A regional Victorian health service is using dietetic intervention to combat obesity in pregnancy and excessive gestational weight gain.

With maternal obesity linked to an increased risk of birth complications, from gestational diabetes to macrosomia, caesarean section and diabetes in later life, West Gippsland Healthcare Group introduced the Positive Pregnancy Program (PPP) in 2010, as a cost-effective approach to optimising gestational weight gain.

A review of the program, featuring data analysis from 174 participants, reveals a major decline in participants’ gestational weight gain (3.6kg on average) compared to previous pregnancies (14kg on average).

Women who attended three or more appointments with a dietitian gained significantly less weight than those who attended just the initial dietetic assessment.

Rates of caesarean delivery among participants were less than those of obese Australian women in other studies (30.5 per cent compared to 48.7 per cent). The group’s rate was also equal to the general Australian population (at 30.9 per cent).

Obesity in pregnancy and excessive gestational weight gain not only poses health risks for mothers and their babies, it’s also an issue for hospitals, particularly for regional health services with weight restrictions.

Accredited Practising Dietitian (APD) Nicole Robertson, a senior dietitian at Warragul’s West Gippsland Healthcare who presented research on the initiative at the Dietitians Association of Australia’s (DAA) National Conference this year, says pregnant women accessing the regional health service who exceed a Body Mass Index (BMI) of more than 50 are required to be transferred to a metropolitan hospital for their labour and birth.

Ms Robertson says the health service’s PPP initiative refers women with a pre-pregnancy BMI of 35kg/m2 and over for individual assessment and counselling with a dietitian, followed with ongoing reviews every four to six weeks.

The dietary education provided is based on the Australian Guide to Healthy Eating. It focuses on promoting nutritional adequacy in pregnancy and gestational weight gain in line with the current guidelines.

Gestational weight gain targets follow Institute of Medicine (IOM) guidelines, which recommend a target of five to nine kilograms for obese women with a BMI of 30kg/m2.

Women with a BMI of 40kg/m2 are encouraged to maintain their weight or lose up to 4kg, in line with individual obstetric recommendations and previous guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Ms Robertson says dietetic intervention for pregnant women provides a common-sense approach to healthy eating, highlighting the importance of adequate nutrition during pregnancy.

“A lot of the participants were actually losing weight because their diets were so awful to begin with - some women were drinking two litres of soft drink a day and having take-away for at least one meal a day,” she says.

“If you pull out that take-away and swap it with a meat and vegetables meal, and pull out the soft drink and swap it for water, that’s a massive calorie deficit, and so you would kind of expect that they would lose weight.”

Despite 75 participants experiencing gestational weight gain below IOM recommendations, including those who lost weight during their pregnancy, the number of babies with a low birth weight in the study group was well below that of population data (1.7 per cent for the study group compared to 6.1 per cent).

Importantly, Ms Robertson says the study shows dietetic intervention can reduce the weight gain of obese pregnant women, and improve the outcomes for mothers and their babies.

“We think that having regular check-ins with the dietitian that there’s a bit of accountability - you’ve got to come back and get weighed again and see how things are going,” she says.

“It also gives us the opportunity, after the first appointment when we made those plans, to ask them how it went and see if there’s an opportunity to fine tune the advice.

“Having individual appointments also means better results because you can deal with the real specific issues to that woman.

“Obesity is really complex, there’s lots of different reasons why people are obese in the first place, and why they eat the way they do - a group really just can’t meet that need.”

Ms Robertson says the PPP has been such a success it’s become the normal approach at the health service, with ongoing dietary support also offered to women after their babies arrive.

“Certainly we’ve had some take up that offer and we’ve also had some doctors tell us that their patients who participated in PPP have lost so much weight that they don’t need to return for their next pregnancy.

“The advice that we’re giving is not radical or experimental, the advice is basic healthy eating and that means that it’s sustainable and women can keep doing it even when they’re not getting the ongoing support.”

Ms Robertson says while dietitians are providing a short-term intervention, there’s strong potential for long-term impact.

“Some of the husbands come and tell me they’ve lost weight as well - because when the mum changes, everyone does the same thing,” she says.

“That’s what’s really rewarding, is that even though you’re working with one pregnant woman, the impact then for her baby and her family…you can have a really far reach with one patient contact.”