Washington Cole Katie O, Gudzune Kimberly A, Bleich Sara N, Bennett Wendy L, Cheskin Lawrence J, Henderson Janice L, Caulfield Laura E, Guan Yue, Roter Debra L
1 Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland.
2 Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
J Womens Health (Larchmt). 2017 Oct;26(10):1123-1130. doi: 10.1089/jwh.2016.6115. Epub 2017 May 19.
Healthy weight gain during pregnancy may improve health outcomes for women and infants. The objective of this study was to examine providers' use of the 5A's (Assess, Advise, Agree, Assist, and Arrange) in discussions of weight, nutrition, and physical activity during prenatal visits and evaluate the effect of this approach on gestational weight gain.
We studied audio recordings of prenatal visits between 22 obstetrics providers and 120 of their patients, coding visits for providers' use of the 5A's. The relationship between the 5A's and gestational weight gain (total weight gain and excess gestational weight gain) was evaluated using multilevel models to account for patient clustering within provider, and adjusted for prepregnancy body mass index, parent study intervention assignment, gestational age at the study visit, and study visit length.
Overall, 55% of prenatal visits included any weight-related behavioral counseling. Of these, 59.1% included one of the 5A's and 40.9% included two or more of the 5A's. Counseling conversations most commonly included Assess or Advise (49% and 85% of counseling conversations, respectively). No recorded visits used all 5A's. In adjusted analyses, patients who received counseling with two or more of the 5A's gained an average of 11.8 fewer pounds than patients who received no counseling (p = 0.001). The odds of excess gestational weight gain were lower among women receiving counseling with at least one of the 5A's (p < 0.05).
The 5A's were associated with lower gestational weight gain and may be a promising counseling strategy to promote healthy weight gain during pregnancy.
孕期健康增重可能改善母婴健康结局。本研究的目的是调查医护人员在产前检查讨论体重、营养和身体活动时对5A's（评估、建议、商定、协助和安排）的使用情况，并评估这种方法对孕期体重增加的影响。
我们研究了22名产科医护人员及其120名患者产前检查的录音，对医护人员使用5A's的情况进行编码。使用多水平模型评估5A's与孕期体重增加（总体重增加和孕期超重增加）之间的关系，以考虑医护人员内部患者的聚类情况，并对孕前体重指数、母研究干预分配、研究访视时的孕周和研究访视时长进行调整。
总体而言，55%的产前检查包含任何与体重相关的行为咨询。其中，59.1%包含一项5A's，40.9%包含两项或更多项5A's。咨询谈话最常包括评估或建议（分别占咨询谈话的49%和85%）。没有记录的访视使用了所有5A's。在调整分析中，接受两项或更多项5A's咨询的患者比未接受咨询的患者平均少增重11.8磅（p = 0.001）。接受至少一项5A's咨询的女性孕期超重增加的几率较低（p < 0.05）。
5A's与较低的孕期体重增加相关，可能是促进孕期健康增重的一种有前景的咨询策略。
