Does Healthcare Provider Advice Matter for Gestational Weight Gain?
Authors: Deputy Nicholas P. , Sharma Andrea J. , Kim Shin Y. 
Published: November 2023

BackgroundGestational weight gain(GWG) has important health consequences for mother and child. The American College of Obstetricians & Gynecologists recommends healthcare providers(HP) advise pregnant women to gain within appropriate Institute of Medicine(IOM) GWG ranges, which depend on prepregnancy body mass index (BMI): 28–40 lbs for underweight (BMI < 18.5); 25–35 lbs for normal weight (BMI 18.5–24.9);15–25 lbs for overweight (BMI 25.0–29.9); and 11–20 lbs for obese (BMI ≥ 30.0)women. Few studies have examined whether HP GWG advice influences women's actual GWG.ObjectiveTo examine the association between HP GWG advice and women's GWG below, within, or above recommendations.MethodsData are from 4states participating in the 2010–11 Pregnancy Risk Assessment Monitoring System(PRAMS), a multi‐state surveillance system linking birth certificate to questionnaire data completed 4 months postpartum. HP GWG advice and prepregnancy BMI were obtained from the PRAMS questionnaire and GWG from the birth certificate. We examined women with no diabetic or hypertensive disease who delivered full‐term (37–42 weeks), singleton infants (unweighted n=5,756). Women were asked if they received HP GWG advice; if yes, they reported the GWG range (start and end values) advised by the HP. Using women's BMI‐specific, IOM GWG recommendation, we categorized HP GWG advised range as: 1) started and ended below the IOM recommendation; 2) started below and ended within; 3) started within and ended within (i.e. IOM‐consistent);4) started within and ended above; 5) started above and ended above; 6) started below and ended above; 7) did not remember range; or 8) received no HP GWG advice. We used multivariable, polytomous logistic regression to estimate the association between HP GWG advice and women's actual GWG below or above, compared to within, recommendations.ResultsOverall, 24%of women reported receiving IOM‐consistent HP GWG advice, of which 46% gained within recommendations. Conversely, 63% received no or inconsistent advice and 13% did not remember advice; of these, 29% gained within recommendations. Compared to women who received IOM‐consistent GWG advice (referent, category 3), women who received advice that started below recommendations (categories 1 & 2) had increased odds of GWG below recommendations (adjusted odds ratio (OR) range= 2.0–2.8, 95%Confidence Interval (CI) range=1.4–5.2); women who received advice that ended above recommendations (categories 4 & 5) had increased odds of GWG above recommendations (OR range=1.9–2.1, 95% CI range=1.04–4.3). Women who received no advice or did not remember advised range (categories 7 & 8) had increased odds of GWG below(OR range=2.1–2.7, 95% CI range=1.5–4.1) and above recommendations (OR range=1.8–1.9, 95% CI range= 1.3–2.8). Women who received advice that started below and ended above recommendations (category6) had non‐statistically significant increased odds of GWG below or above recommendations.ConclusionsProviding IOM‐consistent advice may help women achieve GWG within recommendations, but few women reported receiving this advice. Initiativesare needed to ensure HPs advise women on IOM‐consistent recommendations.Support or Funding InformationNPD supported by NIH training grant T32‐DK007734 and appointment to the Research Participation Program at CDC administered by the Oak Ridge Institute for Science Education through an interagency agreement between the U.S. DOE and the CDC.