• pregnancy
• physical activity
• guidelines
• policy

There is compelling evidence that regular physical activity (PA) during pregnancy benefits both mother and baby.1 2 Notably, physical and psychological benefits are evident in the literature, such as marked reductions in the development of gestational diabetes and hypertensive disorders, alongside improvements in depressive symptoms and cardiorespiratory fitness.1 2 The evidence base has been reflected by recent policy initiatives, for example, in 2017 (relaunched in 2019), the UK‘s chief medical officers (CMOs) published PA guidelines for pregnant women, which made substantial strides in unifying and translating the evidence into recommendations.1 The CMO guidelines are aimed at supporting health professionals to provide consistent, evidence-based PA messages to women throughout pregnancy.1 Recently, the Chartered Institute for the Management of Sport and Physical Activity have updated their professional standards for working with antenatal and postnatal clients to align with these CMO guidelines.3 However, not all women have access to professionals with this level of expertise and training, potentially limiting the impact of the CMO guidelines.

Antenatal healthcare professionals, primarily midwives, are the key sources of information for pregnant women in the UK. Although the CMO guidelines are aimed at healthcare professionals, it is unlikely that the guidelines will be integrated into routine practice unless they are adopted by (or consistent with) the relevant National Institute for Health and Care Excellence (NICE) guidelines, because it is these that are routinely used to underpin practice.4

The most recent UK guidance on antenatal care for uncomplicated pregnancies (NICE Guideline CG62) was issued in March 2008 with a revision due for publication in December 2020.5 This impending update of NICE Guidelines provides an opportunity to increase clarity around the benefits of PA in pregnancy among health professionals and encourages consistent promotion of PA to women with uncomplicated pregnancies, although 3.5 years after publication of the CMO’s guidelines. Yet, NICE has announced that the scope of CG26 has been amended to remove the topic of PA and that this information is currently available in the guideline pertaining to weight management before, during and after pregnancy (NICE Guideline PH27).6 7 Fundamentally, the PA recommendations in PH27 do not currently align with the CMO guidelines nor do they reflect the most recent evidence which informed these. Hence, there is a real risk of pregnant women not receiving the evidence-based PA advice from their most trusted healthcare professionals.

Further, the decision to solely house the PA recommendations in a weight management guideline is limiting. Although PH27 does acknowledge that PA has benefits beyond weight management, it does not explicitly outline the specific benefits of PA for all women regardless of weight status, which are fully outlined in the CMO guidelines. The failure to outline all recognised benefits increases the risk of missed opportunities for offering tailored PA advice for non-weight related issues, especially as previous research has highlighted that healthcare professionals lack the confidence and knowledge to deliver PA advice during routine care.8

While recognition of CMO guidelines in NICE recommendations would provide a vital first step, change in practice only happens when there is training, time and resources provided to implement these.9 It is also important to recognise that antenatal healthcare professionals are not solely responsible for imparting these key evidence-based messages. To fully support PA behaviour during and beyond pregnancy, there is a need to have consistency and coordination between a range of professionals. This editorial calls for the UK to embrace a whole systems approach to establish the foundations from which to normalise engagement with PA from preconception throughout motherhood.

The challenge remains to integrate PA as part of the maternal care pathway and to break NICE’s ‘siloing’ of PA solely within weight management. We call for

• NICE Guidelines to be rapidly revised to reflect and directly link to the new CMO PA pregnancy and postpartum guidelines; we suggest that there is no need to do a full review of the PA evidence, but instead direct reference should be made to the CMO documents (as is the case with alcohol use during pregnancy5).

• A review by the Royal Colleges and key professional bodies (eg, Royal College of General Practitioners, Royal College of Midwives and Institute of Health Visitors) on how best to implement PA into pregnancy and postpartum care, that is, working with the new CMO PA Communications Committee tasked to support the dissemination of new CMO PA guidelines to health professionals.

• This work to feed into a coordinated dissemination plan to be agreed and put in place by stakeholders with the aim of raising awareness and facilitating dissemination of CMO PA guidelines.

With the recent release of the first CMO guidelines for PA for women after childbirth in September 201910, the translation and support of such evidence must remain a priority to enable and reassure women during all stages of motherhood. At present, this system’s failure to implement PA into routine care for pregnancy lets down not only new mothers but also the next generation.