Modeling the Predictive Value of Evidence-Based Referral Criteria to Support Healthy Gestational Weight Gain among an Australian Pregnancy Cohort

Abstract

Globally, there has been a renewed focus on addressing gestational weight gain (GWG). In Australia, the Department of Health pregnancy care guidelines recommend women be offered routine weighing and receive brief nutritional and physical activity support during antenatal care visits. Women gaining weight outside the Institute of Medicine (IOM)’s weight gain reference values are further recommended to be referred to a dietitian. However, professional and organizational barriers, including an absence of weight gain referral pathways and limited workforce resources, exist with the translation and scaling of these recommendations into practice. This study aimed to explore patterns of GWG among a cohort of Australian pregnant women and to determine if pregnancy weight gains of above or below 2 kg or 5 kg in the second and third trimester can be used to predict total GWG outside recommendations. Sensitivity, specificity, negative, and positive likelihood ratios were calculated. The most predictive time point was 24 weeks’ gestation using the minimum weight change parameter of +/−2 kg, demonstrating reasonable sensitivity (0.81, 95% CI 0.61–0.83) and specificity (0.72, 95% CI 0.61–0.83), resulting in 55% (n = 72/131) of the cohort qualifying for dietetic referral. Given the current health service constraints, a review of dietetic services within maternity care is warranted.

Antenatal care addressing gestational weight gain (GWG): a cross sectional study of pregnant women’s reported receipt and acceptability of recommended GWG care and associated characteristics

“…Lower referrals may also reflect a lower prioritisation of GWG as a referring health issue, and a lack of public dietetic service capacity to provide timely referrals to address maternal health as found in other Australian research [ 37 ]. It has been suggested that care aspects like referring to other care services require more time and follow-through [ 36 ], better care provider education and guidance, and different organisational structures and more service capacity [ 37 , 38 ]. Further research should investigate both pregnant women’s acceptability of, and antenatal care providers’ barriers to, offering GWG referrals to maximise acceptance and engagement.…”