Australian Doctor Australian Doctor 15th December 2017 | Page 24

Therapy Update
Getting it just right
W
OMEN
of
reproductive
age are a high-
risk popula-
tion for the development of
overweight and obesity, and
childbearing has a significant
influence on weight gain. 1
Risk factors for weight
gain during childbearing
years include high preconcep-
tion BMI and excessive ges-
tational weight gain, which
hinder return to a healthy
BMI post-partum.
Fifty per cent of women
enter pregnancy overweight
or obese. Add to that the
fact that pregnant women
across the BMI spectrum are
at increased risk of exces-
sive gestational weight gain. 2
Excess weight gain in preg-
nancy then perpetuates a
cycle of overweight/obesity,
excessive gestational weight
gain in future pregnancies,
and post-partum weight
retention.
At the opposite end of
the spectrum, sub-optimal
gestational weight gain can
also have significant adverse
effects on maternal and fetal
outcomes. Although less
common than excess ges-
tational weight gain, this is
nonetheless an important
consideration for a healthy
pregnancy.
The GP role is vital in pre-
vention and early interven-
tion, both of which are key to
stemming the impact of high
weight gain on short- and
long-term health.
WOMEN’S HEALTH
Excessive or sub-optimal weight gain in pregnancy
can have significant adverse effects.
DR BRIONY HILL (PhD), PROFESSOR HELEN SKOUTERIS (PhD), ASSOCIATE PROFESSOR LISA MORAN (PhD)
AND PROFESSOR HELENA TEEDE
comes for mother and infant.
The US Institute of Medicine
has published widely used
recommendations. 3
Recommended gestational
weight gain is based on a
woman’s
pre-pregnancy
BMI, offering total and
weekly rate guidelines (see
table 1). The broad interna-
tional relevance of these rec-
ommendations has recently
been validated, and they are
endorsed by the Royal Aus-
tralian and New Zealand
College of Obstetricians and
Gynaecologists. 2,4
Epidemiological data out-
lining gestational weight gain
in Australian women are
limited. However, smaller
studies indicate that around
one-quarter of women gain
inadequate weight during
pregnancy, at least 40%
exceed
recommendations,
and just one-third of women
meet
recommendations. 5-7
This is similar to interna-
tional data. 2
A significant proportion
of women exceed gestational
weight gain recommenda-
tions early in their pregnancy;
one study identified that 10%
of women had reached or
exceeded their total recom-
mended gestational weight
gain before their hospital
booking visit. 5
Consequences of
inappropriate gestational
weight gain
Compared with adequate
gestational weight gain, gain-
ing weight below recom-
mended limits is associated
with higher risk of delivering
a small-for-gestational-age
(SGA) infant, and a lower
risk of a large-for-gestational-
age (LGA) or macrosomic
infant. 2
Gestational weight gain
above recommendations is
associated with a lower risk
of having a SGA infant or
pre-term birth, and a higher
risk of having an LGA or
macrosomic infant, and
caesarean delivery. Mothers
with excessive gestational
weight gain may also be at
risk of hypertensive disor-
ders of pregnancy and gesta-
tional diabetes. 3,8
Excess gestational weight
gain is associated with short-
and long-term post-partum
weight retention. 9,10
Women with excess ges-
tational weight gain retain
3.15kg more, on average,
than women with optimal
gestational weight gain. 9
Women with excessive
gestational weight gain add
3.78kg/m 2 to their BMI in
the 21 years post-partum. 9
Furthermore, independent of
pre-pregnancy BMI, excess
gestational weight gain is
associated with offspring
obesity in the first 1000
days after birth, throughout
childhood, and into adult-
hood. 11,12-14
Early pregnancy weight
gain is important in the
development of post-partum
weight retention and off-
spring obesity. 15,16 This is
possibly because it is strongly
predictive of total gestational
weight gain, as