Merry K. Moos

A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention.

This systematic review focuses on outcomes of gestational weight gain, specifically birthweight, fetal growth, and postpartum weight retention, for singleton pregnancies with respect to the 1990 Institute of Medicine weight gain recommendations. A total of 35 studies met the inclusion criteria and were reviewed. There was strong evidence to support associations between excessive gestational weight gain and increased birthweight and fetal growth (large for gestational age) as well as inadequate gestational weight gain and decreased birthweight and fetal growth (small for gestational age). There was moderate evidence to support the association between excessive gestational weight gain and postpartum weight retention. Clear clinical recommendations based on this review are challenging because of several limitations in the literature. Improvements in future research include the use of consistent definitions of gestational weight gain and outcomes of interest, assessment of confounders, and better collection of weight and weight gain data.

Perceived Barriers to Physical Activity among Pregnant Women

Objective Physical activity generally declines during pregnancy, but barriers to activity during this time period are not well understood. The objective was to examine barriers to physical activity in a large cohort of pregnant women and to explore these barriers in more depth with qualitative data derived from a separate focus group study using a socioecologic framework. Method A total of 1535 pregnant women (27–30xa0weeks’ gestation) enrolled in the Pregnancy, Infection, and Nutrition Study were asked an open-ended question about their primary barrier to physical activity; responses were coded into categories according to the socioecologic framework. To further elucidate, 13 focus groups of a total of 58 pregnant women (20–37xa0weeks’ gestation) were conducted among Hispanic, African American, and White participants. Results Among the 1535 pregnant women participating in the survey, 85% reported an intrapersonal barrier to physical activity, of which almost two-thirds were health related. Only 2% of the women reported their main barrier to physical activity as interpersonal and 3% reported a neighborhood or environmental barrier. These results were supported by the focus group data, overall and by race/ethnicity and body mass index. Although women discussed barriers to physical activity at a variety of levels, the intrapersonal level was the most frequently cited and discussed factor in both studies. Conclusions Since pregnancy may trigger the development of obesity and since physical activity is recommended for healthy pregnant women, it is imperative to promote physical activity in a more relevant way. These quantitative and qualitative studies revealed many barriers to physical activity among pregnant women and some suggestions for interventions.

Healthier women, healthier reproductive outcomes: recommendations for the routine care of all women of reproductive age

By addressing the reproductive intentions and contraceptive practices and needs of every patient, providers may be able to decrease womens chances of experiencing unintended pregnancies and support women in achieving planned and well-timed pregnancies. By addressing the health promotion needs of every patient and examining and addressing her health profile for reproductive risks, irrespective of her desires for pregnancy, it is likely that more women will enter pregnancy with high levels of preconception wellness and that healthier women and healthier pregnancies and infants will result. The importance of the integration of reproductive planning and health promotion into womens routine healthcare is further emphasized when the potentially far-reaching effects of reproductive outcomes (such as unintended pregnancies, adverse pregnancy outcomes, pregnancy complications, and sexually transmitted infections) on womens health, well-being, and life circumstances are considered.

Group B streptococci: Results of a protocol of antepartum screening and intrapartum treatment

OBJECTIVEnOur purpose was to evaluate and report the results of a protocol for the identification and treatment of all group B streptococcal carriers.nnnSTUDY DESIGNnIn 1991 we instituted a protocol of antepartum cultures for group B streptococci on all pregnant women who attended clinics at the University of North Carolina Hospitals. Cultures were obtained from the lower third of the vagina and rectum at 24 to 28 weeks gestation. Women with positive cultures were treated with intravenous antibiotics in labor. Women with signs of chorioamnionitis (through intrapartum assessment) were also treated in labor, regardless of carrier status.nnnRESULTSnDuring the first 2 years of this protocol 1681 women were delivered. Forty percent of the women were from the private practice, 32% were black, and 62% were married. The group B streptococcal carriage rate was 14%. During the period of evaluation there were no infants infected with group B streptococci and no adverse reactions or complications among women who were treated with antibiotics.nnnCONCLUSIONnWe found antepartum screening and intrapartum chemoprophylaxis of all group B streptococcal carriers to be an acceptable and effective protocol for reducing perinatal group B streptococcal infections.

A qualitative study of women's perceptions of provider advice about diet and physical activity during pregnancy

OBJECTIVEnThe purpose of this qualitative study was to gather insights into pregnant womens experiences with provider advice about diet and physical activity.nnnMETHODSnWe conducted a series of 13 focus groups with a total of 58 pregnant African American, Caucasian, and Hispanic women of varying body sizes. Statements were independently coded, reduced, and then reconstructed to identify overarching themes with the assistance of ATLAS/ti software.nnnRESULTSnMean gestational age at the time of the focus groups was 30 weeks. Women commonly reported overwhelming and confusing diet advice and a paucity of physical activity advice that was largely limited to walking. Many reported following advice; when advice was not followed, it was because women disagreed with it or simply did not want to do it.nnnCONCLUSIONnWomen would benefit from more clear guidance from physicians and other providers regarding dietary choices and physical activity in pregnancy.nnnPRACTICE IMPLICATIONSnProviders should make dietary and physical activity advice in pregnancy more clear and individualized and offer such guidance multiple times throughout pregnancy.

Provider Advice About Weight Loss and Physical Activity in the Postpartum Period

OBJECTIVEnTo explore the association between healthcare provider advice about weight loss and physical activity in the postpartum period and weight retention and activity levels in women assessed at 3 months postpartum.nnnMETHODSnUsing data from a prospective cohort study, we explored the association of advice with postpartum weight retention and activity levels in 688 women at 3 months postpartum. Data from home visits included anthropometric measurements and information collected from sociodemographic, health behavior, and psychosocial questionnaires. Weight retention was calculated as weight at 3 months postpartum minus prepregnancy weight; activity levels and advice were based on maternal self-report. Linear regression and Poisson regression were used to explore associations.nnnRESULTSnThe majority of the population was white (76%), had a greater than high school education (83%), and had an income >185% of the federal poverty level (81%). Women ranged in age from 17 to 48 years. Most women reported receiving no weight loss (89.1%) and no physical activity advice (77.4%) from a healthcare provider during the 3-month postpartum period. After adjustment, we found no association between provider advice and weight retention. When compared with those who reported no advice, following provider advice showed an association with recreational activity above the median (RR 1.50, 95% confidence interval [CI] 1.24, 1.80).nnnCONCLUSIONSnProvider advice may influence physical activity but may not be enough to help postpartum women lose pregnancy weight. Instead, women may benefit more from individualized counseling and follow-up beyond the usual 6-week postpartum visit.

Reducing Unintended Pregnancies Through Web-Based Reproductive Life Planning and Contraceptive Action Planning among Privately Insured Women: Study Protocol for the MyNewOptions Randomized, Controlled Trial

BACKGROUNDnThe Affordable Care Act mandates that most women of reproductive age with private health insurance have full contraceptive coverage with no out-of-pocket costs, creating an actionable time for women to evaluate their contraceptive choices without cost considerations. The MyNewOptions study is a three-arm, randomized, controlled trial testing web-based interventions aimed at assisting privately insured women with making contraceptive choices that are consistent with their reproductive goals.nnnMETHODSnPrivately insured women between the ages of 18 and 40 not intending pregnancy were randomly assigned to one of three groups: 1) a reproductive life planning (RLP) intervention, 2) a reproductive life planning enriched with contraceptive action planning (RLP+) intervention, or 3) an information only control group. Both the RLP and RLP+ guide women to identify their individualized reproductive goals and contraceptive method requirements. The RLP+ additionally includes a contraceptive action planning component, which uses if-then scenarios that allow the user to problem solve situations that make it difficult to be adherent to their contraceptive method. All three groups have access to a reproductive options library containing information about their contraceptive coverage and the attributes of alternative contraceptive methods. Women completed a baseline survey with follow-up surveys every 6 months for 2 years concurrent with intervention boosters. Study outcomes include contraceptive use and adherence. ClinicalTrials.gov identifier: NCT02100124.nnnDISCUSSIONnResults from the MyNewOptions study will demonstrate whether web-based reproductive life planning, with or without contraceptive action planning, helps insured women make patient-centered contraceptive choices compared with an information-only control condition.

Outcomes of Cardiovascular Disease Risk Factor Screening and Referrals in a Family Planning Clinic

BACKGROUNDnCardiovascular disease (CVD) screening in Title X settings can identify low-income women at risk of future chronic disease. This study examines follow-up related to newly identified CVD risk factors in a Title X setting.nnnMETHODSnFemale patients at a North Carolina Title X clinic were screened for CVD risk factors (n=462) and 167/462 (36.1%) were rescreened one year later. Clinical staff made protocol-driven referrals for women identified with newly diagnosed CVD risk factors. We used paired t-tests and chi square tests to compare screening and rescreening results (two-tailed, p<0.05).nnnRESULTSnAmong 11 women in need of referrals for newly diagnosed hypertension or diabetes, 9 out of 11 (81.8%) were referred, and 2 of 11 (18.2%) completed referrals. Among hypertensive women who were rescreened (n=21), systolic blood pressure decreased (139 to 132u2009mmHg, p=0.001) and diastolic blood pressure decreased (90 to 83u2009mmHg, p=0.006). Hemoglobin A1c did not improve among rescreened diabetic women (n=5, p=0.640). Among women who reported smoking at enrollment, 129 of 148 (87.2%) received cessation counseling and 8 of 148 (5.4%) accepted tobacco quitline referrals. Among smokers, 53 out of 148 (35.8%) were rescreened and 11 of 53 (20.8%) reported nonsmoking at that time. Among 188 women identified as obese at enrollment, 22 (11.7%) scheduled nutrition appointments, but only one attended. Mean weight increased from 221 to 225 pounds (p 0<.05) among 70 out of 188 (37.2%) obese women who were rescreened.nnnCONCLUSIONSnThe majority of women in need of referrals for CVD risk factors received them. Few women completed referrals. Future research should examine barriers and facilitators of referral care among low-income women.