A Qualitative Study of Gestational Weight Gain Counseling and Tracking

Abstract

Objectives Excessive gestational weight gain (GWG) predicts adverse pregnancy outcomes and later obesity risk for both mother and child. Women who receive GWG advice from their obstetric clinicians are more likely to gain the recommended amount, but many clinicians do not counsel their patients on GWG, pointing to the need for new strategies. Electronic medical records (EMRs) are a useful tool for tracking weight and supporting guideline-concordant care, but their use for care related to GWG has not been evaluated. Methods We performed in-depth interviews with 16 obstetric clinicians from a multi-site group practice in Massachusetts that uses an EMR. We recorded, transcribed, coded, and analyzed the interviews using immersion-crystallization. Results Many respondents believed that GWG had “a lot” of influence on pregnancy and child health outcomes but that their patients did not consider it important. Most indicated that excessive GWG was a big or moderate problem in their practice, and that inadequate GWG was rarely a problem. All used an EMR feature that calculates total GWG at each visit. Many were enthusiastic about additional EMR-based supports, such as a reference for recommended GWG for each patient based on pre-pregnancy body mass index, a “growth chart” to plot actual and recommended GWG, and an alert to identify out-of-range gains, features which many felt would remind them to counsel patients about excessive weight gain. Conclusion Additional decision support tools within EMRs would be well received by many clinicians and may help improve the frequency and accuracy of GWG tracking and counseling.

Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers

“…Health professionals in the United Kingdom also promoted the concept of group sessions that had an emphasis on behavioral change techniques and were previously piloted as part of a feasibility study of an “antenatal lifestyle course” for women with a BMI≥30 kg/m 2 . (57) The need for groups was partially attributed to the multi-factorial nature of obesity which requires an integration of health care services, similar to the multidisciplinary approach providers in the current study suggested as well.…”

“…Communication skills are critical given that prenatal care providers have difficulty in discussing this topic (e.g., “…have to choose our words carefully”). (57) This concept also extends to the psychological aspects of being obese and pregnant and addressing mental health problems such as depression and anxiety.…”

“…This includes lack of continuity of care, time constraints, training needs (e.g., increased nutrition knowledge, skills to manage obesity), and the need for clear evidence-based guidelines. (54, 57, 59-63) Other providers also struggled with a name for a prenatal intervention for obese women as the title might be a source of embarrassment and negatively impact provider-patient relationships. (64)…”

Lost in translation? English- and Spanish-speaking women’s perceptions of gestational weight gain safety, health risks and counseling

“…15,19,20 In studies of providers' knowledge and attitude of GWG, few providers know and recommend the appropriate weight gain range concordant with IOM guidelines. [21][22][23] Information regarding knowledge and beliefs about GWG among Spanish-speaking women is limited. Several studies have demonstrated that Hispanic women gain more weight than nonHispanic women during pregnancy, 24-26 the reasons for which are unclear.…”

Aspectos Históricos, Conceituais e Organizativos do Pré-natal

“…da equipe de saúde; c) problemas organizacionais para oferecer o controle pré-natal 40 ; d) barreiras do tipo social e/ou cultural 41 ; e) dificuldades de acesso geográfico ao serviço 42 ; f) ausência de credibilidade nos benefícios oferecidos pelo sistema de saúde e na necessidade de controle da gestação; g) falta de promoção do serviço nas comunidades e de aceitação da sua importância 43 . Para que esses obstáculos sejam superados, é necessário que a organização dos cuidados pré-natais contemple, no mínimo, a garantia de: a) captação precoce da gestante na comunidade; b) atendimento periódico contínuo e extensivo à população-alvo; c) provisão de recursos humanos técnico e cientificamente preparados 44 ; d) área física adequada; e) provisão de equipamentos e instrumentais adequados; f) realização de exames laboratoriais obrigatórios; g) abastecimento e acesso aos medicamentos básicos; h) sistema eficiente de referência e contra referência; i) serviço de registro e de estatística 45 ; j) sistema de avaliação da efetividade das ações de assistência pré-natal 10,33 . O envolvimento da comunidade e dos profissionais integrantes da equipe de saúde é essencial para a captação precoce das gestantes, permitindo que ações de prevenção e tratamento sejam introduzidas oportunamente.…”