Weight gain in pregnancy
  • Healthy weight before, during and after pregnancy helps both mother and baby to reduce their risk of chronic diseases later in life
  • Women who are under or over weight are more likely to need extra care and support during pregnancy and birth
  • Many complex social and environmental factors impact on weight (eg food availability, housing conditions, social support, mental health)
  • Need the support of a multi-disciplinary team

Before pregnancy

  • Talk to women of childbearing age about healthy weight, physical activity and diet
  • For women who are overweight
    • Check blood pressure and screen for diabetes — see Diabetes
    • Refer to Dietitian
    • Give folate oral — 500 micrograms once a day (5mg if obese or has diabetes), starting 1–3 months before pregnancy or as soon as possible if pregnant, continue until 12 weeks pregnant

During pregnancy
  • Check woman’s weight at first antenatal visit and offer weight check at all visits throughout pregnancy
  • Talk about risks of being underweight or overweight when pregnant
    • Underweight during pregnancy risks – preterm birth, small for gestational age baby, low birth weight
    • Overweight and obesity during pregnancy and excessive weight gain risks –diabetes, preeclampsia, macrosomia (large for gestational age baby), congenital anomalies, preterm birth, need for caesarian delivery, still birth, neonatal intensive care, breastfeeding problems, obesity risk for child in later life
  • Follow Flowchart 2.1 to arrange weight management strategies and support
    • Work with woman to develop a shared approach to management and avoid contributing to weight stigma (shame)
    • Set individual gestational (pregnancy) weight gain targets
  • If BMI less than 18.5 or more than 35 ultrasound monitoring of foetal growth recommended in third trimester— obstetrician consult

Flowchart 2.1   Monitoring weight in pregnancy

Planning birth for women with obesity

  • Refer women with BMI more than 35 to regional hospital early, with a dating scan
  • Timing and type of birth will be decided with woman and multidisciplinary team — induction of birth may be considered earlier if high risk birth

Table 2.5  Birthing considerations by BMI

After the birth