Obesity care in pregnancy highlighted in latest RCOG guidelines

By Hollie Ewers on 22 November 2018 Obesity RCOG - Royal College of Obstetricians and Gynaecologists

Women who are obese should be supported to lose weight before conception and between pregnancies, the latest clinical guidance from the RCOG states.

Care of women with obesity in pregnancy includes recommendations on how to manage weight before, during and after pregnancy to improve health outcomes for mothers and babies. 

Key recommendations include that women who are obese – with a BMI of 30 and above – should lose weight before becoming pregnant and between pregnancies.

The guidance suggests women should be weighed and offered advice on weight and lifestyle in primary care, such as during pre-conception counselling and appointments about contraception. And a structured weight-loss programme and a referral to a dietician or an appropriately trained healthcare professional may be recommended.

For women unable to lose weight before pregnancy, the guidance recommends comprehensive, sensitive and appropriate multidisciplinary care. This should include a consultation to ensure women are informed about the increased risks of complications for her and her baby, and dietetic advice by a trained healthcare professional should be offered early in the pregnancy, based on NICE guidelines.

The guidelines state that although being obese is itself not a reason to be admitted to a consultant-led unit, women who are obese are more likely to require an induction of labour, emergency CS or a vaginal birth that requires a medical intervention.

The additional care that can be provided promptly in a consultant-led unit, should a woman need it, must be discussed so that she can make an informed choice about her planned place of birth. The guidance says this requires a multidisciplinary, individualised approach, and may need to involve consultations with an obstetrician, anaesthetist, and midwife. Women who are obese may also experience difficulty in breastfeeding and may need additional support.

Even slight weight gain after pregnancy is associated with greater risk of problems in subsequent pregnancies, the guidance notes. It suggests women who are obese should be offered referral to weight management services after giving birth to help them achieve a healthy weight before embarking on a future pregnancy.

Complications for women who are obese include higher risk of miscarriage, stillbirth, pre-eclampsia, gestational diabetes and postpartum haemorrhage. 

Babies whose mothers are obese also have an increased risk of congenital anomalies, being born pre-term, being a large baby and becoming obese and diabetic in later life.

Chair of Translational Obstetrics at the University of Edinburgh and lead author of the RCOG’S guideline Professor Fiona Denison said: ‘Pregnancy provides an opportunity for healthcare professionals to connect with women at a time when they are generally more concerned about their health. 

‘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.’

Access the Care of women with obesity in pregnancy guidance here.