Weight Management Over The Reproductive Years for Adult Women With Obesity

This chapter addresses the management of weight related to three phases of a woman’s reproductive years – precon­ception, during pregnancy and postpartum – for adult wom­en with obesity. Although these reproductive periods are addressed separately, it is important to consider that these phases represent the continuum of weight management over the reproductive years in women with obesity. During these time periods, women frequently access the healthcare system, thus providing clinicians with health promotion opportunities which may have positive impacts on the short- and long-term health of both the woman and her children. Discussion of the obstetric and anesthetic management for women with obesity during pregnancy is beyond the scope of this clinical practice guideline.

These recommendations pertain to the management of weight over the reproductive years for adult women with obesity (i.e., body mass index [BMI] ≥30 kg/m2) with a singleton pregnancy, who are ≥ 18 years of age and do not have pre-existing diabetes or gestational diabetes.

  1. General advice: We recommend primary care providers should discuss weight management targets specific to the reproductive years with adult women with obesity: precon­ception weight loss (Level 3, Grade C), gestational weight gain of 5 kg–9 kg over the entire pregnancy (Level 4, Grade D); postpartum weight loss of – at minimum – gestational weight gain (Level 3, Grade C) to reduce the risk of adverse outcomes in the current or in a future pregnancy.
  2. Combined behaviour change interventions: Primary care providers should offer behaviour change interventions, including both nutrition and physical activity, to adult women with obesity who are considering a pregnancy (Level 3, Grade C), who are pregnant (Level 2a, Grade B) and who are postpartum (Level 1a, Grade A) in order to achieve weight targets.
  3. Nutrition counselling alone: We recommend primary care providers encourage and support pregnant women with obesity to consume foods consistent with a healthy dietary pattern in order to meet their target gestational weight gain (Level 3, Grade C).
  4. Physical activity counselling alone: We recommend pri­mary care providers encourage and support pregnant women with obesity who do not have contraindications to exercise during pregnancy to engage in at least 150 minutes per week of moderate intensity physical activity to assist in the manage­ment of gestational weight gain (Level 3, Grade C).
  5. Pharmacotherapy: Healthcare providers should not pre­scribe metformin for managing gestational weight gain in women with obesity (Level 1b, Grade A). We suggest no weight management medications during pregnancy or breast­feeding (Level 4, Grade D).
  6. Breastfeeding: We recommend women with obesity be offered additional breastfeeding support due to decreased rates of initiation and continuation (Level 3, Grade C).

The reproductive years, including before, during and after pregnancy, bring many additional challenges for women with obesity in maintaining a healthy weight beyond eating well and being physically active. It is important for women with obesity to seek advice and support from their healthcare pro­viders on strategies to optimize their own health outcomes, as well as those of their children, over both the short and long-term.

The strategies described in this chapter include:

  1. Entering pregnancy at a lower BMI;
  2. Targeting weight gain during the entire pregnancy to 5 kg– 9 kg; and
  3. Returning to at least the pre-pregnancy BMI in the year after delivery.

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