Efforts Needed to Provide Institute of Medicine–Recommended Guidelines for Gestational Weight Gain

Simas, Tiffany A. Moore; Curiale, Darrah K. Doyle; Hardy, Janet; Jackson, Sharon D.; Zhang, Yan; Liao, Xun

doi:10.1097/aog.0b013e3181d56e12

Cited by 24 publications

(28 citation statements)

References 26 publications

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“…We are not aware of other studies that examined documentation of adherence to guidelines according to weight category, apart from a single study that examined only gestational weight gain and not the additional outcomes. This study, located in a Massachusetts tertiary care center, found even lower rates (only 4.6%) of documentation of pre-pregnancy BMI in the antenatal records [26]. …”

Section: Discussionmentioning

confidence: 99%

Documentation of guideline adherence in antenatal records across maternal weight categories: a chart review

McDonald

Machold

Marshall

et al. 2014

BMC Pregnancy Childbirth

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BackgroundDocumentation in medical records fulfills key functions, including management of care, communication, quality assurance and record keeping. We sought to describe: 1) rates of standard prenatal care as documented in medical charts, and given the higher risks with excess weight, whether this documentation varied among normal weight, overweight and obese women; and 2) adherence to obesity guidelines for obese women as documented in the chart.MethodsWe conducted a chart review of 300 consecutive charts of women who delivered a live singleton at an academic tertiary centre from January to March 2012, computing Analysis of Variance and Chi Square tests.ResultsThe proportion of completed fields on the mandatory antenatal forms varied from 100% (maternal age) to 52.7% (pre-pregnancy body mass index). Generally, documentation of care was similar across all weight categories for maternal and prenatal genetic screening tests, ranging from 54.0% (documentation of gonorrhea/chlamydia tests) to 85.0% (documentation of anatomy scan). Documentation of education topics varied widely, from fetal movement in almost all charts across all weight categories but discussion of preterm labour in only 20.6%, 12.7% and 13.4% of normal weight, overweight and obese women’s charts (p = 0.224). Across all weight categories, documentation of discussion of exercise, breastfeeding and pain management occurred in less than a fifth of charts.ConclusionDespite a predominance of excess weight in our region, as well as increasing perinatal risks with increasing maternal weight, weight-related issues and other elements of prenatal care were suboptimally documented across all maternal weight categories, despite an obesity guideline.

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Section: Discussionmentioning

confidence: 99%

Documentation of guideline adherence in antenatal records across maternal weight categories: a chart review

McDonald

Machold

Marshall

et al. 2014

BMC Pregnancy Childbirth

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show abstract

“…Height, weight, gestational weight gain, birth weight, and delivery gestational age have been previously validated. 15–17 Data retrieved from the electronic medical record was supplemented by and validated with manual chart abstraction for delivery mode, cervical dilation, and fetal station. The University of Massachusetts Medical School Institutional Review Board approved this study.…”

Section: Methodsmentioning

confidence: 99%

Attempted and Successful Vacuum-Assisted Vaginal Delivery by Prepregnancy Body Mass Index

Ramos

Waring

Leung

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To examine rates of attempted and successful vacuum-assisted vaginal delivery by pre-pregnancy body mass index (BMI). Methods We conducted a retrospective cohort study of 2,084 women with singleton gestations needing operative delivery assistance and vacuum-eligible (fully dilated, ≥ +2 station, ≥34 weeks) using 2006–2014 in-patient records. Pre-pregnancy BMI was categorized as underweight (<18.5kg/m2), normal weight (18.5kg/m2≤BMI<25kg/m2), overweight (25kg/m2≤ BMI<30kg/m2), or obese (≥30kg/m2). Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) of attempted and successful vacuum-assisted vaginal delivery by pre-pregnancy BMI adjusted for age, race, marital status, parity, diabetes, labor induction–augmentation, episiotomy, gestational age, and infant birth weight. Results Thirty-nine percent of women requiring delivery assistance and eligible for a vacuum were overweight or obese, 79% had vacuum attempts, and 95.3% of attempted vacuum-assisted vaginal deliveries were successful. Compared to women who were normal weight pre-pregnancy (82.8%), women who were overweight or obese were less likely to have vacuum attempted (75.8%, OR=0.71, 95% CI 0.53–0.96 and 71.2%, OR=0.53, 95% CI 0.39–0.74, respectively). Among women with attempted vacuum-assisted vaginal delivery, successful delivery did not differ by pre-pregnancy BMI (92.6%, OR=0.54, 95% CI 0.21–1.37 for underweight; 94.5%, OR=1.07, 95% CI 0.57–2.00 for overweight; 96.3%, OR=1.09, 95% CI 0.51–2.33 for obese, versus 95.6% among normal weight women). Conclusions Among women in need of operative delivery assistance, pre-pregnancy obesity was associated with lower likelihood of attempted vacuum-assisted vaginal delivery, but if attempted, success rates were similar to rates among normal weight women. With significant morbidity of second stage cesarean delivery in obese women, research should examine whether vacuum-assisted vaginal delivery may be appropriate for additional obese patients.

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“…(10) However, up to 83% of obese pregnant women exceed these recommendations. (11-13) Given that most women are motivated to have “healthy pregnancies,” gestational weight gain (GWG) is potentially modifiable through behavioral interventions that target physical activity, nutrition, etc. Accordingly, the IOM report stated that interventions will be needed to assist obese women to meet the GWG goals.…”

Section: Introductionmentioning

confidence: 99%

Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers

Kominiarek

Peacock

2015

Matern Child Health J

101

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Objective To investigate perceptions of minority pregnant women and providers about obesity and gestational weight gain (GWG), and to explore strategies to improve management of obesity in pregnancy with an emphasis on group prenatal care. Methods Sixteen primarily non-Hispanic black pregnant women with a body mass index ≥30kg/m2 and 19 prenatal care providers participated in focus groups. Discussion topics included GWG goals, body image, health behaviors, and group prenatal care with additional emphasis on provider training needs. Results Women frequently stated a GWG goal >20lbs. Women described a body image not in line with clinical recommendations (“200 pounds is not that big.”). They avoided the term “obese.” They were interested in learning about nutrition and culturally-acceptable healthy cooking. Women would enjoy massage and exercise in group settings, though definitions of “exercise” varied. Family members could help, but generational differences posed challenges. Most had to “encourage myself” and “do this for me and the baby.” Providers expressed discomfort discussing GWG and difficulty finding the right words for obesity, which was partially attributed to their own weight. They noted the challenges they faced during prenatal care including time constraints, cultural myths, and system issues. Providers considered a group setting with social support an ideal environment to address health behaviors in obese women. Conclusions Culturally-tailored programs that use acceptable terms for obesity, provide education regarding healthy eating and safe exercise, and encourage support from social networks may be effective in addressing GWG in obese minority women. Provider training in communication skills is necessary to address obesity in pregnancy.

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Efforts Needed to Provide Institute of Medicine–Recommended Guidelines for Gestational Weight Gain

Abstract: III.

Cited by 24 publications

References 26 publications

Documentation of guideline adherence in antenatal records across maternal weight categories: a chart review

Documentation of guideline adherence in antenatal records across maternal weight categories: a chart review

Attempted and Successful Vacuum-Assisted Vaginal Delivery by Prepregnancy Body Mass Index

Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers

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