Adequacy of Prenatal Care and Gestational Weight Gain

Abstract

Background: The goal of prenatal care is to maximize health outcomes for a woman and her fetus. We examined how prenatal care is associated with meeting the 2009 Institute of Medicine (IOM) guidelines for gestational weight gain. Sample: The study used deidentified birth certificate data supplied by the North Carolina State Center for Health Statistics. The sample included 197,354 women ( ‡18 years) who delivered singleton full-term infants in 2011 and 2012. Methods: A generalized multinomial model was used to identify how adequate prenatal care was associated with the odds of gaining excessive or insufficient weight during pregnancy according to the 2009 IOM guidelines. The model adjusted for prepregnancy body size, sociodemographic factors, and birth weight. Results: A total of 197,354 women ( ‡18 years) delivered singleton full-term infants. The odds ratio (OR) for excessive weight gain was 2.44 (95% CI 2.37-2.50) in overweight and 2.33 (95% CI 2.27-2.40) in obese women compared with normal weight women. The OR for insufficient weight gain was 1.15 (95% CI 1.09-1.22) for underweight and 1.34 (95% CI 1.30-1.39) for obese women compared with normal weight women. Prenatal care at the inadequate or intermediate levels was associated with insufficient weight gain (OR: 1.32, 95% CI 1.27-1.38; OR: 1.15, 95% CI 1.09-1.21, respectively) compared with adequate prenatal care. Women with inadequate care were less likely to gain excessive weight (OR: 0.88, 95% CI 0.86-0.91). Conclusions: Whereas prenatal care was effective for preventing insufficient weight gain regardless of prepregnancy body size, educational background, and racial/ethnic group, there were no indications that adequate prenatal care was associated with reduced risk for excessive gestational weight gain. Further research is needed to improve prenatal care programs for preventing excess weight gain.

The Effects of Prenatal Care Utilization on Maternal Health and Health Behaviors

“…Further subsample analysis (not shown) indicates that sufficiency on the number of care visits also appears to make a difference in the maternal prenatal and postnatal health outcomes. 15 For instance, according to the statistics of the Pregnancy 14 This finding is line with a recent study by Yeo et al (2016). Column 1 shows that second-trimester and third-trimester care onset increase the risk of insufficient gestational weight gain by 0.8 and 2.8 percentage points (on the base of 0.22), respectively.…”

“…The heterogeneous effects may be partly attributable to the cross-state difference in the quality of prenatal care. 15 For instance, according to the statistics of the Pregnancy 14 This finding is line with a recent study by Yeo et al (2016). But their study neither controls for mother unobserved heterogeneity nor examines any maternal outcome other than weight gain.…”

Excessive Gestational Weight Gain

“…An adequate number of standard prenatal care visits is associated with improved prenatal outcomes but has not been shown to alone help prevent excessive GWG. A retrospective review of 197,354 women with singleton pregnancies, controlling for body size, sociodemographic factors, and birth weight, revealed that women who received adequate standard prenatal care did not have a reduced risk of excessive GWG compared with women who received inadequate prenatal care . The adequacy of prenatal care used by a woman was quantified by looking at when prenatal care began, as well as the number of prenatal care visits received compared with the American College of Obstetricians and Gynecologists (ACOG) recommendations for prenatal care, and was adjusted for gestational age at birth.…”

The contribution of prenatal maternal factors to maternal gestational weight gain

“…Herring et al have demonstrated that behavioral intervention (empirically-supported behavior change goals, interactive self-monitoring text messages, biweekly health coach calls, and skills training and support through Facebook) by utility of technology platforms (text messaging, Internet, Facebook, interactive voice response) promoted weight control during pregnancy and resulted in lower prevalence of excessive GWG (Herring et al, 2016). Furthermore, there is evidence indicating that antenatal nutritional education on obstetric population and prenatal care are effective in preventing insufficient weight gain and its subsequent complications among undernourished women (Ota, Tobe-Gai, Mori, & Farrar, 2012;Yeo, Crandell, & Jones-Vessey, 2016). …”