Objective: Maternal obesity is associated with adverse pregnancy outcomes. To improve outcomes, obstetric providers must effectively evaluate and manage their obese pregnant patients. We sought to determine the knowledge, attitudes, and practice patterns of obstetric providers regarding obesity in pregnancy. Methods: In 2007-2008, we surveyed 58 practicing obstetricians, nurse practitioners, and certified nursemidwives at a multispecialty practice in Massachusetts. We administered a 26-item questionnaire that included provider self-reported weight, sociodemographic characteristics, knowledge, attitudes, and management practices. We created an 8-point score for adherence to 8 practices recommended by the American College of Obstetricians and Gynecologists (ACOG) for the management of obese pregnant women. Results: Among the respondents, 37% did not correctly report the minimum body mass index (BMI) for diagnosing obesity, and most reported advising gestational weight gains that were discordant with 1990 Institute of Medicine (IOM) guidelines, especially for obese women (71%). The majority of respondents almost always recommended a range of weight gain (74%), advised regular physical activity (74%), or discussed diet (64%) with obese mothers, but few routinely ordered glucose tolerance testing during the first trimester (26%), planned anesthesia referrals (3%), or referred patients to a nutritionist (14%). Mean guideline adherence score was 3.4 (SD 1.9, range 0-8). Provider confidence (b ¼ 1.0, p ¼ 0.05) and body satisfaction (b ¼ 1.5, p ¼ 0.02) were independent predictors of higher guideline adherence scores. Conclusions: Few obstetric providers were fully compliant with clinical practice recommendations, defined obesity correctly, or recommended weight gains concordant with IOM guidelines. Provider personal factors were the strongest correlates of self-reported management practices. Our findings suggest a need for more education around BMI definitions and weight gain guidelines, along with strategies to address provider personal factors, such as confidence and body satisfaction, that may be important predictors of adherence to recommendations for managing obese pregnant women.

Newborn T4 concentrations within a normal physiological reference range are not associated with maternal thyroid function and do not predict cognitive outcome in a population living in an iodine-sufficient area.

Objective: To determine first-trimester thyroid function values and associations with thyroperoxidase antibody (TPO-Ab) status, smoking, emesis, and iodine-containing multivitamin use. Methods:We collected information by interview, questionnaire, and blood draw at the initial obstetric visit in 668 pregnant women without known thyroid disease. We compared thyroidstimulating hormone (TSH), total thyroxine (T 4 ), and free T 4 index (FT 4 I) values by TPO-Ab status. Multiple regression was used to identify characteristics associated with thyroid function values. Results:The following median (range containing 95% of the data points) thyroid function test values were obtained in 585 TPO-Ab-negative women: TSH, 1.1 mIU/L (0.04-3.6); FT 4 I, 2.1 (1.5-2.9); and T 4 , 9.9 μg/dL (7.0-14.0). The following median (range containing 95% of the data points) thyroid function test values were obtained in 83 TPO-Ab-positive women: TSH, 1.8 mIU/L (0.3-6.4) (P<.001); FT 4 I, 2.0 (1.4-2.7) (P = .06); and T 4 , 9.3 μg/dL (6.8-13.0) (P = .03) (P values denote statistically significant differences between TPO-Ab-positive and negative participants). Among TPO-Ab-negative participants, TSH level was not associated with use of iodine-containing multivitamins, smoking, or race. TSH increased 0.03 mIU/L for every year of maternal age (P = . 03) and decreased by 0.3 mIU/L for every increase in parity (P<.001). T 4 decreased 0.04 μg/dL for every year of maternal age (P = .04). Mean FT 4 I was 2.05 in smokers and 2.20 in nonsmokers (P<. 01). There were no relationships between T 4 or FT 4 I and parity, race, or iodine-containing multivitamin use. Conclusion:TPO-Ab status of pregnant women should be considered when constructing trimesterspecific reference ranges because elevated serum TPO-Ab levels are associated with higher TSH and lower T 4 values.

Background: Many pregnant women in the United States do not consume enough docosahexaenoic acid (DHA)-an essential nutrient found in fish. Apparently conflicting findings that fish consumption is beneficial for the developing fetus, yet potentially toxic because of mercury contamination, have created uncertainty about the appropriate fish-consumption advice to provide to pregnant women. Objective: Our objective was to determine knowledge, behaviors, and received advice regarding fish consumption among pregnant women who are infrequent consumers of fish. Design: In 2009-2010 we conducted 5 focus groups with 22 pregnant women from the Boston area who ate ,2 fish servings/wk. We analyzed transcripts by using immersion-crystallization. Results: Many women knew that fish might contain mercury, a neurotoxin, and had received advice to limit fish intake. Fewer women knew that fish contains DHA or what the function of DHA is. None of the women had received advice to eat fish, and most had not received information about which fish types contain more DHA or less mercury. Because of advice to limit fish intake, as well as a lack of information about which fish types they should be eating, many of the women said that they would rather avoid fish than possibly harm themselves or their infants. The participants thought that a physician's advice to eat fish and a readily available reference regarding which fish are safe to consume during pregnancy would likely have encouraged them to eat more fish. Conclusion: Pregnant women might be willing to eat more fish if this were advised by their obstetricians or if they had an accessible reference regarding which types are safe.