Advice on weight gain during pregnancy found wanting

Only 12% of women in a recent survey reported receiving correct counseling about weight gain during pregnancy, according to the first study since the Institute of Medicine issued new gestational weight gain recommendations in 2009.

The cross-sectional survey, using a self-administered questionnaire, was given to women at prenatal clinics in Ontario, Canada, one of the countries that adopted the IOM guidelines. Of the 310 women (93.6%) who completed the survey, 28.5% said that their healthcare provider had recommended that they gain a specific amount or range of weight, but only 12% reported that they were advised to gain an amount within the 2009 guidelines. Only about 25% of respondents said they were warned about the risks of gaining too much or too little weight during pregnancy. More than half said that weight gain wasn’t discussed at all.

The study was published online May 30 in the American Journal of Obstetrics and Gynecology.

“Although one might have hypothesized that the release of the guidelines would have improved counseling, this was not the case; we report the lowest rates of appropriate counseling in the literature to date,” the researchers write.

They note that in light of the “very high” response rate and “the high proportion (84%) of patients who reported being comfortable or very comfortable discussing weight-related issues with their healthcare provider, it appears unlikely that the lack of counseling is due to patient-driven factors.” They speculate that some providers consider gestational weight gain to be unimportant, “despite clear evidence to the contrary.” Other factors may include lack of time or skills in counseling about gestational weight gain or the attitude of the providers about their own weight.

Seventy-five percent of overweight and obese women surveyed were inadvertently planning to gain more weight than recommended by the 2009 guidelines. “The results of this study point to an urgent need for patient education, potentially in part through a tool to guide women about weight gain,” the authors conclude.