1 Nutrition and Health Sciences Program, Laney Graduate School, Emory University , Atlanta, Georgia .
2 Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, Georgia .
J Womens Health (Larchmt). 2018 May;27(5):552-560. doi: 10.1089/jwh.2017.6514. Epub 2018 Jan 10.
The Institute of Medicine (IOM) revised gestational weight gain recommendations in 2009. We examined associations between healthcare provider advice about gestational weight gain and inadequate or excessive weight gain, stratified by prepregnancy body mass index category.
We analyzed cross-sectional data from women delivering full-term (37-42 weeks of gestation), singleton infants from four states that participated in the 2010-2011 Pregnancy Risk Assessment Monitoring System (unweighted n = 7125). Women reported the weight gain range (start and end values) advised by their healthcare provider; advice was categorized as follows: starting below recommendations, starting and ending within recommendations (IOM consistent), ending above recommendations, not remembered, or not received. We examined associations between healthcare provider advice and inadequate or excessive, compared with appropriate, gestational weight gain using adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs).
Overall, 26.3% of women reported receiving IOM-consistent healthcare provider advice; 26.0% received no advice. Compared with IOM-consistent advice, advice below recommendations was associated with higher likelihood of inadequate weight gain among underweight (aPR 2.22, CI 1.29-3.82) and normal weight women (aPR 1.57, CI 1.23-2.02); advice above recommendations was associated with higher likelihood of excessive weight gain among all but underweight women (aPR range 1.36, CI 1.08-1.72 to aPR 1.42, CI 1.19-1.71). Not remembering or not receiving advice was associated with both inadequate and excessive weight gain.
Few women reported receiving IOM-consistent advice; not receiving IOM-consistent advice put women at-risk for weight gain outside recommendations. Strategies that raise awareness of IOM recommendations and address barriers to providing advice are needed.
医学研究所（IOM）在 2009 年修订了妊娠体重增加建议。我们研究了医疗保健提供者关于妊娠体重增加的建议与不足或过度体重增加之间的关联，按孕前体重指数类别进行分层。
我们分析了来自四个州参加 2010-2011 年妊娠风险评估监测系统的足月（37-42 周妊娠）、单胎婴儿的横断面数据（未加权 n=7125）。女性报告了医疗保健提供者建议的体重增加范围（起始值和结束值）；建议分为以下几类：起始低于建议值、起始和结束值均在建议范围内（IOM 一致）、结束值高于建议值、未记住或未收到。我们使用调整后的患病率比（aPR）和 95%置信区间（CI）比较了医疗保健提供者建议与不足或过度（与适当相比）妊娠体重增加之间的关联。
总体而言，26.3%的女性报告接受了 IOM 一致的医疗保健提供者建议；26.0%的女性没有收到建议。与 IOM 一致的建议相比，体重不足（aPR 2.22，CI 1.29-3.82）和正常体重女性（aPR 1.57，CI 1.23-2.02）收到的建议不足与体重增加的可能性更高；超重和肥胖女性收到的建议超过建议与体重增加的可能性更高（aPR 范围为 1.36，CI 1.08-1.72 至 aPR 1.42，CI 1.19-1.71）。未记住或未收到建议与体重不足和体重增加过多有关。
很少有女性报告接受 IOM 一致的建议；未接受 IOM 一致的建议使女性面临体重增加超出建议范围的风险。需要制定提高对 IOM 建议的认识和解决提供建议障碍的策略。
