No global consensus: a cross-sectional survey of maternal weight policies

Abstract

BackgroundGrowing evidence suggests that maternal prepregnancy weight and gestational weight gain are risk factors for perinatal complications and subsequent maternal and child health. Postpartum weight retention is also associated with adverse birth outcomes and maternal obesity. Clinical guidelines addressing healthy weight before, during, and after pregnancy have been introduced in some countries, but at present a systematic accounting for these policies has not been conducted. The objective of the present study was to conduct a cross-national comparison of maternal weight guidelines.MethodsThis cross sectional survey administered a questionnaire online to key informants with expertise on the subject of maternal weight to assess the presence and content of preconceptional, pregnancy and postpartum maternal weight guidelines, their rationale and availability. We searched 195 countries, identified potential informants in 80 and received surveys representing 66 countries. We estimated the proportion of countries with guidelines by region, income, and formal or informal policy, and described and compared guideline content, including a rubric to assess presence or absence of 4 guidelines: encourage healthy preconceptional weight, antenatal weighing, encourage appropriate gestational gain, and encourage attainment of healthy postpartum weight.ResultsFifty-three countries reported either a formal or informal policy regarding maternal weight. The majority of these policies included guidelines to assess maternal weight at the first prenatal visit (90%), to monitor gestational weight gain during pregnancy (81%), and to provide recommendations to women about healthy gestational weight gain (62%). Guidelines related to preconceptional (42%) and postpartum (13%) weight were less common. Only 8% of countries reported policies that included all 4 fundamental guidelines. Guideline content and rationale varied considerably between countries, and respondents perceived that within their country, policies were not widely known.ConclusionsThese results suggest that maternal weight is a concern throughout the world. However, we found a lack of international consensus on the content of guidelines. Further research is needed to understand which recommendations or interventions work best with respect to maternal weight in different country settings, and how pregnancy weight policies impact clinical practices and health outcomes for the mother and child.

Women’s perceptions of discussions about gestational weight gain with health care providers during pregnancy and postpartum: a qualitative study

“…Maternal body weight is simple to measure and widely used in many countries as a general indicator of maternal and fetal health throughout pregnancy [24]. Studies indicate that although maternal weight may be measured at most prenatal visits, between 45 and 80% of women exceed recommended amounts for total weight gain [6–8, 11].…”

Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations

“…The recommended ranges of weight gain for each BMI category were devised on the basis of available data from observational studies, to prevent small for gestational age and large for gestational age infants, reduce caesarean section rates and prevent post-partum weight retention. Since there is lack of evidence from controlled intervention trials for benefits of applying these recommendations, some expert groups have not recommended adoption of these guidelines for routine clinical practice [57,58,60]. In relation to obese pregnant women, gestational diabetes and pre-eclampsia, that is, two of the most common adverse outcomes, were not considered by the IOM due DOI: 10.1159/000496471 to the lack of available evidence.…”

“…There is lack of consensus for advice on GWG given to pregnant women, which varies extensively between countries [58]. Most widely used are the IOM guidelines (USA) which recommend different ranges of weight gain for normal weight, overweight and obese women [59].…”

Weight management during pregnancy: a qualitative thematic analysis on knowledge, perceptions and experiences of overweight and obese women in Singapore

“…Yet, there is a lack of international consensus on the content of guidelines, recommendations or interventions which are most efficacious with respect to maternal weight, and how health policies impact clinical practices and outcomes for the woman and child [37]. We would like to call for guidelines from international organizations such as World Health Organization or FIGO (International Federation of Gynecology and Obstetrics) to release guidelines on what can be done for overweight and obese women to improve maternal and child health, so that nations can modify and adopt these guidelines to suit their specific cultural and socio-economic context.…”