title: Perspectives about and approaches to weight gain in pregnancy: a qualitative study of physicians and nurse midwives.
abstract: BACKGROUND
  Over one third of reproductive age women in the US are obese. Pregnancy is a strong risk factor for obesity, with excess weight gain as the greatest predictor of long term obesity. The majority of pregnant women gain more weight than recommended by the Institute of Medicine guidelines. The objective of this study was to understand prenatal care providers' perspectives on weight gain during pregnancy.
  
  
  METHODS
  Semi-structured qualitative interviews of 10 prenatal care providers (three family physicians, three obstetricians, and four nurse midwives) at a University Hospital in the Midwest, that included the ranking of important prenatal issues, and open-ended questions addressing: 1) general perceptions; 2) approach with patients; and 3) clinical care challenges.
  
  
  RESULTS
  Providers felt that appropriate weight gain during pregnancy was not a high priority. Many providers waited until patients had gained excess weight before addressing the issue, were not familiar with established guidelines, and lacked resources for patients. Providers also believed that their counseling had low impact on patients, avoided counseling due to sensitivity of the topic, and believed that patients were more influenced by other factors, such as their family, habits, and culture.
  
  
  CONCLUSIONS
  Both providers and patients may benefit from increased awareness of the morbidity of excess weight gain during pregnancy. Practice-level policies that support the monitoring and management of weight gain during pregnancy could also improve care. Research that further investigates the barriers to appropriate weight gain is warranted.
authors: Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA. tachang@med.umich.edu
authors: Tammy
authors: T
authors: Chang
authors: Mikel
authors: M
authors: Llanes
authors: Katherine J
authors: KJ
authors: Gold
authors: Michael D
authors: MD
authors: Fetters
mesh_terms: D001291:Attitude of Health Personnel; D037001:Directive Counseling; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009721:Nurse Midwives; D009765:Obesity / Q000209:etiology* / Q000517:prevention & control; D009774:Obstetrics; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care; D014481:United States; D015430:Weight Gain