Health-care providers often skip conversations about pregnancy weight gain, study finds

Some health-care providers don't feel they have the skills or the time to coach women about healthy weight during short pre-natal visits

Lesley Young - 01 March 2018

Pregnant women are not getting the advice they need from health-care providers-including family physicians, obstetricians, nurses, nurse practitioners and midwives-about healthy gestational weight gain, according to a new study.

"It was very surprising the extent to which health-care providers reported that they are not routinely implementing national gestational weight gain guidelines put out in 2010," said Rhonda Bell, a nutritional science professor and the study's senior author.

Only 30 per cent of health-care providers reported discussing nutrition and dietary intake during pregnancy with their pregnant patients, she said.

Gestational weight gain that is higher (or lower) than recommended is linked to a range of poor maternal, fetal and childhood outcomes, such as gestational diabetes, emergency caesarean section delivery and high amounts of weight retained after pregnancy for mom, and risks to the baby, including obesity in childhood.

"Evidence is clear that most Canadian women are gaining more weight during pregnancy than is suggested," said Bell.

Health-care providers are women's most trusted source of information during pregnancy, she pointed out. "If women are not getting the right information about healthy weights starting early in pregnancy, they are missing an important cog of support in the challenging journey of gestational weight management."

Having the conversation

Bell said it is known that if health-care providers help women set an appropriate weight gain goal during pregnancy women are more likely to gain within the national (or Health Canada) guidelines..

Yet the study-carried out by the study's lead author, Jillian Morris, an MSc student on Bell's team, showed that this is not happening routinely.

"Only 21 per cent of health-care providers who work with pregnant women from across Canada who were surveyed reported giving women a target weight based on their pre-pregnancy BMI." said Bell.

"Although 76 per cent of respondents noted that they weighed women at each check-up, only 50 per cent of health-care providers reported closing the loop by discussing their current weight with them."

Survey respondents said a myriad of factors possibly lead them to not implement guidelines and may contribute to the lack of adherence by women to the Health Canada guidelines. One such factor is that health-care providers are still learning about the best ways to implement the guidelines within regular prenatal practices.

"One of the biggest predictors of whether health-care providers talked about weight gain with pregnant women was the importance they placed on it," said Bell. "Those who put pregnancy-related weight as a high priority were more likely to discuss it regularly with women. Those who prioritize weight lower say that they may not bring it up in the limited time they have with a patient, especially if there are other medical concerns that they need to address in a short prenatal visit."

Results from the survey also suggest some health-care providers may not talk much about weight gain because they don't feel they have the skills to help women maintain a healthy weight during and after pregnancy, said Bell, noting that counselling people about lifestyle behaviour can be tricky and take time.

This could account for the finding that 70 per cent of the health-care providers made more straightforward recommendations to women, such as taking a prenatal vitamin (70 per cent) and doing physical activity (46 per cent), rather than tackling nutrition (30 per cent), she said.

Help for health-care providers

Since health-care providers in the study asked for more resources to learn how to talk about weight gain in short and concise ways with women, Bell's research team and Alberta Health Services are tackling that.

Together, they are developing online, interactive continuing medical education modules, which will be available in the coming weeks, aimed at helping health-care providers refine their counselling skills related to weight in pregnancy.

These modules pair nicely with other health-care provider tools such as the 5As for Healthy Pregnancy Weight Gain, developed by the Canadian Obesity Network, said Bell.

"Health-care providers can also direct patients to for resources and tools aimed at women and families, including a weight gain tracker that's easy to use."

Bell said this research highlighted differences in some of the ways midwives and other health-care providers work with pregnant women. For example, midwives reported providing more lifestyle counselling in pregnancy than other health-care providers.

This could be because the current health-care system allocates more time in a typical prenatal visit by midwives to focus on a woman's lifestyle, than it does for other health-care providers, said Bell.

"We need to give some thought to how we can optimize the health-care system to allow all practitioners time to talk to patients," added Bell. "There are definitely constraints within the system when it comes to lifestyle discussions, and a new model for Alberta is needed."

The study, which is part of ENRICH-a research program focused on promoting healthy maternal weight in pregnancy-is funded by Alberta Innovates and was published in BMJ Open.