Leveraging Action to Support Dissemination of the Pregnancy Weight Gain Guidelines Workshop Summary (2013) / Chapter Skim
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2 Keynote Addresses
2 Keynote Addresses
Pages 5-18
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From page 5... ...
In 2007, however, the United States was experiencing an obesity epidemic, and pregnancy weight gain was seen as potentially a major driver of the weight gain occurring among women of childbearing age. The average weight of American women has been increasing for a long time, but the increase has been particularly pronounced since 1990.
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Overweight and obese women who gain within the guidelines are more able to maintain a postpartum weight that is at or below their pre-pregnancy weight. Excessive gestational weight gain has consequences for both mother and child.
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In particular, a number of studies have found that a higher weight gain by the mother during pregnancy is associated with childhood obesity in her offspring. The association between high maternal systolic blood pressure and higher weight in children years later could indicate that prepregnancy BMI has some effect on fetal developmental programming (Wen et al., 2011)
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There were insufficient data to create recommendations specifically for heavier classes of obese women, and further research may suggest that lower gain might be desirable for these heavier women. Finally, the guidelines are not modified for short stature, young age, racial or ethnic subgroups, primiparity, or smoking, and they include some provisional recommendations on the rate of weight gain and on twin pregnancies that are based on limited data.
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Through Medicaid expansion and subsidies for women who lack employersponsored health insurance, the ACA is designed to expand access to health care coverage for nearly 90 million previously uninsured women. The implementation of the ACA provisions on clinical preventive services for women means that an additional 47 million women will have the opportunity to gain access to preventive health services, including coverage for gestational diabetes, intimate partner violence, HIV screening and counseling, counseling on sexually transmitted infections, human papillomavirus DNA testing, Food and Drug Administration– approved contraceptive products, and breastfeeding support.
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must take to maintain their board certification. The goal of reproductive health care is to produce healthy women, healthy mothers, and healthy babies, but the United States is currently comparable to a third-world country in terms of maternal mortality.
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To reinforce these messages, Conry and the physicians in the Kaiser Permanente Medical Group use two prescription pads. One is a walking prescription (see Figure 2-3)
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QUESTION-AND-ANSWER SESSION Following the keynote addresses, the floor was opened for questions and discussion. The discussion covered three primary topics: time constraints and centered pregnancy, working with the family as a whole, and restructuring the postpartum visit.
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KEYNOTE ADDRESSES 13 FIGURE 2-3 Kaiser Permanente walking prescription. SOURCE: Conry, 2013.
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14 DISSEMINATION OF THE PREGNANCY WEIGHT GAIN GUIDELINES FIGURE 2-4 Kaiser Permanente prescription for a healthy pregnancy. SOURCE: Conry, 2013.
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For example, the success with hypertension that has occurred in the United States in recent years is due not only to increased knowledge about hypertension and to improved medications, but also to the fact that patients are in programs in which their blood pressure is measured, desired outcomes are made clear, and patients are followed to track progress on those outcomes. Lu added that everything people have learned over the past 30 years indicates that quality improvement is not only about making individuals work harder, but also about making the systems work smarter.
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The challenge will be to determine what decisions the states will make and how to ensure that the resources needed to help women achieve a healthy weight after pregnancy become available either through the health care marketplace or through Medicaid expansion. If states do not choose those options, then an alternative route is to consider pursuing an "1115" waiver1 for interconception care.
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In addition, HRSA's National Maternal Health Initiative also provides an opportunity for groups to look at how the postpartum visit may be redesigned. Lu added that successful efforts will include many types of providers -- OB-GYNs as well as family practitioners, nurse midwives and nurse practitioners, health educators, and registered dietitians -- coming together to help support weight gain within guidelines during pregnancy as well as to achieve a healthy weight before pregnancy and return to a healthy weight after pregnancy.
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Presented at Leveraging Action to Support Dissemination of Pregnancy Weight Gain Guidelines: A Workshop, National Academies, Washington, DC, March 1. Available at http://www.
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