New Guidance for Managing Obesity in Pregnancy

Peter Russell

November 22, 2018

A multidisciplinary approach should be adopted to help women who are obese to lose weight before conception and between pregnancies, new clinical guidance said.

The Royal College of Obstetricians and Gynaecologists (RCOG) said obesity was becoming increasingly prevalent and was one of the most common health risk factors in pregnancy.

Latest UK figures showed around 22% of pregnant women were obese, 28% overweight, and 47% within a normal range.

Avoiding Complications for Mother and Baby

Complications for women who were obese included higher risk of miscarriage, stillbirth, pre-eclampsia, gestational diabetes, and postpartum haemorrhage, while babies who had obese mothers had an increased risk of congenital anomalies, being born pre-term, being a large baby, becoming obese themselves, and having diabetes in later life.

A green-top guideline, Care of Women with Obesity in Pregnancy , made several recommendations, including:

  • Ensuring through primary care services that all women of childbearing age had the opportunity to optimise their weight before pregnancy

  • Giving information and advice about the risks of obesity during pregnancy and childbirth to women of childbearing age with a BMI of 30 kg/m2 or greater

  • Supporting women to lose weight before conception and between pregnancies in line with National Institute for Health and Care Excellence (NICE) clinical guidelines

  • Informing women that weight loss increases the chances of successful vaginal birth after caesarean (VBAC) section

For women unable to lose weight before pregnancy, the guidance recommended comprehensive, sensitive and appropriate multi-disciplinary care, a discussion of the risks of maternal obesity, and an offer of dietetic advice by a trained healthcare professional early in pregnancy.

The guidance also included advice to healthcare professionals for caring for women with a BMI of 30 kg/m2 in antenatal settings, including the importance of carrying out a risk assessment.

'Sensitive and Comprehensive Advice'

Professor Fiona Denison, chair of translational obstetrics at the University of Edinburgh, and lead author of the RCOG'S guideline, said: "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. Losing weight by dieting or taking weight loss drugs is not recommended as this may harm the health of the unborn baby.

"We hope these new guidelines will support healthcare professionals to provide women with sensitive and comprehensive advice, based on the best available evidence, and to ultimately empower them to maintain a healthy weight and lifestyle before, during and after pregnancy."

Dr Max Davie, officer for health promotion for the Royal College of Paediatrics and Child Health (RCPCH), commented: "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 today’s new guidance acts as the catalyst needed to reverse these cuts."


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