Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BMC Pregnancy Childbirth. 2023 Mar 11;23(1):164. doi: 10.1186/s12884-023-05343-9.
Women who enter pregnancy with a Body Mass Index above 30 kg/m face an increased risk of complications during pregnancy and birth. National and local practice recommendations in the UK exist to guide healthcare professionals in supporting women to manage their weight. Despite this, women report inconsistent and confusing advice and healthcare professionals report a lack of confidence and skill in providing evidence-based guidance. A qualitative evidence synthesis was conducted to examine how local clinical guidelines interpret national recommendations to deliver weight management care to people who are pregnant or in the postnatal period.
A qualitative evidence synthesis of local NHS clinical practice guidelines in England was conducted. National Institute for Health and Care Excellence and Royal College of Obstetricians and Gynaecologists guidelines for weight management during pregnancy constructed the framework used for thematic synthesis. Data was interpreted within the embedded discourse of risk and the synthesis was informed by the Birth Territory Theory of Fahy and Parrat.
A representative sample of twenty-eight NHS Trusts provided guidelines that included weight management care recommendations. Local recommendations were largely reflective of national guidance. Consistent recommendations included obtaining a weight at booking and informing women of the risks associated with being obese during pregnancy. There was variation in the adoption of routine weighing practices and referral pathways were ambiguous. Three interpretive themes were constructed, exposing a disconnect between the risk dominated discourse evident in the local guidelines and the individualised, partnership approach emphasised in national level maternity policy.
Local NHS weight management guidelines are rooted in a medical model rather than the model advocated in national maternity policy that promotes a partnership approach to care. This synthesis exposes the challenges faced by healthcare professionals and the experiences of pregnant women who are in receipt of weight management care. Future research should target the tools utilised by maternity care providers to achieve weight management care that harnesses a partnership approach empowering pregnant and postnatal people in their journey through motherhood.
体重指数（BMI）超过 30kg/m² 的女性在妊娠和分娩期间面临更高的并发症风险。英国存在国家和地方实践建议，以指导医疗保健专业人员支持女性管理体重。尽管如此，女性报告称她们得到的建议不一致且令人困惑，医疗保健专业人员报告称他们缺乏提供循证指导的信心和技能。进行了一项定性证据综合研究，以检查当地临床指南如何解释国家建议，为妊娠或产后期间的人员提供体重管理护理。
对英格兰 NHS 临床实践指南进行了定性证据综合研究。国家卫生与保健卓越研究所和皇家妇产科医师学院的妊娠期间体重管理指南为主题综合提供了框架。数据在风险的嵌入式话语中进行解释，综合研究受到 Fahy 和 Parratt 的分娩地域理论的启发。
有代表性的 28 家 NHS 信托基金提供了包含体重管理护理建议的指南。当地建议在很大程度上反映了国家指导。一致的建议包括在预约时测量体重，并告知女性肥胖与妊娠相关的风险。常规称重做法的采用存在差异，转诊途径不明确。构建了三个解释性主题，揭示了当地指南中明显存在的风险主导话语与国家产妇政策中强调的个体化、伙伴关系方法之间的脱节。
NHS 的当地体重管理指南根植于医学模式，而不是国家产妇政策所倡导的促进以伙伴关系为基础的护理模式。这项综合研究揭示了医疗保健专业人员面临的挑战，以及接受体重管理护理的孕妇的经历。未来的研究应该针对产妇保健提供者使用的工具，以实现利用伙伴关系方法为怀孕和产后人员赋权的体重管理护理，使她们在母亲身份的旅途中受益。
