Maternal characteristics & gestational weight gain

Objectives: The purpose of this study was to examine gestational weight gain (GWG) patterns among a group of racially, ethnically, economically diverse women as it relates to the Institute of Medicine (IOM)/National Academy of Medicine (NAM) Guidelines.

Hypothesis: Body mass index and medical provider type will affect the patterns of gestational weight gain among a group of diverse women.

Methods: This retrospective cross-sectional study from a sample of women (N=4,500) who gave birth between January 1, 2011 and December 31, 2012. There were 1,397 charts of mothers who delivered singleton babies were assessed; 621 cases were randomly selected and 320 met the inclusion criteria. Information on maternal socio-demographic were obtained from the electronic medical record.

Results: The sample skewed towards younger women; approximately 58% were 29 years of age or less. Overall, almost half (43%) of the births were to women who identified themselves as Latina. Over 48% of women received MediCal Insurance, a type of insurance for low income women. Seventy-one women (25%) reported Spanish as their primary language. More Latina women were receiving MediCal (p<0.001), saw a CNM rather than a physician (p<0.001), and were single (p<0.001). Across racial/ethnic categories there were no significant differences in age or weight gain. Almost half of the participants were either overweight or obese pre-pregnant. More than two-thirds of the sample (69.1%) gained weight outside the recommend range. Pre-pregnancy BMI (Fisher’s X2 10.4; p=.03) significantly correlated to GWG within guidelines. The association of having a certified nurse midwife and staying within guidelines demonstrated an interesting trend toward statistical significance (p=.09). There was a trending association among those women who gained weight above the guidelines and cesarean delivery (p=0.07) and those women who gained weight outside the guidelines had babies weighing significantly more at birth (p<0.001).

Conclusion: Women are not adhering to the 2009 IOM/NAM GWG recommendations.