Maternal and Child Health Journal

, Volume 18, Issue 7, pp 1610–1618 | Cite as

US Provider-Reported Diet and Physical Activity Counseling to Pregnant and Non-pregnant Women of Childbearing Age During Preventive Care Visits

  • Ayae YamamotoEmail author
  • Marie C. McCormick
  • Heather H. Burris


Healthy diet, physical activity and appropriate weight gain during pregnancy contribute to healthy birth outcomes. The Institute of Medicine recommends that women receive counseling about diet and exercise during preconception, pregnancy and postpartum periods. We sought to determine how often healthcare providers report counseling women of childbearing age about diet or exercise and if such rates vary by pregnancy, overweight/obesity status or physician specialty. We combined the 2005–2010 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to obtain nationally representative estimates of outpatient preventive care visits for women of child-bearing age (15–44 years). Accounting for survey design, we compared proportions of preventive visits that included diet/exercise counseling for pregnant women versus non-pregnant women and performed multivariable logistic regression models to estimate odds ratios. Providers reported counseling pregnant women about diet/exercise during 17.9 % of preventive care visits compared to 22.6 % of visits for non-pregnant women (P < 0.01, adj. OR 0.8, 95 % CI 0.7, 1.0). Overweight/obese pregnant (vs. non-pregnant) women were significantly less likely to receive diet/exercise counseling (adj. OR 0.7, CI 0.5, 0.9) as were women seen by OB/GYNs versus non-OB/GYNs (adj. OR 0.4, CI 0.3, 0.5). Our findings suggest that provider-reported diet/exercise counseling rates during preventive care visits for women of childbearing age vary by overweight/obesity and pregnancy statuses, as well as by provider specialty. Our data suggest that there may be missed opportunities to provide diet/exercise counseling and that increasing rates of counseling could result in improved maternal and infant health outcomes.


Diet Physical activity Nutrition Counseling Pregnancy Provider practices Physician specialty 



The authors would like to thank the CDC and the participating patients and providers who contributed to NAMCS and NHAMCS. The senior author is funded by the Klarman Scholars Program and by NIH/NIEHS K23-ES022242.


  1. 1.
    Institute of Medicine (IOM), National Research Council (NRC). (Eds.). (2009). Weight gain during pregnancy: Reexamining the guidelines. 2010/07/30 Ed. Washington, DC: The National Academies Press.Google Scholar
  2. 2.
    Evenson, K. R., Savitz, D. A., & Huston, S. L. (2004). Leisure-time physical activity among pregnant women in the US. Paediatric and Perinatal Epidemiology, 18, 400–407.CrossRefPubMedGoogle Scholar
  3. 3.
    Guenther, P. M., Dodd, K. W., Reedy, J., & Krebs-Smith, S. M. (2006). Most Americans eat much less than recommended amounts of fruits and vegetables. Journal of the American Dietetic Association, 106, 1371–1379.CrossRefPubMedGoogle Scholar
  4. 4.
    Serdula, M. K., Gillespie, C., Kettel-Khan, L., Farris, R., Seymour, J., & Denny, C. (2004). Trends in fruit and vegetable consumption among adults in the United States: Behavioral risk factor surveillance system, 1994–2000. American Journal of Public Health, 94, 1014–1018.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Compton, W. M., Conway, K. P., Stinson, F. S., & Grant, B. F. (2006). Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991–1992 and 2001–2002. American Journal of Psychiatry, 163, 2141–2147.CrossRefPubMedGoogle Scholar
  6. 6.
    Gaynes, B. N., Gavin, N., Meltzer-Brody, S., Lohr, K. N., Swinson, T., Gartlehner, G., et al. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Evidence report/technology assessment (Summary), 198, 1–8.Google Scholar
  7. 7.
    Getahun, D., Nath, C., Ananth, C. V., Chavez, M. R., & Smulian, J. C. (2008). Gestational diabetes in the United States: Temporal trends 1989 through 2004. American Journal of Obstetrics and Gynecology, 198(525), e521–e525.Google Scholar
  8. 8.
    Wallis, A. B., Saftlas, A. F., Hsia, J., & Atrash, H. K. (2008). Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987–2004. American Journal of Hypertension, 21, 521–526.CrossRefPubMedGoogle Scholar
  9. 9.
    Chu, S. Y., Kim, S. Y., Schmid, C. H., Dietz, P. M., Callaghan, W. M., Lau, J., et al. (2007). Maternal obesity and risk of cesarean delivery: A meta-analysis. Obesity Reviews, 8, 385–394.CrossRefPubMedGoogle Scholar
  10. 10.
    MacDorman, M. F., Menacker, F., & Declercq, E. (2008). Cesarean birth in the United States: Epidemiology, trends, and outcomes. Clinics in Perinatology, 35, 293–307.CrossRefPubMedGoogle Scholar
  11. 11.
    Menacker, F., Declercq, E., & Macdorman, M. F. (2006). Cesarean delivery: Background, trends, and epidemiology. Seminars in Perinatology, 30, 235–241.CrossRefPubMedGoogle Scholar
  12. 12.
    Martin, J. A., Kung, H. C., Mathews, T. J., Hoyert, D. L., Strobino, D. M., Guyer, B., et al. (2008). Annual summary of vital statistics: 2006. Pediatrics, 121, 788–801.CrossRefPubMedGoogle Scholar
  13. 13.
    Martin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J., Kirmeyer, S., Mathews, T. J., et al. (2009). Births: Final data for 2009. National Vital Statistics Reports, 60, 1–70.Google Scholar
  14. 14.
    Martin, J. A., Osterman, M. J., & Sutton, P. D. (2010). Are preterm births on the decline in the United States? Recent data from the National Vital Statistics System. NCHS Data Brief, 39, 1–8.Google Scholar
  15. 15.
    Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. J., & Flegal, K. M. (2006). Prevalence of overweight and obesity in the United States, 1999–2004. JAMA: The Journal of the American Medical Association, 295, 1549–1555.CrossRefGoogle Scholar
  16. 16.
    Ambulatory Health Care Data. Accessed 4 Dec 2012.
  17. 17.
    (2005). Namcs Micro-Data File Documentation, 2005. Accessed 20 Oct 2012.
  18. 18.
    (2005). Nhamcs Micro-Data File Documentation, 2005. Accessed 4 Nov 2012.
  19. 19.
    (2010). Nhamcs Micro-Data File Documentation, 2010. Accessed 4 Nov 2012.
  20. 20.
    (2010). Namcs Micro-Data File Documentation, 2010. Accessed 5 Nov 2012.
  21. 21.
    Burris, H. H., & Werler, M. M. (2010). U.S. provider reported folic acid or multivitamin ordering for non-pregnant women of childbearing age: Namcs and Nhamcs, 2005–2006. Maternal and Child Health Journal, 15, 352–359.CrossRefGoogle Scholar
  22. 22.
    Kraschnewski, J. L., Sciamanna, C. N., Stuckey, H. L., Chuang, C. H., Lehman, E. B., Hwang, K. O., et al. (2013). A silent response to the obesity epidemic: Decline in US physician weight counseling. Medical Care, 51, 186–192.CrossRefPubMedGoogle Scholar
  23. 23.
    Post, R. E., Mainous, A. G, I. I. I., Gregorie, S. H., Knoll, M. E., Diaz, V. A., & Saxena, S. K. (2011). The influence of physician acknowledgment of patients’ weight status on patient perceptions of overweight and obesity in the United States. Archives of Internal Medicine, 171, 316–321.CrossRefPubMedGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar
  25. 25.
    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.CrossRefPubMedGoogle Scholar
  26. 26.
    Herring, S. J., Platek, D. N., Elliott, P., Riley, L. E., Stuebe, A. M., & Oken, E. (2010). Addressing obesity in pregnancy: What do obstetric providers recommend? Journal of Women’s Health (Larchmt), 19, 65–70.Google Scholar
  27. 27.
    Kotelchuck, M., Kogan, M. D., Alexander, G. R., & Jack, B. W. (1997). The influence of site of care on the content of prenatal care for low-income women. Maternal and Child Health Journal, 1, 25–34.CrossRefPubMedGoogle Scholar
  28. 28.
    McCormick, M. C., Deal, L. W., Devaney, B. L., Chu, D., Moreno, L., & Raykovich, K. T. (2001). The impact on clients of a community-based infant mortality reduction program: The National Healthy Start Program Survey of postpartum women. American Journal of Public Health, 91, 1975–1977.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Health, United States. (2011). With special feature on socioeconomic status and health, 2012. Accessed 4 Dec 2012.
  30. 30.
    (2011). Pregnancy nutrition surveillance: Summary of trends in maternal health indicators by race/ethnicity, 2011. Accessed 15 Dec 2012.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Ayae Yamamoto
    • 1
    • 3
    • 4
    Email author
  • Marie C. McCormick
    • 2
    • 3
  • Heather H. Burris
    • 3
  1. 1.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  2. 2.Department of Social and Behavioral SciencesHarvard School of Public HealthBostonUSA
  3. 3.Department of NeonatologyBeth Israel Deaconess Medical CenterBostonUSA
  4. 4.Kaiser Permanente Southern California Regional OfficePasadenaUSA

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