Lowering Gestational Diabetes Risk by Prenatal Weight Gain Counseling

Evelyn M. Figueroa, MD; Kara Nitti, MPH; Stephen M. Sladek, MD

Disclosures

J Am Board Fam Med. 2020;33(2):189-197. 

In This Article

Results

A total of 1571 pregnant women were identified during the study period. Of these women, 795 (50.6%) were seen during preintervention period and 776 (49.4%) were seen during the postintervention period. The mean maternal ages of each group were comparable, with a mean of 27.5 ± 5.6 years in preintervention and 28.0 ± 5.6 years in postintervention groups; the proportions of insurance types were also comparable (Table 2). However, a significant difference in the proportions of Hispanic mothers was identified, with 26.2% being Hispanic in the preintervention group compared with 40.3% being Hispanic in the postintervention group (P < .01; Table 2). There was a borderline significant difference in the proportion identified as obese at enrollment, with 27.0% obese in the preintervention group and 32.5% obese in the postintervention group (P = .055; Table 2).

A significant difference occurred as intended between pre- versus postintervention regarding weight gain counseling: 10.1% of those in the preintervention group received IOM-congruent counseling compared with 62.8% of those in the postintervention group (P < .01; Table 3).

Total weight gain did decrease between groups: the preintervention group had a mean weight gain of 28.3 pounds (12.84 kg) compared with 25.9 pounds (11.75 kg) in the postintervention group. However, this difference did not reach statistical significance (P = .61) (Table 3). Multivariate regression to adjust for any counseling received, site, race, insurance status, parity, pre-BMI, and maternal age again showed a trend toward decrease in maternal prenatal weight gain, but it was still not statistically significant (adjusted odds ratio [AOR] = 0.85; 95% CI, 0.63–1.16; P = .10; Table 4; Appendix 2). Pre-versus postintervention was not significantly associated with low weight gain (AOR = 1.2; 95% CI, 0.85–1.69; P = .31; Table 4; Appendix 2). Hence, our improved counseling did not go to the overzealous extreme of thwarting a healthy minimum weight gain during pregnancy.

Pre- versus postintervention was significantly associated with a decrease of gestational diabetes (AOR = 0.54; 95% CI, 0.32–0.91; P = .02) after adjusting for counseling received, site, race, insurance status, parity, pre-BMI, and maternal age (Table 5; Appendix 2).

No significant difference was identified between pre- versus postintervention regarding shoulder dystocia after sensitivity analysis revealed that 1 site changed their diagnostic criteria between the pre- and postintervention time periods. Therefore, data from that site were excluded (Table 3). Specifically, this 1 site overreported shoulder dystocia (in the preintervention phase only) as any use of the McRoberts maneuver. The consistent consensus among our other 6 sites was that shoulder dystocia was indicated if more techniques than the McRoberts maneuver were needed to accomplish vaginal delivery (e.g., suprapubic pressure, Rubin or Woods rotations, or removing the posterior fetal arm.).

No significant difference was identified between pre- and postintervention groups and the incidence of low birth weight (<2500 g): 2.6% of those in the preintervention group having a low birth weight compared with 2.2% of those in the postintervention group (P = .68; Table 3). There were also no significant differences in gestational age, macrosomia (birth weight, >4 kg), route of delivery, and incidence of hypertensive disorders (Table 3).

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