Midwives need the time and resources to help mothers stay healthy during pregnancy, the Royal College of Midwives has said in light of new US research highlighting the risks of excessive weight gain or loss among expectant mothers.
A major review of research evidence, published in the Journal of the American Medical Association, found an increased risk of larger babies and the need for Caesarean sections among pregnant women who gained more than the recommended amount of weight.
“Gestational weight gain… was associated with higher risk of adverse maternal and infant outcomes”
Meanwhile mothers who did not put on enough weight during pregnancy were at greater risk of giving birth to smaller than average babies and pre-term birth.
All these are factors are potentially associated with more difficult births and greater risk of harm to both women and babies, noted the paper, called Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis.
The review specifically looked at women who gained weight both within and outside the recommended range published in guidelines by the US’s Institute of Medicine in 2009 – which called for less weight gain in obese women than in the prior 1990 recommendations.
It encompassed 23 different studies and data on more than one million women and found 47% had gestational weight gain greater than the IOM guidelines. A total of 23% put on less weight than recommended in the guidance.
“Gestational weight gain greater than or less than guideline recommendations, compared with weight gain within recommended levels, was associated with higher risk of adverse maternal and infant outcomes,” concluded the paper.
“Midwives need time with women during postnatal care to provide these messages [about weight gain]”
UK midwives do not have such guidelines on which to base their practice but would benefit from them if they did, noted Louise Silverton, director for midwifery at the RCM.
She said the research underlined the need for good support for women before, during and after pregnancy to help them maintain a healthy weight.
“This study shows how important it is for women to avoid gaining excessive weight during pregnancy and, if overweight at the end of pregnancy, to try to lose that weight before they have another baby,” she said.
“Midwives need time with women during postnatal care to provide these messages. We also know that they are best received where the midwife has already formed a relationship with the women and that continuity of carer improves outcomes,” she added.
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She said midwives could help women avoid gaining excess weight during pregnancy as well as giving advice on healthy eating and weight loss after the baby was born.
“There is a need for a greater priority to be placed on health promotion including better information, education and support for women and their families, about the benefits of healthy eating before and during pregnancy, and taking appropriate exercise.
“More emphasis also needs to be placed on pre-conception care,” she said.
“It is also important to look at women who do not put on enough a weight, as this may be related to other issues,” said Ms Silverton.
It was vital to ensure midwives had access to accurate weighing scales including those for women who are severely obese and were reaching out to disadvantaged groups who may find it harder to adopt healthier lifestyles, she added.