Midwives call for official guidance on healthy weight gain for women during pregnancy

Risks associated with gaining too much weight during pregnancy, the potential increase of insulin resistance and impact on children’s blood pressure were highlighted earlier this week following the publication of a study in the journal Diabetologia.

With one in five women in the UK classified as clinically obese at the start of their pregnancy, concerns have been raised that there are no national targets for what constitutes ‘normal’ pregnancy weight gain. The Royal College of Midwives has called for clear guidance on healthy weight management during pregnancy.

Regular weigh-ins fell out of fashion in the 1990s, as it was suggested that they may cause unnecessary anxiety and stress for little or no proven clinical gain. Current guidelines call for the weight and height of the expectant mother to be measured during her first appointment, but not regularly during the course of pregnancy.

Across social media, women have expressed concern that potential new guidelines could cause further confusion, unnecessary stress, and anxiety.

Clinical psychologist and University of Leeds lecturer, Judith Johnson, went on to highlight that monitoring pregnant women’s weights was phased on during the 90s.

While others expressed concern that this could be another way in which pregnant bodies are dehumanised.

Supporters of the call for pregnancy weight gain guidance and tracking have highlighted US guidelines. The American College of Obstetricians and Gynecologists set clear targets for pregnant women in 2013 (which were reaffirmed earlier this year).

These recommended women to gain weight during their second and third trimesters, based on their BMI:

  • Underweight women with a BMI of less than 18.5 gain 28-40lbs.
  • Normal weight with a BMI of 18.5-24.9 gain 25-35lbs.
  • Overweight with a BMI of 25-29.9 gain 15-25lbs.
  • Obese women with a BMI of 30 or higher gain 11-20lbs.

Royal College of Midwives, Mandy Forrester, said some UK midwives are already using US weight guidelines, while others do not have access to weighing scales.

"There is a clear need for midwives to have the tools, guidance and training they need so they can offer women the best possible support and care. This is especially pressing because of the potentially serious complications that can arise in pregnancy as a result of women being overweight or obese."

The study published in the journal Diabetological says too much or too little weight gain during pregnancy may be linked with adverse outcomes in seven year olds. The study found health problems, including high blood pressure and poor blood sugar control, amongst mothers who gained less or more than the recommended weight across 905 mothers and children.

However, this does not take into account other factors that may have affected the results outside of their pregnancy, such as genetic components, parental and family attitudes to food and healthy eating habits, or activity and exercise levels.

Earlier this year, The Royal College of Midwives (RCM) called for clearer guidance on healthy weight management for expectant mothers, as well as more support, training and equipment for midwives as part of a joint effort with Slimming World.

Surveys led by both Slimming World and the RCM of 110 midwives and 740 women revealed that overweight expectant mothers are left feeling confused by a lack of clear information. Midwives also expressed concern that, without clear guidelines, they cannot offer the best support to these women.

Over 90% of women surveyed said they were potentially more open than usual to healthy lifestyle messages while pregnant, yet less than 50% discussed their weight with their midwife. One in 10 reported they were not weighed at all during their pregnancy, despite women normally being weighed during their first appointment with a midwife.

In a Behind the Headlines update earlier this week, the NHS addressed the issue.

"Media reports in the UK focused on calls from the Royal College of Midwives for the UK to adopt guidelines on recommended weight gain in pregnancy, and for pregnant women to be given advice about how much weight they should expect to gain. But many of the headlines suggested there are confirmed plans to introduce these types of guidelines, which currently isn't the case.

"[Headlines that suggest] 'Pregnant women may have to submit to regular weigh-ins' could be taken to mean that weight testing would be mandatory. But as with all medical testing or interventions, women would have the option of choosing or declining these check-ups.

"This study adds to evidence that keeping healthy during pregnancy, with a good diet and plenty of exercise, can give the baby a head start when it comes to its own health.

"There's a pervasive myth that women need to ‘eat for two’ while pregnant, but that's not true. Most women don't need to increase how much they eat or take in many extra calories (though the types of food they eat may need to alter)."

National Institute for Health and Clinical Excellence (NICE) last issued new weight advice for pregnant women in 2010. This highlighted the increased risk of complications for women with a BMI of 30 or higher, which can include:

  • diabetes
  • miscarriage
  • pre-eclampsia
  • blood clots

Women who are clinically obese are also more likely to have a longer or induced labour, slower healing, and post-delivery bleeding.