Little Congruence Between Health Care Provider and Patient Perceptions of Counselling on Gestational Weight Gain

Lutsiv, Olha; Bracken, Keyna; Pullenayegum, Eleanor; Sword, Wendy; Taylor, Valerie H.; McDonald, Sarah D.

doi:10.1016/s1701-2163(16)35267-7

Cited by 37 publications

(47 citation statements)

References 15 publications

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“…At a system level include: ensuring liberal access to internet facilities including databases tailored to each particular specialty at point of care (if the barrier consisted of poor access to best evidence), and at a local workplace level of having regular evidence-based rounds and mentors including change mentors, innovators and educators (if the barrier was lack of knowledge) [31]. However, in our study, the issue is unlikely to be one of inadequate knowledge translation concerning the guideline, given that in previous research [32], the same practitioners as those whose charts were included in this study, generally demonstrated awareness of the guideline by recommending the correct amount of weight gain for pregnant women [32]. …”

Section: Discussionmentioning

confidence: 92%

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: 92%

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

“…However, studies have shown mixed results as to effect of provider advice on patient's adherence to GWG goals. 19,40,41 Nationally, there is conflicting data as to whether Hispanic women are more or less likely to have inadequate or excessive GWG than other groups of women 24,25,26,42 and very little information on GWG counseling directed at Spanish-speaking women. Our results suggest a disparity in GWG counseling that Spanish-speaking women receive compared with those who speak English.…”

Section: Discussionmentioning

confidence: 99%

Lost in translation? English- and Spanish-speaking women’s perceptions of gestational weight gain safety, health risks and counseling

2015

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“…In one study, nearly 27 percent of pregnant women reported that they received no GWG advice at all from their obstetrician, and 36 percent reported that they received advice to gain weight outside of the IOM’s recommendations [20]. In a Canadian study, over half of women reported that no discussions about GWG took place with their health care provider [21], while another Canadian-based survey found that 95% of health care providers reported that they did counsel pregnant women on appropriate GWG [22]. Qualitative research on the meaning of quality in prenatal care, however, has shown that Canadian obstetric care providers and patients agree nutrition and weight are important topics for prenatal counseling [23].…”

Section: Introductionmentioning

confidence: 99%

Patient-provider communication about gestational weight gain among nulliparous women: a qualitative study of the views of obstetricians and first-time pregnant women

Duthie

Drew

Flynn

2013

BMC Pregnancy Childbirth

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BackgroundIn 2009 the Institute of Medicine updated its guidelines for weight gain during pregnancy, in part because women of childbearing age now weigh more pre-pregnancy and tend to gain more weight during pregnancy than women did when the previous set of guidelines were released in 1990. Women who begin pregnancy overweight or obese and women who gain weight outside IOM recommendations are at risk for poor maternal and fetal health outcomes. With these concerns in mind, we examined what obstetricians communicate about gestational weight gain to their pregnant patients and how nulliparous patients perceive weight-related counseling from their obstetricians.MethodsWe conducted one-on-one, semi-structured interviews with 19 nulliparous women and 7 obstetricians recruited from a single clinic at a large academic medical center in the United States. Interviews were transcribed verbatim and analyzed inductively using thematic analysis.ResultsWe identified 4 major themes: 1) Discussions about the amount and pace of gestational weight gain: obstetricians reported variation in the frequency and timing of weight-related discussions with patients while most patients said that weight was not emphasized by their obstetricians; 2) The content of communication about nutrition and physical activity: obstetricians said they discuss nutrition and activity with all patients while most patients reported that their obstetrician either discussed these topics in general terms or not at all; 3) Communication about postpartum weight loss: obstetricians said that they do not typically address postpartum weight loss with patients during prenatal visits while patients had concerns about postpartum weight; and 4) Patient feelings about obstetrician advice: most patients said that their obstetrician does not tend to offer “unsolicited advice”, instead offering information in response to patient questions or concerns. Women were divided about whether they desired more advice from their obstetrician on weight gain, nutrition, and activity.ConclusionsOur analysis revealed discrepancies between obstetricians’ and patients’ perceptions of their weight-related clinical interactions. Our findings suggest that there is a missed opportunity to use prenatal visits as opportunities to discuss healthy eating and exercise during pregnancy, the postpartum period, and beyond. Additional research on the design, implementation, and testing of interventions to address prenatal nutrition and physical activity is warranted.

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Little Congruence Between Health Care Provider and Patient Perceptions of Counselling on Gestational Weight Gain

Cited by 37 publications

References 15 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

Lost in translation? English- and Spanish-speaking women’s perceptions of gestational weight gain safety, health risks and counseling

Patient-provider communication about gestational weight gain among nulliparous women: a qualitative study of the views of obstetricians and first-time pregnant women

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