Maternal gestational weight gain during pregnancy: prioritising the conversation
Ruth Walker A C , Danielle Mazza B , Michelle Blumfield A , Christie Bennett A and Helen Truby A
+ Author Affiliations
- Author Affiliations
A Department of Nutrition and Dietetics and Food, School of Clinical Sciences, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia.
B Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia.
C Corresponding author. Email: ruth.walker@monash.edu
Australian Journal of Primary Health 24(1) 4-8 https://doi.org/10.1071/PY17111
Submitted: 14 August 2017 Accepted: 12 October 2017 Published: 21 December 2017
Abstract
Pregnancy is a critical stage of life requiring urgent attention when taking a lifespan approach to obesity prevention. Excessive gestational weight gain (GWG) is highly predictive of overweight and obesity later in life for women and their offspring. This discussion describes the challenges faced by health professionals (general practitioners, midwives, allied health) in primary care in Australia when addressing GWG, presents evidence that supports re-prioritising GWG and highlights strategies that can be used to address GWG. The revised National Health and Medical Research Council antenatal care guidelines (to be formally released in early 2018) indicate it will be the responsibility of health professionals in antenatal care to initiate conversations about GWG with women. Women are open to discussing this sensitive topic and health professionals in primary care have an opportunity to be proactive in addressing barriers that have hindered conversations about GWG in the past so that women are supported to manage their weight during pregnancy.
Additional keywords: antenatal, primary care, weight management.
References
Afshin A, Forouzanfar M, Reitsma M, Sur P, Estepk K, Lee A, Marczak L, Mokdad AH, Moradi-Lakeh M, Naghavi M, Salama JS, Vos T, Abate KH, Abbafati C, Ahmed MB, Al-Aly Z, Alkerwi A, Al-Raddadi R, Amare AT, Amberbir A, et al (2017) Health effects of overweight and obesity in 195 countries over 25 years. The New England Journal of Medicine 377, 13–27.| Health effects of overweight and obesity in 195 countries over 25 years.Crossref | GoogleScholarGoogle Scholar |
Australian Bureau of Statistics (2017) National Health Survey: First Results, 2014–2015. (ABS: Canberra, ACT, Australia) Available at http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2014-15~Main%20Features~Overweight%20and%20obesity~22 [Verified 2 November 2017]
Australian Health Ministers’ Advisory Council (2012) Clinical Practice Guidelines: Antenatal Care – Module 1. (Australian Government Department of Health and Ageing: Canberra. ACT, Australia) Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-antenatal-care-index/$File/ANC_Guidelines_Mod1_v32.pdf [Verified 2 November 2017]
Australian Institute of Health and Welfare (2017) Impact of overweight and obesity as a risk factor for chronic conditions: Australian Burden of Disease Study. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/reports-statistics/behaviours-risk-factors/overweight-obesity/overview [Verified 2 November 2017]
Australian Medical Association (2016) Obesity 2016. (AMA: Barton, ACT, Australia) Available at https://ama.com.au/position-statement/obesity-2016 [Verified 2 Nov 2017]
Blumfield ML, Hure AJ, Macdonald-Wicks LK, Smith R, Simpson SJ, Giles WB, Raubenheimer D, Collins CE (2012) Dietary balance during pregnancy is associated with fetal adiposity and fat distribution. The American Journal of Clinical Nutrition 96, 1032–1041.
| Dietary balance during pregnancy is associated with fetal adiposity and fat distribution.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38Xhs1ektrzJ&md5=fa213c3447d29b15ce5de911094aa9ebCAS |
Bray GA, Kim KK, Wilding JPH (2017) Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obesity Reviews 18, 715–723.
| Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC1crlslyrsw%3D%3D&md5=f93ee416d5234ae8a3cd29363171542cCAS |
Brodribb WE (2014) Maternity care in general practice. The Medical Journal of Australia 201, 626–627.
| Maternity care in general practice.Crossref | GoogleScholarGoogle Scholar |
Brownfoot FC, Davey MA, Kornman L (2016) Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial. British Journal of Obstetrics and Gynaecology 123, 254–261.
| Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC28nnsFSqsQ%3D%3D&md5=81ea8382f3c648e8e929264c5d1f32baCAS |
Catalano P, de Mouzon S (2015) Maternal obesity and metabolic risk of the offspring: why lifestyle interventions may not have achieved the desired outcomes. International Journal of Obesity 39, 642–649.
| Maternal obesity and metabolic risk of the offspring: why lifestyle interventions may not have achieved the desired outcomes.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2MnksVeitA%3D%3D&md5=a4781bed364a5964efb4d32557dd8750CAS |
Dawes MG, Grudzinskas JG (1991) Repeated measurement of maternal weight during pregnancy. Is this a useful practice? British Journal of Obstetrics and Gynaecology 98, 189–194.
| Repeated measurement of maternal weight during pregnancy. Is this a useful practice?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M7mslClsg%3D%3D&md5=4293e54e88ce01f20ba71cdc4f21e51eCAS |
de Jersey SJ, Nicholson JM, Callaway LK, Daniels LA (2012) A prospective study of pregnancy weight gain in Australian women. Australian and New Zealand Journal of Obstetrics and Gynaecology 52, 545–551.
| A prospective study of pregnancy weight gain in Australian women.Crossref | GoogleScholarGoogle Scholar |
Eastman NJ, Jackson E (1968) Weight relationships in pregnancy: the bearing of maternal weight gain and pre-pregnancy weight on birth weight in full term pregnancies. Obstetrical & Gynecological Survey 23, 1003–1025.
| Weight relationships in pregnancy: the bearing of maternal weight gain and pre-pregnancy weight on birth weight in full term pregnancies.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaF1M%2FotFehsg%3D%3D&md5=12ae6d92f50035c9b6af8eae617a5566CAS |
Fealy SM, Taylor RM, Foureur M, Attia J, Ebert L, Bisquera A, Hure AJ (2017) Weighing as a stand-alone intervention does not reduce excessive gestational weight gain compared to routine antenatal care: a systematic review and meta-analysis of randomised controlled trials. BMC Pregnancy and Childbirth 17, 36
| Weighing as a stand-alone intervention does not reduce excessive gestational weight gain compared to routine antenatal care: a systematic review and meta-analysis of randomised controlled trials.Crossref | GoogleScholarGoogle Scholar |
Furness PJ, McSeveny K, Arden MA, Garland C, Dearden AM, Soltani H (2011) Maternal obesity support services: a qualitative study of the perspectives of women and midwives. BMC Pregnancy and Childbirth 11, 69
| Maternal obesity support services: a qualitative study of the perspectives of women and midwives.Crossref | GoogleScholarGoogle Scholar |
Goldstein RF, Abell SK, Ranasinha S, Misso M, Boyle JA, Black MH, Li N, Hu G, Corrado F, Rode L, Kim YJ, Haugen M, Song WO, Kim MH, Bogaerts A, Devlieger R, Chung JH, Teede HJ (2017) Association of gestational weight gain with maternal and infant outcomes. A systematic review and meta-analysis. Journal of the American Medical Association 317, 2207–2225.
| Association of gestational weight gain with maternal and infant outcomes. A systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
Grima M, Dixon J (2013) Obesity: recommendations for management in general practice and beyond. Australian Family Physician 42, 532–541.
Harrison CL, Lombard CB, Strauss BJ, Teede HJ (2013) Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. Obesity 21, 904–909.
| Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar |
Keating CL, Peeters A, Swinburn BA, Magliano DJ, Moodie ML (2013) Utility‐based quality of life associated with overweight and obesity: the Australian diabetes, obesity, and lifestyle study. Obesity 21, 652–655.
| Utility‐based quality of life associated with overweight and obesity: the Australian diabetes, obesity, and lifestyle study.Crossref | GoogleScholarGoogle Scholar |
Loudon K, Santesso N, Callaghan M, Thornton J, Harbour J, Graham K, Harbour R, Kunnamo I, Liira H, McFarlane E, Ritchie K (2014) Patient and public attitudes to and awareness of clinical practice guidelines: a systematic review with thematic and narrative syntheses. BMC Health Services Research 14, 321
| Patient and public attitudes to and awareness of clinical practice guidelines: a systematic review with thematic and narrative syntheses.Crossref | GoogleScholarGoogle Scholar |
McIntyre M, Francis K, Chapman Y (2012) The struggle for contested boundaries in the move to collaborative care teams in Australian maternity care. Midwifery 28, 298–305.
| The struggle for contested boundaries in the move to collaborative care teams in Australian maternity care.Crossref | GoogleScholarGoogle Scholar |
McPhie S, Skouteris H, Hill B, Hayden M (2015) Understanding gestational weight gain: the role of weight‐related expectations and knowledge. Australian and New Zealand Journal of Obstetrics and Gynaecology 55, 21–26.
| Understanding gestational weight gain: the role of weight‐related expectations and knowledge.Crossref | GoogleScholarGoogle Scholar |
Ministry of Health (2014) Guidance for healthy weight gain in pregnancy. (Ministry of Health: Wellington, New Zealand) Available at https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/NZ-Guidance-for-healthy-weight-gain.pdf?ext=.pdf [Verified 2 November 2017]
National Health and Medical Research Council (2015) Obesity prevention through preventing excess weight gain during pregnancy and postpartum. (NHMRC Research Translation Faculty Obesity Steering Group: Melbourne, Vic., Australia) Available at https://www.nhmrc.gov.au/_files_nhmrc/file/research/research_translation_faculty/rtf_cfa_obesity_nhmrc_150320.pdf [Verified 2 November 2017]
National Health and Medical Research Council (2017) Antenatal care guidelines review draft. (NHMRC: Canberra, ACT, Australia) Available at https://consultations.health.gov.au/health-services-division/antenatal-care-guidelines-review/ [Verified 27 June 2017]
Nikolopoulos H, Mayan M, Macisaac J, Miller T, Bell R (2017) Women’s perceptions of discussions about gestational weight gain with health care providers during pregnancy and postpartum: a qualitative study. BMC Pregnancy and Childbirth 17, 97
| Women’s perceptions of discussions about gestational weight gain with health care providers during pregnancy and postpartum: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
Nolan C, Deehan A, Wylie A, Jones R (2012) Practice nurses and obesity: professional and practice-based factors affecting role adequacy and role legitimacy. Primary Health Care Research and Development 13, 353–363.
| Practice nurses and obesity: professional and practice-based factors affecting role adequacy and role legitimacy.Crossref | GoogleScholarGoogle Scholar |
Oken E, Tavera E, Kleinman K, Rich-Edwards J, Gillman M (2007) Gestational weight gain and child adiposity at age 3 years. American Journal of Obstetrics and Gynecology 196, 322.e1–322.e8.
| Gestational weight gain and child adiposity at age 3 years.Crossref | GoogleScholarGoogle Scholar |
Olander EK, Atkinson L, Edmunds JK, French DP (2011) The views of pre-and post-natal women and health professionals regarding gestational weight gain: an exploratory study. Sexual & Reproductive Healthcare – Official Journal of the Swedish Association of Midwives 2, 43–48.
| The views of pre-and post-natal women and health professionals regarding gestational weight gain: an exploratory study.Crossref | GoogleScholarGoogle Scholar |
Park MH, Falconer C, Viner RA, Kinra S (2012) The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review. Obesity Reviews 13, 985–1000.
| The impact of childhood obesity on morbidity and mortality in adulthood: a systematic review.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38jks1yntw%3D%3D&md5=7bc89d7fd8fde1d9d02a8590830fd809CAS |
Preiss K, Brennan L, Clarke D (2013) A systematic review of variables associated with the relationship between obesity and depression. Obesity Reviews 14, 906–918.
| A systematic review of variables associated with the relationship between obesity and depression.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3sjms1eruw%3D%3D&md5=71bbf384ff026ceee0822937af73bd51CAS |
Rooney BL, Mathiason MA, Schauberger CW (2011) Predictors of obesity in childhood, adolescence and adulthood in a birth cohort. Maternal and Child Health Journal 15, 1166–1175.
| Predictors of obesity in childhood, adolescence and adulthood in a birth cohort.Crossref | GoogleScholarGoogle Scholar |
Royal Australian and New Zealand College of Obstetrics and Gynaecology (2017) Management of obesity in pregnancy. (RANZCOG: Melbourne, Vic., Australia) Available at https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Management-of-obesity-(C-Obs-49)-Review-March-2017.pdf?ext=.pdf [Verified 2 November 2017]
Schmied VA, Duff M, Dahlen HG, Mills AE, Kolt GS (2011) ‘Not waving but drowning’: a study of the experiences and concerns of midwives and other health professionals caring for obese childbearing women. Midwifery 27, 424–430.
| ‘Not waving but drowning’: a study of the experiences and concerns of midwives and other health professionals caring for obese childbearing women.Crossref | GoogleScholarGoogle Scholar |
Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, Thieda P, Lux L, Lohr K (2009) A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. American Journal of Obstetrics and Gynecology 201, 339.e1–339.e14.
| A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention.Crossref | GoogleScholarGoogle Scholar |
Stewart ZA, Wallace E, Allan C (2012) Weight gain in pregnancy: a survey of current practices in a teaching hospital. Australian and New Zealand Journal of Obstetrics and Gynaecology 52, 208–210.
| Weight gain in pregnancy: a survey of current practices in a teaching hospital.Crossref | GoogleScholarGoogle Scholar |
Sturgiss E, Douglas K, Kathage R (2016) A synthesis of selected national Australian guidelines on the general practice management of adult patients who are overweight or obese. Australian Family Physician 45, 327
Swift JA, Pearce J, Jethwa PH, Taylor MA, Avery A, Ellis S, Langley-Evans S, McMullen S (2016) Antenatal weight management: women’s experiences, behaviours, and expectations of weighing in early pregnancy. Journal of Pregnancy 2016, 8454759
| Antenatal weight management: women’s experiences, behaviours, and expectations of weighing in early pregnancy.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC2snmtVCktQ%3D%3D&md5=44ce16767b2aa1f08c08778e4f189dcaCAS |
Turner LR, Harris MF, Mazza D (2015) Obesity management in general practice: does current practice match guideline recommendations? The Medical Journal of Australia 202, 370–372.
| Obesity management in general practice: does current practice match guideline recommendations?Crossref | GoogleScholarGoogle Scholar |
van der Pligt P, Campbell K, Willcox J, Denney-Wilson E (2011) Opportunities of primary and secondary prevention of excess gestational weight gain: General Practitioners’ perspectives. BMC Family Practice 12, 124
| Opportunities of primary and secondary prevention of excess gestational weight gain: General Practitioners’ perspectives.Crossref | GoogleScholarGoogle Scholar |
Vernooij RW, Willson M, Gagliardi AR (2016) Characterizing patient-oriented tools that could be packaged with guidelines to promote self-management and guideline adoption: a meta-review. Implementation Science 11, 52
| Characterizing patient-oriented tools that could be packaged with guidelines to promote self-management and guideline adoption: a meta-review.Crossref | GoogleScholarGoogle Scholar |
Wong C, Gordon J, Pan Y, Henderson J, Britt H (2016) Antenatal care in Australian general practice. Australian Family Physician 45, 538–541.
