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Table 2 Outcomes in whole study sample

From: Documentation of guideline adherence in antenatal records across maternal weight categories: a chart review

Variable Number and proportion (%) of study sample Number and proportion (%) for normal weight (BMI = 18.5-24.9) Number and proportion (%) for overweight (BMI = 25.0-29.9 kg/m2) Number and proportion (%) for obese (BMI ≥ 30 kg/m2) P value
  N = 3001 N = 126 N = 79 N = 82 N/A
Pre-pregnancy BMI recorded in chart 2 159 (53.0%) 71 (56.3%) 42 (53.2%) 39 (47.6%) 0.71
Weight recorded at antenatal visits      0.88
 Always 277 (92.3%) 115 (91.3%) 74 (93.7%) 77 (93.9%)
 Never 4 (1.3%) 1 (0.8%) 0 (0.0%) 1 (1.2%)
 Sometimes 19 (6.3%) 10 (7.9%) 5 (6.3%) 4 (4.9%)
Documented recommendation of weight gain 2 41 (13.7%) 20 (13.7%) 7 (8.9%) 14 (17.1%) 0.26
Obesity correctly identified a risk factor 8 76/82 (92.7%) 0 (0.0%) 4 (5.1%) 76 (92.7%) N/A
Papanicolaou test      0.87
 Documented within last year 197 (65.7%) 84 (66.7%) 53 (67.1%) 52 (63.4%)
 Documented greater than 1 year ago 28 (9.3%) 10 (7.9%) 6 (7.6%) 11 (13.4%)
 Not documented anywhere in chart 54 (18.0%) 24 (19.0%) 14 (17.7%) 13 (15.9%)
 Date not legible 21 (7.0%) 8 (6.3%) 6 (7.6%) 6 (7.3%)
Gonorrhea and chlamydia tests      0.67
 Documented as swabbed 162 (54.0%) 70 (55.6%) 44 (55.7%) 42 (51.2%)
 Documented as not swabbed 6 (2.0%) 4 (3.2%) 0 (0.0%) 2 (2.4%)
 Not documented anywhere in chart 131 (43.7%) 51 (40.5%) 35 (44.3%) 38 (46.3%)
 Not legible 1 (0.3%) 1 (0.8%) 0 (0.0%) 0 (0.0%)
Prenatal genetic screening 3      0.37
 Documented accepted5 153 (51.0%) 68 (54.0%) 32 (40.5%) 46 (56.1%)
 Documented declined or too late for tests 90 (30.0%) 35 (27.8%) 31 (39.2%) 21 (25.6%)
 No results or offer documented anywhere in chart 35 (11.7%) 13 (10.3%) 10 (12.7%) 11 (13.4%)
 Unclear (documented as both accepted and declined or too late4) 22 (7.3%) 10 (7.9%) 6 (7.6%) 4 (4.9%)
First ultrasound scan      
 Documented in first trimester 212 (70.7%) 89 (70.6%) 54 (68.3%) 60 (73.2%) 0.09
Second trimester 18–22 week ultrasound scan for anatomy 2 255 (85%) 109 (86.5%) 69 (87.3%) 65 (79.3%) 0.27
 No ultrasounds documented anywhere in chart 8 (2.7%) 5 (4.0%) 0 (0.0%) 2 (2.4%)
 Unclear (dates not legible or discrepant documentation5) 1 (0.3%) 1 (0.8%) 0 (0.0%) 0 (0.0%)
Gestational diabetes testing 2 (Glucose challenge test and/or Glucose tolerance test)      0.09
 Documented as completed 207 (69.0%) 90 (71.4%) 60 (75.9%) 51 (62.2%)
 Documented as not completed 28 (9.3%) 15 (11.9%) 6 (7.6%) 6 (7.3%)
 Not documented anywhere in chart 65 (21.7%) 21 (16.7%) 13 (16.5%) 25 (30.5%)
Group B streptococcus screening      0.05
 Documented as swabbed6 259 (86.3%) 109 (86.5%) 69 (87.3%) 71 (86.6%)
 Documented as not swabbed7 21 (7.0%) 13 (10.3%) 6 (7.6%) 2 (2.4%)
 Not documented anywhere in chart 20 (6.7%) 4 (3.2%) 4 (5.1%) 9 (11.0%)
Primary health care provider during pregnancy      0.01
 Shared antenatal care9 125 (41.7%) 51 (40.5%) 42 (53.2%) 28 (34.1%)
 Exclusive care by Obstetrician 121 (40.3%) 46 (36.5%) 24 (30.4%) 45 (54.9%)
 Exclusive care by Midwife 53 (17.7%) 28 (22.2%) 13 (16.5%) 9 (11.0%)
 Exclusive care by Family Physician 1 (0.3%) 1 (0.8%) 0 (0.0%) 0 (0.0%)
Counseling and education topics      
 Discussion of exercise checked off or written in chart2 40 (13.3%) 17 (13.5%) 14 (17.7%) 6 (7.3%) 0.14
 Discussion of preterm labor checked off or written in chart 50 (16.7%) 26 (20.6%) 10 (12.7%) 11 (13.4%) 0.22
 Discussion of fetal movement checked off or written in chart 293 (97.7%) 123 (97.6%) 78 (98.7%) 80 (97.6%) 1.00
 Discussion of prenatal classes checked off or written in chart 41 (13.7%) 20 (15.9%) 12 (15.2%) 7 (8.5%) 0.28
 Discussion of birth plans checked off or written in chart 116 (38.7%) 47 (37.3%) 31 (39.2%) 37 (45.1%) 0.52
 Discussion of pain management checked off or written in chart 32 (10.7%) 15 (11.9%) 6 (7.6%) 8 (9.8%) 0.60
 Discussion of breastfeeding checked off or written in chart 33 (11.0%) 16 (12.7%) 6 (7.6%) 10 (12.2%) 0.50
  1. 1No available BMI or weight for 2/300 women who were excluded from these analyses; 11/300 underweight were excluded from these analyses due to the small number; therefore, total included in these analyses N = 287.
  2. 2Indicates a recommendation within the obesity guidelines, while the remainder of the outcomes are part of standard antenatal care for all women regardless of weight category, as noted on the mandatory antenatal records (with regard to gestational diabetes, the guideline recommends advising obese women that they are at risk for medical complications including gestational diabetes).
  3. 3Integrated prenatal screen (IPS), or maternal serum screen (MSS) or Chorionic villus sampling/amniocentesis for Down Syndrome.
  4. 4Documented as both completed and declined or too late on first page of antenatal record, but no documentation confirming decision elsewhere in chart.
  5. 5Documented as scheduled in visit notes on second page of antenatal record, but no documentation confirming completion elsewhere in chart.
  6. 6“Positive” or “Negative” for Group B streptococcus or “Yes” documented for “Group B streptococcus at 35–37 weeks?” in maternal record.
  7. 7“No” documented for “Group B streptococcus at 35–37 weeks?” in maternal record.
  8. 8Obesity was incorrectly identified as a risk factor in 4/79 overweight women.
  9. 9Any combination of Obstetrician, Maternal-Fetal Medicine, Family Physician, Midwife and/or Nurse Practitioner.
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BMC Pregnancy and Childbirth

ISSN: 1471-2393

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