Weight Gain and Nutrition during Pregnancy

Key points

• A systematic search of grey literature from 38 Asia-Pacific countries identified 10 clinical practice guidelines (CPGs) on gestational weight gain and/or maternal nutrition.
• Of the 10 guidelines, 90% were classified as low quality with AGREE II; only the Australian guideline was rated high quality and recommended without modification.
• Most of the nine guidelines with weight gain recommendations used US Institute of Medicine (IOM) values, while Japan and Vietnam gave unique recommendations.
• All nine guidelines covering supplementation recommended 400-800 µg of folic acid per day for all pregnant women; advice on iron and calcium was inconsistent.
• Recommendations on additional energy intake varied between guidelines and trimesters.

Overview

This systematic review assessed the quality of clinical practice guidelines on weight gain and nutrition in pregnancy across the Asia-Pacific region and the variability of their recommendations. The guidelines were generally of poor quality with significant variation, and the authors conclude that they need to be improved so that pregnant women receive appropriate advice.

Methods

The search covered 11 South-East Asian and 27 Western Pacific WHO member countries through government websites, direct inquiries to government agencies and manual searches. Of 23 documents obtained, 10 CPGs were included: from Sri Lanka, Myanmar, Australia, China, Japan, New Zealand (two), the Philippines, Vietnam and the Pacific Community. Two authors appraised each guideline with AGREE II across six domains; a guideline was rated high quality if all domains scored 70% or more and low quality if any domain scored below 50%. The protocol was registered with PROSPERO (CRD42021291395).

Guideline quality

Scope and purpose, stakeholder involvement and clarity of presentation scored higher, while rigour of development, applicability and editorial independence scored lower; editorial independence was 0% in five guidelines. The Australian guideline rated above 90% in all six domains, with an overall quality rating of 100%. The Japanese and both New Zealand guidelines were recommended with modifications, and the guidelines from Sri Lanka, China and the Philippines received the lowest overall rating of 25%.

Weight gain and nutrition recommendations

Nine guidelines gave weight gain targets by pre-pregnancy BMI; six were linked to evidence, all based on IOM recommendations from 2009 or 1990. The Australian guideline added BMI cut-offs for women of Asian background. Japan recommended 9-12 kg for BMI below 18.5 kg/m2, 7-12 kg for 18.5-25 kg/m2 and an individualised approach above 25 kg/m2; Vietnam expressed targets as a percentage of pre-pregnancy weight outside the normal BMI range. Additional energy intake ranged from 0-50 kcal/day in the first, 250-340 kcal/day in the second and 300-450 kcal/day in the third trimester, or 300-360 kcal/day as a single value. Seven guidelines recommended iron for all pregnant women, and calcium was recommended for all in two and under specific conditions in three.

Frequently asked questions

Which guideline performed best?

The Australian Clinical Practice Guidelines: Pregnancy Care 2020 Edition, the only one unanimously recommended for use without modification.

Why do BMI cut-offs for Asian women matter?

The IOM 2009 recommendation was designed for white, Hispanic and black populations in the United States; the body composition of Asians differs, and emerging evidence suggests population-specific cut-offs are more appropriate for some Asian populations.

What are the main limitations?

The search covered only some languages (English, Chinese, Korean, Japanese and Indonesian), so guidelines in other languages may have been missed.

Source

Aoyama T, Li D, Bay JL. Weight Gain and Nutrition during Pregnancy: An Analysis of Clinical Practice Guidelines in the Asia-Pacific Region. Nutrients 2022;14(6):1288. doi:10.3390/nu14061288. Open access. Summary prepared by Medpresso from the original publication; it is not a substitute for the full text or for medical advice.