Provider Adherence to Recommended Prenatal Care Content: Does It Differ for Obese Women?

Abstract

Objective To examine provider adherence to prenatal care (PNC) content in obese and non-obese women and perinatal outcomes in obese women experiencing low and medium versus high adherence to PNC content. Methods Provider adherence to PNC content (low <50%, medium 50–79%, and high ≥80%) was compared between obese (n=69) and non-obese (n=128) women in a linked database of deliveries to low-income, minority women from 2003-2004. Sample content items included procedures delivered at every visit (blood pressure, urinalysis, maternal weight, fetal heart rate check), timed screenings for birth defects and gestational diabetes, prenatal vitamin prescriptions, and depression screening. Weight gain, preterm deliveries, cesareans, and birthweight were compared between obese women with low and medium versus high adherence to PNC content using multivariable logistic regression. Results High provider adherence to an eight-item PNC content score (56.3% vs. 66.5%, p=0.02) and depression screening (2.0% vs. 11.4%, p=0.001) were both lower for obese versus non-obese women. Among obese women, there were no differences by level of provider adherence to PNC content in preterm delivery, cesareans, and low birth weight, but obese women experiencing low and medium versus high adherence were more likely to gain ≥20lbs (aOR 5.5, 95%CI 1.3-23.3). Conclusion Providers may be administering PNC differently to obese and non-obese women. PNC for obese women who are at high risk of adverse perinatal outcomes needs to be addressed especially as it relates to depression screening and gestational weight gain.

Observational Descriptive Study of Clinical Outcomes on Extremely Obese Pregnant, Nulliparous Women Carrying a Single Term Fetus in Vertex Presentation (NTSV)

“…While early screening for obesity is still an incomplete clinical accomplishment [5], obesity itself has had an impact on our nation's health and our social perceptions of acceptability. It has been reported that obstetrical providers may not adhere uniformly to the monitoring of gestational weight gaining and other variables when treating obese and non-obese pregnant women [6]. Many women have expressed their desire for the conversation to focus on the medical issues brought upon during preconception counseling or while they are pregnant [7].…”