Weight management over the reproductive years for adult women living with obesity
DOI:
https://doi.org/10.7196/SAMJ.2025.v115i9b.3682Keywords:
Reproductive years, Women, Obesity, Guideline, South AfricaAbstract
RECOMMENDATIONS
These recommendations pertain to the management of weight over the reproductive years for adult women living with obesity (i.e. body mass index ≥30 kg/m2) with a singleton pregnancy, who are ≥18 years of age and do not have pre-existing diabetes or gestational diabetes.
General advice. We recommend that healthcare providers (HCPs) should discuss weight management targets specific to the reproductive years with adult women living with obesity: pre-conception weight loss (Level 3, Grade C); gestational weight gain of 5 - 9 kg over the entire pregnancy (Level 4, Grade D); and postpartum weight loss of – at minimum – gestational weight gain (Level 3, Grade C), to reduce the risk of adverse outcomes in the current or a future pregnancy.
Combined behaviour change interventions. HCPs should offer behaviour change interventions, including both nutrition and physical activity, to adult women living 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),[16] in order to achieve weight targets.
Nutrition counselling alone. We recommend that HCPs 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).
Physical activity counselling alone. We recommend that HCPs 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).
Pharmacotherapy. HCPs 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).
Breastfeeding. We recommend that women with obesity be offered additional breastfeeding support owing to decreased rates of initiation and continuation (Level 3, Grade C).
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