Objective: To examine the effects of weight gain/loss on delivery outcomes stratified by class of obesity in an obese, low-income, predominantly minority population.Methods: A retrospective review of a cohort of 1428 women receiving care at a large Medicaid clinic from 2013 to 2016 with pregravid body mass index ≥30 was conducted. Multinomial logistic regression analysis was used to compare differences in gestational weight change to the primary outcomes of birth-weight percentile and delivery type and secondary outcomes of preterm delivery, preterm labor, gestational diabetes mellitus, and gestational hypertension.Results: Obesity class 1 patients who lost weight were more likely to have a small-for-gestational-age (SGA) infant compared with those who had recommended weight gain. Obesity classes 2 and 3 patients had no statistically significant increase in SGA infants with weight loss or weight gain below current recommendations. Obesity classes 1 and 2 patients with weight loss had a statistically significant increase in both preterm delivery and preterm labor; however, class 3 patients did not. Obesity class 3 patients who lost weight were significantly more likely to have gestational diabetes mellitus.Conclusions: Obesity class 3 women may benefit from less weight gain than current recommendations without increasing their risk of SGA infants or preterm birth, especially if gestational diabetes mellitus is present.

Objective To examine how social support factors affect compliance with gestational weight gain (GWG) recommendations in an obese, low-income, predominantly minority population. Study Design A retrospective cohort of 772 pregnant women with body mass index > 30 was reviewed. Univariate and multinomial logistic regression analyses were used to compare GWG with pregnancy planning, relationship status, participation in group prenatal care, nutritional education, and demographic factors. Subgroup analysis was performed to determine if differences existed in entry into prenatal care. Results Planned nature of pregnancy, relationship status, nutritional education, and group prenatal care did not significantly affect GWG. Women with planned pregnancies and in group prenatal care had their first appointment during the first trimester at a higher rate than those with unplanned pregnancy and in traditional care, respectively. Regardless of timing of nutrition consult, GWG was not affected. Nulliparous patients and Class 1 obese patients were more likely to have excessive GWG. Conclusion Social support factors in this study did not individually affect compliance with GWG recommendations in a low-income, obese pregnant population, although some factors were associated with earlier entry to prenatal care. Multimodal, longitudinal programs are likely necessary to achieve increased compliance with GWG recommendations in this population.

INTRODUCTION: Postpartum testing of gestational diabetes (GDM) patients with an oral 2-hour glucose tolerance test (OGTT) is suboptimal, with national rates ranging from 18-57%. The purpose of this study was to investigate if a standardized workflow supplemented with educational sessions could improve the OGTT screening rate. METHODS: A multi-disciplinary workflow was implemented in two Medicaid clinics in January 2018. Pre-intervention subjects were GDM patients in the 4-12 week postpartum period between March-June 2017, while post-intervention subjects were between January-April 2018. Immediately prior and during the post-intervention time period, the obstetrical team received small-group education sessions on the American College of Obstetricians and Gynecologists (ACOG) GDM guidelines, with re-enforcement of workflow. A pretest and posttest were performed to assess effectiveness. Paired t-test was used to compare the pretest and posttest scores, and chi-square testing was used to compare compliance with screening. IRB approval was obtained for this study. RESULTS: Nineteen out of thirty members (63%) of the obstetric team completed the educational session. Mean pretest score for the team was 57.4%; the mean posttest score was 99.2% (p<0.01). Eighteen patients were in the pre-intervention group, while 26 patients were in the post-intervention group. Postpartum screening of GDM patients improved from 39% to 77% after workflow implementation (p=0.01). CONCLUSION: Educational sessions and standardized workflow interventions utilizing a multi-disciplinary team were associated with improvement in both understanding of the ACOG guidelines and patient compliance with postpartum glucose screening. This team-based approach may be useful in other quality improvement initiatives.

INTRODUCTION: The 2009 Institute of Medicine guidelines recommend 11-20 pounds weight gain for pregnant women with BMI ≥30. This study examines factors that affect compliance with weight gain recommendations in an obese, low-income population. METHODS: A retrospective cohort of 1,440 women receiving care at a large Medicaid clinic from 2013-2016 with BMI ≥30 was reviewed. Eligible women were non-smokers with a singleton full-term delivery that initiated care before 20 weeks. Linear and multinomial logistic regression analysis was used to compare gestational weight gain to demographic characteristics, nutritional education, participation in group prenatal care, and medical conditions. RESULTS: Inclusion criteria was met by 803 women, with mean weight gain of 21.8 pounds. In total, 162 (20%) gained weight within guidelines, 211 (26%) below, and 430 (54%) above. Controlling for pre-pregnancy BMI, multiparous women gained significantly fewer pounds then nulliparous women (19 versus 28, P<.001), with a greater proportion of multiparous women within the recommended guidelines (29% versus 16%, P<.001). In univariate analysis, patients that were married, had prior spontaneous preterm birth, or had chronic hypertension were associated with less weight gain, but none were significant after adjusting for parity. Race, nutritional education, and group prenatal care did not significantly affect weight gain. CONCLUSION: Interventions such as group prenatal care and nutrition visits do not significantly affect gestational weight gain in an obese, low-income population. Parity may be an important modifying factor in gestational weight gain. These findings may be useful for targeting policies aimed at attaining healthy weight gain based on parity.