June 10, 2021, 4:16 p.m. David Mitchell — Nearly half of pregnant patients had either overweight or obesity at conception in 2015. According to the CDC, the obesity rate for such patients nearly doubled from 13% in 1993 to 24% in 2015.
For the first time, the U.S. Preventive Services Task Force is weighing in on the topic with a recommendation that clinicians offer pregnant patients effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. The new recommendation comes with a “B” designation.
Healthy weight gain during pregnancy is important for both pregnant people and their babies, task force member Aaron Caughey, M.D., M.P.P., M.P.H., Ph.D., said in a statement.
“The Task Force found that clinicians can help their patients maintain a healthy weight by offering effective counseling throughout pregnancy,” said Caughey, a professor and chair of the Department of Obstetrics and Gynecology and associate dean for Women’s Health Research and Policy at Oregon Health & Science University.
Healthy weight gain during pregnancy lowers the risk for gestational diabetes, babies born with a high birth weight and emergency cesarean sections, said task force member Chien-Wen Tseng, M.D., M.P.H., M.S.E.E., the Hawaii Medical Service Association endowed chair in health services and quality research and professor and research director in the Department of Family Medicine and Community Health at the University of Hawaii John A. Burns School of Medicine.
“There are many effective counseling interventions that can help,” Tseng said in the task force’s statement, “so clinicians should work with their patients to identify the best fit.”
Scott Hartman, M.D., associate professor of clinical family medicine and maternity care coordinator for the primary care network at the University of Rochester Medical Center in Rochester, N.Y., said it was important for primary care physicians to be aware of resources in their local social safety net.
“Food insecurity is associated with worse health outcomes, and it’s quite common in the United States,” said Hartman, past chair of the AAFP’s Commission on Health of the Public and Science. “People often don’t have a healthy diet not because they don’t want to but because they don’t have the ability to access healthy food.”
More than 10% of all U.S. households experienced food insecurity during 2019, according to the U.S. Department of Agriculture, and that figure more than doubled last year during the pandemic. The CDC estimates that nearly half of pregnant patients gain too much weight, and roughly one-fifth gain less than recommended.
The task force noted that primary care clinicians can “deliver effective in-person behavioral counseling interventions or refer patients to behavioral counseling interventions in other settings.”
Hartman said that in his own practice he offers referrals to nutritionists for all patients who present for preconception or maternity care and emphasizes referrals to those with other risk factors, such as a high BMI, pre-existing diabetes or other chronic medical conditions.
He said a team-based approach could be useful because some primary care physicians may prefer to refer patients to someone with more expertise or experience in nutritional counseling, and some payers may not reimburse physicians adequately for the time-consuming service. The task force said in its statement that counseling on nutrition, physical activity, and lifestyle or behavior changes should be reinforced throughout pregnancy, rather than limited to a single discussion.
Hartman said that the referral process can be challenging and noted that telehealth may offer a solution for patients with transportation limitations or those in underserved areas.