Not what, but how much: discussing weight gain during pregnancy

The subject of weight gain during pregnancy may be a touchy one to discuss with women, but it’s important to bring it up.

Pregnancy is a time when many women become motivated to improve their health, not just  for themselves but for their growing baby as well.

Traditionally, antenatal nutrition information has centred on what women shouldn’t eat and this has been reinforced by what they read in the media.

Questions such as, “How do I avoid potential danger foods (such as mercury-containing fish, some deli meats and soft cheeses)?” or “What are my chances of contracting listeriosis?” are frequently asked. While these are important food safety issues, they are quite uncommon and many dietitians have suggested a refocus of priorities.

The majority of pregnant women in Australia perceive their diets to be healthy, yet they do not consume the recommended daily servings from the five food groups. Only 56 per cent meet their recommendations for fruit and 29 per cent for dairy. Women who smoke during pregnancy are more likely to have a high pre-pregnancy body mass index (BMI) and have low household incomes. They are also less likely to meet their recommended fruit intakes.

A resource that should be available in every antenatal care setting is Healthy Eating During Your Pregnancy, published by the Australian Government. This pamphlet outlines foods and their serving sizes that are best for optimal nutrition, as well as simple food safety and weight-gain advice. To access this resource, go to: eatforhealth.gov.au

Managing weight in pregnancy

More women are becoming pregnant with a BMI well above the healthy range and this may result in excessive gestational weight gain. This can have serious effects during pregnancy and may also contribute to lifelong risks for chronic disease in the offspring and for the mother.

So what is a healthy gestational weight gain? Although there are no locally developed guidelines, it is common for Australian antenatal healthcare professionals to use those published by the US Institute of Medicine (IOM).

The IOM recommendations define obesity as a BMI of 30 kg/m2 or greater and do not differentiate between the different classes of obesity. Thus, weight gain during pregnancy is recommended to be 5.0–9.1kg for obese women.

Some women with a high BMI may reduce their food intake during pregnancy to lose weight or to avoid weight gain. In these circumstances, there is a real risk of micronutrient deficiency, which may require supplementation with folic acid, iron, iodine and vitamin D. Like with excessive weight gain, in most circumstances not gaining enough weight should be actively discouraged. Consequently, high BMI in pregnancy has become an important challenge for health professionals working in antenatal care.

Dr David Knight, senior obstetrician at the Canberra Hospital, argues that: “Prevalence of overweight and obesity among pregnant women in Australia has increased to such an extent that special multidisciplinary clinics have now been established in many teaching hospitals. Collaboration between obstetricians, midwives and dietitians, in particular, is instrumental in improving outcomes for both mothers and babies in this population. Such collaboration has also provided opportunities for ongoing research and for the introduction of new and improved interventions.”

Despite such professional partnerships, many pregnant women are still unaware of current weight gain guidelines and several put on more weight than is recommended. This is partly due to the fact that weight monitoring is not routinely carried out by many Australian antenatal clinics and weight can also be a sensitive topic to discuss. Some health professionals avoid ‘weight-related’ conversations for fear of embarrassing the pregnant woman or causing distress. Others have reported a lack of time or confidence with their knowledge base in this area.

As a result, more and more pregnant women are looking online for answers to their nutrition- and weight-related questions. This does not always lead to credible information. A team of researchers at the University of Canberra have used mobile technology in an attempt to address some of these issues.

Professor of midwifery Dr Deborah Davis says she believes weight, especially women’s weight, is a complex issue that must be addressed in ways that are helpful and, above all, kind and empowering. Obesity has proved to be a health concern that can be difficult to manage, and this includes obesity in pregnancy. She suggests new and innovative approaches are required as part of a management plan.

Davis and her team have developed the Eating4Two app, which aims to support women in achieving a healthy weight gain in pregnancy. She’s careful to point out that such technologies have been designed as an adjunct to usual antenatal care and should in no way replace the advice health professional provides an individual.

Many women make a conscious effort to be healthy in pregnancy but obviously some need additional support. Clear gestational weight gain guidelines and access to credible dietary information is paramount. Ideally, women should be encouraged to seek expert, individualised dietary advice from an accredited practising dietitian.

Weight monitoring is particularly important for obese pregnant women because excessive weight gain during pregnancy is associated with an increased risk of adverse outcomes in this population. Women may be more receptive to regular weight monitoring if this is undertaken in a sensitive, non-judgemental way with a well-defined purpose.

Ultimately, our goal as health professionals must be to reduce the morbidity and mortality associated with being overweight or obese in pregnancy by providing ongoing support, education and innovation.

Cathy Knight-Agarwal is an accredited practising dietitian.

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