Physicians Cite Barriers to Effective Counseling for Prenatal Weight Gain

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Obstetricians agree that excessive weight gain during pregnancy is associated with both short and long term adverse health outcomes for mom and baby, but cite barriers to being able to adequately provide counseling. The research, available online this month, will be published in the April 2010 issue of the Journal of Women’s Health.

The rate of excess weight during pregnancy is rising in the US. Of the more than four million births each year, about 60% of mothers begin pregnancy either overweight or obese.

Naomi Stotland MD and researchers from the University of California San Francisco conducted seven focus groups with a total of 52 participants in the San Francisco Bay area. Obstetricians and gynecologists comprised three of the groups while certified nurse midwives and nurse practitioners participated in the remaining four groups.

Providers of prenatal services agree that weight gain is an important topic to discuss with pregnant women, but barriers to counseling include insufficient training, concern about the sensitivity of the topic, and the perception that counseling is ineffective.

Most physicians agree with the Institutes of Medicine’s guidelines for weight gain during pregnancy, but several providers said that they did not proactively share these with their patients.

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In particular, excessive weight gain in the first trimester of pregnancy raises the risk of developing gestational diabetes, a glucose intolerance the typically occurs during the last half of pregnancy. GDM causes complications in nearly 7% of pregnancies in the US and can lead to an increased risk for both mother and child for developing type 2 diabetes later in life.

"Clinicians in the study raised concerns about shaming or stressing pregnant women, and often wait for patients to raise the question of proper weight gain. Many providers - especially physicians - also said they lacked education in weight management issues," said Dr. Stotland, MD, lead author of the study and assistant professor in the UCSF Department of Obstetrics, Gynecology, and Reproductive Sciences.

Prenatal care is an opportune time for healthcare providers to help women make positive lifestyle chances in nutrition and physical activity, added Stotland. During pregnancy, most women see a healthcare provider at least once a month to receive prenatal care and are especially motivated to make changes for the health of their babies.

Simple messages are often best and have been shown to have a positive impact on patient behaviors. For example, an Australian study found that many pregnant women ate less than half of the recommended servings of fruits and vegetables. Poor diet quality is linked with unhealthy weight gain, high blood pressure and anemia in moms and lower birth weight and long-term risk of chronic disease in babies.

"It is important to identify new tools that will enable clinicians to more easily and effectively counsel pregnant woman so that together they can determine strategies to achieve the healthiest weight for that individual," Stotland said. "I also would encourage women to initiate the conversation if their doctors are not raising the topic of weight gain."

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