Management of prepregnancy, pregnancy, and postpartum ......the Global Voice for Women’s Health...

the Global Voice for Women’s Health

Pregnancy Obesity and Nutrition Initiative (PONI)

Co leads: Prof. Fionnuala McAuliffe & Prof Mark Hanson

Chair of the FIGO PNCDC: Prof Moshe Hod


Speaker: Professor Fionnuala McAuliffeUCD Perinatal Research Centre, School of Medicine, University College

Dublin, National Maternity Hospital, Dublin, Ireland

Management of prepregnancy, pregnancy, and postpartum

obesity from the FIGO Pregnancy and Non‐Communicable

Diseases Committee: A FIGO (International Federation of

Gynecology and Obstetrics) guideline



Global prevalence of obesity

Source OECDhttps://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf

In most countries, obesity is

common, affecting at least

10% to 40% of women and

older adolescents

The most

common

condition in

women of

reproductive

age

https://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf

https://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf



Significance of prepregnancy, pregnancy and postpartum obesity

Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: Women.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/595439/CMO_annual_report_2014.pdf




Significance of prepregnancy, pregnancy and postpartum obesity

The now:

The future:

The trans-generational effect:

Good health is

passed from

generation to

generation as

children grow into

adults free of NCDs

Reduce NCD in future generations

Reduce NCD development in women and improve pregnancy outcomes

Annual Report of the Chief Medical Officer, 2014, The Health of the 51%: Women.





Role of healthcare professionals in obesity management

1. Obstetricians and gynecologists are uniquely positioned to influence obesity risk and prevalence, as well as health outcomes, through lifestyle and other interventions with women of reproductive age

• Weight loss in prepregancy and postpartum

• Gestational weight gain management during pregnancy

2. Women with obesity during pregnancy may have additional requirements and specialized care

Over 30 clinical practice guidelines relating to the management of maternal obesity have been published and these vary in scope, content and evidence1.

1 Simon A, Pratt M, Hutton B, et al. Obes Rev. 2020;21(3):e12972.



Role of healthcare professionals in obesity management

1. Obstetricians and gynecologists are uniquely positioned to influence obesity risk and prevalence, as well as health outcomes, through lifestyle and other interventions with women of reproductive age

• Weight loss in prepregancy and postpartum

• Gestational weight gain management during pregnancy

2. Women with obesity during pregnancy may have additional requirements and specialized care

Over 30 clinical practice guidelines relating to the management of maternal obesity have been published and these vary in scope, content and evidence1.

Clear clinical guidance is needed for frontline practitioners globally on the management of obesity before, during and after pregnancy

1 Simon A, Pratt M, Hutton B, et al. Obes Rev. 2020;21(3):e12972.



Fionnuala M. McAuliffe#, Sarah Louise Killeen#, Chandni Maria Jacob, Mark A. Hanson,

Eran Hadar, H. David McIntyre, Anil Kapur, Anne B. Kihara, Ronald C. Ma, Hema Divakar,

Moshe Hod

#joint first authors

Management of prepregnancy, pregnancy, and

postpartum obesity from the FIGO Pregnancy and

Non‐Communicable Diseases Committee: A FIGO

(International Federation of Gynecology and

Obstetrics) guideline

Aim: to consolidate recommendations from published clinical practice guidelines in one resource and provide evidence to support healthcare providers, and those involved in service planning and policy making.



Target audience

This guidance is directed at healthcare providers working with women with obesity, before, during, and after pregnancy. It is relevant to general practitioners/family physicians, midwives, nurses, community health workers, dietitians, nutritionists, physiotherapists, and others.

This guidance is also relevant to governments, legislators, healthcare and insurance organizations, and development agencies.



Identification of individual good clinical practice recommendations and evidence grading

To be included in the review, clinical practice guidelines needed to

• Focus on maternal obesity, including pregnancy obesity

• Include clear consideration of evidence grading

• Originate from a FIGO member organization

Recommendations were extracted, along with their evidence grading. All evidence grading was converted to GRADE (Grading of Recommendations Assessment, Development and Evaluation).



Main body of guideline

The FIGO extracted good clinical

practice recommendations are qualified

with supporting text

• Colour coded based on time-point

• Key references throughout



Recommendations from the FIGO PNCDC

12 recommendations, 3 time-points, Consensus based

PNCDC = Pregnancy and non-communicable disease committee



Example: pregnancy obesity recommendations

Recommendation B.1. All women should have their weight and height measured and their BMI calculated at the first anetanal visit. Consider ethnic differences. Advise on appropriate gestational weight gain.

Recommendation B.2. All women should receive information on diet and lifestyle appropriate to their gestation including nutrient supplements, weight management, and regular physical activity.



Recommendations from the FIGO PNCDC

PNCDC = Pregnancy and non-communicable disease committee



Ethical considerations

• Consideration of the potential impact of using the terms “obese” and “obesity” with women is needed among healthcare providers1

• Obesity is defined as a chronic, progressive, relapsing disease and warrants “people-first” language2

• It may be necessary to refer a woman with obesity to a clinician with specialized resources or experience, however it is unethical for healthcare providers to decline to care for women based on BMI2.

1. Rubino F, Puhl RM, Cummings DE, et al. Nat Med. 2020;26:485–497.

2. ACOG Committee Opinion No. 763. Obstet Gynecol. 2019;133:e90–e96.



Use of this resource by FIGO member organizations

We encourage member organizations to use the guidance as a framework to create and publish their own evidence‐based localized and pragmatic clinical practice guidelines, especially in LMICs, which are currently underrepresented in the literature and have specific needs in relation to obesity that warrant special consideration.



Conclusion

• By addressing nutrition and weight with women of reproductive age, global health outcomes can

be improved and the burden on healthcare systems reduced

• Diet and lifestyle are the cornerstone of obesity management and healthy diets and lifestyles

should be encouraged

• Outside of weight management, women with obesity require specific considerations for medical,

surgical, and other care planning as outlined in this guidance

• The specific recommendations that are applicable to individual women or within resource settings

may vary


NUTRITION AND WEIGHT AT THE FRONTLINE OF PREGNANCY CARE FOR WOMEN GLOBALLY VISION:

We will achieve this through:

ACTION:THINK NUTRITION AND WEIGHT FIRST, AT EVERY CONTACT

…..Give the GIFT of a life free from non-communicable diseases

Hanson, McAuliffe, Hod FIGO NCD Committee, [email protected] , [email protected]


FIGO Pregnancy Obesity and Nutrition Initiative

mailto:[email protected]

Management of prepregnancy, pregnancy, and postpartum ......the Global Voice for Women’s Health...

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