Perspectives about and approaches to weight gain in pregnancy: a qualitative study of physicians and nurse midwives

Abstract

BackgroundOver one third of reproductive age women in the US are obese. Pregnancy is a strong risk factor for obesity, with excess weight gain as the greatest predictor of long term obesity. The majority of pregnant women gain more weight than recommended by the Institute of Medicine guidelines. The objective of this study was to understand prenatal care providers’ perspectives on weight gain during pregnancy.MethodsSemi-structured qualitative interviews of 10 prenatal care providers (three family physicians, three obstetricians, and four nurse midwives) at a University Hospital in the Midwest, that included the ranking of important prenatal issues, and open-ended questions addressing: 1) general perceptions; 2) approach with patients; and 3) clinical care challenges.ResultsProviders felt that appropriate weight gain during pregnancy was not a high priority. Many providers waited until patients had gained excess weight before addressing the issue, were not familiar with established guidelines, and lacked resources for patients. Providers also believed that their counseling had low impact on patients, avoided counseling due to sensitivity of the topic, and believed that patients were more influenced by other factors, such as their family, habits, and culture.ConclusionsBoth providers and patients may benefit from increased awareness of the morbidity of excess weight gain during pregnancy. Practice-level policies that support the monitoring and management of weight gain during pregnancy could also improve care. Research that further investigates the barriers to appropriate weight gain is warranted.

Advice given by community members to pregnant women: a mixed methods study

“…Our results suggest that respondents in our community-based sample were less comfortable addressing weight gain compared to smoking during pregnancy, a well-documented risk factor for poor maternal and fetal outcomes [2, 3]. This data from community members is consistent with, and adds to, previous studies that demonstrate significant weight stigma and concern for offending pregnant patients among prenatal care providers [12, 14, 15, 39]. …”

“…There is variability in the consistency with which clinicians discuss appropriate weight gain with their pregnant patients: studies report that between 12 and 85 % of pregnant women were counseled correctly by their healthcare provider regarding how much they should gain during pregnancy [12, 13]. Clinicians may be reluctant to discuss the sensitive topic of weight gain with their overweight or obese patients [12, 14, 15]. Additionally, the Internet is a common source of health information among pregnant women with nearly all women (94 %) using the Internet for pregnancy-related information [16–18].…”

Improving Gestational Weight Gain Counseling Through Meaningful Use of an Electronic Medical Record

“…Provider discomfort discussing weight issues was identified as a barrier to counseling during study development, a finding in keeping with other research on this topic (23). Interdisciplinary, collaborative development of scripted counseling focusing on a positive message was vital in overcoming provider concerns about the sensitivity of discussing weight with patients.…”

“It’s a Wild Ride”: A Phenomenological Exploration of High Maternal, Gestational Weight Gain

“…While recognizing that uncontrollable factors, such as macro-and meso-level influences that exceed the micro-or individual-level (e.g., the broad determinants of health), impinge on gestational weight gain, health care professionals need to provide pregnant women with specific information concerning pregnancy weight gain, dietary, and physical activity recommendations. Stotland and colleagues [69] and Chang et al [70] discussed measures to overcome barriers to effective weight gain counseling. The idea of a "license to eat" in pregnancy, which surfaced in this research, has been cited in other publications [71] and might be related to the relaxation of weight expectations during pregnancy in former years [15] [16] [72] [73] and normative constructions of the "good" mother, who deserves pampering during pregnancy [74].…”