Provider Advice on Weight Gain, Physical Activity, and Healthy Eating in Twin Pregnancies

Abstract

PURPOSE: To examine provider advice on gestational weight gain (GWG), physical activity (PA), and healthy eating (HE) during twin pregnancies, and to determine if advice on GWG is associated with women’s GWG. METHODS: Data are from 301 women, aged 21-43 years, who delivered twins in the prior 24 months and completed an online survey in 2018. The 2009 Institute of Medicine (IOM) provisional weight gain guidelines for twin pregnancies defined whether provider advice on GWG and women’s GWG were below, within, or above guidelines. Content analysis described provider advice on PA and HE. Multinomial logistic regression examined the associations of provider advice on GWG with women’s GWG, after adjustment for potential confounders. RESULTS: Approximately 66% of women reported provider advice on GWG, 73% on PA, and 59% on HE during their twin pregnancy. Of those who reported GWG advice, 30% described advice below, 60% within, and 10% above the IOM guidelines. Women who were not on bedrest (15%) reported recommendations to engage in light- or moderate-intensity activities like walking or swimming, but cautioned to avoid overexertion. Advice on HE included recommendations to increase consumption of protein, fruits, vegetables and vitamins/minerals, with emphasis on increasing caloric intake. As seen in Table 1, compared to women who reported GWG advice within IOM guidelines, women who reported advice below guidelines or who reported no advice were 7.23 and 2.76 times more likely to gain less than recommended, respectively. Women who reported provider advice above guidelines were 5.05 times more likely to exceed guidelines (all p<0.05). CONCLUSION: Forty percent of women reported GWG advice outside IOM guidelines, and inaccurate or no advice was strongly associated with inadequate or excessive GWG. There is a clear need for intervention strategies to educate providers about IOM guidelines, including how to counsel women on GWG, PA, and HE to optimize outcomes in twin pregnancies.Table 1: Association Between Provider Advice on Gestational Weight Gain (GWG) and Compliance with the Institute of Medicine (IOM) Guidelines*