Starting Conversations About Gestational Weight Gain: How Weight and Weight Gain Communication Is Initiated in the First Prenatal Visit [ID 2683652

Abstract

INTRODUCTION: The American College of Obstetricians and Gynecologists (ACOG) recommends that obstetric (OB) providers discuss appropriate weight gain and body mass index (BMI) with their patients at initial prenatal care visits. Few studies have examined how obstetric care providers initiate and discuss this topic. The aim of this study is to describe weight conversations during initial prenatal visits. METHODS: We analyzed data from an IRB-approved, larger prospective observational study. Patient–provider conversations at initial prenatal visits were audio-recorded with patient consent. Transcripts of 70 visits were coded for discussions of diet, exercise, and weight discussions, including who initiated weight conversations. RESULTS: Thirty-four out of 70 visits (49%) included weight discussions. Out of these 34 visits, the OB provider brought up weight 71% of the time. Providers gave weight recommendations by generally speaking about how much weight gain can be expected (55%). In 12% of the visits, providers specifically cited organizational guidelines. There were no visits during which providers mentioned patients' BMI. Patients expressed concern over their weight at 29% of the visits. Providers reassured patients during weight discussions in 32% of the visits. Providers made potentially judgmental comments about their patients’ bodies regarding weight on 9% of visits (eg, “if anything you are a little twig of a woman”). CONCLUSION: Although providers usually initiated weight discussions, these discussions occurred in only half of initial prenatal visits; this does not meet ACOG recommendations. Providers mostly reassured patients but occasionally expressed comments that could be interpreted as judgmental or stigmatizing. Communication strategies to invite patients’ weight/weight gain concerns may be helpful to improve these conversations.