In the U.S., nearly two-thirds of women are overweight or obese, and for those who are pregnant, unhealthy bodyweight dramatically increases their risk of developing significant medical complications, such as gestational diabetes, pre-eclampsia, postpartum hemorrhage, preterm birth, and maternal and infant mortality. Obstetricians and other health providers rely on Institute of Medicine (IOM) guidelines written in 2009 to determine appropriate rates of weight gain during pregnancy. Now, a commentary co-authored by a School of Public Health scientist is suggesting it may be time to review the U.S. guidelines to assure they reflect current research and thinking as well as factor in the diversity of women across the country.
“It’s time to reexamine the obesity-specific gestational weight gain guidelines because a lot more women are entering pregnancy obese and there is more research to draw from now than prior to 2009,” says Stang. “Additionally, women from racial and ethnic minority populations experience overweight and obesity at higher rates than White women. Given that half of babies born each year are children of color, this makes prepregnancy obesity a major public health issue that contributes to disparities in maternal and fetal health.”
The basis for the commentary emerged from a workgroup Stang participated in organized by the National Academy of Sciences to examine the state of gestational weight guidelines research and its knowledge gaps.
Stang said a number of recommended health care priorities and recommendations related to obesity in pregnancy emerged from the workgroup.
Help women obtain their ideal weight prior to pregnancy
Many providers delay addressing obesity until a woman becomes pregnant. More attention needs to be paid to women’s health overall, particularly to implementing programs that help them obtain an ideal weight prior to becoming pregnant
“We need to go upstream to figure out how we can prevent women from becoming obese in the first place,” says Stang. “Half of pregnancies are unplanned, which means our health system needs to do a better job of routinely helping all women achieve their ideal weight for both their general and maternal health.”
Talk about obesity with women
Researchers need to determine the best methods for health providers to broach the topic of obesity with women whether or not they’re pregnant, and in a way that empowers both the practitioner and patient.
“It’s hard for health care professionals to bring up weight with women for fear of upsetting or offending their patients,” says Stang. “Also, some women report wanting to talk about it, but their providers refuse to discuss it.”
Consider developing different guidelines for women with varying levels of obesity
Women are diagnosed with obesity when they have a body mass index (BMI) of 30 or more. However, the risks for illness and death can vary drastically between women with a BMI of 30 versus 40. For example, women with a BMI of 30 have much lower rates of gestational diabetes versus those with a BMI of 40.
“Rather than have blanket recommendations for all women who are obese, it may be best to vary guidelines based on the patient’s actual BMI or class of obesity in order to provide the care that is most appropriate for their individual situation,” says Stang.
Incorporate new research into the guidelines
New research may change hard and fast rules that governed the 2009 guidelines. For example, as a general rule women have long been told to never attempt to lose weight during pregnancy. However, there are now new trials underway investigating if weight loss during pregnancy can be safe and beneficial for mothers and their babies.
Also, recent research is showing how weight relates to major pregnancy-related conditions, including postpartum depression.
“There’s new research that shows the relationship is pretty linear and it appears the risk of postpartum depression goes up with increasing BMI values,” says Stang.
Research all populations at risk — especially women of color
Recently, there have been significant increases in pregnancy-related illness and death in the United States.
“We have a lot more women dying during pregnancy — and it’s particularly a problem for women of color, who are also more likely to be obese coming into pregnancy,” says Stang.
A key way to reduce maternal mortality is by improving the weight of all women, particularly women of color, prior to pregnancy and offering better guidelines in terms of managing weight gain in obese pregnant women.
“The problem is the body of research is based on largely White, upper level income, college educated women. But that’s not your typical woman and it’s not very inclusive, which means we don’t know if the current research is applicable to everyone,” says Stang. “There’s a need to conduct studies that look at women of all racial, socioeconomic, ethnic and geographic backgrounds in order to create guidelines and intervention programs that can actually help them.”