NICE Guidance referred to in this study
1. Contraception – assessment
Type: Clinical Knowledge Summary
Last revised in December 2017
Relevant recommendations:
2. Weight management before, during and after pregnancy
Type: Public health guideline [PH27]
Published date: July 2010
Relevant recommendations:
3. Pre-conception - advice and management
Type: Clinical Knowledge Summary
Last revised in August 2017
Scenario: Advice for all women
Recommendations:
4. Maternal and child nutrition
Type: Public health guideline [PH11]
Published date: March 2008
Last updated: November 2014
Relevant recommendations:
Type: Clinical Knowledge Summary
Last revised in December 2017
Relevant recommendations:
- Take a clinical history and perform a clinical examination, including blood pressure, and body mass index.
- Factors which should be considered when deciding upon a method of contraception include:
- Comorbidities and other conditions - cardiovascular disease (CVD) risk factors; diabetes mellitus; epilepsy; headache or migraine; hypertension; menorrhagia; fibroids; previous ectopic pregnancy; obesity; sexually transmitted infections (STIs) or pelvic inflammatory disease (PID); smoking; and venous thromboembolism (VTE).
- Also discuss the woman's:
- Requirements for contraception, the importance of avoiding pregnancy, future plans for having children, and the attitudes of her partner and family towards contraception.
2. Weight management before, during and after pregnancy
Type: Public health guideline [PH27]
Published date: July 2010
Relevant recommendations:
- Recommendation 1
- Preparing for pregnancy: women with a BMI of 30 or more
- Who should take action:
- GPs, health visitors, midwives, practice nurses, pharmacists and other health professionals working in weight management, fertility, pre-conception advice and care services, gynaecology and contraceptive services.
- Health professionals should use any opportunity, as appropriate, to provide women with a BMI of 30 or more with information about the health benefits of losing weight before becoming pregnant (for themselves and the baby they may conceive). This should include information on the increased health risks their weight poses to themselves and would pose to their unborn child.
- GPs, dietitians and other appropriately trained health professionals should advise, encourage and help women with a BMI of 30 or more to reduce weight before becoming pregnant. They should explain that losing 5–10% of their weight (a realistic target) would have significant health benefits[2] and could increase their chances of becoming pregnant. Further weight loss, to achieve a BMI within the healthy range (between 24.9 and 18.5 kg/m2) should also be encouraged, using evidence-based behaviour change techniques. Losing weight to within this range may be difficult and women will need to be motivated and supported.
- Health professionals should encourage women to check their weight and waist measurement periodically or, as a simple alternative, check the fit of their clothes.
- Health professionals should offer a weight-loss support programme involving diet and physical activity. The programme should follow the principles of good practice, as outlined at the beginning of this section.
- Health professionals should offer specific dietary advice in preparation for pregnancy, including the need to take daily folic acid supplements. This includes professionals working in pre-conception clinics, fertility clinics, sexual and reproductive health services and children's centres.
3. Pre-conception - advice and management
Type: Clinical Knowledge Summary
Last revised in August 2017
Scenario: Advice for all women
Recommendations:
- Advice on weight management
- Advise women that achieving a healthy weight (BMI 18.5–24.9 kg/m2) before becoming pregnant reduces the risk of pregnancy complications.
- Advise the woman of the potential health risks of being obese (BMI of 30 kg/m2 or more) including:
- Reduced fertility.
- Increased risk of miscarriage.
- Gestational diabetes.
- Gestational hypertension/pre-eclampsia.
- Macrosomia and shoulder dystocia.
- Preterm delivery.
- Birth trauma.
- Caesarean delivery.
- Postpartum complications (for example haemorrhage, thrombosis and infection).
- Stillbirth.
- Congenital anomalies (for example neural tube defects, cardiovascular anomalies, cleft palate, limb reduction, anorectal atresia, hydrocephaly).
- Advise and encourage women who are obese (BMI of 30 kg/m2 or more) to lose weight before becoming pregnant.
- Women should be informed that losing 5–10% of their weight (a realistic target) would have significant health benefits and could increase their chances of becoming pregnant.
- Women should be encouraged to check their weight and waist measurement periodically, or as an alternative, check the fit of their clothes.
- Offer a weight loss support programme that includes advice about diet and physical activity.
- Women should be aware that if they do become pregnant, there is no need to 'eat for two' or to drink full-fat milk.
4. Maternal and child nutrition
Type: Public health guideline [PH11]
Published date: March 2008
Last updated: November 2014
Relevant recommendations:
- Who should take action?
- Obstetricians, gynaecologists, GPs, midwives, health visitors, nurses, dietitians, those working in contraceptive services or on weight management programmes (commercial or voluntary).
- Inform women who have a BMI over 30 about the increased risks this poses to themselves and their babies and encourage them to lose weight before becoming pregnant or after pregnancy. Provide a structured programme that:
- addresses the reasons why women may find it difficult to lose weight, particularly after pregnancy
- is tailored to the needs of an individual or group
Links
NICE (2017) Contraception – assessment [online]. Clinical knowledge summary. Click here.
NICE (2017) Pre-conception - advice and management [online]. Clinical knowledge summary. Click here.
NICE (2014) Maternal and child nutrition [online]. Public health guideline [PH11]. Click here.
NICE (2010) Weight management before, during and after pregnancy [online]. Public health guideline [PH27]. Click here.
NICE (2017) Pre-conception - advice and management [online]. Clinical knowledge summary. Click here.
NICE (2014) Maternal and child nutrition [online]. Public health guideline [PH11]. Click here.
NICE (2010) Weight management before, during and after pregnancy [online]. Public health guideline [PH27]. Click here.