Table 2 Counselling topics addressed by midwives, obstetricians and family physicians regarding GWG

Gestational Weight Gain Targets

➢ Counselled underweight and overweight women on specific GWG targets.

➢ Provided detailed counselling to women with inadequate or excess GWG.

➢ Counselled those with elevated BMI on aiming for little to no weight gain

➢ MW explained how GWG is distributed over the body during pregnancy.

➢ FPs discussed the amount of GWG to expect on a weekly basis per trimester.

“I don’t concentrate much on the women who are normal to start off with. But for underweight and overweight, especially my obese population, which we do have a lot, I definitely talk about what the ideal weight gain is and I go with the Institute of Medicine guidelines actually.” – O4

Nutritional Counselling

➢ Counselled clients to maintain a balanced diet.

➢ Did not provide counselling on caloric requirements.

➢ Gave general counselling on serving sizes.

➢ MWs asked for dietary intake record for 3 days which they then used to provide advice on adjusting diet to meet target GWG goals.

➢ OBs and FPs recommended patients be thoughtful about what they ate, required nutrients for pregnancy and nutritional safety.

“You do need increases in specific nutrients, so you want to be careful about watching and making sure you’re getting enough protein, you’re getting enough iron, you’re getting enough, so you’re taking your vitamins and you’re being thoughtful about what you’re eating.” – O2

Exercise counselling

➢ Discussed the importance of regular exercise, dispelled the notion that pregnancy is a time to slow down their physical activity.

➢ OBs and FPs recommended continuing exercise done prior to pregnancy but avoiding starting new exercise activities.

➢ OBs and FPs advised which activities were safe during pregnancy. Most reported not providing specific strategies for getting physical activity.

➢ MWs reported providing specific strategies for staying active. Then would check in at a later visit to review exercise habits.

“My basic line for that is to not to start doing anything rigorous, but to continue doing what you’re doing.” – FP6

“I’ll try to strategize some simple things, let’s say, you know, just small things like if they sit at a desk job all day to suggest like, over your lunch hour get some fresh air and just take a walk around.” – M3

Adverse maternal and neonatal outcomes

➢ Counselled only those women considered high risk regarding adverse maternal and neonatal outcomes associated with inappropriate GWG.

➢ Counselled about risks only if the patient had inappropriate GWG.

➢ MWs counselled those with excess GWG on increased risk for large babies.

➢ OBs & FPs counseled on the inter-related nature of obesity, gestational diabetes, gestational hypertension, macrosomia and mode of delivery.

➢ OBs counselled those with inadequate weight gain on risk of pre-term birth.

“I don’t think for the average-risk woman that I talk a lot about pre-term births or underweight babies or macrosomia… I mean we’re generally talking about how all of those issues for women in the higher weight categories are inter-related, right; their risk of high blood pressure, their risk of diabetes that impact on size of baby, impact on mode of delivery, they’re all connected.” – O2

Gestational diabetes (GDM)

➢ Discussed GDM, generally in response to excess GWG.

➢ Recommeded GDM screening earlier if concerned it was contributing to excess GWG.

➢ MWs discussed strategies for maintaining blood sugar levels.

➢ OBs & FPs referred women with GDM or a high risk of developing it to a dietician.

“I talk about them not wanting to have their blood sugars go sky high and then drop down. So, I talk about, you know, eating five smaller meals in a day.” – M2

“Somebody who has GDM, I may explicitly get them to do some more detailed counselling.” – FP1