Lifestyle in NICE guidance – Part 4b – Weight & Pregnancy

So picking up right where we left off from last week (if you haven’t read last week’s post I highly recommend it as covers the first part of this guidance, you can find it here: https://thelifestylepill.org/2019/10/13/lifestyle-in-nice-guidance-part-4a-weight-pregnancy/).

  • Advise that moderate-intensity physical activity will not harm her or her unborn child. At least 30 minutes per day of moderate intensity activity is recommended.
  • Give specific and practical about being physically active during pregnancy:
    • recreational exercise such as swimming or brisk walking and strength conditioning exercise is safe and beneficial
    • the aim of recreational exercise is to stay fit, rather than to reach peak fitness
    • if women have not exercised routinely they should begin with no more than 15 minutes of continuous exercise, three times per week, increasing gradually to daily 30-minute sessions
    • if women exercised regularly before pregnancy, they should be able to continue with no adverse effects.

As an aside, the chief medical officer has released physical activity guidance for women in pregnancy, I’ll share the infographics which relate to these below:

physical activity pregnancy infographic.png

Picture source: https://www.gov.uk/government/publications/physical-activity-guidelines-infographics
  • Explain to those women who would find this level of physical activity difficult that it is important not to be sedentary, as far as possible. Encourage them to start walking and to build physical activity into daily life, for example, by taking the stairs instead of the lift, rather than sitting for long periods.
  • Measure weight and height at the first contact with the pregnant woman, being sensitive to any concerns she may have about her weight.
    • If these data are not available at their first booking appointment, then the midwife should do this. Do not rely on self-reported measures of weight and height. Clearly explain why this information is needed and how it will be used to plan her care. Weigh her in light clothing using appropriate, calibrated weighing scales that are regularly checked. Calculate BMI.
  • Do not weigh women repeatedly during pregnancy as a matter of routine. Only weigh again if clinical management can be influenced or if nutrition is a concern.
  • Explain to women with a BMI of 30 or more at the booking appointment how this poses a risk, both to their health and the health of the unborn child. Explain that they should not try to reduce this risk by dieting while pregnant and that the risk will be managed by the health professionals caring for them during their pregnancy.
  • Offer women with a BMI of 30 or more at the booking appointment a referral to a dietitian or appropriately trained health professional for assessment and personalised advice on healthy eating and how to be physically active. Encourage them to lose weight after pregnancy.

POST PREGNANCY

What action should health professionals take?

  • Use the 6–8-week postnatal check as an opportunity to discuss the woman’s weight. Ask those who are overweight, obese or who have concerns about their weight if they would like any further advice and support now – or later. If they say they would like help later, they should be asked whether they would like to make an appointment within the next 6 months for advice and support.
  • During the 6–8-week postnatal check, or during the follow-up appointment within the next 6 months, provide clear, tailored, consistent, up-to-date and timely advice about how to lose weight safely after childbirth. Ensure women have a realistic expectation of the time it will take to lose weight gained during pregnancy. Discuss the benefits of a healthy diet and regular physical activity, acknowledging the woman’s role within the family and how she can be supported by her partner and wider family. Advice on healthy eating and physical activity should be tailored to her circumstances. For example, it should take into account the demands of caring for a baby and any other children, how tired she is and any health problems she may have (such as pelvic floor muscle weakness or backache).
  • Health professionals should advise women, their partners and family to seek information and advice from a reputable source. Women who want support to lose weight should be given details of appropriate community-based services.
  • Health professionals should give advice on recreational exercise from the Royal College of Obstetrics and Gynaecology. In summary, this states that:
      • If pregnancy and delivery are uncomplicated, a mild exercise programme consisting of walking, pelvic floor exercises and stretching may begin immediately. But women should not resume high-impact activity too soon after giving birth.
      • After complicated deliveries, or lower segment caesareans, a medical care-giver should be consulted before resuming pre-pregnancy levels of physical activity, usually after the first check-up at 6–8 weeks after giving birth.
  • Health professionals should also emphasise the importance of participating in physical activities, such as walking, which can be built into daily life.

Again, the chief medical officer has just released new physical activity guidelines and included post-pregnancy in this. The infographic for this is below:

post-pregnancy physical activity infographic.png

Picture source: https://www.gov.uk/government/publications/physical-activity-guidelines-infographics

Women with a BMI of 30 or more after childbirth

What action should health professionals take?

  • Explain the increased risks that being obese poses to them and, if they become pregnant again, their unborn child. Encourage them to lose weight.
  • Offer a structured weight-loss programme. If more appropriate, offer a referral to a dietitian or an appropriately trained health professional. They will provide a personalised assessment, advice about diet and physical activity and advice on behaviour change strategies such as goal setting. Women who are not yet ready to lose weight should be provided with information about where they can get support when they are ready.
  • Use evidence-based behaviour change techniques to motivate and support women to lose weight.
  • Encourage breastfeeding and advise women that losing weight by eating healthily and taking regular exercise will not affect the quantity or quality of their milk.

The above evidently means health care professionals need to be confident in sensitively yet openly discussing weight with their patient. This is a skill that takes practice and I am definitely still learning this myself.

Link to the full guidance is here: https://www.nice.org.uk/guidance/ph27/chapter/1-Recommendations

Hope this blog was helpful, let me know any thoughts in the comments here or on Instagram,

Emma

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s