• This chapter addresses the management of weight related to three phases of a woman’s reproductive years
  – preconception, during pregnancy and postpartum
  – for adult women living with obesity. Although these reproductive periods are addressed separately, it is important to consider that these phases represent the continuum of weight management over the reproductive years in women living with obesity.
• During these time periods, women frequently access the healthcare system, thus providing clinicians with opportunities to support women in health-promoting behaviours and chronic disease prevention and management strategies that may have positive impacts on the short- and long-term health of both the woman and her children.
• Weight bias and stigma can impact access and quality of healthcare services as well as health outcomes for individuals living with obesity and should be addressed. Individuals living with obesity should be supported in a non-stigmatising manner to manage obesity-related health outcomes by continuing disease-management strategies that are safe and evidence based, and that increase the likelihood of achieving pregnancy-related weight gain targets.
• The obstetric and medical management for women living with obesity during pregnancy is beyond the scope of this clinical practice guideline.

These recommendations pertain to the management of weight over the reproductive years for adult women living with obesity (i.e., body mass index (BMI) ≥ 30 kg/m²) with a singleton pregnancy, who are ≥ 18 years of age and do not have pre-existing diabetes or gestational diabetes.

1. General advice: We recommend healthcare professionals (HCPs) discuss weight-management targets specific to the reproductive years with adult women living with obesity: preconception weight loss (Level 3, Grade C)^1-4, gestational weight gain (GWG) of 5 kg – 9 kg over the entire pregnancy (Level 4, Grade D^5,6; postpartum weight loss of – at minimum – GWG (Level 3, Grade C)^7,8 to reduce the risk of adverse outcomes in the current or in a future pregnancy.
2. Combined behavioural-support interventions: HCPs should offer behavioural support interventions, including both nutrition and physical activity, to adult women living with obesity who are considering a pregnancy (Level 3, Grade C)^8,9, who are pregnant (Level 2a, Grade B)^10-16 and who are postpartum (Level 1a, Grade A)¹⁷ to increase the likelihood of achieving weight targets.
3. Nutrition counselling alone: We recommend HCPs encourage and support pregnant women living with obesity to consume foods consistent with a healthy dietary pattern in order to meet their target GWG (Level 3, Grade C)¹⁸.
4. Physical activity counselling alone: We recommend HCPs encourage and support pregnant women living 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 GWG (Level 3, Grade C)^19-22.
5. Pharmacotherapy: HCPs should not prescribe metformin for managing GWG in women living with obesity (Level 1b, Grade A)^23-25. We suggest no weight-management medications during pregnancy or breastfeeding (Level 4, Grade D)²⁶.
6. Breastfeeding: We recommend women living with obesity be offered additional breastfeeding support due to decreased rates of initiation and continuation (Level 3, Grade C)²⁷.

• The reproductive years, including before, during and after pregnancy, bring many additional challenges for women living with obesity. Since obesity is a chronic disease, it is important for women living with obesity to seek advice and support from their healthcare professionals on strategies to optimise their obesity-related health outcomes over both the short and long term.
• When planning and entering pregnancy, aim to be at your best weight and optimal health.
• During pregnancy aim for weight-gain targets (5 kg – 9 kg) to reduce the risk of obesity-related health complications and poorer health outcomes. Seek support in aiming to return to pre-pregnancy weight and health in the year after delivery.