Page 62 - Retail Pharmacy Magazine October 2020

60 CPD ACTIVITY FROM PAGE 59 women to consume a balanced diet with adequate nutrient intake to support reduction of post-pregnancy weight retention. Women should not be encouraged to modify or supplement their diet with the aim of reducing the infant’s risk of later overweight or obesity. Pharmacists should refer new mothers who require assistance or support with positioning and latching to either a credentialled lactation consultant or the Australian Breastfeeding Association Helpline (1800 mum2mum / 1800 686 268) where trained counsellors are available to provide advice 24 hours a day, seven days a week. Interpregnancy care The period between pregnancies can be used to optimise maternal health. Pregnancy-induced hypertensive disorders, GDM, intrauterine growth restriction and preterm delivery are indicators of underlying maternal cardiovascular risk and should raise concern for development of worsening health status with future pregnancies.35 The pregnancy and the postpartum period provides a unique opportunity to discuss these risks. Informing women of the lifelong implications of pregnancy complications associated with obesity is an initiative that should be undertaken by all healthcare providers caring for women of reproductive age.38 Women with a BMI of ≥40 kg/m2 who fail recommended postpartum weight loss strategies may seek advice about bariatric surgery as an option. Several systematic reviews have compared the effects of bariatric surgery with control on both maternal and infant health outcomes. Where BMI-matched controls without surgery were compared with bariatric surgery before pregnancy, the reviews found generally positive outcomes for the bariatric intervention group. Benefits of prepregnancy bariatric surgery included reduced rates of: 39,40 • GDM. • Large-for-gestational-age infants. • Postpartum haemorrhage. • Caesarean delivery. However, groups of patients showed an increase in small-for-gestational- age infants, intrauterine growth restriction and preterm deliveries. There were no differences in rates of pre- eclampsia, neonatal intensive care unit admissions, stillbirths, malformations, and neonatal death. 39,40 While the optimal conception gap remains unclear, the American Academy of Obstetricians and Gynecologists recommends that women should avoid conceiving within 18 months of bariatric surgery, to avoid pregnancy at a time of rapid weight loss.41 Obese women are at risk of nutritional deficiencies, including folic acid, iron, vitamin B12, vitamin D, and calcium. This risk will escalate after bariatric surgery, with expert dietitian guidance for supplementation requirements necessary in this setting.42 Therefore, there are many opportunities for upskilled pharmacists to provide evidence-based, weight-related counselling to improve preconception, antenatal, postnatal and interpregnancy care. References 1. Goldstein RF, Abell SK, Ranasinha S et al. ‘Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta- analysis’. JAMA, 2017; 317: 2207–25. 2. Farpour-Lambert N, Ells LJ, Martinez de Tejada B, Scott C. ‘Obesity and weight gain in pregnancy and postpartum: An evidence review of lifestyle interventions to inform maternal and child health policies’. Front Endocrinol, 2018; 9: 546. 3. Linnér A, Almgren M. ‘Epigenetic programming: The important first 1000 days’. Acta Paediatrica, 2019; 109: 443-52. 4. Schwarzenberg SJ, Georgieff MK, AAP Committee on Nutrition. ‘Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health’. Pediatrics, 2018; 141: e20173716. 5. Rasmussen KM, Yaktine AL. Institute of Medicine and National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press, 2009. Available at: ncbi.nlm.nih.gov/books/NBK32802/ 6. Gandhi, M. ‘Why pregnancy weight gain guidelines need to differ for multiple versus single pregnancies’. Curr Nutr Rep, 2020; 9: 101-6. 7. Chu SY, Callaghan WM, Bish CL et al. ‘Gestational weight gain by body mass index among US women delivering live births, 2004–2005: Fuelling future obesity’. Am J Obstet Gynecol, 2009; 200: 271. 8. Catalano PM, Huston L, Amini SB et al. ‘Longitudinal changes in glucose metabolism in obese women with normal glucose tolerance and gestational diabetes’. Am J Obstet Gynecol, 1999; 180: 903–16. 9. Institute of Medicine (US) Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy: Part I Weight gain: Part II Nutrient supplements. Washington (DC): National Academies Press (US) 1990; 5. 10.Ma RCW, Schmidt MI, Tam WH, McIntyre HD, Catalano PM. ‘Clinical management of pregnancy in the obese mother: Before conception, during pregnancy, and postpartum’. Lancet Diabetes Endocrinol, 2016; 4: 1037–49. 11. National Health and Medical Research Council. The Australian dietary guidelines. Canberra: NHMRC, 2013. Available at nhmrc.gov.au/about-us/ publications/australian-dietary-guidelines \\\\\\\\\\\\\\\[Accessed 24/7/20\\\\\\\\\\\\\\\]. 12.Stothard KJ, Tennant PW, Bell R et al. ‘Maternal overweight and obesity and the risk of congenital anomalies: A systematic review and meta-analysis’. JAMA, 2009; 301: 636–50. 13. Catalano PM, Mele L, Landon MB et al. ‘Inadequate weight gain in overweight and obese pregnant women: What is the effect on foetal growth?’ Am J Obstet Gynecol, 2014; 211: 137. 14. McCuen-Wurst C, Elizabeth Culnan E, Stewar NL, Allison KC. ‘Weight and eating concerns in women’s reproductive health’. Curr Psychiatry Rep, 2017; 19:68: 1-10. 15.Skouteris H, Carr R, Wertheim EH et al. ‘A prospective study of factors that lead to body dissatisfaction during pregnancy’. Body Image, 2005; 2: 347–61. 16.Silveira ML, Ertel KA, Dole N et al.’ The role of body image in prenatal and postpartum depression: A critical review of the literature’. Arch Womens Ment Health, 2015; 18: 409–21. 17. Mater Health and Wellness. The Mater Personalised Pregnancy Weight Tracker: An evidence-based resource that takes the guesswork out of healthy pregnancy weight gain. South Brisbane, Qld: Mater Health and Wellness, 2016. Available at wellness.mater.org.au/Our-Services/ Nutrition-and-Dietetics/Outpatients/The-Mater- Personalised-Pregnancy-Weight-Tracker-%C2%A9 \\\\\\\\\\\\\\\[Accessed 26/7/20\\\\\\\\\\\\\\\]. RETAIL PHARMACY • OCT 2020