Health-care providers often skipping pregnancy weight gain conversations

UAlberta study reveals surprising lack of adherence to guidelines that address growing concern of gestational weight gain.

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 University of Alberta study.

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

"Only 30 per cent of health-care providers reported discussing nutrition and dietary intake over pregnancy with women."

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," added 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

How important are health-care providers to a women's healthy weight gain during pregnancy?

"We do know that if they help women set an appropriate weight gain goal, women are more likely to gain within the national (or Health Canada) guidelines," said Bell.

Yet the study-carried out by the study's lead author, Jillian Morris, as 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."

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

Survey respondents indicated a myriad of factors that possibly lead to them not implementing guidelines and may contribute to the lack of adherence to the GWG guidelines by women. 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.

"Some of them report that they just don't feel confident they have the skills or time to help women change the ways they eat that contribute to weight gain in pregnancy."

This could be behind 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 added.

Help for health-care providers

"Health-care providers in our study asked for more resources to learn how to talk about weight gain in short and concise ways with women," said Bell.

In response, Bell's research team and Alberta Health Services have partnered to develop 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, noted 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 pointed out that 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 related to health system factors that allow midwives more time for focusing on a woman's lifestyle, while other health-care providers don't have as much time allocated to this in a typical prenatal visit.

"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.