Obesity among reproductive age women is a prevalent, debilitating, and expensive public health problem. Obesity is associated with serious physical, psychological and social problems including cardiovascular disease, lower quality of life, and stigma [1–4]. Despite over a decade of focus, overall rates of obesity among reproductive age women in the US remain high, with between a quarter and a third of women age 20–44 categorized as obese [5, 6].
Pregnancy is a time of expected weight gain. However, the majority of US women gain more than the recommended weight per Institute of Medicine guidelines [7, 8]. In fact, pregnancy itself is a strong risk factor for future obesity, with excess weight gain during pregnancy as the greatest predictor of long term obesity [9–11].
Excess weight gain during pregnancy is associated with serious short and long-term consequences for both mothers and their infants. Risks of excess maternal weight gain to infants include low five- minute APGAR score, seizure, hypoglycemia, hyperbilirubinemia, polycythemia, meconium aspiration syndrome, macrosomia, and childhood overweight [12–14]. Perinatal complications such as miscarriage, Caesarean section, development of diabetes mellitus, pregnancy-induced hypertension, as well postpartum weight retention and overweight are among the adverse consequences of excess weight gain during pregnancy for mothers [10, 15, 16].
In general, weight management during pregnancy has not been emphasized in the prenatal care of patients. One cross-sectional study of Canadian patients of midwives, family physicians, and obstetricians showed very low rates (5.7%-16.3%) of counseling about gestational weight gain by all types of providers . When information is given antenatally regarding weight gain, the advice is typically brief and generally not related to weight management as reported by a recent study in the UK . Interestingly, despite having the highest rates of excessive weight gain nationally, white women were the least likely to receive counseling about nutrition during pregnancy in a cohort study of predominantly low-income prenatal patients in the US .
Studies have examined the patient’s perspective of weight gain during pregnancy. These studies show that gestational weight gain is associated with overall body image , and that the desire to return to prepregnancy weight was a strong motivating factor to control weight gain. In addition, the health and well-being of their unborn baby is often central in women’s decisions about appropriate weight gain , and women’s attitudes about weight gain in pregnancy are embedded in their overall orientation toward pregnancy and their general psychological functioning . Low-income black women in the US had more perceptions encouraging high gestational weight gain than discouraging it . Furthermore, low-income black women did not limit their gestational weight gain, despite knowledge of the risk for weight retention due to their belief that gaining more weight is indicative of a healthy infant .
To better understand the complex problem of excess weight gain during pregnancy, it is vital to understand the perspectives of prenatal care providers as well. The objective of this study was to understand the perceptions, approach, and challenges regarding management of weight gain during pregnancy among a sample of family physicians, obstetricians, and certified nurse midwives who provide prenatal care.