Australian Doctor Australian Doctor 15th December 2017 | Page 25

make lifestyle changes) have
been shown to be effec-
tive. 20-23
Other
strategies
for
promoting healthy gesta-
tional weight gain include
weight gain monitoring and
addressing
psychosocial
wellbeing.
While less evidence is
available to make strong
conclusions about the effi-
cacy of these approaches,
they both have promise
and should be considered in
conjunction with traditional
lifestyle interventions. 24-27
Weight gain monitoring
during pregnancy is reported
as acceptable by women and
involves plotting weight on
a specialised chart with
BMI-specific Institute of
Medicine recommendations
superimposed to track pro-
gress (figure 1). 28
With regards to psycho-
social wellbeing, causes for
concern include maternal
depression, anxiety or stress,
poor body image, physical
symptoms of pregnancy,
poor sleep quality, and poor
self-efficacy or motivation
to change behaviours. 29,30
By addressing these fac-
tors, women may be more
able to implement lifestyle
change to promote healthy
gestational weight gain. 25
Furthermore,
interven-
tions delivered by primary
care providers offer the
benefits of convenience,
reduced barriers to access,
and ability to individualise
care. 31
Gestational weight
management in general
practice
Viewing
pregnancy
as
a phase in the care of
reproductive-aged women
is essential to achieving
healthy gestational weight
gain goals. 3,32
Optimising healthy ges-
tational weight gain during
pregnancy by monitoring
weight gain, encouraging
healthy lifestyle and encour-
aging ongoing physical
activity is proven to reduce
gestational weight gain and
improve health. Promoting
return to healthy weight in
the post-partum period will
also assist with weight con-
trol in subsequent pregnan-
cies and beyond (see box 1).
It is important to engage
with women early in their
pregnancy around healthy
lifestyle conversations and
appropriate
gestational
weight gain. As the GP often
confirms pregnancy, there is
scope to provide early preg-
nancy advice on gestational
weight gain: advise women
to gain 0.5-2kg in the first
trimester of pregnancy and
around 200-500g per week
thereafter (table 1 outlines
precise gestational weight
gain
recommendations
according to BMI).
It is difficult to prescribe
specific
recommendations
for energy requirements dur-

ing pregnancy because of
women’s diverse biological
responses to pregnancy, life-
style and needs. 3
However, the Australian
Dietary Guidelines recom-
mend adult pregnant women
increase their daily intake
from the grains/cereals food
group from 6 serves to 8.5
serves per day and increase
their intake of protein-rich
foods from 2.5 serves to
3.5 serves per day. 33 All
other food groups remain
unchanged.
Notably, it is not neces-
sary to ‘eat for two’ and the
increased energy require-
ments of pregnancy are mod-
est, with an extra 1400kJ/
day and 1900kJ/day recom-
mended during the second
and third trimesters, respec-
tively. 34
Advice such as abstaining
from exercise is also out-
dated; women should aim to
meet the Australian Physical
Activity Guidelines of at least
150 minutes of moderate
intensity activity or 75 min-
utes of vigorous activity per
week (or a combination of
both) unless contra-indica-
tions are present. 35 Women
who remain active through-
out pregnancy have better
birth outcomes.
Healthcare providers often
report difficulty in discuss-
ing weight or lifestyle advice
with their patients due to lack
of time, poor rapport, stigma,
or inadequate knowledge
or training. 36-38 Box 2 con-
tains some tips for initiating
healthy conversations.
Women receiving preg-
nancy care from an obstetri-
cian or midwife may benefit
from GP support regarding
appropriate
gestational
wei