Leveraging Action to Support Dissemination of the Pregnancy Weight Gain Guidelines Workshop Summary (2013) / Chapter Skim
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5 Session 3: Implementing the Guidelines
5 Session 3: Implementing the Guidelines
Pages 41-54
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pregnancy weight gain guidelines into action. The three panelists and one speaker for this session were Marta Kealey, a nutritionist with the Supplemental Food Pro grams Division at the Food and Nutrition Service (FNS)
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This feature is part of WIC's effort to encourage breastfeeding. The IOM pregnancy weight gain guidelines were very useful to WIC because the program relies on other professions and experts in the field to provide guidance on how to evaluate and assess appropriate preconception weight and maternal weight gain.
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Two of the bureaus have particular relevance to the work of the Committee on Implementation of the IOM Pregnancy Weight Gain Guidelines: the Maternal and Child Health Bureau (MCHB) , which is primarily focused on the delivery of core public health services, and the Bureau of Primary Health Care (BPHC)
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The Kentucky Department of Health provides annual training to local health department nurses and staff, including training on the IOM pregnancy weight gain guidelines. Wyoming focuses on helping women gain enough weight during pregnancy in its Healthy Baby Is Worth the Weight program.
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Of the total number of patients served, 41 percent were white non-Hispanic, 31 percent Hispanic, and 21 percent black non-Hispanic. Although the health centers' uniform data system has no measures specific to pregnancy weight gain, a few are somewhat related to pregnancy weight gain, such as the percentage of early entry into prenatal care and the percentage of newborns below normal birth weight.
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HRSA programs in both MCHB and BPHC offer many opportunities for reaching key audiences in order to promote the adoption of the guidelines among providers and to educate women about their importance. HRSA considers broad dissemination of the guidelines to be essential to its efforts to inform women, health care providers, state Title V programs, community health agencies, and others about the importance of women entering pregnancy within a normal BMI and achieving recommended weight gain during pregnancy.
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Finally, HRSA is committed to continued research on effective interventions to promote healthy weight in women before and after pregnancy and to help women achieve weight gain during pregnancy that is within the recommended ranges. SUZANNE PHELAN, CALIFORNIA POLYTECHNIC STATE UNIVERSITY In considering ways to disseminate the IOM pregnancy weight gain guidelines, Phelan said, workshop participants face three large questions: One, do we know how to help women gain the recommended amounts of weight in pregnancy?
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Although the intervention stopped at delivery, the study saw positive effects at 6 months postpartum in both the normal-weight and the overweight and obese groups in terms of the percentage of women who had returned to their pre-pregnancy weight or less by 6 months postpartum. Among the normal-weight women, 35 percent of the intervention group returned to their pre-pregnancy weight compared with only 20 percent of
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. Thus, in addressing the first question of whether we know how to help women gain the recommended amount of weight during pregnancy, the results from Fit for Delivery indicate that a low-intensity behavioral intervention can help prevent excessive gestational weight gain in normal-weight women but not in the overweight and obese, and that such an intervention is not very effective in helping women who are exceeding guidelines get back within guidelines.
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The effective strategies include setting calorie goals, using structured meal plans or meal replacements, weight monitoring, high physical activity, behavioral strategies, and ongoing patient– provider contact. Randomized clinical trials of lifestyle interventions in pregnancy that have used a combination of several of these strategies have generally found positive effects on reducing excessive gestational weight gain, while studies that have used fewer of the strategies have had mixed effects or no effects.
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It is important to note that efficacy is not the same as effectiveness, so what is studied in research centers may not translate, that is, may not be feasible or have the same effects in the community. However, in light of the promising activities already described by presenters and programs that are available to women to help prevent excessive weight gain, it is reasonable to predict that "real-world programs" will show that the same pattern as the efficacy trials -- that is, the comprehensive programs will be the ones that work.
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The study team compared self-reported prepregnancy weight and chart-abstracted measured weights, and the correlation was 0.96. Andrea Sharma stated that she is using data from the Pregnancy Risk Assessment Monitoring System to conduct analyses of serial measured weights during pregnancy.
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One participant asked whether pregnancy weight gain should be treated like non-pregnancy weight gain, given that the same weight control strategies are effective for both populations. Would programs such as Weight Watchers or other weight loss programs be acceptable for the pregnant population?
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2013. Presentation at Leveraging Action to Support Dissemination of Pregnancy Weight Gain Guidelines: A Workshop.
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