A qualitative study of gestational weight gain counseling and tracking.
Excessive gestational weight gain (GWG) predicts adverse pregnancy outcomes and later obesity risk for both mother and child. Women who receive GWG advice from their obstetric clinicians are more likely to gain the recommended amount, but many clinicians do not counsel their patients on GWG, pointing to the need for new strategies. Electronic medical records (EMRs) are a useful tool for tracking weight and supporting guideline-concordant care, but their use for care related to GWG has not been evaluated. We performed in-depth interviews with 16 obstetric clinicians from a multi-site group practice in Massachusetts that uses an EMR. We recorded, transcribed, coded, and analyzed the interviews using immersion-crystallization. Many respondents believed that GWG had "a lot" of influence on pregnancy and child health outcomes but that their patients did not consider it important. Most indicated that excessive GWG was a big or moderate problem in their practice, and that inadequate GWG was rarely a problem. All used an EMR feature that calculates total GWG at each visit. Many were enthusiastic about additional EMR-based supports, such as a reference for recommended GWG for each patient based on pre-pregnancy body mass index, a "growth chart" to plot actual and recommended GWG, and an alert to identify out-of-range gains, features which many felt would remind them to counsel patients about excessive weight gain. Additional decision support tools within EMRs would be well received by many clinicians and may help improve the frequency and accuracy of GWG tracking and counseling.
Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA, 02215, USA, Emily_Oken@harvardpilgrim.org.
Emily
E
Oken
Karen
K
Switkowski
Sarah
S
Price
Lauren
L
Guthrie
Elsie M
EM
Taveras
Matthew
M
Gillman
Jonathan
J
Friedes
William
W
Callaghan
Patricia
P
Dietz
D000328:Adult; D015992:Body Mass Index; D002648:Child; D003376:Counseling; D004282:Documentation / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008404:Massachusetts; D008875:Middle Aged; D009035:Mothers; D009765:Obesity / Q000517:prevention & control*; D009774:Obstetrics; D010820:Physicians; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods; D036301:Qualitative Research; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015430:Weight Gain