title: Adequacy of Prenatal Care and Gestational Weight Gain.
abstract: BACKGROUND
  The goal of prenatal care is to maximize health outcomes for a woman and her fetus. We examined how prenatal care is associated with meeting the 2009 Institute of Medicine (IOM) guidelines for gestational weight gain.
  
  
  METHODS
  The study used deidentified birth certificate data supplied by the North Carolina State Center for Health Statistics. The sample included 197,354 women (≥18 years) who delivered singleton full-term infants in 2011 and 2012.
  
  
  METHODS
  A generalized multinomial model was used to identify how adequate prenatal care was associated with the odds of gaining excessive or insufficient weight during pregnancy according to the 2009 IOM guidelines. The model adjusted for prepregnancy body size, sociodemographic factors, and birth weight.
  
  
  RESULTS
  A total of 197,354 women (≥18 years) delivered singleton full-term infants. The odds ratio (OR) for excessive weight gain was 2.44 (95% CI 2.37-2.50) in overweight and 2.33 (95% CI 2.27-2.40) in obese women compared with normal weight women. The OR for insufficient weight gain was 1.15 (95% CI 1.09-1.22) for underweight and 1.34 (95% CI 1.30-1.39) for obese women compared with normal weight women. Prenatal care at the inadequate or intermediate levels was associated with insufficient weight gain (OR: 1.32, 95% CI 1.27-1.38; OR: 1.15, 95% CI 1.09-1.21, respectively) compared with adequate prenatal care. Women with inadequate care were less likely to gain excessive weight (OR: 0.88, 95% CI 0.86-0.91).
  
  
  CONCLUSIONS
  Whereas prenatal care was effective for preventing insufficient weight gain regardless of prepregnancy body size, educational background, and racial/ethnic group, there were no indications that adequate prenatal care was associated with reduced risk for excessive gestational weight gain. Further research is needed to improve prenatal care programs for preventing excess weight gain.
authors.affiliation: 1 School of Nursing, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
authors.forename: SeonAe
authors.initials: S
authors.lastname: Yeo
authors.affiliation: 1 School of Nursing, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.|2 Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Crandell
authors.affiliation: 3 North Carolina Department of Health and Human Services , Raleigh, North Carolina.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Jones-Vessey
mesh_terms: D000293:Adolescent; D000328:Adult; D001719:Birth Certificates; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011295:Prenatal Care; D012307:Risk Factors; D012959:Socioeconomic Factors; D013851:Thinness / Q000453:epidemiology; D015430:Weight Gain; D055815:Young Adult