Evidence

There is a lack of published evidence on the management of maternal obesity and the safety of weight loss during pregnancy. Maternity service health care practitioners and community service providers have identified that partnership work and community public health services are essential in the development of interventions for maternal obesity since it is a public health problem rather than an isolated maternity issue [15][47]. However, little is known about how maternity services can best work with external agencies and with obese pregnant women to improve their experience and health outcomes.

National guidance and recommendations

Guidance and recommendations of relevance to maternal obesity include:

The National Institute for Health and Clinical Excellence (NICE)

NICE guidance on the management of obesity [44] and behaviour change [45], and the Foresight report [46], identify pregnancy as a critical period to address obesity in a woman’s life course and to initiate behaviour change. However, caution is required to avoid compromising foetal growth.

NICE also refers to the management of obesity during pregnancy in its guidance on maternal and child nutrition [48] and in its clinical guidelines for antenatal care [49], diabetes in pregnancy [50], and intrapartum care [51]. Overall, these guidelines consider obese women to be among the high risk groups that require additional screening, intervention and monitoring.

In July 2010 NICE published guidance on weight management before, during and after pregnancy.

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The Centre for Maternal and Child Enquiries (CMACE formerly CEMACH)

The CEMACH report (2004) recommends that the care of women with a BMI of more than 35kg/m2 should be shared with an obstetrician and the mother advised to deliver in a consultant led obstetric unit as they are at increased risk of developing problems [7].

Recommendations have also been made in CEMACH reports regarding the management of thromboembolism, the leading cause of maternal death, and the provision of anaesthesia for morbidly obese women during pregnancy. The increased risk for obese women in pregnancy has led to recommendations that obese women should be assisted with weight loss prior to conception or receiving any form of assisted reproductive technologies, and should receive pre-pregnancy counselling and advice [8].

CMACE, together with the Royal College of Obestricians and Gynaecologists, has developed national standards of care and service provision for women with obesity and their babies. The standards, published in March 2010, as the CMACE/RCOG Joint Guideline 'Management of Women with Obesity in Pregnancy' cover the pre-conception, pregnancy, and postnatal periods [52].

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The Royal College of Obstetricians and Gynaecologists (RCOG)

The RCOG published consensus views on obesity and reproductive health in 2007. They include specific recommendations regarding the management of obese women during pregnancy [53].

The CMACE/RCOG Joint Guideline 'Management of Women with Obesity in Pregnancy' was published in March 2010 [52].

Institute of Medicine (IOM), United States

The Institute of Medicine in the US has recently published updated guidelines on weight gain in pregnancy, which include recommendations for total weight gain in pregnancy split by BMI group and rate of weight gain [54].