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: 5.18). 04/2010; 115(4):777-83. DOI: 10.1097/AOG.0b013e3181d56e12
Source: PubMed


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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    • "We are not aware of other studies that examined documentation of adherence to guidelines according to weight category, apart from a single study that examined only gestational weight gain and not the additional outcomes. This study, located in a Massachusetts tertiary care center, found even lower rates (only 4.6%) of documentation of pre-pregnancy BMI in the antenatal records [26]. "
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    ABSTRACT: Background Documentation 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. Methods We 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. Results The 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. Conclusion Despite 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 · 2.19 Impact Factor
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    ABSTRACT: Frauen mit Gewichtsproblemen, speziell adipöse Frauen (BMI ≥ 30 kg/m2) gelten als Risikoschwangere. Etwa ein Drittel der übergewichtigen und mehr als 50% der adipösen Schwangeren nehmen über das empfohlene Maß hinaus zu. Sowohl ein erhöhter prägravider BMI als auch eine übermäßige Gewichtsakkumulation in graviditate sind entscheidende Prädiktoren sowohl des perinatalen Outcome (nachweislich erhöhtes Risiko für spätere Kindheitsadipositas und kardiovaskuläre Erkrankungen) als auch einer längerfristigen Gewichtsentwicklung bzw. Manifestation einer tatsächlichen Adipositas. Neben einer empfohlenen präkonzeptionellen Gewichtsregulation ist die Erörterung und Definition individueller Zielgrößen der Gewichtszunahme (nach IOM-Richtlinien) zusammen mit Empfehlungen zu Ernährung und körperlicher Aktivität für die Betreuung adipöser Schwangerer von maßgeblicher Bedeutung. Post partum sollten Frauen mit erhöhtem BMI zum Stillen angehalten und über präventive Maßnahmen zur postpartalen Gewichtsretention (Änderung des Lebens- und Essgewohnheiten, körperliche Aktivität) informiert werden.
    Der Gynäkologe 11/2011; 44(11). DOI:10.1007/s00129-011-2830-7
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    ABSTRACT: Our objective was to quantify how the 2009 revisions of the 1990 Institute of Medicine (IOM) gestational weight gain (GWG) guidelines change women's body mass index (BMI) categorization and BMI-specific GWG adherence categories. The goal was to identify how provider counseling practices need to change on a population level. A retrospective review of automated labor and delivery records from a tertiary care hospital in Central Massachusetts was performed. The study cohort included women who delivered singleton, live birth gestations from from April 1, 2006, to September 30, 2009. Records missing weight, height, GWG, gestational age (GA), and/or GA <22 or >43 weeks were excluded. BMI groups and GWG adherence were categorized according to IOM 1990 and 2009 recommendations. Adherence analyses included full-term gestations only. The cohort consisted of 11,688 women, mean age 28.9 (±6.1) years and mean parity 1.0 (±1.1). By 1990 recommendations, 10.1%, 52.5%, 14.1%, and 23.3% gravidas were low weight, normal weight, high weight, and obese; and 19.8%, 33.3%, and 46.9% were undergainers, appropriate gainers, and overgainers, respectively. By 2009 recommendations, 3.9%, 51.3%, 24.5%, and 20.3% gravidas were underweight, normal weight, overweight, and obese, and 16.7%, 30.8%, and 52.6% were undergainers, appropriate gainers, and overgainers, respectively. Differences in categorization by guideline year was significant for BMI category (p<0.0001) and GWG adherence (p<0.0001). Compared to 1990 guidelines, 16.7% of women were classified differently using 2009 guidelines, with fewer classified as underweight, normal weight, or obese and more as overweight; 17.1% of 1990 appropriate gainers would be classified as overgainers, given new guidelines. Changes in IOM GWG recommendations alter gravidas' BMI categories and, thus, the recommended GWG. As the amount advised is associated with actual gain, accuracy is paramount. GWG is a modifiable parameter associated with immediate and long-term maternal/neonatal health outcomes, and counseling can have a significant public health impact and should involve BMI determination, followed by BMI-specific GWG recommendations in accordance with current guidelines.
    Journal of Women's Health 06/2011; 20(6):837-44. DOI:10.1089/jwh.2010.2429 · 2.05 Impact Factor
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