OBJECTIVE: To evaluate patient satisfaction after integration of audio-only virtual visits into a pre-existing prenatal care schedule within a large, county-based system during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHODS: We implemented audio-only prenatal virtual visits in response to the SARS-CoV-2 pandemic within a large, county-based prenatal care system serving predominantly women with low socioeconomic status and limited resources. Using a four-question telephone survey, we surveyed a cross-section of patients who had opted to participate in virtual visits to assess their level of satisfaction surrounding audio-only visits. In addition, average clinic wait times and attendance rates by visit type were examined. RESULTS: From March 17 to May 31, 2020, more than 4,000 audio-only virtual prenatal visits were completed in our system. After implementation, the percentage of visits conducted through the virtual platform gradually rose, with nearly 25% of weekly prenatal visits being performed through the virtual platform by the month of May. Clinic wait times trended downward after implementation of virtual visits (P<.001). On average, 88% of virtual prenatal visits were completed as scheduled, whereas only 82% of in-person visits were attended (P<.001). Hospital administration attempted to contact 431 patients who had participated in at least one virtual visit to assess patient satisfaction; 283 patients were reached and agreed to participate (65%). Ninety-nine percent of respondents reported that their needs were met during their audio-only virtual visits. The majority of patients preferred a combination of in-person and virtual visits for prenatal care, and patients reported many benefits with virtual visits. CONCLUSION: Audio-only virtual prenatal visits—as a complement to in-person prenatal visits—have specific and distinct advantages compared with video-enabled telehealth in a vulnerable population of women and offer a viable option to increase access to care.

Gestational weight gain guidelines may need modification for severity of obesity.

A pilot study was conducted to determine if a nutritional intervention aimed at portion control leads to significant weight loss in a community of low-income Mexican American women. Nineteen low-income Mexican American women were randomized to a standard care group or an intervention group in portion control. The trial was 20 weeks in length, and the intervention included four 2-hour classes. Both interventions were administered by a certified nurse-midwife (CNM) and a promotora de salud (i.e., lay health advisor). Women in the intervention group lost more weight than women in the standard care group, though this difference was not statistically significant. The mean weight loss in the intervention group was 6.57 pounds (2.9 kg) compared to a mean weight loss of 2.8 pounds (1.3 kg) in the standard care group (P = .47). Mean weight loss, regardless of group, was significantly greater when participants reported self-weighing (P = .02). This pilot study in portion control for low-income Mexican American women merits further study.

Introduction Prepregnancy obesity and excessive gestational weight gain (GWG) pose health risks to woman and fetus, yet gestational weight management interventions are largely unsuccessful. Little research examines the perceptions of women with obesity about weight gain and exercise. Although women with obesity have different body habitus and life experiences, most studies combine overweight and obese women into one group. Methods We conducted 3 focus groups with pregnant women with obesity to determine perceptions of GWG, exercise, and a proposed behavioral intervention. Results Seventeen women participated in the focus groups including 6 at a birth center and 11 at a federally qualified health center. A key finding was that women with obesity felt stigmatized and perceived pregnancy as a refuge from fat shaming. Participants viewed risks associated with excessive GWG as exaggerated and instead deemed self‐assessments of how they feel and look as more reliable measures of maternal and fetal health. Participants reported that quality rather than quantity of food promotes pregnancy health and that restrained eaters put their fetuses at risk. Knowledge gaps emerged related to dissatisfaction with counseling about weight gain guidelines. Although physical activity was endorsed, participants voiced safety concerns about exercise during pregnancy and instead favored walking and routine daily activity. Goal setting, positive messaging, and positive reinforcement were identified as favorable aspects of the proposed behavioral intervention. Discussion Pregnant women with obesity share other pregnant women's perceptions about weight gain and exercise in pregnancy but also have unique perceptions. Pregnant women with obesity in this study reported feeling stigmatized and fearful of being shamed by their health care providers but paradoxically eager for guidance. The findings offer implications for health care counseling and GWG interventions for this population.