Midwives Call for Guidance on Weight Gain in Pregnancy

Peter Russell

September 18, 2018

Midwives have renewed a call for clear guidance on healthy weight management in pregnancy after a study suggested that both excessive and inadequate gestational weight gain can significantly affect children's health.

The Royal College of Midwives (RCM) said it was concerned that some midwives were not being provided with scales to monitor women in their care. 
 

Weight Problems, High Blood Pressure, and Insulin Resistance

The study, published in Diabetologia , the journal of the European Association for the Study of Diabetes, found that too much or too little weight gain during pregnancy can lead to cardiometabolic risk in offspring.

Researchers in Hong Kong found that women who gained more weight than guidelines drawn up by the US Institute of Medicine (IOM) in 2009 were more likely to have children with higher body fat, higher blood pressure, and insulin resistance, at 7 years of age, compared with those who gained weight within the recommended range.

The study included 905 mother-child pairs who were enrolled in a study into hyperglycaemia and adverse pregnancy outcomes in Hong Kong. Women were classified as having gained weight below, within, or exceeding the 2009 Institute of Medicine (IOM) guidelines.

The study found that the mean pre-pregnancy body mass index (BMI) was 21 kg/m2 and that the proportion of women who were overweight and/or obese was 8.3%. On average, weight change from pre-pregnancy to delivery was 15kg (33lbs). Compared with the IOM guidelines:

  • 17% gained less weight than recommended

  • 42% gained weight within the recommended range

  • 41% gained more weight than recommended

The authors wrote: "These findings have important implications for both prevention and treatment. There is a need for greater awareness and monitoring of weight gain during pregnancy. Pregnancy might be a potential window of opportunity for intervention through modifiable behaviours, including maternal nutrition and physical activity."

However, they acknowledge that among the study's limitations was a mismatch between guidelines drawn up for white women and the study's cohort of women with Chinese ancestry.

They also called for a follow-up study to assess cardiometabolic risk in adolescence and adulthood.

Call for Guidance on Weight Management

Commenting on the research Mandy Forrester, the RCM's head of quality and standards, said: "There is a clear need for midwives to have the tools, guidance and training they need so that they can offer women the best possible support and care. This is especially pressing because of the potentially serious complications that can arise in pregnancy as a result of women being overweight or obese.

"It is a real concern that some midwives do not have access to that most basic piece of equipment, scales.

"We are calling for clear guidance on healthy weight management in pregnancy and will be looking at how we can take this forward so that women and midwives have the information, support and resources needed."

Earlier this year, the RCM and Slimming World called for clearer guidance on healthy weight management for expectant mothers, and more support, training and equipment for midwives. It said that despite NHS data showing that 21% of women start pregnancy when they are obese, there are no national guidelines for women, midwives, or health professionals on weight management during pregnancy.

A survey found that 24.7% of midwives said they did not have facilities to weigh women in all of the settings in which they provide antenatal care, the RCM said.

The National Institute for Health and Care Excellence (NICE) is in the process of updating 2010 guidelines on weight management before, during, and after pregnancy. As part of the update, NICE is considering whether it would be appropriate to apply IOM guidelines.

Commenting on the latest research, Dr Daghni Rajasingam, consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG), said: "These findings add to the growing body of evidence that shows the increase in risk of health complications from too much weight gain or too little weight gain during pregnancy."

Diabetologia, September 17th 2018: Either too much or too little weight gain during pregnancy is associated with adverse outcomes in children aged 7 years. Abstract.

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