A new study from UCSF shows that prenatal health care professionals are concerned about patients’ excessive weight gain during pregnancy but have difficulty providing effective counseling.
Rates of excessive weight gain during pregnancy, which is associated with short- and long-term adverse health outcomes for mothers and children, have increased in the United States according to the researchers. Health care providers agree that weight gain is an important topic to broach with pregnant women, yet the researchers identified inconsistent counseling styles among clinicians as well as barriers preventing doctors and nurses from discussing the issue. Barriers include insufficient training, concern about the sensitivity of the topic and the perception that counseling is ineffective.
Study findings will be reported in the April 2010 issue of the Journal of Women’s Health and are available online this month at http://www.liebertonline.com/doi/pdfplus/10.1089/jwh.2009.1462 .
“Clinicians in the study raised concerns about shaming or stressing pregnant women, and often wait for patients to raise the question of proper weight gain. Many providers — especially physicians — also said they lacked education in weight management issues,” said Naomi E. Stotland, MD, lead author of the study and assistant professor in the UCSF Department of Obstetrics, Gynecology, and Reproductive Sciences.
The Institute of Medicine’s (IOM) guidelines for weight gain during pregnancy are widely accepted by professional medical organizations. However, several providers said they did not proactively share the ranges with patients. Another clinician intentionally advised weight gain above the guidelines to avoid causing the patient anxiety and another thought the IOM weight gain guidelines are too high.
Of more than four million births annually in the United States, nearly 60 percent of mothers begin pregnancy either overweight or obese, so prenatal care may be an opportune time for healthcare providers to help women make positive lifestyle changes in nutrition and physical activity that affect weight, Stotland said.
During pregnancy, perhaps unlike any other time in a woman’s life, most women see a healthcare provider frequently to receive prenatal care. Pregnant women may be especially motivated to make lifestyle changes out of concern for the health of their offspring.
“It is important to identify new tools that will enable clinicians to more easily and effectively counsel pregnant woman so that together they can determine strategies to achieve the healthiest weight for that individual,” Stotland said. “I also would encourage women to initiate the conversation if their doctors are not raising the topic of weight gain.”
“Simple messages from clinicians to patients about nutrition and physical activity during pregnancy have been shown to have an important positive impact on patient behaviors. We encourage clinicians to take this opportunity to improve the health of their patients. Every pregnant woman has the potential to leave pregnancy in better health than when she began pregnancy,” according to Barbara Gerbert, PhD, senior author of the study and professor in the Division of Behavioral Sciences, Professionalism, and Ethics, UCSF School of Dentistry.
The researchers conducted seven focus groups with a total of 52 participants from the San Francisco Bay Area. Obstetrician/gynecologists comprised three groups, and there were two groups each of certified nurse midwives and nurse practitioners.
Other authors include Paul Gilbert, ScM, and Alyssa Bogetz, BS, of the Division of Behavioral Sciences, Professionalism, and Ethics, UCSF School of Dentistry; Cynthia C. Harper, PhD, of the UCSF Department of Obstetrics, Gynecology, and Reproductive Sciences; and Barbara Abrams, PhD, of the Division of Epidemiology, School of Public Health, University of California, Berkeley.
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