Despite 2009 guidelines, few women report being counseled correctly about weight gain during pregnancy




Objective


The purpose of this study was to determine the information that pregnant women report receiving when being counseled about weight gain and the risks of inappropriate gain.


Study Design


With the use of a self-administered questionnaire at prenatal clinics in Hamilton, Ontario, Canada, a cross-sectional survey was conducted of women who had had at least 1 prenatal visit, who could read English, and who had a live singleton gestation.


Results


Three hundred ten women completed the survey, which was a 93.6% response rate. Although 28.5% (95% confidence interval, 23.5–33.6%) reported that their health care provider had made a recommendation about how much weight they should gain, only 12.0% (95% confidence interval, 8–16.1%) of the women reported having achieved the recommended weight gain in accordance with the 2009 guidelines. One quarter of the women reported being told that there were risks with inappropriate gain.


Conclusion


Despite the recent 2009 publication of the gestational weight gain guidelines, only 12% of women reported being counseled correctly, which suggests an urgent need for improved patient education.


Women of childbearing age are particularly vulnerable for becoming obese, in part because of excess weight gain during pregnancy. High gestational weight gain is associated with a 2- to 3-fold increased risk of becoming overweight after delivery and, along with failure to lose weight after delivery, is an important predictor of obesity in midlife.




For Editors’ Commentary, see Table of Contents



In 2009, the Institute of Medicine released new gestational weight gain recommendations, which were adopted by several other countries, including Canada, that advised that underweight women (body mass index [BMI], <18.5 kg/m 2 ) gain 12.5-18 kg (28-40 lbs), normal weight women (BMI, 18.5-24.9 kg/m 2 ) gain 11.5-16 kg (25-35 lbs), overweight women (BMI, 25-29.9 kg/m 2 ) gain 7-11.5 kg (15-25 lbs), and obese women (BMI, ≥30 kg/m 2 ) gain 5-9 kg (11-20 lbs).


Despite the current guidelines and their 1990 predecessor, only 30 -40% of pregnant women gain the appropriate amount of weight during pregnancy. More than one-half of women exceed the recommendations, which significantly increases the risks to their health both during pregnancy (gestational diabetes mellitus, hypertension, delivery complications such as cesarean section and operative vaginal delivery ), and longer term (overweight and obesity ). Excess gestational weight gain increases risks for infants of macrosomia, birth trauma, and childhood overweight. Conversely, inadequate gestational weight gain increases infant risks of low birthweight and prematurity.


Despite the well-documented adverse maternal, infant, and childhood outcomes that accompany both excess and inadequate gestational weight gain, data are lacking on the extent to which women are counseled about the risks of inappropriate weight gain during pregnancy, and there are no data on the proportion of women who have been counseled about gestational weight gain since the new guidelines were released. We sought to address the current paucity of information through a survey of pregnant women to determine what they understand about the counseling from their health care provider about weight gain during pregnancy and the risks of inappropriate weight gain.


Materials and Methods


We conducted a cross-sectional survey using a piloted, self-administered questionnaire.


Study population


The study population included pregnant women who were attending prenatal care provided by obstetricians, midwives, nurse practitioners, and family physicians in Hamilton, Ontario, Canada, from representative clinics in obstetrics (4), family medicine (3), and midwifery (2).


Women were eligible to participate if they had had at least 1 prenatal visit, could read English sufficiently well to complete the survey, and had a live singleton gestation.


Women were ineligible for the study if they had experienced a fetal death by the time of survey completion or were pregnant with >1 fetus.


Recruitment


Pregnant patients were invited to participate in the study by clinic staff and prenatal care providers. Posters that informed patients about the study were displayed at clinics. Blank surveys were provided to each participating clinic, along with clipboards, pens, and drop boxes for completed surveys.


This study was approved by the Hamilton Health Sciences/McMaster University Faculty of Health Sciences Research Ethics Board before study commencement (#10-214). As per the introductory paragraph on the first page of the survey, consent to participate was demonstrated through survey completion; no identifying information was collected.


Outcomes


Our primary outcomes were the proportion of women who reported being counseled at all and the proportion of women who were counseled appropriately according to the guidelines about how much weight to gain. We assessed this by asking, “Has your doctor, midwife, or nurse made a recommendation about how much weight you should gain during pregnancy (total amount of weight)?” Respondents could check “No,” “Yes” (in which case they were asked “How much?”), or “I can’t remember.” We chose to assess patient recall of the counseling rather than what the health care providers reported, because it is ultimately the patient’s own recall that will direct her weight gain. We calculated the respondent’s prepregnancy BMI from the self-reported prepregnancy weight and height and determined whether the recommendation was within the guidelines. Secondary outcomes included reported counseling about the risks of inappropriate gain, the women’s perceptions of the risks of inappropriate gain, plans for weight gain during pregnancy, and knowledge of weight-related lifestyle issues that included nutrition and exercise. For all questions that involved height or weight, patients were given the choice of responding in imperial or metric units.


Statistical analysis


We performed duplicate data entry using Access Database software (Microsoft Corporation, Redmond, WA), then checked and corrected any inconsistencies, and analyzed the data using PASW Statistics 18 (SPSS Inc, Chicago, IL). Descriptive statistics were performed to characterize the respondents (eg, maternal age, parity). Characteristics of women who were and were not counseled appropriately about gestational weight gain were compared with the use of a t test for continuous data and χ 2 test for proportions. With having been appropriately counseled as to the outcome or dependent variable, logistic regression analysis was planned to control for potentially confounding variables, such as maternal age and parity.


Sample size was set to estimate the proportion of women who reported correct counseling to within ±6%. For a given proportion (p) and sample size (n), the 95% CI around the proportion will be a probability of ±1.96 square root (p [1 – p]/n). We were unsure as to the proportion of women who would be counseled correctly but noted that precision is always the worst (ie, CIs the widest) when the probability value is .5. Thus, 266 valid responses would allow us to estimate proportions to the required precision. Allowing for 15% of respondents missing data, a total of 310 women were needed to achieve the desired precision.




Results


Three hundred ten women completed the survey between June and October 2010, which was a 93.6% response rate (of 331 eligible women who were approached by the clinic staff). The characteristics of the study sample are shown in Table 1 . The mean age of the respondents was 29.5 ± 5.7 years; they completed the survey at a median gestational age of 33 weeks (interquartile range, 26.4–36.7 weeks’ gestation). Most women were white (73.9%), and had some amount of postsecondary education (76.8%). Approximately one-third of women reported a household income of $20,000-$80,000; another one-third reported an income of >$80 000. Most of the women were either married (65.5%) or in a common-law relationship (17.1%). It was the first time giving birth for 42.6% of women; 34.5% of the women had given birth once before. The mean prepregnancy BMI of respondents was 25.1 ± 6.7 kg/m 2 ; the breakdown of underweight, normal weight, overweight, and obese women was 6.5%, 52.3%, 20.6%, and 13.5%, respectively.



TABLE 1

Characteristics of the study sample of survey participants















































































Variable Respondents, n a
Maternal age, y b 29.5 ± 5.7
Gestational age, wk c 33.0 (26.4-36.7)
White, n (%) 229 (73.9)
Married or common-law, n (%) 256 (82.5)
Education, n (%)
Any postsecondary 234 (76.8)
Secondary or less 72 (23.2)
Income, n (%)
High, >$80 000 105 (33.9)
Middle, $20,000-80,000 106 (34.2)
Low, <$20,000 52 (16.8)
Unreported 47 (15.2)
Current smoker, n (%) 32 (10.3)
Pregnancy history, n (%)
First time giving birth 132 (42.6)
1 previous birth 107 (34.5)
≥2 previous births 56 (18.1)
Unreported 15 (4.8)
Prepregnancy body mass index (kg/m 2 ) of 288 (92.9%) respondents b 25.1 ± 6.7
Body mass index classification, n (%)
Underweight (<18.5 kg/m 2 ) 20 (6.5)
Normal weight (18.5-24.9 kg/m 2 ) 162 (52.3)
Overweight (25.0-29.9 kg/m 2 ) 64 (20.6)
Obese (>30 kg/m 2 ) 42 (13.5)

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Jun 4, 2017 | Posted by in GYNECOLOGY | Comments Off on Despite 2009 guidelines, few women report being counseled correctly about weight gain during pregnancy

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