Managing obesity in pregnancy: Are psychological dimensions of behavioural change important to midwives and women?

Abstract

Currently a quarter of British women are obese. It is well known that maternal obesity increases the risk of suboptimal pregnancy outcomes. The National Institute for Health and Care Excellence (NICE) in the UK recommends that pregnant women should be given advice and support on achieving appropriate weight gain during pregnancy. However, evidence suggests that such advice relating to diet and physical activity in pregnancy is inconsistent, as well as sometimes being ineffectual. Recent research shows that many midwives at the forefront of maternity care lack the confidence to discuss weight gain during pregnancy with obese women, and midwives recognise that further training concerning weight gain would enhance their ability to support obese women. Concerns include offending and potentially disengaging women from health services. This paper considers the policy position on diet and activity for obese, pregnant women and the evidence for nutrition and lifestyle intervention for controlling gestational weight gain. It is suggested that the inclusion of a psychological dimension may increase the efficacy of interventions relating to obesity during pregnancy. Recommendation is made for a controlled trial for community midwives examining the efficacy of behaviour change intervention, underpinned by psychological theory that would enable community midwives to offer specific advice and support for obese, pregnant women.