Effective counseling urged to help pregnant patients prevent excess weight gain

Recommendations issued earlier this year by the U.S. Preventive Services Task Force (USPSTF) urge health care providers to guide pregnant patients with effective counseling to help them maintain a healthy weight and prevent excess weight gain.

Gaining too much weight during pregnancy can lead to a higher risk of gestational diabetes, cesarean deliveries and high-birth-weight babies.

Counseling should focus on nutrition, physical activity, and lifestyle or behavior changes, and can take place during routine office visits or more formal programs. Health care providers should plan on counseling sessions of more than 15 minutes and to reinforce the message throughout pregnancy rather than in a single discussion, the USPSTF advised.

“The clinician’s role is to respectfully and consistently address healthy gestational weight gain. The clinician should use a patient-centered approach to encourage healthy eating and exercise habits during preconception, pregnancy and postpartum, and give patients the resources to succeed,” said Kara B. Knapp, M.D., an OB/GYN with Norton Women’s Care.

RELATED: Gestational diabetes diagnosis criteria and management

In 2015, almost half of all persons began pregnancy either overweight or obese, according to the USPSTF.

Obesity is such a common condition that the implications for pregnancy are often unrecognized, overlooked or ignored because there is a lack of evidence-based treatment options, the American College of Obstetricians and Gynecologists (ACOG), advised in a June 2021 practice bulletin.

Management of obesity should begin before pregnancy and continue through postpartum with involvement of obstetricians and nutritionists.

The USPSTF offered examples for health care providers with a range of counseling and exercise interventions.

Counseling interventions

	High intensity	Moderate intensity	Low intensity
Mode of delivery	Individual or group counseling in person, online or over the telephone	Individual or group counseling in person or over the telephone	Individual sessions
Intensity	Once a week to once a month, lasting from 30 minutes to two hours. Telephone call or email follow-up one to two times per week; e-health interventions offered online or text message support	From once a month to once a trimester, lasting from 15 to 45 minutes Phone call “booster” sessions and toolkits with educational materials or physical activity accessories for participants	Part of usual antenatal care, or one to two brief extra sessions
Content	Counseling focused on nutrition, goal-setting, physical activity, and behavioral and social support strategies	Counseling focused on healthy eating and/or physical activity based on American College of Obstetricians and Gynecologists recommendations	Counseling focused on maintaining healthy weight, often including personalized graphs with weight gain guidance based on National Academy of Medicine recommendations.
Materials	DASH Eating Plan SmartMoms Intervention Lessons	ESTEEM Study Patient Information Sheet ESTEEM Trial Intervention Fact Sheets and Educational Presentation ESTEEM Recipe Ideas	Oldways Healthy Weight Gain During Pregnancy

 

Supervised exercise

• Structured, supervised exercise classes
• One to three times per week (average, 45 to 60 minutes)
• Aerobic, resistance and flexibility exercises based on American College of Obstetricians and Gynecologists recommendations for exercise during pregnancy
• Free weights, resistance equipment or both
• Lifestyle Interventions for Expectant Moms

Weight gain recommendations during pregnancy

 

Prepregnancy weight	Pregnancy gain with one baby	Twins
Body mass index (BMI) less than 18.5	28 to 40 pounds	50 to 62 pounds
BMI 18.5 to 24.9	25 to 35 pounds	37 to 54 pounds
BMI 25 to 29.9	15 to 25 pounds	31 to 50 pounds
BMI 30 or greater	11 to 20 pounds	25 to 42 pounds

Source: Centers for Disease Control and Prevention.