Maternal and Child Health Journal

, Volume 17, Issue 8, pp 1508–1517 | Cite as

A Qualitative Study of Gestational Weight Gain Counseling and Tracking

  • Emily Oken
  • Karen Switkowski
  • Sarah Price
  • Lauren Guthrie
  • Elsie M. Taveras
  • Matthew Gillman
  • Jonathan Friedes
  • William Callaghan
  • Patricia Dietz


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.


Gestational weight gain Obstetrics Electronic medical record Counseling 


  1. 1.
    Siega-Riz, A. M., Viswanathan, M., Moos, M. K., et al. (2009). A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: Birthweight, fetal growth, and postpartum weight retention. American Journal of Obstetrics and Gynecology, 201(339), e1–e14.PubMedGoogle Scholar
  2. 2.
    Institute of Medicine and National Research Council of the National Academies. (2009). Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: National Academies Press.Google Scholar
  3. 3.
    Chen, A., Feresu, S. A., Fernandez, C., & Rogan, W. J. (2009). Maternal obesity and the risk of infant death in the United States. Epidemiology, 20, 74–81.PubMedCrossRefGoogle Scholar
  4. 4.
    Oken, E., Kleinman, K. P., Belfort, M. B., Hammitt, J. K., Gillman, M. W. (2009). Associations of gestational weight gain with short- and longer-term maternal and child health outcomes. American Journal of Epidemiology 170, 173–180. PMCID: PMC2727269.Google Scholar
  5. 5.
    Oken, E., Rifas-Shiman, S. L., Field, A. E., Frazier, A. L., & Gillman, M. W. (2008). Maternal gestational weight gain and offspring weight in adolescence. Obstetrics and Gynecology, 112, 999–1006.PubMedCrossRefGoogle Scholar
  6. 6.
    Oken, E., Taveras, E. M., Kleinman, K. P., Rich-Edwards, J. W., Gillman, M. W. (2007). Gestational weight gain and child adiposity at age 3 years. American Journal of Obstetrics and Gynecology, 196, 322 e1–322 e8. PMCID: PMC1899090.Google Scholar
  7. 7.
    Stotland, N. E., Haas, J. S., Brawarsky, P., Jackson, R. A., Fuentes-Afflick, E., & Escobar, G. J. (2005). Body mass index, provider advice, and target gestational weight gain. Obstetrics and Gynecology, 105, 633–638.PubMedCrossRefGoogle Scholar
  8. 8.
    Herring SJ, Platek DN, Elliott P, Riley LE, Stuebe AM, Oken E. Addressing obesity in pregnancy: What do obstetric providers recommend? Journal of Womens Health (Larchmt) 2010; 19: 65-70. PMCID: PMC2828196.Google Scholar
  9. 9.
    Power, M. L., Cogswell, M. E., & Schulkin, J. (2009). US obstetrician–gynaecologist’s prevention and management of obesity in pregnancy. Journal of Obstetrics and Gynaecology, 29, 373–377.PubMedCrossRefGoogle Scholar
  10. 10.
    Sorensen, G., Emmons, K., Hunt, M. K., et al. (2003). Model for incorporating social context in health behavior interventions: Applications for cancer prevention for working-class, multiethnic populations. Preventive Medicine, 37, 188–197.PubMedCrossRefGoogle Scholar
  11. 11.
    Borkan, J. (1999). Immersion/crystalization. In B. Crabtree & W. Miller (Eds.), Doing qualitative research (2nd ed., pp. 179–194). Thousand Oaks, CA: Sage Publications.Google Scholar
  12. 12.
    Schedlbauer, A., Prasad, V., Mulvaney, C., et al. (2009). What evidence supports the use of computerized alerts and prompts to improve clinicians’ prescribing behavior? Journal of the American Medical Informatics Association, 16, 531–538.PubMedCrossRefGoogle Scholar
  13. 13.
    George, J., & Bernstein, P. S. (2009). Using electronic medical records to reduce errors and risks in a prenatal network. Current Opinion in Obstetrics and Gynecology, 21, 527–531.PubMedCrossRefGoogle Scholar
  14. 14.
    Shea, S., DuMouchel, W., & Bahamonde, L. (1996). A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. Journal of the American Medical Informatics Association, 3, 399–409.PubMedCrossRefGoogle Scholar
  15. 15.
    Adams, W. G., Mann, A. M., & Bauchner, H. (2003). Use of an electronic medical record improves the quality of urban pediatric primary care. Pediatrics, 111, 626–632.PubMedCrossRefGoogle Scholar
  16. 16.
    Bordowitz, R., Morland, K., & Reich, D. (2007). The use of an electronic medical record to improve documentation and treatment of obesity. Family Medicine, 39, 274–279.PubMedGoogle Scholar
  17. 17.
    Rattay, K. T., Ramakrishnan, M., Atkinson, A., Gilson, M., & Drayton, V. (2009). Use of an electronic medical record system to support primary care recommendations to prevent, identify, and manage childhood obesity. Pediatrics, 123(Suppl 2), S100–S107.PubMedCrossRefGoogle Scholar
  18. 18.
    Schriefer, S. P., Landis, S. E., Turbow, D. J., & Patch, S. C. (2009). Effect of a computerized body mass index prompt on diagnosis and treatment of adult obesity. Family Medicine, 41, 502–507.PubMedGoogle Scholar
  19. 19.
    Arterburn, D. E., Alexander, G. L., Calvi, J., et al. (2010). Body mass index measurement and obesity prevalence in ten U.S. health plans. Clinical Medicine & Research, 8, 126–130.CrossRefGoogle Scholar
  20. 20.
    Flower, K. B., Perrin, E. M., Viadro, C. I., & Ammerman, A. S. (2007). Using body mass index to identify overweight children: Barriers and facilitators in primary care. Ambulatory Pediatrics, 7, 38–44.PubMedCrossRefGoogle Scholar
  21. 21.
    Studney, D. R., Adams, J. B., Gorbach, A., Guenthner, S., Morgan, M. M., & Barnett, G. O. (1977). A computerized prenatal record. Obstetrics & Gynecology, 50, 82–87.Google Scholar
  22. 22.
    Gonzalez, F. A., & Fox, H. E. (1989). The development and implementation of a computerized on-line obstetric record. British Journal of Obstetrics and Gynaecology, 96, 1323–1327.PubMedCrossRefGoogle Scholar
  23. 23.
    Miller, D. W., Jr. (2003). Prenatal care: A strategic first step toward EMR acceptance. Journal of Healthcare Information Management, 17, 47–50.PubMedGoogle Scholar
  24. 24.
    Bradley, J. H., & King, D. E. (1998). Electronic medical records for prenatal patients: Challenges and solutions. MD Computing, 15(316–22), 331.Google Scholar
  25. 25.
    Phelan, S. T. (2008). The prenatal medical record: purpose, organization and the debate of print versus electronic. Obstetrics and gynecology clinics of North America 35, 355–368, vii.Google Scholar
  26. 26.
    Gregory, K. D., Johnson, C. T., Johnson, T. R., & Entman, S. S. (2006). The content of prenatal care. Update 2005. Womens Health Issues, 16, 198–215.PubMedCrossRefGoogle Scholar
  27. 27.
    Metz, J. P., Son, S. J., Winter, R. O., & Chae, S. (2011). Increasing timely and available prenatal studies by electronic health records. Journal of the American Board of Family Medicine, 24, 344–350.PubMedCrossRefGoogle Scholar
  28. 28.
    Eden, K. B., Messina, R., Li, H., Osterweil, P., Henderson, C. R., & Guise, J. M. (2008). Examining the value of electronic health records on labor and delivery. American Journal of Obstetrics & Gynecology, 199, 307 e1–307 e9.CrossRefGoogle Scholar
  29. 29.
    Nielsen, P. E., Thomson, B. A., Jackson, R. B., Kosman, K., & Kiley, K. C. (2000). Standard obstetric record charting system: Evaluation of a new electronic medical record. Obstetrics and Gynecology, 96, 1003–1008.PubMedCrossRefGoogle Scholar
  30. 30.
    Haberman, S., Feldman, J., Merhi, Z. O., Markenson, G., Cohen, W., & Minkoff, H. (2009). Effect of clinical-decision support on documentation compliance in an electronic medical record. Obstetrics and Gynecology, 114, 311–317.PubMedCrossRefGoogle Scholar
  31. 31.
    Haberman, S., Rotas, M., Perlman, K., & Feldman, J. G. (2007). Variations in compliance with documentation using computerized obstetric records. Obstetrics and Gynecology, 110, 141–145.PubMedCrossRefGoogle Scholar
  32. 32.
    Trick, W. E., Linn, E. S., Jones, Z., Caquelin, C., Kee, R., & Morita, J. Y. (2010). Using computer decision support to increase maternal postpartum tetanus, diphtheria, and acellular pertussis vaccination. Obstetrics and Gynecology, 116, 51–57.PubMedCrossRefGoogle Scholar
  33. 33.
    American College of Obstetrics and Gynecology. (2005). ACOG committee opinion. Number 319, October 2005. The role of obstetrician–gynecologist in the assessment and management of obesity. Obstetrics and Gynecology 106, 895–899.Google Scholar
  34. 34.
    Flegal, K. M., Carroll, M. D., Ogden, C. L., & Curtin, L. R. (2010). Prevalence and trends in obesity among US adults, 1999–2008. JAMA: Journal of the American Medical Association, 303, 235–241.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Emily Oken
    • 1
  • Karen Switkowski
    • 1
    • 2
  • Sarah Price
    • 1
  • Lauren Guthrie
    • 1
  • Elsie M. Taveras
    • 1
  • Matthew Gillman
    • 1
  • Jonathan Friedes
    • 3
  • William Callaghan
    • 4
  • Patricia Dietz
    • 4
  1. 1.Obesity Prevention Program, Department of Population MedicineHarvard Medical School and the Harvard Pilgrim Health Care InstituteBostonUSA
  2. 2.Friedman School of Nutrition Science and PolicyTufts UniversityBostonUSA
  3. 3.Harvard Vanguard Medical AssociatesBostonUSA
  4. 4.Division of Reproductive HealthCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations