perspectives about and approaches to weight gain in pregnancy a qualitative study of physicians and nurse midwives观点和方法到孕期体重增加的医生和护士助产士的定性研究.pdfVIP

Chang et al. BMC Pregnancy and Childbirth 2013, 13:47 /1471-2393/13/47 RESEARCH ARTICLE Open Access Perspectives about and approaches to weight gain in pregnancy: a qualitative study of physicians and nurse midwives Tammy Chang 1,2*, Mikel Llanes1,4, Katherine J Gold1,3 and Michael D Fetters1,5 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 als