Date Published: October 5, 2018
Publisher: Public Library of Science
Author(s): Michelle A. Kominiarek, Linda C. O’Dwyer, Melissa A. Simon, Beth A. Plunkett, Rebecca A Krukowski.
Providers need to be comfortable addressing obesity and gestational weight gain so they may give appropriate care; however, health care providers lack guidelines for the most effective educational strategies to assist in providing optimal care.
To identify studies that involved the obstetric provider in interventions for either the perinatal management of obesity and/or gestational weight gain in a systematic review.
A keyword search of databases was performed up to April 2017.
Obstetric providers who participated in an intervention with the aim to change a provider’s clinical practice, knowledge, and/or satisfaction with the intervention in relation to the perinatal management of obesity or gestational weight gain were included. Provider intervention could include training or education, changes in systems or organization of care, or resources to support practice. PROSPERO database #42016038921.
Bias was assessed according to the validated Mixed Methods Appraisal Tool. The following variables were synthesized: study location and setting, provider and patient characteristics, intervention features, outcomes and efficacy, and strengths and weakness.
Of the 6,821 abstracts screened, seven studies (4 quantitative, 3 mixed-methods) with a total of 335 providers met the inclusion criteria; two of which focused on the management of obesity, three focused on gestational weight gain, and two focused on both topics. Interventions that incorporated motivational interviewing skills (n = 2), required additional training for the research study and addressed specific knowledge deficits such as nutrition and exercise (n = 3), and interfaced with the electronic medical record (n = 1) demonstrated the greatest impact on provider outcomes. Provider reported satisfaction scores were generally favorable, but none addressed provider-level efficacy in practice change.
Given the limited number of studies, varying range of provider participation, and lack of provider-level efficacy, further evaluation of provider training and involvement in interventions for perinatal obesity or gestational weight gain is indicated to determine best practices for provider and patient outcomes.
The morbidity associated with obesity is magnified in pregnancy, as the risk for pregnancy-related hypertension and diabetes, cesarean delivery, birth defects, abnormal fetal growth, and stillbirth all increase.  Among obese women, a gestational weight gain of 11–20 pounds, as recommended in the 2009 National Academy of Medicine guidelines, can improve short- and long-term maternal and neonatal outcomes; yet, up to 60% of obese women exceed these gestational weight gain guidelines and consequently they are at risk for cesarean deliveries, large-for-gestational-age infants, and postpartum weight retention.  Nonetheless, women of all body mass index categories encounter excess morbidity including cesarean deliveries and macrosomia when gestational weight gain is excessive. [3, 4]
A librarian (L.C.O.) collaboratively developed the search strategies with the other authors (M.A.K., B.A.P.) and ran the searches in the following databases: PubMed MEDLINE, clinicaltrials.gov, Embase (embase.com), Cochrane Central Register of Controlled Trials (CENTRAL) on the Wiley platform, CINAHL (Ebsco), and PsycINFO (Ebsco). The search strategies for the Embase, CENTRAL, CINAHL, and PsycINFO databases were adapted from the MEDLINE search strategy. All databases were searched back to their inception and no language or date limits were applied. Searching for eligible studies to include in the review involved the following approaches: controlled vocabulary (MeSH headings and thesauri of relevant databases) and the keywords of obesity, pregnancy, behavior change, healthcare professionals, trials, and gestational weight gain. Complete search strategies are provided (S1 File). We also attempted to discover additional studies by searching the reference lists of key studies and relevant systematic reviews. The review protocol was registered on December 5, 2016 in the PROSPERO database (#42016038921). The search was completed in April 2017.
Of the 6821 abstracts screened, 60 full-text studies were reviewed after conflict resolution by M.A.K. and B.A.P.(Fig 1) The most common reasons for exclusion of studies at the initial phase (6821 abstracts) were intervention not related to pregnancy, intervention focused on post-partum period only, and intervention focused on patients only. A total of seven studies met the inclusion and exclusion criteria for this study. These studies are summarized in Table 1. Of the seven studies, two focused on the management of obesity, three focused on gestational weight gain, and two focused on both topics.
Obesity and gestational weight gain are serious problems in pregnancy. Not only are there short-term implications for perinatal outcomes, but long-term maternal and child health are at risk too.  If providers can enhance their knowledge of obesity risks and skills in gestational weight gain counseling, it is likely that they can better assist women in meeting their gestational weight gain goals and perhaps influence other outcomes. Thus, obstetric providers should be participants in trials that assess the management of perinatal obesity and health behavior interventions for improving gestational weight gain and related perinatal outcomes so that their involvement can be more formally evaluated with respect to patient outcomes.