Providers' Familiarity with Guidelines for Weight Gain During Pregnancy Impacts Counseling and Compliance in Obese Women.

Obesity in women of childbearing age is one of the most common chronic conditions of pregnancy. More than half of U.S. women between the ages of 20 and 39 have a body mass index (BMI) >25 kg/m. Obesity is a significant risk factor for a number of pregnancy complications, including gestational diabetes, preeclampsia, and cesarean delivery. Pregnancy provides an opportunity for the obstetrician gynecologist to counsel women on the appropriate weight gain based on prepregnancy BMI. Furthermore, the obstetrician and gynecologist should counsel women on the long-term health benefits of achieving a healthier weight postpartum for those who are overweight or obese. In 2009, the Institute of Medicine (IOM) modified the weight gain recommendation for obese women with a BMI >30 to 11–20 pounds. The recommendations did not differentiate by BMI class which has remained a point of controversy. However, this recommendation was endorsed by the American College of Obstetricians and Gynecologists. Recent data suggest that nearly 50% of all pregnant women gain in excessive of the IOM recommendations and that overweight and obese women are most likely to gain more than the IOM recommendations. This article by Powers and Schulkin from the Research Department of the American College of Obstetricians and Gynecologists examines obstetricians/gynecologists’ knowledge, attitudes, and practices regarding weight gain during pregnancy. The data collected was from a questionnaire sent to practicing obstetriciansgynecologists between 2012 and 2014. After corrections for those practicing obstetrics, the overall response rate was 47%. Fifty percent of respondents agreed that excessive weight gain was a major health concern and *79% indicated that they often or always calculate the BMI and use the BMI to modify their weight gain recommendations. However, more concerning was that nearly 20% of respondents indicated lack of familiarity with the IOM guidelines for weight gain published in 2009. It was encouraging that those who were familiar were more likely to counsel their patient about weight gain during pregnancy often or always compared with those not familiar with the IOM guidelines (93.3% vs. 80.7%; p = 0.006) and that excessive weight gain increases the risk for pregnancy complications (83% vs. 61.5%, p = 0.001). This report confirms a previous publication of a survey of obstetric and family medicine residents that indicated weak provider knowledge of the IOM recommendations. This survey also indicated that there was a perception that private insurance patients compared with Medicaid were more likely to view weight gain recommendations more favorably. Fiftyfive percent were not confident in their ability to impact the patients’ weight gain, but those more confident physicians did exhibit more appropriate practice efforts. The conclusions of the report raise several concerns even though the majority of participants perceived excessive weight gain as a concern for pregnancy complications. However, the fact that nearly 20% of respondents were unfamiliar with the IOM guidelines nearly 4 years beyond the publication in 2009 does not speak well for counseling on the ramification of excessive weight during pregnancy or for postpartum counseling of obese women to achieve a healthier weight between pregnancies and for the benefit of their long-term health. Clearly, there is a need for better provider and patient education on the impact of obesity and excessive weight gain on pregnancy and long-term health. Women who gained excess weight during pregnancy were at two to four times higher risk of being overweight or obese. The more the weight gain the harder it is to lose, and on average, women retain 40% of their pregnancy weight gain at 6 months. The long-term health implications for those women are an increased risk of hyperlipidemia, diabetes, hypertension, cardiovascular disease, and mortality. These educational efforts should also focus on how to improve the confidence of all physicians in obesity and weight gain counseling.