By Anne Harding

NEW YORK (Reuters Health) - Obstetricians can help their pregnant patients avoid putting on too many pounds by taking a few extra minutes at each routine visit to talk about and chart the woman's weight, new research shows.

"It was a very brief and very concise intervention," Dr. Shelly M. Asbee of Lake Norman Ob/Gyn in Mooresville, North Carolina, told Reuters Health. She and her colleagues report on a randomized, controlled trial of the diet and counseling intervention in the February issue of Obstetrics and Gynecology.

The percentage of women who gain more than the recommended amount of weight during pregnancy is on the rise, Asbee and her team note, with overweight and obese women being particularly likely to exceed Institute of Medicine (IOM) guidelines for weight gain in pregnancy.

Being too heavy during pregnancy increases the risk of complications of pregnancy and delivery, they add, and also makes it more difficult for a woman to maintain a healthy weight after she has her baby.

Asbee and her colleagues designed an intervention to help women stick to the IOM recommendations. At the time of a woman's first pregnancy visit with her obstetrician, she also met with a registered dietitian, who offered pregnancy-specific counseling on lifestyle including recommendations on calorie intake and instructions to exercise at moderate intensity at least three times a week, and preferably five times a week.

At each routine pregnancy visit thereafter, a woman's doctor measured her weight and recorded it on an IOM Gestational Weight Gain Grid, which illustrated whether she was within the guidelines. If the patient's weight gain met the guidelines, "the patient was praised and encouraged to continue her current diet and exercise regimen," the researchers explain. If she was gaining too much or too little, the physician gave the patient advice on eating and exercising more or less as appropriate.

One hundred women were randomized to the intervention or to standard care, which involved giving a woman a booklet of prenatal information. While women in the standard care were weighed at each visit, the doctor did not discuss their weight gain or suggest any lifestyle modifications.

Among the 57 women in the intervention group, average weight gain was 28.7 pounds, compared to 35.6 pounds for the women in the standard care group. Women who were pregnant for the first time gained significantly more weight, putting on 36.5 pounds, on average, compared to 27.7 pounds for women who already had children.

While 61.4 percent of women in the counseling group stayed within IOM weight gain guidelines, 48.8 percent of the women in the standard care group did, but this was not a statistically significant difference. Babies born to women who didn't meet the guidelines weighed 7 pounds 12 ounces, on average, compared to 7 pounds 1 ounce for the newborns whose moms didn't gain too much weight.

The only factor associated with whether or not a woman's weight gain would meet the IOM guidelines was her pre-pregnancy body mass index; women with normal BMIs were more likely meet the guidelines.

Counseling on weight gain during pregnancy may often fall through the cracks, Asbee noted. "In an ideal world, one would hope that it was always addressed at each appointment, but of course that varies from physician to physician."

But implementing an intervention like the one she and her colleagues tested would not be difficult, she added, noting that the first pregnancy visit is typically longer and more involved than later routine visits, so adding on a meeting with a dietitian should be fairly simple.

"I think the importance of taking the couple minutes at each OB visit is just essential on the physician's part in order to optimize the patient's and baby's health during pregnancy and afterwards," Asbee said. Such counseling is particularly important, she and her colleagues conclude, for women who are pregnant for the first time and women who are overweight or obese.

SOURCE: Obstetrics & Gynecology, February 2009.

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