The 5As of healthy pregnancy weight gain: possible applications in the Brazilian context to improve maternal-fetal health

Abstract

The 5As of healthy pregnancy weight gain: possible applications in the Brazilian context to improve maternal-fetal health | LETTER TO EDITOR Sao Paulo Med J. 2016; 134(2):180-1 181 may be a unique addition to the clinician's tool box in Brazil.Ignoring one's bias and making assumptions about a patient's health-related behavior can lead to ineffective interventions and should be thoughtfully considered. For example, asking a woman to change her diet by purchasing healthy food from a vendor located far from her home when she does not have transportation may not be helpful. Here, the recommended "intervention" failed the patient, and not the other way around, so not passing judgement is key to strengthening the patient-provider relationship."Agree" alludes to the notion that both the expectant mother and her care team agree on a tentative (behavioral modification) plan that ultimately leads to healthy amounts of weight gain per trimester (this is based on the mother's pre-pregnancy BMI category)."Assist" is associated with offering education and credible resources that may help each patient to increase self-management, and this capitalizes on allied care providers when available.It is universally accepted that weight management programs are more successful when using an interdisciplinary approach.Care can be appropriately triaged, with the necessary referrals made, such that these choices are made as a team and are appropriate for each woman. Only then can unique social determinants be addressed, with minimization of complications and removal of barriers to healthier pregnancy. Much of this success also depends on arranging follow-up appointments or referrals and tracking behaviour over time. 5In summary, the 5As framework can be an alternative to current standard practice with the aims of harmonizing the care provider strategy and guiding healthcare professionals in their practices, while adding a personalized and empathetic approach to the patient encounter. It is strongly recommended that future studies assess the efficacy and effectiveness of the 5As framework's ability to facilitate provider-patient dialogue and improve patient experiences. Only then can we hope to directly translate these into healthier maternal-fetal clinical outcomes (e.g., adequate GWG, less gestational diabetes and other cardiometabolic risk factors, decreased mortality, etc.).Lastly, studies focusing on translation, cultural adaption and validation of the tool are also needed. We look forward to academic discussion on this topic in order to improve the quality of the health care system.