353
BIRTH 41:4 December 2014
Patient Report of Guideline-Congruent Gestational Weight Gain Advice From Prenatal Care Providers: Differences by Prepregnancy BMI Molly E. Waring, PhD, Tiffany A. Moore Simas, MD, MPH, MEd, Katharine C. Barnes, MD, Daniel Terk, MD, Inna Baran, MD, Sherry L. Pagoto, PhD, and Milagros C. Rosal, PhD ABSTRACT: Background: Prenatal care provider weight gain advice consistent with the Institute of Medicine recommendations is related to guideline-adherent gestational weight gain (GWG), yet many women may not receive guideline-congruent advice. We examined pregnant women’s recall of prenatal care provider GWG advice in relation to prepregnancy body mass index (BMI). Methods: We conducted a prospective cohort study of women (n = 149) receiving prenatal care for a singleton pregnancy at a large academic medical center in 2010. Data were collected via a survey during late pregnancy and medical record abstraction. Results: Thirty-three percent of women did not recall receiving the provider GWG advice; 33 percent recalled advice consistent with 2009 Institute of Medicine recommendations. Recalled advice differed by prepregnancy BMI; 29 percent of normal weight, 26 percent of overweight, and 45 percent of obese women reported not receiving advice, and 6, 37, and 39 percent, respectively, recalled advice exceeding Institute of Medicine recommendations. Among the 62 percent who recalled that their provider had labeled their prepregnancy BMI, 100 percent of normal weight, 32 percent of overweight, and 23 percent of obese women recalled the labels “normal weight,” “overweight,” and “obese,” respectively. Conclusions: Helping providers give their patients memorable and guideline-consistent GWG advice is an actionable step toward preventing excessive GWG and associated maternal and child health consequences. (BIRTH 41:4 December 2014)
Key words: body mass index, gestational weight gain, pregnancy, provider counseling
Molly E. Waring, PhD, is an Assistant Professor in the Department of Quantitative Health Sciences at the University of Massachusetts Medical School, Worcester, MA, USA; Tiffany A. Moore Simas, MD, MPH, MEd, is a practicing obstetrician-gynecologist at the University of Massachusetts Memorial Health Care and Associate Professor in the Departments of Obstetrics and Gynecology and Pediatrics at the University of Massachusetts Medical School, Worcester, MA, USA; Katharine C. Barnes, MD, is a resident physician in the Department of Obstetrics and Gynecology at the Beth Israel Deaconess Medical Center, Boston, MA, USA; Daniel Terk, MD, is a resident physician in the Department of Obstetrics and Gynecology at the University of Rochester Medical Center, Rochester, NY, USA; Inna Baran, MD, is a resident physician in the Department of Emergency Medicine at the Warren Alpert Medical School of Brown University, Providence, RI, USA; Sherry L. Pagoto, PhD, is an Associate Professor in the Division of Behavioral and Preventive Medicine in the Department of
Medicine at the University of Massachusetts Medical School, Worcester, MA, USA; Milagros C. Rosal, PhD, is a Professor in the Division of Behavioral and Preventive Medicine in the Department of Medicine at the University of Massachusetts Medical School, Worcester, MA, USA. Address correspondence to Molly E. Waring, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS8-1077, Worcester, MA 01605, USA. Accepted July 23, 2014 © 2014 Wiley Periodicals, Inc.
BIRTH 41:4 December 2014
354 Gestational weight gain (GWG) in excess of Institute of Medicine recommendations increases the risk of adverse pregnancy and birth outcomes (1–4), postpartum weight retention and subsequent maternal obesity (4,5), and overweight in the offspring (4,6). Although excessive GWG is associated with negative maternal and child outcomes for women of all weights (1–12), excessive GWG may be particularly detrimental for obese women and their neonates given the elevated risk imparted by prepregnancy obesity (1,2,11,12). Upwards of half of pregnant women exceed the Institute of Medicine recommendations for weight gain during pregnancy (13,14), with higher rates of excessive gain among overweight and obese women (3,15–19). In recent studies, 43–55 percent of normal weight, 65–74 percent of overweight, and 54–70 percent of obese women gained more than the recommended (3,12,15,17). Guideline-congruent provider advice is associated with weight gain within the range recommended by the Institute of Medicine (20,21), yet as many as two-thirds of women report not receiving advice from their prenatal care providers or report advice that is inconsistent with these recommendations (20–24). In one study that reported recalled provider GWG advice by women’s prepregnancy weight status, 22 percent of overweight or obese compared with 2 percent of normal weight women reported being advised to gain an amount in excess of the Institute of Medicine recommendations (22). Given that overweight and obese women are more likely to experience excessive GWG, and excessive gain may put them at an elevated risk of negative maternal and child health consequences, a better understanding of provider advice about GWG in relation to prepregnancy weight is warranted. The purpose of this study was to describe pregnant women’s recall of prenatal care provider advice about gestational weight gain in relation to prepregnancy body mass index (BMI).
Methods We conducted a prospective cohort study of pregnant women at a large academic medical center in Central Massachusetts. The University of Massachusetts Medical School Institutional Review Board approved this study. Data collection included a survey and abstraction of the woman’s delivery medical record. Pregnant women were approached during routine prenatal care visits during spring 2010. Eligibility criteria were receipt of prenatal care at the faculty or resident obstetric clinics, aged 14–45 years, singleton pregnancy at 37–42 weeks’ gestation, ability to complete the survey in English or Spanish, and ability to provide informed consent. We merged participants’ self-reported information with clinical data derived from the electronic labor
and delivery medical record. The medical record export database is surveyed periodically to evaluate internal consistency by direct comparison with patient charts. Missing data and outliers were verified or corrected by chart review where possible. Prepregnancy weight and height were obtained from medical records. Prepregnancy weight recorded at the time of delivery was, as available, self-reported weight recorded at first prenatal visit, prepregnancy weight reported on presentation for delivery, or weight measured at the first prenatal visit transferred from the prenatal medical record. Height was transferred from the prenatal record or self-reported at time of delivery. Prepregnancy BMI was calculated from these values and categorized as underweight (BMI
BIRTH 41:4 December 2014
Patient Report of Guideline-Congruent Gestational Weight Gain Advice From Prenatal Care Providers: Differences by Prepregnancy BMI Molly E. Waring, PhD, Tiffany A. Moore Simas, MD, MPH, MEd, Katharine C. Barnes, MD, Daniel Terk, MD, Inna Baran, MD, Sherry L. Pagoto, PhD, and Milagros C. Rosal, PhD ABSTRACT: Background: Prenatal care provider weight gain advice consistent with the Institute of Medicine recommendations is related to guideline-adherent gestational weight gain (GWG), yet many women may not receive guideline-congruent advice. We examined pregnant women’s recall of prenatal care provider GWG advice in relation to prepregnancy body mass index (BMI). Methods: We conducted a prospective cohort study of women (n = 149) receiving prenatal care for a singleton pregnancy at a large academic medical center in 2010. Data were collected via a survey during late pregnancy and medical record abstraction. Results: Thirty-three percent of women did not recall receiving the provider GWG advice; 33 percent recalled advice consistent with 2009 Institute of Medicine recommendations. Recalled advice differed by prepregnancy BMI; 29 percent of normal weight, 26 percent of overweight, and 45 percent of obese women reported not receiving advice, and 6, 37, and 39 percent, respectively, recalled advice exceeding Institute of Medicine recommendations. Among the 62 percent who recalled that their provider had labeled their prepregnancy BMI, 100 percent of normal weight, 32 percent of overweight, and 23 percent of obese women recalled the labels “normal weight,” “overweight,” and “obese,” respectively. Conclusions: Helping providers give their patients memorable and guideline-consistent GWG advice is an actionable step toward preventing excessive GWG and associated maternal and child health consequences. (BIRTH 41:4 December 2014)
Key words: body mass index, gestational weight gain, pregnancy, provider counseling
Molly E. Waring, PhD, is an Assistant Professor in the Department of Quantitative Health Sciences at the University of Massachusetts Medical School, Worcester, MA, USA; Tiffany A. Moore Simas, MD, MPH, MEd, is a practicing obstetrician-gynecologist at the University of Massachusetts Memorial Health Care and Associate Professor in the Departments of Obstetrics and Gynecology and Pediatrics at the University of Massachusetts Medical School, Worcester, MA, USA; Katharine C. Barnes, MD, is a resident physician in the Department of Obstetrics and Gynecology at the Beth Israel Deaconess Medical Center, Boston, MA, USA; Daniel Terk, MD, is a resident physician in the Department of Obstetrics and Gynecology at the University of Rochester Medical Center, Rochester, NY, USA; Inna Baran, MD, is a resident physician in the Department of Emergency Medicine at the Warren Alpert Medical School of Brown University, Providence, RI, USA; Sherry L. Pagoto, PhD, is an Associate Professor in the Division of Behavioral and Preventive Medicine in the Department of
Medicine at the University of Massachusetts Medical School, Worcester, MA, USA; Milagros C. Rosal, PhD, is a Professor in the Division of Behavioral and Preventive Medicine in the Department of Medicine at the University of Massachusetts Medical School, Worcester, MA, USA. Address correspondence to Molly E. Waring, PhD, Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, AS8-1077, Worcester, MA 01605, USA. Accepted July 23, 2014 © 2014 Wiley Periodicals, Inc.
BIRTH 41:4 December 2014
354 Gestational weight gain (GWG) in excess of Institute of Medicine recommendations increases the risk of adverse pregnancy and birth outcomes (1–4), postpartum weight retention and subsequent maternal obesity (4,5), and overweight in the offspring (4,6). Although excessive GWG is associated with negative maternal and child outcomes for women of all weights (1–12), excessive GWG may be particularly detrimental for obese women and their neonates given the elevated risk imparted by prepregnancy obesity (1,2,11,12). Upwards of half of pregnant women exceed the Institute of Medicine recommendations for weight gain during pregnancy (13,14), with higher rates of excessive gain among overweight and obese women (3,15–19). In recent studies, 43–55 percent of normal weight, 65–74 percent of overweight, and 54–70 percent of obese women gained more than the recommended (3,12,15,17). Guideline-congruent provider advice is associated with weight gain within the range recommended by the Institute of Medicine (20,21), yet as many as two-thirds of women report not receiving advice from their prenatal care providers or report advice that is inconsistent with these recommendations (20–24). In one study that reported recalled provider GWG advice by women’s prepregnancy weight status, 22 percent of overweight or obese compared with 2 percent of normal weight women reported being advised to gain an amount in excess of the Institute of Medicine recommendations (22). Given that overweight and obese women are more likely to experience excessive GWG, and excessive gain may put them at an elevated risk of negative maternal and child health consequences, a better understanding of provider advice about GWG in relation to prepregnancy weight is warranted. The purpose of this study was to describe pregnant women’s recall of prenatal care provider advice about gestational weight gain in relation to prepregnancy body mass index (BMI).
Methods We conducted a prospective cohort study of pregnant women at a large academic medical center in Central Massachusetts. The University of Massachusetts Medical School Institutional Review Board approved this study. Data collection included a survey and abstraction of the woman’s delivery medical record. Pregnant women were approached during routine prenatal care visits during spring 2010. Eligibility criteria were receipt of prenatal care at the faculty or resident obstetric clinics, aged 14–45 years, singleton pregnancy at 37–42 weeks’ gestation, ability to complete the survey in English or Spanish, and ability to provide informed consent. We merged participants’ self-reported information with clinical data derived from the electronic labor
and delivery medical record. The medical record export database is surveyed periodically to evaluate internal consistency by direct comparison with patient charts. Missing data and outliers were verified or corrected by chart review where possible. Prepregnancy weight and height were obtained from medical records. Prepregnancy weight recorded at the time of delivery was, as available, self-reported weight recorded at first prenatal visit, prepregnancy weight reported on presentation for delivery, or weight measured at the first prenatal visit transferred from the prenatal medical record. Height was transferred from the prenatal record or self-reported at time of delivery. Prepregnancy BMI was calculated from these values and categorized as underweight (BMI
