Abstract
BackgroundIn 2009 the Institute of Medicine updated its guidelines for weight gain during pregnancy, in part because women of childbearing age now weigh more pre-pregnancy and tend to gain more weight during pregnancy than women did when the previous set of guidelines were released in 1990. Women who begin pregnancy overweight or obese and women who gain weight outside IOM recommendations are at risk for poor maternal and fetal health outcomes. With these concerns in mind, we examined what obstetricians communicate about gestational weight gain to their pregnant patients and how nulliparous patients perceive weight-related counseling from their obstetricians.MethodsWe conducted one-on-one, semi-structured interviews with 19 nulliparous women and 7 obstetricians recruited from a single clinic at a large academic medical center in the United States. Interviews were transcribed verbatim and analyzed inductively using thematic analysis.ResultsWe identified 4 major themes: 1) Discussions about the amount and pace of gestational weight gain: obstetricians reported variation in the frequency and timing of weight-related discussions with patients while most patients said that weight was not emphasized by their obstetricians; 2) The content of communication about nutrition and physical activity: obstetricians said they discuss nutrition and activity with all patients while most patients reported that their obstetrician either discussed these topics in general terms or not at all; 3) Communication about postpartum weight loss: obstetricians said that they do not typically address postpartum weight loss with patients during prenatal visits while patients had concerns about postpartum weight; and 4) Patient feelings about obstetrician advice: most patients said that their obstetrician does not tend to offer “unsolicited advice”, instead offering information in response to patient questions or concerns. Women were divided about whether they desired more advice from their obstetrician on weight gain, nutrition, and activity.ConclusionsOur analysis revealed discrepancies between obstetricians’ and patients’ perceptions of their weight-related clinical interactions. Our findings suggest that there is a missed opportunity to use prenatal visits as opportunities to discuss healthy eating and exercise during pregnancy, the postpartum period, and beyond. Additional research on the design, implementation, and testing of interventions to address prenatal nutrition and physical activity is warranted.
Highlights
In 2009 the Institute of Medicine updated its guidelines for weight gain during pregnancy, in part because women of childbearing age weigh more pre-pregnancy and tend to gain more weight during pregnancy than women did when the previous set of guidelines were released in 1990
We describe the perspectives of pregnant women and their obstetricians regarding their discussions about Gestational weight-gain (GWG) during routine prenatal clinic visits
We address two aims: (1) to describe what obstetricians communicate about GWG to their patients, as well as what they communicate to their patients about weight loss in the postpartum period; (2) to describe the experiences women have communicating with their obstetricians about GWG
Summary
Women who begin pregnancy overweight or obese and women who gain weight outside IOM recommendations are at risk for poor maternal and fetal health outcomes. With these concerns in mind, we examined what obstetricians communicate about gestational weight gain to their pregnant patients and how nulliparous patients perceive weight-related counseling from their obstetricians. Gestational weight-gain (GWG) warrants attention because both inadequate and excessive weight gain are associated with negative birth outcomes [5,6]. Women who gain weight outside of the recommendations are at risk for gestational diabetes [7], hypertension [8], pre-eclampsia [9], labor and delivery complications [5] including need for cesarean section [10], and postpartum weight retention [5,9]. Inadequate and excessive GWG are associated with small-for-gestational age and large-for-gestational age infants, respectively [11,12], hypoglycemia in infants [13], and infant mortality [5,14]
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