Lowering Gestational Diabetes Risk by Prenatal Weight Gain Counseling
Figueroa EM, Nitti K, Sladek SM. Lowering Gestational Diabetes Risk by Prenatal Weight Gain Counseling. J Am Board Fam Med. 2020;33(2):189-197.
PURPOSE: Excess weight gain during pregnancy is at epidemic proportions, and pregnancy complications are also on the rise. We sought to determine whether better weight gain counseling of expectant mothers will improve obstetric outcomes.
METHODS: Our historic control study design included 2 years of preintervention data, then 6 months of physician and staff training in prenatal weight gain counseling in accordance with 2009 Institute of Medicine guidelines, and finally, 2 more years of data collection for postintervention outcomes. Seven family medicine residency clinics monitored 1571 continuity prenatal cases. Counseling recommendations were noted and the following outcomes were analyzed: gestational age, birth weight, route of delivery, and the incidences of hypertension and gestational diabetes. Multiple logistic regression was used to control for demographic variables and body mass index at enrollment.
RESULTS: Institute of Medicine congruent counseling increased from 10% to 63% (P < .01). Excess weight gain decreased from 46.4% to 41.5% (adjusted odds ratio [AOR] = 0.85; 95% CI, 0.63-1.16; P = .10). Gestational diabetes decreased significantly from 11.5% to 7.3% (P = .008). The difference remained statistically significant even after adjusting for prepregnancy obesity and other clinical and demographic characteristics (AOR = 0.54; 95% CI, 0.32-0.91; P = .02). Differences in gestational age, birth weight, hypertension, primary cesarean, and shoulder dystocia were not statistically significant.
CONCLUSIONS: Improved weight gain counseling of prenatal patients by physicians did reduce the pregnancy complication of gestational diabetes. This occurred even though the trend toward less excess weight gain was not statistically significant.