Pregnancy

Optimising health behaviors in pregnancy

Promoting healthy habits during pregnancy

Eating a range of nutritious food and staying physically active supports baby’s development in utero and helps to prepare the mother’s body for labour and recovery.[1] A woman’s gestational weight gain (GWG) and health behaviours during pregnancy are strong predictors of pregnancy complications and child health outcomes including childhood obesity.[2, 3]

Ask and Assess

  • Use positive, health-focused language that minimises judgment.
  • Pre-conception: Ask women about planning a pregnancy, and ask permission to discuss and assess preconception weight and explain its relevance.
  • Antenatal: Calculate BMI at entry to care, weigh and plot at every antenatal visit.

Advise and Assist

  • Pre-conception: Advise women of their weight range.
  • Antenatal: Advise women of recommended GWG based on their pre-pregnancy BMI. Regularly monitor and discuss pattern and rate of weight gain. Encourage self-monitoring. Provide general information on optimal nutrition, physical activity and sedentary time.

Arrange and Ask Again

Arrange referral to allied health services for women identified as at-risk. Ask women for follow-up appointment for weight monitoring.

Resource Library

Preconception BMI, and the amount and rate of weight gained during pregnancy influences pregnancy outcomes.[3]

Explain the purpose of assessing health behaviours, weight and weight gain during pregnancy and discuss sensitively and without judgement. With women’s consent, BMI should be calculated at their first antenatal visit and at every following visit and plotted on GWG charts.[1] This will allow for monitoring of healthy weight gain.

It is important that all conversations are approached sensitively and respectfully. Women living with higher body weights are vulnerable to weight stigma when accessing maternity services. Compassionate care, free from stigma is fundamental in encouraging positive relationships and continuity of maternity care.[4]

Resources below can assist you to discuss and assess healthy gestational weight gain:

Resource
Author
ASK
Ask: starting the conversation about weight
WA Shape
ASSESS GROWTH
Pregnancy weight gain chart for BMI <25
Qhealth/NEMO
Pregnancy weight gain chart for BMI >25
Qhealth/NEMO
Pregnancy weight gain chart for BMI <25 + multiple birth
Qhealth/NEMO
Pregnancy weight gain chart for BMI >25 + multiple birth
Qhealth/NEMO
ASSESS READINESS
ESSA Pre-exercise screening tool: physical activity during pregnancy
Exercise & Sports Science Australia (ESSA)
Physical Activity Stage of Change
Exercise is medicine Australia

Advise, assist, and empower women.

Provide women with appropriate advice on the benefits of a healthy diet and regular physical activity during pregnancy. Where behaviour changes are required, you can work with individuals to create SMART goals which are achievable and sustainable, and which are more likely to become habits.

Healthy eating:

The Healthy Eating during pregnancy resource outlines the amount of food and drinks adults are recommended to consume each day, along with tips and information.

Physical Activity

The guidelines for physical activity during pregnancy provides information on the amount and type of activity recommended during pregnancy.

Further resources below can be used to educate and advise women to adopt healthy behaviour changes that will help them work towards achieving their health goals:

Resource
Author
NUTRITION
Health and Wellbeing in Pregnancy
Healthify NZ
Healthy Eating During Pregnancy
NHMRC
Your Healthy Pregnancy - Nutrition Advice
DoH
Healthy eating for vegetarian or vegan pregnant and breastfeeding mothers
Qhealth: NEMO
Vegetables for pregnancy
Vegetables NZ
Iron for pregnant women
Qhealth: NEMO
Mater Mothers nine months of nutrition
Mater Mothers
PHYSICAL ACTIVITY
Exercising in pregnancy
DoH
Your Healthy Pregnancy - Physical Activity Advice
DoH
PREGNANCY WITH A HIGHER WEIGHT
Patient information: Pregnancy after bariatric surgery or with a weight above a healthy range
Qhealth
ALCOHOL
Patient information: Pregnancy after bariatric surgery or with a weight above a healthy range
Qhealth
The risks of alcohol and pregnancy
FARE
SMOKING
Quit smoking for baby
Stillbirth Centre for Research Excellence
ABORIGINAL AND TORRES STRAIT ISLANDER COMMUNITIES
Morning sickness and other pregnancy issues - Aboriginal and Torres Strait Islander
Qhealth
Healthy eating in pregnancy - Aboriginal and Torres Strait Islander
Qhealth
Strong Born - Alcohol and pregnancy
NACCHO

When supporting individuals with health behaviours and weight management, it is important to arrange follow-up appointments to continue to monitor progress and provide or coordinate required support. Antenatal interventions that support healthy gestational weight gain are effective and supported by strong evidence.[5]

Consider Referral:

Women with a BMI above or below a healthy weight range, or who are gaining weight during pregnancy at a rate above or below recommendations may benefit from referral for nutrition advice from an accredited practicing dietitian.[4] When making referrals, consider access to and costs of care and develop alternative care pathways for women who experience health inequalities as a result of social and cultural barriers.

Up-to-date information about the assessment and management of a range of conditions can be found on HealthPathways, find your local HealthPathways website here.

Programs and resources listed below may help facilitate health behaviour change for individuals, or provide additional support or management where appropriate:

Resource
Author
HEALTH BEHAVIOURS
RACGP Healthy Habits App
RACGP
RBWH - Living Well During Pregnancy
Metro North
PHYSICAL ACTIVITY
10,000 Steps
CQUniversity
Heart foundation walking
Heart Foundation
Exercise Professional (ESSA)
ESSA
MENTAL HEALTH
Queensland Perinatal Mental Health Support Services
Queensland Health
Health pathways
Queensland Government
Ready to COPE app
Centre of Perinatal Excellence - COPE
NUTRITION
Dietitian (Dietitians Australia)
Dietitians Australia

Health professionals are recommended to upskill in best-practice prevention, treatment, and management of individuals with overweight or obesity to continue to deliver care with empathy, confidence and success.

Further resources to upskill in prevention, treatment and management of overweight and obesity during pregnancy can be found below:

Resource
Format
Author
PREGNANCY
Healthy Pregnancy, Healthy Baby
eLearning
Metro North
Brief Interventions for a healthy lifestyle: Maternal health.
eLearning
Insight - Qhealth
5As of healthy pregnancy weight gain
PDF
Obesity Canada
Perinatal social and emotional wellbeing screening
PDF
Queensland Health
Healthy weight gain in pregnancy
eLearning
NSW health & HETI
Gestational Diabetes eLearning series
eLearning
Medcast
B.Strong in pregnancy and early life for First Nations Australians
eLearning
Insight - Qhealth
Supporting alcohol-free pregnancy and safe breastfeeding
eLearning
Foundation for Alcohol Research and Education
First 2000 Days Webinar Series
Webinar Series
NSW Health - Mid North Coast Local Health District
GENERAL
5As: Ask, assess, advise, assist and arrange
PDF
RACGP
5As of Obesity Management
Webpage
Obesity Canada
SCOPE E-learning for obesity
eLearning
World Obesity
Brief interventions for a healthy lifestyle
eLearning
Insight - Qhealth
Brief Interventions: Nutrition and Physical Activity
eLearning
Insight - Qhealth
Motivational Interviewing RACGP
Journal Article
RACGP
Motivational Interviewing
eLearning
Healthify NZ
Weight stigma and obesity
Video
Yale University
Shift: A guide for media and communications professionals
PDF
Government of Western Australia
EQUITY
Working with people with a disability
Metro South

Clinical guidelines which may assist clinicians supporting healthy weight management in pregnancy are included below:

Resource
Author
PREGNANCY
Clinical practice guidelines for pregnancy care
DoH
Qld Clinical Guidelines for Obesity and pregnancy (including post-bariatric surgery)
Qhealth
Flowchart: Obesity and Pregnancy (Including post bariatric surgery)
Qhealth
RANZCOG Mx of obesity in pregnancy
RANZCOG
Queensland Health Maternity and Neonatal Clinical Guidelines
Qhealth
Weight management before, during and after pregnancy
NICE - UK
PHYSICAL ACTIVITY
Physical activity guidelines for pregnancy
DoH
NUTRITION
Australian Dietary Guidelines
NHMRC
PREVENTION
Guidelines for preventive activities in general practice
RACGP
WEIGHT MANAGEMENT
Clinical Practice Guidelines for the management of overweight and obesity
DoH
WEIGHT INCLUSIVITY
Quick Guide: Safe, inclusive and accessible environments for people with obesity
The Obesity Collective

References

  1. Department of Health (2020) Clinical Practice Guidelines: Pregnancy Care.
    Canberra: Australian Government Department of Health. 
  2. Rath SR, Marsh JA, Newnham JP, Zhu K, Atkinson HC, Mountain J, et al. Parental pre‐pregnancy BMI is a dominant early‐life risk factor influencing BMI of offspring in adulthood. Obesity Science & Practice. 2016; 2:48-57 
  3. e Jersey S, Guthrie T, Tyler J, Yin Ling W, Powlesland H, Byrne B, et al. Evaluating the integration of a pregnancy weight gain chart into routine antenatal care. Maternal & Child Nutrition. 2018 
  4. Queensland Clinical Guidelines. Obesity and pregnancy (including post bariatric surgery). Guideline No. MN21.14-V6-R26. Queensland Health. 2021. Available from: http://www.health.qld.gov.au/qcg 
  5. (i-WIP), T. I. (2017). Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ, doi: https://doi.org/10.1136/bmj.j3119. 

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Last updated 4 January 2024