Efforts Needed to Provide Institute of Medicine-Recommended Guidelines for Gestational Weight Gain

University of Massachusetts Medical School/UMass Memorial Health Care, Department of Obstetrics and Gynecology, Worcester, Massachusetts 01605, USA.
Obstetrics and Gynecology (Impact Factor: 4.37). 04/2010; 115(4):777-83. DOI: 10.1097/AOG.0b013e3181d56e12
Source: PubMed

ABSTRACT To estimate body mass index (BMI)-specific gestational weight gain recommendations and frequency of weight and gestational weight gain discussions and documentation.
Medical record review of 477 randomly selected patients who met inclusion criteria and who received care in faculty and resident clinics at a central Massachusetts tertiary care center. Patients started prenatal care at or before 14 weeks of gestation and delivered between April 2007 and March 2008.
Our patients were mean (+/-standard deviation) 27.8 (+/-6.3) years, 69.8% multiparous, 45.3% white, 10.5% black, and 15.9% Hispanic. Mean gestational age at initial visit was 9.6 (+/-2.1) weeks and mean prenatal visits attended were 12.6 (+/-2.7). Using prenatal chart data alone, BMI was not calculable for 41.2% of patients due to missing height (27.7%), prepregnancy weight (27.9%), or both (14.5%). In the total sample, documentation was missing with regard to BMI (95.4%), gestational weight gain (85.3%), gestational weight gain goals (90.1%), and discussion of weight (88.9%). Supplemental data were obtained to calculate prepregnancy BMI for 469 patients. Per 1990 (BMI at least 26.1) and 2009 (BMI at least 25.0) guidelines, 42% and 49% of patients were overweight or obese, respectively, before pregnancy. Analysis of actual gestational weight gain by BMI revealed that 76% of overweight and 65% of obese patients gained excessively.
Prenatal care providers should include recording height and weight to calculate BMI and to provide BMI-specific gestational weight gain guidelines.

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