Healthy Weight

Management Guidelines
Before, During and After Pregnancy
A Quick Reference Guide for Primary Care
(see www.icgp.ie/weightmanagement or www.hse.ie for additional online resources)

Pre-pregnancy
Height, Weight taken and Body Mass Index calculated on all women
Body Weight who are planning a pregnancy
and Conception If BMI < 18.5kg/m2 consider appropriate referral to dietician

For women who are overweight advise a weight loss programme

Women who have a BMI > 29.0kg/m2 of 5 – 10% weight loss over a 3 – 6 month period before becoming
who are not ovulating should be pregnant consider referral to dietician
informed that they are likely to
take longer to conceive and losing Consider referral to commercial self-help and community organisations
weight is likely to increase their e.g. Weight Watchers and Unislim as well as the online resource
chance of conception www.safefood.eu/weigh2live all of which are evidence based

Women should be informed that Once 5 – 10% weight loss is achieved encourage ongoing weight
participating in regular physical maintenance
activity and following dietary advice Use the Weight Management Treatment Algorithm to support health
leads to more pregnancies than behaviour change and to discuss current eating habits and physical
weight loss via dietary advice alone activity levels – see www.icgp.ie/weightmanagement
Women with a BMI < 19.0kg/m2 Additional training for health professionals in achieving behaviour
and who have irregular change in physical activity is available as an e learning module on
menstruation or are not http://www.icgp-education.ie/physical-activity/
menstruating should be advised that
increasing body weight is likely to An oral glucose tolerance test (OGTT) is performed for women with a
improve their chance of conception BMI > 30kg/m2 and all women who have had Gestational Diabetes
Mellitus (GDM) in a previous pregnancy or who have gained
Source: NICE Clinical Guideline II Fertility: considerable weight since their previous post natal check
assessment and treatment for people with
fertility problems. Feb. 2004. Higher doses of folate (5mg) and Vitamin D (10ug) should be
prescribed pre pregnancy for women of a BMI > 30.0kg/m2

There are certain life stages and events that can trigger
weight gain, these include Pregnancy and child rearing

Body Weight and Assisted Reproduction

BMI should ideally be in the range 19.0 – 30.0 kg/m2 before commencing assisted reproduction

Female BMI outside this range is likely to reduce the success of assisted reproduction procedures

Source: NICE Clinical Guideline II Fertility: assessment and treatment for people with fertility problems. Feb. 2004.
 BMI > 40 Grade III
National Physical - Severe Obesity
- High Risk
Activity Guidelines - Specialist Referral
www.getirelandactive.ie Indicated
BMI > 30 Obese or Very Obese
- Combination of Diet, physical activity,
Suggest starting with small, regular, www.getirelandactive.ie psychology + or - pharmacotherapy
planned bouts of Physical Activity (pre or post pregnancy only)

(10 minutes or more). Build to target BMI > 25-30 with co-morbidities
time over months. - Advise patient re health risks
- Highlight need for lifestyle change to revert to
a healthy weight
To lose weight
BMI > 25 patient overweight or obese
Suggest 60 – 75 minutes of moderate - Assess readiness to change and proceed
intensity Physical Activity per day
between 5 to 7 days a week Calculate BMI regularly and advise patient accordingly
(> 250 mins per week)

Weight maintenance BMI < 18.5

Refer if
BMI 18.5 - 25
Healthy
BMI 25 - 30
Overweight
BMI 25 - 30
+ Co-morbidities
BMI 30 - 35 BMI 35 - 40 BMI > 40
Grade I Grade II Grade III
appropriate Weight Overweight Obesity Very Obese Severe Obesity
Suggest 30 – 60 minutes moderate
intensity Physical Activity between 5 to
7 days a week (>150 mins per week) South Asian Population Reference Points
BMI Over-
60 minutes of moderate or 30 minutes BMI Underweight
BMI
Healthy weight
weight BMI Obese BMI Very Obese
(<18.5 kgs/m2) (23.0 - (25.0 - 34.9 kgs/m2) (> 35 kgs/m2)
of vigorous activity per day (18.5 -22.9 kgs/m2)
24.9 kgs/m2)

This can be broken up into smaller Source: Deurenberg P, YAP N, Van Staveran WA: Body Mass Index and % body fat: a meta analysis
bouts (e.g. 15 mins x 5) among different ethnic groups. International Journal Obes Relat Metab Disord 22:1164-1171. 1998
World Health Organisation: WHO Recommendations: Obesity: Preventing and Managing the
Global Epidemic. Geneva. WHO, 2000. (Tech, no 894)

Breastfeeding
During Pregnancy A 15-30% reduction in adolescent and adult obesity
During the initial visit to confirm pregnancy height and weight rates has been found if any breastfeeding occurred
should be taken and BMI recorded in infancy compared with no breastfeeding.
Children breastfed for 3 to 6 months have a 38% less
Discuss recommended weight gain (Institute of Medicine)
risk of obesity at age 9. Breastfeeding for more than
Minimum weight gain advised up to 20 weeks, average weight
6 months leads to a 51% reduction (McCrory and
gain of 1lb per week advised from 20 weeks to term. Weight
Layte, 2012)
should be recorded at each ante natal visit and at regular
intervals
Discuss eating habits and physical activity levels, suggest
monitoring these using the food and exercise diaries see
www.icgo.ie/weightmanagement
Post Pregnancy
Avoid ‘dieting’ to reduce weight in pregnancy but encourage
At the initial Public Health Nurse/GP visit,
healthy eating using the ‘healthy eating in pregnancy booklet’
encourage maintenance of breastfeeding and
www.healthpromotion.ie
reinforce benefits of breastfeeding for mother
Advise that moderate intensity physical activity is beneficial. and child
At least 30 minutes per day of moderate intensity activity is At the 6 week postnatal check consider
recommended. Recommend the site www.getirelandactive.ie for measuring height and weight and calculate BMI.
further advice and information about physical activity Advise woman with BMI> 25 to aim for a gradual
All women with a BMI > 30 should have an oral glucose tolerance 5 – 10% weight reduction using food and exercise
test (OGTT) performed at 24-28 weeks in line with HSE / ICGP diaries for monitoring her progress see www.icgp.
guidelines “A practical guide to integrated type 2 diabetes care” ie/weightmanagement
available at www.hse.ie Encourage healthy eating and resumption of
http://www.rcpi.ie/Faculties/Pages/ClinicalPracticeGuidelinesinObstetricsandGynaecology.aspx
A community ante natal class offered in early pregnancy through mild activities such as daily walking (see physical
primary care teams which will advise on healthy eating, physical activity box)
activity, breastfeeding and health behaviour change should be An oral glucose tolerance test (OGTT) should be
developed and offered where appropriate taken for those women who had Gestational
Encourage the mother to breastfeed her baby and enquire as to diabetes mellitus (GDM) at 6 – 12 weeks post
the support available from partner and family partum followed by reinforcement of lifestyle
change as appropriate
Assess psychological history if relevant – history of depression,
Remind all mothers who have had GDM that they
anxiety or eating disorders see www.icgp.ie/weightmanagement
should attend for diabetic screening annually
for screening tools
from now on