Maternal overweight and obesity: a survey of clinicians’ characteristics and attitudes, and their responses to their pregnant clients

Abstract

BackgroundStatewide (Queensland) Clinical Guidelines reflecting current best practice have recently become available for the management of pregnancy-related obesity. Our aim was to assess staff knowledge about, adherence to, and characteristics that influence delivery of care according to these Guidelines.MethodsAn online survey, available over a three week period (May-June 2011), was disseminated to obstetric, midwifery and allied health staff working in a tertiary maternity hospital. Outcomes included knowledge of guideline content, advice given, knowledge of obesity pregnancy-related complications, previous training, referral patterns, and staff characteristics, including lifestyle habits, body satisfaction, and Body Mass Index (BMI).ResultsSeventy-three staff completed surveys (59.6% response rate). Mean self-reported BMI was 24.2 ± 4.1 kg/m2 (17.9-36.4); 28.5% of staff were overweight (19%) or obese (9.5%), and 27.4% were underweight. However, 28.6%, 2.4%, and 1.2% ‘self-classified’ themselves as overweight, obese, and underweight, respectively. Almost 40% were dissatisfied/extremely dissatisfied with their weight. While the majority reported overweight/obesity (ow/ob) as an important/very important general obstetric issue and most correctly identified associated perinatal complications, only 32.1% were aware of existing guidelines, with only half correctly identifying BMI categories for ow/ob. A quarter indicated they did not provide women with gestational weight gain (GWG) advice relative to BMI category. Staff identified they would like more training in the area of supporting women to achieve and understand the need for healthy GWG. Staff role was significantly associated with guideline adherence (p=0.03) and association with BMI category approached significance (p=0.07). An association was observed between staff’s BMI and their belief in the influence of their advice on women’s GWG (p=0.013) and weight satisfaction and belief in women having the resources to make the changes they recommend (p=0.003).ConclusionsWhilst lack of guideline knowledge provides a barrier to best-practice care, our findings suggest an interplay between staff confidence and personal characteristics in delivering such care which deserves recognition in staff education and training, and service development programs and future research.

Excessive gestational weight gain and gestational diabetes: importance of the first weeks of pregnancy

“…In addition, it has been shown that women reported not being advised on how much weight to gain during pregnancy. Moreover, studies have shown that a large proportion of clinicians lack knowledge about GWG guidelines [13], suggesting that even if women can be reached before entering a pregnancy or in the first weeks of their pregnancy, clinicians need to pay more attention to appropriate weight gain during pregnancy.…”

Weight-related risk perception among healthy and overweight pregnant women: a cross-sectional study

“…However, consistent with previous research, it appears that this may not be the case. 29,30,31 A number of surveys have identified that fewer than half of the healthcare providers frequently discuss risks associated with women about being above a healthy weight in pregnancy. 29,30,31 These results support previous studies suggesting that health professionals should highlight the increased risk associated with being overweight before pregnancy and gaining excess weight.…”

“…29,30,31 A number of surveys have identified that fewer than half of the healthcare providers frequently discuss risks associated with women about being above a healthy weight in pregnancy. 29,30,31 These results support previous studies suggesting that health professionals should highlight the increased risk associated with being overweight before pregnancy and gaining excess weight. 15,16,29,32 Although this is an important step, explicitly linking behavior and susceptibility to these risk is required to ensure that women recognize their personal vulnerability to these risks.…”

Weight Management in Pregnancy

“…4 These represented an update from the guidelines previously issued almost 20 years earlier in 1990. 10 A full 25% reported that they gave no advice on GWG to patients relative to patient's BMI. In addition, data from studies performed 15 or even as few as 10 years ago were derived from a population that had much lower rates of obesity than currently exist.…”