Department of Obstetrics and Gynecology, Midwifery Education Program, McMaster Midwifery Research Centre, Hamilton, Ontario, Canada.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
BMC Pregnancy Childbirth. 2020 Feb 12;20(1):102. doi: 10.1186/s12884-020-2791-8.
Inappropriate gestational weight gain in pregnancy may negatively impact health outcomes for mothers and babies. While optimal gestational weight gain is often not acheived, effective counselling by antenatal health care providers is recommended. It is not known if gestational weight gain counselling practices differ by type of antenatal health care provider, namely, family physicians, midwives and obstetricians, and what barriers impede the delivery of such counselling. The objective of this study was to understand the counselling of family physicians, midwives and obstetricians in Ontario and what factors act as barriers and enablers to the provision of counselling about GWG.
Semi-structured interviews were conducted with seven family physicians, six midwives and five obstetricians in Ontario, Canada, where pregnancy care is universally covered. Convenience and purposive sampling techniques were employed. A grounded theory approach was used for data analysis. Codes, categories and themes were generated using NVIVO software.
Providers reported that they offered gestational weight gain counselling to all patients early in pregnancy. Counselling topics included gestational weight gain targets, nutrition & exercise, gestational diabetes prevention, while dispelling misconceptions about gestational weight gain. Most do not routinely address the adverse outcomes linked to gestational weight gain, or daily caloric intake goals for pregnancy. The health care providers all faced similar barriers to counselling including patient attitudes, social and cultural issues, and accessibility of resources. Patient enthusiasm and access to a dietician motivated health care providers to provide more in-depth gestational weight gain counselling.
Reported gestational weight gain counselling practices were similar between midwives, obstetricians and family physicians. Antenatal knowledge translation tools for patients and health care providers are needed, and would seem to be suitable for use across all three types of health care provider specialties.
妊娠期间体重增加不当可能对母婴健康产生负面影响。虽然通常无法实现最佳妊娠体重增加，但建议产前保健提供者提供有效的咨询。目前尚不清楚产前保健提供者（家庭医生、助产士和产科医生）的妊娠体重增加咨询实践是否存在差异，以及哪些障碍阻碍了这种咨询的实施。本研究的目的是了解安大略省家庭医生、助产士和产科医生的咨询情况，以及哪些因素是提供妊娠体重增加咨询的障碍和促进因素。
在加拿大安大略省，采用便利和目的性抽样技术，对 7 名家庭医生、6 名助产士和 5 名产科医生进行了半结构式访谈，这些医生提供了普遍覆盖的妊娠护理。采用扎根理论方法进行数据分析。使用 NVIVO 软件生成代码、类别和主题。
提供者报告称，他们在妊娠早期向所有患者提供妊娠体重增加咨询。咨询主题包括妊娠体重增加目标、营养与运动、妊娠糖尿病预防，同时消除关于妊娠体重增加的误解。大多数人没有例行讨论与妊娠体重增加相关的不良后果，也没有为妊娠制定每日热量摄入目标。医疗保健提供者在咨询方面都面临着类似的障碍，包括患者态度、社会和文化问题以及资源的可及性。患者的热情和获得营养师的机会激励医疗保健提供者提供更深入的妊娠体重增加咨询。
报告的妊娠体重增加咨询实践在助产士、产科医生和家庭医生之间相似。需要为患者和医疗保健提供者提供产前知识转化工具，并且似乎适合所有三种医疗保健提供者专业使用。
