MD, from Case Western Reserve University School of Medicine, and Metro Health, both in Cleveland, Ohio, said in an ACOG news release. "Ob-gyns are often the only physician women see on a regular basis, therefore we are in the optimal position to help educate women on the importance of fighting obesity."

The updated practice bulletin recommendations include the following:

  • behavioral interventions that use diet and exercise can improve postpartum weight loss better than exercise alone (level A recommendation);

  • use body mass index calculated at the initial prenatal visit to counsel women on diet and exercise according to Institute of Medicine recommendations for prenatal weight gain (level A);

  • even small prepregnancy weight reductions can improve pregnancy outcomes (level B recommendation);

  • consider permitting a longer first stage of labor before performing cesarean delivery for arrest of labor in obese women (level B);

  • venous thromboembolism thromboprophylaxis dosage based on weight may be more effective than dosage based on body mass index in class III obese women after cesarean delivery (level B); and

  • between-pregnancy weight loss in obese women may lower the risk for a large-for-gestational-age newborn in a later pregnancy (level B).

"Ideal Time for Lifestyle Modification"

The purpose of the committee opinion on exercise is to remind physicians to encourage their patients to establish a regular exercise routine.

"Pregnancy should not be looked at as a state of confinement," Raul Artal, MD, the main author of the committee opinion, said in an ACOG news release. "In fact, it is an ideal time for lifestyle modification. That is because more than any other time in her life, a pregnant woman has the most available access to medical care and supervision." Dr Artal is a member of the International Olympic Committee's Medical Commission, which is drafting similar guidelines for elite Olympic athletes.

The committee opinion recommendations include:

  • physical activity during pregnancy is associated with minimal risks and benefits most women, but women may need to modify exercise routines "because of normal anatomic and physiologic changes and fetal requirements";

  • conduct a thorough clinical evaluation before recommending an exercise program to ensure the pregnant patient has no medical contraindications to exercise;

  • encourage women with uncomplicated pregnancies to participate in aerobic and strength conditioning exercises before, during, and after pregnancy; and

  • regular physical activity helps pregnant women maintain physical fitness, manage weight, and improve psychologic well-being and helps obese pregnant women reduce their risk for gestational diabetes.

Absolute contraindications to aerobic exercise during pregnancy include hemodynamically significant heart disease, restrictive lung disease, incompetent cervix or cerclage, multiple gestation at risk for premature labor, persistent second- or third-trimester bleeding, placenta previa after 26 weeks of gestation, premature labor during the current pregnancy, ruptured membranes, preeclampsia or pregnancy-induced hypertension, and severe anemia.

The authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2015;126:1321-1322, e135-e142. Practice Bulletin summary, Committee Opinion

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