Efforts needed to provide institute of medicine-recommended guidelines for gestational weight gain

OBJECTIVE: To estimate body mass index (BMI)-specific gestational weight gain recommendations and frequency of weight and gestational weight gain discussions and documentation. METHODS: Medical record review of 477 randomly selected patients who met inclusion criteria and who received care in faculty and resident clinics at a central Massachusetts tertiary care center. Patients started prenatal care at or before 14 weeks of gestation and delivered between April 2007 and March 2008. RESULTS: Our patients were mean (+/-standard deviation) 27.8 (+/-6.3) years, 69.8% multiparous, 45.3% white, 10.5% black, and 15.9% Hispanic. Mean gestational age at initial visit was 9.6 (+/-2.1) weeks and mean prenatal visits attended were 12.6 (+/-2.7). Using prenatal chart data alone, BMI was not calculable for 41.2% of patients due to missing height (27.7%), prepregnancy weight (27.9%), or both (14.5%). In the total sample, documentation was missing with regard to BMI (95.4%), gestational weight gain (85.3%), gestational weight gain goals (90.1%), and discussion of weight (88.9%). Supplemental data were obtained to calculate prepregnancy BMI for 469 patients. Per 1990 (BMI at least 26.1) and 2009 (BMI at least 25.0) guidelines, 42% and 49% of patients were overweight or obese, respectively, before pregnancy. Analysis of actual gestational weight gain by BMI revealed that 76% of overweight and 65% of obese patients gained excessively. CONCLUSION: Prenatal care providers should include recording height and weight to calculate BMI and to provide BMI-specific gestational weight gain guidelines. LEVEL OF EVIDENCE: III