Efforts Needed to Provide Institute of Medicine-Recommended Guidelines for Gestational Weight Gain
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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ABSTRACT: In 2009, the Institute of Medicine revised gestational weight gain recommendations; revisions included body mass index (BMI) category cut-point changes and provision of range of gain for obese women. Our objective was to examine resident prenatal caregivers' knowledge of revised guidelines. Anonymous electronic survey of obstetrics/gynecology and family medicine residents across the United States from January to April 2010. Overall, 660 completed the survey; 79 percent female and 69 percent aged between 21 and 30. When permitted to select ≥ 1 response, 87.0 percent reported using BMI to assess weight status at initial visits, 44.4 percent reported using "clinical impression based on patient appearance," and 1.4 percent reported not using any parameters. When asked the most important baseline parameter for providing recommendations, 35.8 percent correctly identified prepregnancy BMI, 2.1 percent reported "I don't provide guidelines," and 4.5 percent reported "I do not discuss gestational weight gain." Among respondents, 57.6 percent reported not being aware of new guidelines. Only 7.6 percent selected correct BMI ranges for each category, and only 5.8 percent selected correct gestational weight gain ranges. Only 2.3 percent correctly identified both BMI cutoffs and recommended gestational weight gain ranges per 2009 guidelines. Guideline knowledge is the foundation of accurate counseling, yet resident prenatal caregivers were minimally aware of the 2009 Institute of Medicine gestational weight gain guidelines almost a year after their publication.Birth 12/2013; 40(4):237-246. DOI:10.1111/birt.12061 · 2.05 Impact Factor
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ABSTRACT: About 60 percent of women in the U.S. between the ages of 20 and 39, who are most likely to become pregnant, are pregnant, or are post-pregnancy, are overweight or obese. Forty percent of women with a normal pre-pregnancy BMI, 70 percent who are overweight, and about 46 percent of women who are obese before becoming pregnant gain more weight during their pregnancy than recommended. Initiating a pregnancy while overweight or obese, or gaining more weight than recommended can lead to negative outcomes for the mother and the baby, including greater risk for gestational diabetes, gestational hypertension, preeclampsia, preterm birth and cesarean delivery, miscarriage, stillbirth, increased weight retention post-pregnancy, macrosomia, large for gestational age infants, childhood and adult obesity, among many others. While there are general guidelines regarding what not to eat when pregnant (i.e., foods that pose risk for toxicity), there is no comprehensive, science-based, up-to-date source incorporating most recent medical research available for women to follow regarding what to eat. Therefore, the goal of this thesis was to help Dr. Nicole Avena in translating science into practical knowledge and assist with the development of content that may be used in chapters for a book on prenatal nutrition. Search engines and databases such as PubMed, Cochrane Library, DynaMed, Ovid MEDLINE, and Google Scholar, as well as other published resources were used to collect, analyze, and assess the most recent science-based evidence of how different foods, vitamins and nutrients affect a developing baby, and what prenatal diets and weight gain patterns produce the best outcomes for the mother and the baby. The end-result of the project included a detailed explanation of the key nutrients needed during pregnancy, a week-by-week guide of fetal development accompanied by a “food of the week” in order to encourage women to eat healthier, and nutrition advice for gestational diabetes, preeclampsia, twin pregnancy, breastfeeding, and beyond. In addition, sample menus for each trimester of pregnancy were created so that women could better understand what their daily diet should look like in order to supply them and their babies with the nutrients they need. The hope is that once the book is published, it will provide many women with accessible science-based prenatal nutrition advice and contribute to optimal maternal and fetal health.09/2014, Degree: MSc in Human Nutrition, Supervisor: Nicole Avena, PhD
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ABSTRACT: BackgroundDocumentation in medical records fulfills key functions, including management of care, communication, quality assurance and record keeping. We sought to describe: 1) rates of standard prenatal care as documented in medical charts, and given the higher risks with excess weight, whether this documentation varied among normal weight, overweight and obese women; and 2) adherence to obesity guidelines for obese women as documented in the chart.MethodsWe conducted a chart review of 300 consecutive charts of women who delivered a live singleton at an academic tertiary centre from January to March 2012, computing Analysis of Variance and Chi Square tests.ResultsThe proportion of completed fields on the mandatory antenatal forms varied from 100% (maternal age) to 52.7% (pre-pregnancy body mass index). Generally, documentation of care was similar across all weight categories for maternal and prenatal genetic screening tests, ranging from 54.0% (documentation of gonorrhea/chlamydia tests) to 85.0% (documentation of anatomy scan). Documentation of education topics varied widely, from fetal movement in almost all charts across all weight categories but discussion of preterm labour in only 20.6%, 12.7% and 13.4% of normal weight, overweight and obese women’s charts (p = 0.224). Across all weight categories, documentation of discussion of exercise, breastfeeding and pain management occurred in less than a fifth of charts.ConclusionDespite a predominance of excess weight in our region, as well as increasing perinatal risks with increasing maternal weight, weight-related issues and other elements of prenatal care were suboptimally documented across all maternal weight categories, despite an obesity guideline.BMC Pregnancy and Childbirth 06/2014; 14(1):205. DOI:10.1186/1471-2393-14-205 · 2.15 Impact Factor