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Am J Perinatol 2016; 33(05): 433-441
DOI: 10.1055/s-0035-1567856
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Obesity Before, During, and After Pregnancy: A Review and Comparison of Five National Guidelines

Michelle A. Kominiarek
1   Division of Maternal–Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Chicago, Illinois
,
Suneet P. Chauhan
2   Division of Maternal–Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, Texas
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Publikationsverlauf

25. August 2015

01. Oktober 2015

Publikationsdatum:
20. November 2015 (online)

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Abstract

Objective This study aims to compare how national guidelines approach the management of obesity in reproductive age women.

Study Design We conducted a search for national guidelines in the English language on the topic of obesity surrounding the time of a pregnancy. We identified six primary source documents and several secondary source documents from five countries. Each document was then reviewed to identify: (1) statements acknowledging increased health risks related to obesity and reproductive outcomes, (2) recommendations for the management of obesity before, during, or after pregnancy.

Results All guidelines cited an increased risk for miscarriage, birth defects, gestational diabetes, hypertension, fetal growth abnormalities, cesarean sections, difficulty with anesthesia, postpartum hemorrhage, and obesity in offspring. Counseling on the risks of obesity and weight loss before pregnancy were universal recommendations. There were substantial differences in the recommendations pertaining to gestational weight gain goals, nutrient and vitamin supplements, screening for gestational diabetes, and thromboprophylaxis among the guidelines.

Conclusion Stronger evidence from randomized trials is needed to devise consistent recommendations for obese reproductive age women. This research may also assist clinicians in overcoming one of the many obstacles they encounter when providing care to obese women.

Keywords

body mass index - national guidelines - obesity - pregnancy

The abstract was presented as a poster at the 82nd Annual Meeting of the Central Association of Obstetricians and Gynecologist; October 21–24, 2015; Charleston, SC.


 

  • References

  • 1 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311 (8) 806-814
    CrossrefPubMedGoogle Scholar
  • 2 Australian Bureau of Statistics. 4364.0.55.001 Australian health survey: first results. Available at: http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/1680ECA402368CCFCA257AC90015AA4E/ . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 3 McGuire S. Shields M., Carroll M.D., Ogden C.L. adult obesity prevalence in Canada and the United States. NCHS data brief no. 56, Hyattsville, MD: National Center for Health Statistics, 2011. Adv Nutr 2011; 2 (4) 368-369
    CrossrefPubMedGoogle Scholar
  • 4 Valera B, Sohani Z, Rana A, Poirier P, Anand SS. The ethnoepidemiology of obesity. Can J Cardiol 2015; 31 (2) 131-141
    CrossrefPubMedGoogle Scholar
  • 5 Heslehurst N, Ells LJ, Simpson H, Batterham A, Wilkinson J, Summerbell CD. Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36,821 women over a 15-year period. BJOG 2007; 114 (2) 187-194
    CrossrefPubMedGoogle Scholar
  • 6 Weiss JL, Malone FD, Emig D , et al; FASTER Research Consortium. Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. Am J Obstet Gynecol 2004; 190 (4) 1091-1097
    CrossrefPubMedGoogle Scholar
  • 7 Chu SY, Kim SY, Lau J , et al. Maternal obesity and risk of stillbirth: a metaanalysis. Am J Obstet Gynecol 2007; 197 (3) 223-228
    CrossrefPubMedGoogle Scholar
  • 8 Kominiarek MA, Vanveldhuisen P, Hibbard J , et al; Consortium on Safe Labor. The maternal body mass index: a strong association with delivery route. Am J Obstet Gynecol 2010; 203 (3) 264.e1-264.e7
    CrossrefPubMedGoogle Scholar
  • 9 Stothard KJ, Tennant PWG, Bell R, Rankin J. Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis. JAMA 2009; 301 (6) 636-650
    CrossrefPubMedGoogle Scholar
  • 10 Herring SJ, Platek DN, Elliott P, Riley LE, Stuebe AM, Oken E. Addressing obesity in pregnancy: what do obstetric providers recommend?. J Womens Health (Larchmt) 2010; 19 (1) 65-70
    CrossrefPubMedGoogle Scholar
  • 11 Mhyre JM, Greenfield ML, Polley LS. Survey of obstetric providers' views on the anesthetic risks of maternal obesity. Int J Obstet Anesth 2007; 16 (4) 316-322
    CrossrefPubMedGoogle Scholar
  • 12 Heslehurst N, Moore H, Rankin J, Ells LJ, Wilkinson JR, Summberbell CD. How can maternity services be developed to effectively address maternal obesity? A qualitative study. Midwifery 2011; 27 (5) e170-e177
    CrossrefPubMedGoogle Scholar
  • 13 ACOG Committee Opinion No. 549: Obesity in pregnancy. Obstet Gynecol 2013; 121 (1) 213-217
    CrossrefPubMedGoogle Scholar
  • 14 National Institute for Health and Clinical Excellence (NICE). Weight management before, during, and after pregnancy (July 2010). NICE public health guidance 27. Available at: https://www.nice.org.uk/guidance/ph27/resources/guidance-weight-management-before-during-and-after-pregnancy-pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 15 Centre for Maternal and Child Enquiries and the Royal College of Obstetricians and Gynaecologists. Management of women with obesity in pregnancy (March 2010). Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/cmacercogjointguidelinemanagementwomenobesitypregnancya.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 16 Davies GA, Maxwell C, McLeod L , et al; Society of Obstetricians and Gynaecologists of Canada. SOGC Clinical Practice Guidelines: Obesity in pregnancy. No. 239, February 2010. Int J Gynaecol Obstet 2010; 110 (2) 167-173
    CrossrefPubMedGoogle Scholar
  • 17 Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and Clinical Strategy and Programmes Directorate, Health Service Executive. Obesity and pregnancy: clinical practice guideline. Guideline no.2, June 2011, revised June 2013. Available at: http://www.rcpi.ie/content/docs/000001/648_5_media.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 18 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists . Obesity in Pregnancy, Management of (C-Obs 49) (March 2013, revised September 2013). Available at: https://www.ranzcog.edu.au/college-statements-guidelines.html . Accessed June 1, 2015
    PubMed
  • 19 ACOG Committee Opinion Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol 2002; 99 (1) 171-173
    CrossrefPubMedGoogle Scholar
  • 20 ACOG Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2 Pt 1) 406-416
    CrossrefPubMedGoogle Scholar
  • 21 ACOG Practice Bulletin No. 40: Shoulder dystocia. Obstet Gynecol 2002; 100 (5 Pt 1) 1045-1050
    CrossrefPubMedGoogle Scholar
  • 22 ACOG Practice Bulletin No. 120: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol 2011; 117 (6) 1472-1483
    CrossrefPubMedGoogle Scholar
  • 23 ACOG Practice Bulletin No. 105: Bariatric surgery and pregnancy. Obstet Gynecol 2009; 113 (6) 1405-1413
    CrossrefPubMedGoogle Scholar
  • 24 National Institute for Health and Clinical Excellence (NICE). Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period (February 2015). NICE guidelines [NG3]. Available at: nice.org.uk/guidance/ng3 . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 25 Royal College of Obstetricians and Gynaecologists. Exercise in pregnancy (January 2006). Statement no. 4. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/statements/statement-no-4.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 26 Royal College of Obstetricians and Gynaecologists. Nutrition in pregnancy (Revised September 2010). Scientific impact paper no. 18. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-papers/sip_18.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 27 Royal College of Obstetricians and Gynaecologists. Reducing the risk of venous thromboembolism during pregnancy and the puerperium (April 2015). Green-top guideline no. 37a. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 28 Royal College of Obstetricians and Gynaecologists. Thromboembolic disease in pregnancy and the puerperium: acute management (April 2015). Green-top guideline no. 37b. Available at: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37b.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 29 van Schalkwyk J, Van Eyk N ; Society of Obstetricians and Gynaecologists of Canada Infectious Diseases Committee. Antibiotic prophylaxis in obstetric procedures. J Obstet Gynaecol Can 2010; 32 (9) 878-892
    PubMedGoogle Scholar
  • 30 Berger H, Crane J, Farine D , et al; Maternal-Fetal Medicine Committee; Executive and Coundil fo the Society of Obstetricians and Gynaecologists of Canada. Screening for gestational diabetes mellitus. J Obstet Gynaecol Can 2002; 24 (11) 894-912
    PubMedGoogle Scholar
  • 31 Office of the Nursing & Midwifery. Guidelines for the management of pre-gestational and gestational diabetes mellitus from pre-conception to the postnatal period (July 2010). Available at: http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/guide11.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 32 Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and HSE Clinical Care Programme in Obstetrics and Gynaecology and Irish Haematology Society. Venous thromboprophylaxis in pregnancy clinical practice guideline no. 20 (November 2013). Available at: http://www.rcpi.ie/content/docs/000001/1392_5_media.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 33 Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and HSE Clinical Care Programme in Obstetrics and Gynaecology and Irish Haematology Society. Nutrition for pregnancy clinical practice guideline no. 27 (August 2013). Available at: http://www.hse.ie/eng/about/Who/clinical/natclinprog/obsandgynaeprogramme/nutpreg.pdf . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 34 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Birth after previous caesarean section new college statement C-Obs 38. (July 2013). Available at: http://www.ranzcog.edu.au/component/docman/doc_view/971-c-obs-38-planned-vaginal-birth-after-caesarean-section-trial-of-labour-.html . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 35 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Intrapartum fetal surveillance clinical guidelines- third edition (September 2014). Available at: https://www.ranzcog.edu.au/intrapartum-fetal-surveillance-clinical-guidelines.html . Accessed June 1, 2015
    PubMedGoogle Scholar
  • 36 Guidance for Healthy Weight Gain in Pregnancy. Wellington: Ministry of Health; 2014
    Google Scholar
  • 37 Hendler I, Goldenberg RL, Mercer BM , et al. The Preterm Prediction Study: association between maternal body mass index and spontaneous and indicated preterm birth. Am J Obstet Gynecol 2005; 192 (3) 882-886
    CrossrefPubMedGoogle Scholar
  • 38 Hawkins JL, Koonin LM, Palmer SK, Gibbs CP. Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990. Anesthesiology 1997; 86 (2) 277-284
    CrossrefPubMedGoogle Scholar
  • 39 Weight Gain during Pregnancy: Reexamining the Guidelines. Washington, DC: Institute of Medicine; 2009
    Google Scholar
  • 40 Nutrition during Pregnancy. Washington, DC: Institute of Medicine; 1990
    Google Scholar
  • 41 Chauhan SP, Gupta LM, Hendrix NW, Berghella V ; American College of Obstetricians and Gynecologists. Intrauterine growth restriction: comparison of American College of Obstetricians and Gynecologists practice bulletin with other national guidelines. Am J Obstet Gynecol 2009; 200 (4) 409.e1-409.e6
    CrossrefPubMedGoogle Scholar
  • 42 Hill JB, Chauhan SP, Magann EF, Morrison JC, Abuhamad AZ. Intrapartum fetal surveillance: review of three national guidelines. Am J Perinatol 2012; 29 (7) 539-550
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 43 Hill JB, Ammons A, Chauhan SP. Vaginal birth after cesarean delivery: comparison of ACOG practice bulletin with other national guidelines. Clin Obstet Gynecol 2012; 55 (4) 969-977
    CrossrefPubMedGoogle Scholar
  • 44 Wrotniak BH, Dentice S, Mariano K, Salaam EM, Cowley AE, Mauro EM. Counseling about weight gain guidelines and subsequent gestational weight gain. J Womens Health (Larchmt) 2015;
    PubMedGoogle Scholar
  • 45 Tanentsapf I, Heitmann BL, Adegboye AR. Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth 2011; 11: 81
    CrossrefPubMedGoogle Scholar
  • 46 Poston L, Bell R, Croker H , et al; UPBEAT Trial Consortium. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2015; 3 (10) 767-777
    PubMedGoogle Scholar
  • 47 Campbell F, Johnson M, Messina J, Guillaume L, Goyder E. Behavioural interventions for weight management in pregnancy: a systematic review of quantitative and qualitative data. BMC Public Health 2011; 11: 491
    CrossrefPubMedGoogle Scholar
  • 48 Dodd JM, Grivell RM, Crowther CA, Robinson JS. Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials. BJOG 2010; 117 (11) 1316-1326
    CrossrefPubMedGoogle Scholar
  • 49 Centers for Disease Control (CDC). Use of folic acid for prevention of spina bifida and other neural tube defects—1983-1991. MMWR Morb Mortal Wkly Rep 1991; 40 (30) 513-516
    PubMedGoogle Scholar
  • 50 Cole BF, Baron JA, Sandler RS , et al; Polyp Prevention Study Group. Folic acid for the prevention of colorectal adenomas: a randomized clinical trial. JAMA 2007; 297 (21) 2351-2359
    CrossrefPubMedGoogle Scholar
  • 51 Fife J, Raniga S, Hider PN, Frizelle FA. Folic acid supplementation and colorectal cancer risk: a meta-analysis. Colorectal Dis 2011; 13 (2) 132-137
    CrossrefPubMedGoogle Scholar
  • 52 Johnson MA. If high folic acid aggravates vitamin B12 deficiency what should be done about it?. Nutr Rev 2007; 65 (10) 451-458
    PubMedGoogle Scholar
  • 53 Knight M ; UKOSS. Antenatal pulmonary embolism: risk factors, management and outcomes. BJOG 2008; 115 (4) 453-461
    CrossrefPubMedGoogle Scholar
  • 54 Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton III LJ. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143 (10) 697-706
    CrossrefPubMedGoogle Scholar
  • 55 Kominiarek MA, Vonderheid S, Endres LK. Maternal obesity: do patients understand the risks?. J Perinatol 2010; 30 (7) 452-458
    CrossrefPubMedGoogle Scholar
  • 56 Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR. Practitioner advice and gestational weight gain. J Womens Health (Larchmt) 2011; 20 (4) 585-591
    CrossrefPubMedGoogle Scholar
  • 57 Stotland NE, Gilbert P, Bogetz A, Harper CC, Abrams B, Gerbert B. Preventing excessive weight gain in pregnancy: how do prenatal care providers approach counseling?. J Womens Health (Larchmt) 2010; 19 (4) 807-814
    CrossrefPubMedGoogle Scholar
  • 58 Power ML, Cogswell ME, Schulkin J. Obesity prevention and treatment practices of U.S. obstetrician-gynecologists. Obstet Gynecol 2006; 108 (4) 961-968
    CrossrefPubMedGoogle Scholar
  • 59 Kushner RF, Roth JL. Assessment of the obese patient. Endocrinol Metab Clin North Am 2003; 32 (4) 915-933
    CrossrefPubMedGoogle Scholar
  • 60 Stewart ZA, Wallace E, Allan C. Weight gain in pregnancy: a survey of current practices in a teaching hospital. Aust N Z J Obstet Gynaecol 2012; 52 (2) 208-210
    CrossrefPubMedGoogle Scholar
  • 61 Kirk SF, Cramm CL, Price SL, Penney TL, Jarvie L, Power H. The state of obesity management for women giving birth in Atlantic Canada. Matern Child Health J 2010; 14 (3) 453-458
    CrossrefPubMedGoogle Scholar
  • 62 Stotland N, Tsoh JY, Gerbert B. Prenatal weight gain: who is counseled?. J Womens Health (Larchmt) 2012; 21 (6) 695-701
    CrossrefPubMedGoogle Scholar
  • 63 Knight BA, Wyatt K. Barriers encountered when recruiting obese pregnant women to a dietary intervention. Nurs Times 2010; 106 (32) 20-22
    PubMedGoogle Scholar
  • 64 Perrin EM, Flower KB, Garrett J, Ammerman AS. Preventing and treating obesity: pediatricians' self-efficacy, barriers, resources, and advocacy. Ambul Pediatr 2005; 5 (3) 150-156
    CrossrefPubMedGoogle Scholar
  • 65 Eve R, Golton I, Hodgkin P, Munro J, Musson G. Beyond guidelines: promoting clinical change in the real world. J Manag Med 1996; 10 (1) 16-25
    CrossrefPubMedGoogle Scholar