title: US provider-reported diet and physical activity counseling to pregnant and non-pregnant women of childbearing age during preventive care visits.
abstract: Healthy diet, physical activity and appropriate weight gain during pregnancy contribute to healthy birth outcomes. The Institute of Medicine recommends that women receive counseling about diet and exercise during preconception, pregnancy and postpartum periods. We sought to determine how often healthcare providers report counseling women of childbearing age about diet or exercise and if such rates vary by pregnancy, overweight/obesity status or physician specialty. We combined the 2005-2010 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to obtain nationally representative estimates of outpatient preventive care visits for women of child-bearing age (15-44 years). Accounting for survey design, we compared proportions of preventive visits that included diet/exercise counseling for pregnant women versus non-pregnant women and performed multivariable logistic regression models to estimate odds ratios. Providers reported counseling pregnant women about diet/exercise during 17.9 % of preventive care visits compared to 22.6 % of visits for non-pregnant women (P < 0.01, adj. OR 0.8, 95 % CI 0.7, 1.0). Overweight/obese pregnant (vs. non-pregnant) women were significantly less likely to receive diet/exercise counseling (adj. OR 0.7, CI 0.5, 0.9) as were women seen by OB/GYNs versus non-OB/GYNs (adj. OR 0.4, CI 0.3, 0.5). Our findings suggest that provider-reported diet/exercise counseling rates during preventive care visits for women of childbearing age vary by overweight/obesity and pregnancy statuses, as well as by provider specialty. Our data suggest that there may be missed opportunities to provide diet/exercise counseling and that increasing rates of counseling could result in improved maternal and infant health outcomes.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, ayamamot@post.harvard.edu.
authors.forename: Ayae
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Marie C
authors.initials: MC
authors.lastname: McCormick
authors.forename: Heather H
authors.initials: HH
authors.lastname: Burris
mesh_terms: D000328:Adult; D003376:Counseling; D004032:Diet; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D006293:Health Promotion; D006801:Humans; D008427:Maternal Health Services; D009043:Motor Activity; D011247:Pregnancy; D011314:Preventive Health Services; D014481:United States; D055815:Young Adult