Article

Maternal and Child Health Journal

, Volume 17, Issue 8, pp 1508-1517

A Qualitative Study of Gestational Weight Gain Counseling and Tracking

  • Emily OkenAffiliated withObesity Prevention Program, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute Email author 
  • , Karen SwitkowskiAffiliated withObesity Prevention Program, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care InstituteFriedman School of Nutrition Science and Policy, Tufts University
  • , Sarah PriceAffiliated withObesity Prevention Program, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute
  • , Lauren GuthrieAffiliated withObesity Prevention Program, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute
  • , Elsie M. TaverasAffiliated withObesity Prevention Program, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute
  • , Matthew GillmanAffiliated withObesity Prevention Program, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute
  • , Jonathan FriedesAffiliated withHarvard Vanguard Medical Associates
  • , William CallaghanAffiliated withDivision of Reproductive Health, Centers for Disease Control and Prevention
  • , Patricia DietzAffiliated withDivision of Reproductive Health, Centers for Disease Control and Prevention

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Abstract

Excessive gestational weight gain (GWG) predicts adverse pregnancy outcomes and later obesity risk for both mother and child. Women who receive GWG advice from their obstetric clinicians are more likely to gain the recommended amount, but many clinicians do not counsel their patients on GWG, pointing to the need for new strategies. Electronic medical records (EMRs) are a useful tool for tracking weight and supporting guideline-concordant care, but their use for care related to GWG has not been evaluated. We performed in-depth interviews with 16 obstetric clinicians from a multi-site group practice in Massachusetts that uses an EMR. We recorded, transcribed, coded, and analyzed the interviews using immersion-crystallization. Many respondents believed that GWG had “a lot” of influence on pregnancy and child health outcomes but that their patients did not consider it important. Most indicated that excessive GWG was a big or moderate problem in their practice, and that inadequate GWG was rarely a problem. All used an EMR feature that calculates total GWG at each visit. Many were enthusiastic about additional EMR-based supports, such as a reference for recommended GWG for each patient based on pre-pregnancy body mass index, a “growth chart” to plot actual and recommended GWG, and an alert to identify out-of-range gains, features which many felt would remind them to counsel patients about excessive weight gain. Additional decision support tools within EMRs would be well received by many clinicians and may help improve the frequency and accuracy of GWG tracking and counseling.

Keywords

Gestational weight gain Obstetrics Electronic medical record Counseling