Gestational Weight Gain and Obesity Counseling at the Initial Prenatal Visit [17K]

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Excess weight gain in pregnancy is associated with maternal and neonatal morbidity. Although the Institute of Medicine (IOM) issued revised guidelines in 2009 for weight gain in pregnancy, it is uncertain whether obstetric providers are discussing weight, and if these conversations adhere to these guidelines. We aim to describe the frequency of these discussions and adherence to IOM guidelines during first prenatal visits.


Data for this analysis came from a larger study involving audio-recorded initial prenatal visits and post-visit patient questionnaires assessing patients' recall of their encounters. Transcripts from a random sampling of 100 visits were qualitatively coded for weight discussions. Descriptive statistics were used to characterize the sample and frequency of weight discussions. Chi square tests examined associations between discussion occurrence and patient or provider characteristics.


The mean BMI among our sample was 28.6 kg/m2±7.2 (39% obese). Gestational weight discussions were infrequent (26%), with 62% providing specific recommendations; 56% of recommendations were consistent with IOM guidelines. On post-visit questionnaires, 46% of patients reported concern regarding weight, 44% recalled discussing weight, and 65% reported a desire to discuss weight gain recommendations. Patients interested in discussing weight were more likely to have this discussion (P=.015). Providers were not more likely to discuss weight with obese women (P=.166).


Discussions regarding gestational weight gain are infrequent and often do not adhere to IOM guidelines. Providers should become more familiar with recommendations regarding gestational weight gain in order to provide appropriate and meaningful patient counseling.

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