Quality statement 8: Maternal health – weight management

Quality statement

Women with a body mass index (BMI) of 30 kg/m2 or more at the 6–8 week postnatal check are offered a referral for advice on healthy eating and physical activity.

Rationale

The woman's eating habits and physical activity levels could influence the health behaviour of the wider family, including children who are developing habits that may remain with them for life. Supporting the woman in the postnatal period to change her eating habits and physical activity levels may improve her health, her infant's health and the health of the wider family. It may also improve the outcomes of future pregnancies.

Women who are obese during pregnancy face increased risks of complications that include gestational diabetes, miscarriage, pre‑eclampsia, thromboembolism and maternal death. Risks for the infant include fetal death, stillbirth, shoulder dystocia, and macrosomia. Infants of obese women face health risks in childhood including diabetes and obesity in later life.

Quality measures

Structure

a) Evidence of local arrangements to ensure that women have their BMI assessed and recorded at the 6–8 week postnatal check.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check are offered a referral for advice on healthy eating and physical activity.

Data source: Local data collection.

c) Evidence of local arrangements to ensure that the local workforce has appropriate numbers of staff trained to deliver healthy eating and physical activity services to postnatal women.

Data source: Local data collection.

Process

a) The proportion of women who have their BMI recorded at the 6–8 week postnatal check.

Numerator – the number of women in the denominator who have their BMI recorded.

Denominator – the number of women who attend a 6–8 week postnatal check.

Data source: Local data collection.

b) The proportion of women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check who are offered a referral for advice on healthy eating and physical activity.

Numerator – the number of women in the denominator who are offered a referral for advice on healthy eating and physical activity.

Denominator – the number of women with a BMI of 30 kg/m2 or more who attend a 6–8 week postnatal check.

Data source: Local data collection.

c) The proportion of women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check who accept a referral for advice on healthy eating and physical activity.

Numerator – the number of women in the denominator who accept a referral for advice on healthy eating and physical activity.

Denominator – the number of women with a BMI of 30 kg/m2 or more who attend a 6–8 week postnatal check.

Data source: Local data collection.

Outcome

Women feel able to make informed decisions about healthy eating, physical activity and weight management for themselves and their family.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check to be offered a referral for advice on healthy eating and physical activity.

Healthcare practitioners offer women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check a referral for advice on healthy eating and physical activity.

Commissioners ensure that they commission services that offer women with a BMI of 30 kg/m2 or more at the 6–8 week postnatal check a referral for advice on healthy eating and physical activity.

Women who have a body mass index of 30 kg/m 2 or more at the 6–8 week postnatal check are offered a referral for advice on healthy eating and physical activity.

Source guidance

Definitions of terms used in this quality statement

Structured programme

Women should be offered a referral to an individual or group‑based service that uses a structured programme. Services should deliver a structured programme that:

  • addresses the reasons why women may find it difficult to lose weight, particularly after pregnancy

  • is tailored to the needs of an individual or group

  • combines advice on healthy eating and physical exercise (advising them to take a brisk walk or other moderate exercise for at least 30 minutes on at least 5 days of the week)

  • identifies and addresses individual barriers to change

  • provides ongoing support over a sufficient period of time to allow for sustained lifestyle changes.

Services should be delivered by an appropriately trained person. This is someone who can demonstrate expertise and competencies in healthy eating and/or physical activity, including weight management for women in the postnatal period. This may include midwives, health visitors, obstetricians, dietitians, GPs, nurses, midwifery assistants, support workers and those working in weight management programmes (commercial or voluntary).

Women who choose not to accept a referral should be given information about where they can get support on healthy eating and physical activity in future.

[Adapted with expert group consensus from NICE's guidelines on weight management before, during and after pregnancy, recommendations 3 and 4, and maternal and child nutrition, recommendation 6]

Equality and diversity considerations

Women should be able to access services that are appropriate to their cultural and religious beliefs, and that make relevant adjustments for anyone who has communication difficulties, and for those who don't speak or read English.