Inadequate and excessive gestational weight gain (GWG) is associated with adverse health outcomes for mother and child. Health care providers are well positioned to help women achieve appropriate GWG. This systematic review examined associations between women's report of provider advice on GWG and women's compliance with the Institute of Medicine (IOM) GWG guidelines.
Materials and Methods:
In March 2019, PubMed, EMBASE, and Cochrane CENTRAL databases were searched. Observational studies were eligible if published from 1990 to 2019, described provider advice on GWG, and determined whether women's target or actual GWG was consistent with the 1990 or 2009 IOM guidelines. Heterogeneity across studies precluded the use of meta-analytic methods.
Results:
Seventeen cross-sectional and cohort studies of poor to good quality, representing 20,717 women were included. Approximately 69% of women reported provider advice on GWG during pregnancy; however, only 50% reported provider advice consistent with IOM guidelines. Eleven studies found that provider advice on GWG was significantly associated with women's compliance with IOM guidelines, and six studies found no association.
Conclusions
: While a high percentage of women report provider advice on GWG, accuracy of reported advice is less than optimal. The evidence examining associations of provider advice and women's compliance with guidelines is mixed and limited by methodological concerns. Future studies using more robust methods in diverse populations are needed to confirm the role of provider advice in optimizing GWG. Intervention studies are also necessary to increase the proportion of providers who accurately counsel their patients on appropriate GWG to improve health outcomes.
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References
1.
Institute of Medicine: Committee on Nutritional Status During Pregnancy and Lactation. Nutrition During Pregnancy:. Part I: Weight Gain, Part II: Nutrient Supplements. Washington, DC: National Academies Press, 1990.
2.
Institute of Medicine and National Research Council. Weight gain during pregnancy: Reexamining the guidelines. Washington DC: National Academies Press, 2009.
3.
GoldsteinRF, AbellSK, RanasinhaS, et al.Association of gestational weight gain with maternal and infant outcomes: A systematic review and meta-analysis. JAMA, 2017; 317:2207–2225.
4.
XuZ, WenZ, ZhouY, LiD, LuoZ. Inadequate weight gain in obese women and the risk of small for gestational age (SGA): A systematic review and meta-analysis. J Matern Fetal Neonatal Med, 2017; 30:357–367.
5.
CarrenoCA, CliftonRG, HauthJC, et al.Excessive early gestational weight gain and risk of gestational diabetes mellitus in nulliparous women. Obstet Gynecol, 2012; 119:1227–1233.
6.
GibsonKS, WatersTP, CatalanoPM. Maternal weight gain in women who develop gestational diabetes mellitus. Obstet Gynecol, 2012; 119:560–565.
7.
HeddersonMM, GundersonEP, FerraraA. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol, 2010; 115:597–604.
8.
de la TorreL, FlickAA, IstwanN, et al.The effect of new antepartum weight gain guidelines and prepregnancy body mass index on the development of pregnancy-related hypertension. Am J Perinatol, 2011; 28:285–292.
9.
DeVaderSR, NeeleyHL, MylesTD, LeetTL. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstet Gynecol, 2007; 110:745–751.
10.
KielDW, DodsonEA, ArtalR, BoehmerTK, LeetTL. Gestational weight gain and pregnancy outcomes in obese women: How much is enough?. Obstet Gynecol, 2007; 110:752–758.
11.
StotlandNE, ChengYW, HopkinsLM, CaugheyAB. Gestational weight gain and adverse neonatal outcome among term infants. Obstet Gynecol, 2006; 108 (3 Pt 1):635–643.
12.
VescoKK, SharmaAJ, DietzPM, et al.Newborn size among obese women with weight gain outside the 2009 Institute of Medicine recommendation. Obstet Gynecol, 2011; 117:812–818.
13.
HernandezDC. Gestational weight gain as a predictor of longitudinal body mass index transitions among socioeconomically disadvantaged women. J Womens Health (Larchmt), 2012; 21:1082–1090.
14.
NehringI, SchmollS, BeyerleinA, HaunerH, von KriesR. Gestational weight gain and long-term postpartum weight retention: A meta-analysis. Am J Clin Nutr, 2011; 94:1225–1231.
15.
OlsonCM. Achieving a healthy weight gain during pregnancy. Annu Rev Nutr, 2008; 28:411–423.
16.
DeierleinAL, Siega-RizAM, HerringAH, AdairLS, DanielsJL. Gestational weight gain and predicted changes in offspring anthropometrics between early infancy and 3 years. Pediatr Obes, 2012; 7:134–142.
17.
FraserA, TillingK, Macdonald-WallisC, et al.Association of maternal weight gain in pregnancy with offspring obesity and metabolic and vascular traits in childhood. Circulation, 2010; 121:2557–2564.
18.
OkenE, Rifas-ShimanSL, FieldAE, FrazierAL, GillmanMW. Maternal gestational weight gain and offspring weight in adolescence. Obstet Gynecol, 2008; 112:999–1006.
19.
OkenE, TaverasEM, KleinmanKP, Rich-EdwardsJW, GillmanMW. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol, 2007; 196:322.e1–322.e8.
20.
OlsonCM, StrawdermanMS, DennisonBA. Maternal weight gain during pregnancy and child weight at age 3 years. Matern Child Health J, 2009; 13:839–846.
21.
SimasTA, LiaoX, GarrisonA, SullivanGM, HowardAE, HardyJR. Impact of updated Institute of Medicine guidelines on prepregnancy body mass index categorization, gestational weight gain recommendations, and needed counseling. J Womens Health, 2011; 20:837–844.
22.
American College of Obstetricians and Gynecologists. Committee opinion no. 548: Weight gain during pregnancy. Obstet Gynecol, 2013; 121:210–212.
23.
StreulingI, BeyerleinA, von KriesR. Can gestational weight gain be modified by increasing physical activity and diet counseling? A meta-analysis of interventional trials. Am J Clin Nutr, 2010; 92:678–687.
24.
International Weight Management in Pregnancy Collaborative Group. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: Meta-analysis of individual participant data from randomised trials. BMJ, 2017; 358:j3119.
25.
ThangaratinamS, RogozinskaE, JollyK, et al.Effects of interventions in pregnancy on maternal weight and obstetric outcomes: Meta-analysis of randomised evidence. BMJ, 2012; 344:e2088.
26.
WeeksA, LiuRH, FerraroZM, DeonandanR, AdamoKB. Inconsistent weight communication among prenatal healthcare providers and patients: A narrative review. Obstet Gynecol Surv, 2018; 73:423–432.
27.
MoherD, ShamseerL, ClarkeM, et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev, 2015; 4:1.
28.
ShamseerL, MoherD, ClarkeM, et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ, 2015; 350:g7647.
29.
BramerWM, GiustiniD, de JongeGB, HollandL, BekhuisT. De-duplication of database search results for systematic reviews in EndNote. J Med Libr Assoc, 2016; 104:240–243.
30.
ShiehC, CullenDL, PikeC, PresslerSJ. Intervention strategies for preventing excessive gestational weight gain: Systematic review and meta-analysis. Obes Rev, 2018; 19:1093–1109.
31.
BennettCJ, WalkerRE, BlumfieldML, et al.Interventions designed to reduce excessive gestational weight gain can reduce the incidence of gestational diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials. Diabetes Res Clin Pract, 2018; 141:69–79.
32.
ParkCK, TimmV, NeupaneB, BeyeneJ, SchmidtLA, McDonaldSD. Factors associated with women's plans to gain weight categorized as above or below the national guidelines during pregnancy. J Obstet Gynaecol Can, 2015; 37:225–235.
33.
DeputyNP, SharmaAJ, KimSY, OlsonCK. Achieving appropriate gestational weight gain: The role of healthcare provider advice. J Womens Health (Larchmt), 2018; 27:552–560.
34.
EmeryRL, BennoMT, SalkRH, KolkoRP, LevineMD. Healthcare provider advice on gestational weight gain: Uncovering a need for more effective weight counselling. J Obstet Gynaecol, 2018; 38:916–921.
35.
HerringSJ, NelsonDB, DaveyA, et al.Determinants of excessive gestational weight gain in urban, low-income women. Womens Health Issues, 2012; 22:e439–e446.
36.
LiuJ, WhitakerKM, YuSM, ChaoSM, LuMC. Association of provider advice and pregnancy weight gain in a predominantly hispanic population. Womens Health Issues, 2016; 26:321–328.
37.
WrotniakBH, DenticeS, MarianoK, SalaamEM, CowleyAE, MauroEM. Counseling about weight gain guidelines and subsequent gestational weight gain. J Womens Health (Larchmt), 2015; 24:819–824.
38.
StotlandNE, HaasJS, BrawarskyP, JacksonRA, Fuentes-AfflickE, EscobarGJ. Body mass index, provider advice, and target gestational weight gain. Obstet Gynecol, 2005; 105:633–638.
39.
CogswellME, ScanlonKS, FeinSB, SchieveLA. Medically advised, mother's personal target, and actual weight gain during pregnancy. Obstet Gynecol, 1999; 94:616–622.
40.
Lopez-CeperoA, LeungK, Moore SimasT, RosalMC. Association between obstetric provider's advice and gestational weight gain. Matern Child Health J, 2018; 22:1127–1134.
41.
VinturacheA, WinnA, MannionC, ToughS. Women's recall of health care provider counselling on gestational weight gain (GWG): A prospective, population-based study. BMC Pregnancy Childbirth, 2019; 19:136.
42.
Washington ColeKO, GudzuneKA, BleichSN, et al.Influence of the 5A's counseling strategy on weight gain during pregnancy: An observational study. J Womens Health (Larchmt), 2017; 26:1123–1130.
43.
National Heart Lung and Blood Institute. Study quality assessment tools. National Institutes of Health, 2013. Available at: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools Accessed July1, 2019.
44.
ArinzeNV, KarpSM, GesellSB. Evaluating provider advice and women's beliefs on total weight gain during pregnancy. J Immigr Minor Health, 2016; 18:282–286.
TovarA, GuthrieLB, PlatekD, StuebeA, HerringSJ, OkenE. Modifiable predictors associated with having a gestational weight gain goal. Matern Child Health J, 2011; 15:1119–1126.
47.
Van Der PligtP, CampbellK, TeychenneM, BallK, HeskethK, CrawfordD. Management of maternal weight during pregnancy: Examining the association between provision of antenatal care and gestational weight gain in first time mothers. J Paediatr Child Health, 2014; 50:63.
48.
WhitakerKM, WilcoxS, LiuJ, BlairSN, PateRR. Provider advice and women's intentions to meet weight gain, physical activity, and nutrition guidelines during pregnancy. Matern Child Health J, 2016; 20:2309–2317.
49.
FerrariRM, Siega-RizAM. Provider advice about pregnancy weight gain and adequacy of weight gain. Matern Child Health J, 2013; 17:256–264.
50.
PowerML, SchulkinJ. Obstetrician/Gynecologists' knowledge, attitudes, and practices regarding weight gain during pregnancy. J Womens Health (Larchmt), 2017; 26:1169–1175.
51.
MuktabhantB, LawrieTA, LumbiganonP, LaopaiboonM. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev, 2015; 6:CD007145.
52.
BaileyC, SkouterisH, HarrisonCL, et al.Cost effectiveness of antenatal lifestyle interventions for preventing gestational diabetes and hypertensive disease in pregnancy. Pharmacoecon Open, 2020 [Epub ahead of print]; DOI: 10.1007/s41669-020-00197-9.
53.
DaleyA, JollyK, LewisA, et al.The feasibility and acceptability of regular weighing of pregnant women by community midwives to prevent excessive weight gain: RCT. Pregnancy Hypertens, 2014; 4:233–234.
54.
RoseSA, PoynterPS, AndersonJW, NoarSM, ConigliaroJ. Physician weight loss advice and patient weight loss behavior change: A literature review and meta-analysis of survey data. Int J Obes (Lond), 2013; 37:118–128.
55.
ShinD, ChungH, WeatherspoonL, SongWO. Validity of prepregnancy weight status estimated from self-reported height and weight. Matern Child Health J, 2014; 18:1667–1674.
56.
TomeoCA, Rich-EdwardsJW, MichelsKB, et al.Reproducibility and validity of maternal recall of pregnancy-related events. Epidemiology, 1999; 10:774–777.
57.
Connor GorberS, TremblayM, MoherD, GorberB. A comparison of direct vs. self-report measures for assessing height, weight and body mass index: A systematic review. Obes Rev, 2007; 8:307–326.
58.
GoldsteinRF, AbellSK, RanasinhaS, et al.Gestational weight gain across continents and ethnicity: Systematic review and meta-analysis of maternal and infant outcomes in more than one million women. BMC Med, 2018; 16:153.
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