Pregnant women will be offered a weigh-in at every antenatal visit and consistently advised about diet and exercise while routine vitamin D testing will be scrapped under updated pregnancy care guidelines.
Routine testing for hepatitis C at the first antenatal visit is also recommended.
“Routine testing of all pregnant women for vitamin D status and subsequent vitamin D supplementation is not supported by evidence and should cease as the benefits and harms of vitamin D supplementation remain unclear,” according to the guidelines, published on Monday in the Medical Journal of Australia and led by Prof Caroline Homer from Melbourne’s Burnet Institute.
“The recommendation for health professionals to provide advice to pregnant women about weight, diet and physical activity, and the opportunity to be weighed, will help women to make changes leading to better health outcomes for themselves and their babies.”
The guidelines are intended for midwives, obstetricians, general practitioners, nurses, Aboriginal and Torres Strait Islander health workers and allied health professionals.
A professor of midwifery at Western Sydney University, Hannah Dahlen, has studied the experiences and concerns of pregnant obese women and said the guidelines would have to be carefully implemented by doctors.
“Our research shows health providers aren’t adequately skilled to do this in a way that’s sensitive, while some are great at it,” she said. “A lot more needs to be done on how to deliver the message in a way that’s helpful and not harmful.
“It’s not just about a physical outcome, there can be a significant psychological impact of bringing up weight. We have got an issue, definitely, in our society with more and more women being overweight having babies and that’s not a healthy thing. But let’s be careful not to alienate those women further. I think you can bring weight and diet up much more safely in a relationship when the woman is seeing the same care provider throughout the pregnancy.”
While overweight and obese women carrying overweight babies were more likely to need interventions at childbirth, Dahlen said it was important to remember intervention rates were increasing for pregnant women regardless of health status.
Tim Gill, a professor of public health nutrition at the Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders in Sydney, said it was already common for women to be weighed at some stage during pregnancy but usually to ensure women were not underweight.
He said the data showed a substantial number of women were entering pregnancy substantially overweight, or gained significantly more weight than was healthy during pregnancy.
But he said pregnancy was the wrong time to embark on drastic diet and lifestyle changes to lose weight, and that the new guidelines did not suggest doing so.
“That would be counterproductive and potentially dangerous,” he said. “What these guidelines are about is restricting the amount of weight gain and being extra vigilant of women and their babies who may be at risk.”
He said people were often most receptive to health advice during pregnancy and that made it an ideal time to make diet and lifestyle suggestions.
