Issues for DebateWeight management across pregnancy and postpartum care: The need for interprofessional education and collaboration
Introduction
The prevalence of obesity has increased globally, with the greatest rate of increase being in women during their reproductive years (Global Burden of Disease 2015 Obesity Collaborators, 2017). Approximately 50% of women gain weight in excess of the Institute of Medicine's (2009) recommendations for weight gain during pregnancy (Goldstein et al., 2017), elevating their risk of postpartum weight retention and entering subsequent pregnancies in a higher weight category (Van der Pligt et al., 2013). Women themselves identify pregnancy and postpartum as critical periods when weight management became a concern for them (Olander et al., 2011).
The journey from pregnancy to caring for a new infant is a significant experience for many women, when they experience considerable changes in physical, social, and emotional health (Behringer et al., 2011). During this time, women generally have access to a range of health professionals, with seven to ten encounters with a midwife or obstetrician during pregnancy followed by additional encounters with a maternal and child health nurse (MCHN; also known as a child health nurse, family and child health nurse, health visitor) for postnatal support within 12 months postpartum. As the involvement of midwives and MCHNs is generally a constant element of care across pregnancy and postpartum, there is potential for these inextricably linked professions to collaborate and play a crucial role in supporting women with weight management (Kothe et al., 2018).
There is clear evidence that lifestyle interventions based on diet and physical activity promote weight management during pregnancy (Walker et al., 2018) and postpartum (Dodd et al., 2018). Internationally, clinical practice guidelines advocate for models of pregnancy care that support women to achieve a healthy weight (National Institute for Health and Care Excellence (NICE), 2010; Australian Government Department of Health, 2018). These guidelines differ regarding gestational weight-monitoring but all promote practitioner-led and women-centred conversations about healthy lifestyles. Midwives have reported barriers to the implementation of pregnancy care guidelines relating to gestational weight gain including limited time and inadequate training (Schmied et al., 2011). The role of MCHNs in supporting postpartum weight-loss remains unclear. These unresolved issues highlight the need for a coordinated approach by midwives and MCHNs so that women benefit from continuity in weight management support throughout pregnancy and postpartum. The aim of this Issues for Debate discussion is to describe two foundational elements to achieving this: i) education that develops midwives' and MCHNs’ professional identities within this important area and equips them to provide evidence-based support for weight management, and ii) interprofessional collaboration so that healthy lifestyle messages are reinforced consistently throughout pregnancy and postpartum.
Section snippets
Education that equips midwives and MCHNs to provide evidence-based support
Women report wanting consistent messages for weight management and healthy lifestyles across pregnancy and postpartum (Aquino et al., 2018). However, current midwifery curricula contains inadequate content related to the provision of weight management advice (Arrish et al., 2017). A recent qualitative study of Australian midwifery curricula found that student midwives are taught the importance of maternal weight management but receive minimal guidance on evidence-based behavioural change
Conclusion
Pregnancy and postpartum are crucial periods for obesity prevention in women. Weight management advice during pregnancy alone is often insufficient to elicit sustained change in health behaviours and women have asked for interprofessional collaboration between midwives and MCHN so healthy lifestyle support during pregnancy continues postpartum. Undergraduate and postgraduate curricula should equip midwives and MCHNs via interprofessional education and training that incorporates affective
Funding
None.
Declaration of competing interest
None.
Acknowledgement
Funding for this research has been provided from the Australian Government’s Medical Research Future Fund (MRFF). The MRFF provides funding to support health and medical research and innovation, with the objective of improving the health and wellbeing of Australians. MRFF funding has been provided to the Australian Prevention Partnership Centre under the MRFF Boosting Preventive Health Research Program. Further information on the MRFF is available at www.health.gov.au/mrff.
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