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A Qualitative Study of Gestational Weight Gain Counseling and Tracking

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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.

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Acknowledgments

This project was supported by the Centers for Disease Control and Prevention (200-2010-M-33818), the National Institutes of Health (P30 HL101312, P30 DK092924, K24 HL068041, K24 HD069408), and by the Harvard Pilgrim Health Care Institute.

Conflict of interest

The study authors have no conflicts of interest to report.

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Authors and Affiliations

  1. Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA, 02215, USA

    Emily Oken, Karen Switkowski, Sarah Price, Lauren Guthrie, Elsie M. Taveras & Matthew Gillman

  2. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA

    Karen Switkowski

  3. Harvard Vanguard Medical Associates, Boston, MA, USA

    Jonathan Friedes

  4. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA

    William Callaghan & Patricia Dietz

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  1. Emily Oken
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  2. Karen Switkowski
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  3. Sarah Price
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  4. Lauren Guthrie
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  5. Elsie M. Taveras
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  6. Matthew Gillman
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  7. Jonathan Friedes
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  9. Patricia Dietz
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Correspondence to Emily Oken.

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Oken, E., Switkowski, K., Price, S. et al. A Qualitative Study of Gestational Weight Gain Counseling and Tracking. Matern Child Health J 17, 1508–1517 (2013). https://doi.org/10.1007/s10995-012-1158-9

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  • DOI: https://doi.org/10.1007/s10995-012-1158-9

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