We know that a woman’s health prior to and during pregnancy is important for best possible outcomes for both mom and baby. The reproductive years, including before, during, and after pregnancy, bring challenges for many women in maintaining a healthy weight. Carrying excess weight increases the risk of many issues including infertility, congenital malformations, high blood pressure in pregnancy, gestational diabetes, cesarean section and preterm birth; fortunately, emerging data shows that weight management prior to pregnancy may reduce many of these risks.
This chapter of the 2020 Canadian Obesity Guidelines provides recommendations for adult women with obesity (body mass index [BMI] ≥ 30 kg/m2) with a singleton (one baby) pregnancy and who do not have pre-existing diabetes or gestational diabetes. (information regarding diabetes, pregnancy and weight can be found in the Diabetes Canada Guidelines here)
To reduce the risk of adverse outcomes in the current or future pregnancy, the three main goals are:
- To enter pregnancy at a lower body mass index (BMI)
- Targeting weight gain during pregnancy to 5-9kg (11-20lb)
- Returning to at least your pre-pregnancy BMI in the year after delivery.
The authors point out that primary care providers are in a great position to support women with obesity to achieve the recommended targets, as they have the most longitudinal relationship with their patients.
Lifestyle interventions including both nutrition and physical activity should be offered to adult women with obesity who are considering a pregnancy, who are pregnant, and who are postpartum.
It is recommended that primary care providers encourage and support pregnant women with obesity to:
- consume foods consistent with a healthy dietary pattern in order to meet their target gestational weight gain
- engage in at least 150 minutes per week of moderate intensity exercise to assist in the management of weight gain in pregnancy, provided there is no health related reason (contraindication) not to exercise
It is advised NOT to use metformin to manage weight gain during pregnancy, and NOT to use obesity medications during pregnancy or breastfeeding.
Because rates of initiation and continuation of breastfeeding are lower in women with obesity, the authors recommend that women with obesity be offered additional breastfeeding support.
NOTE: This blog is not intended to be a full synopsis of the chapter. There is a wealth of information in this chapter that is beyond the scope of one blog post. I encourage everyone to read the recommendations and key messages in full, and to dig in to the entire chapter!
Stay tuned for much more on the Obesity Guidelines in coming weeks!
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