The American College of Obstetricians and Gynecologists has guidelines regarding the management of pregnancies complicated by obesity. It is unclear if prenatal care providers follow these guidelines.
A retrospective cohort study of women with a prepregnancy body mass index greater than 30 kg/m2, singleton gestation, first prenatal visit less than 16 weeks of gestation, and at least two visits by 20 weeks of gestation with the same health care provider type (certified nurse-midwife or obstetrician–gynecologist) was performed from 2009 to 2013. Age, race, parity, prepregnancy body mass index, and comorbidities were abstracted. Six American College of Obstetricians and Gynecologists guidelines (exercise encouraged, weight goals discussed, nutrition consult, early diabetes screening, anesthesia consult, obesity risk discussion) and obesity recorded on problem list and depression screening were compared between certified nurse-midwife (n=106) and obstetrician–gynecologist (n=94) patients with χ2 and Fisher's exact tests.
Certified nurse-midwife patients were younger (27.3±5.5 compared with 30.9±5.8 years, P<.001) with fewer comorbidities (35.8% compared with 56.4%, P=.004) compared with obstetrician–gynecologists. Adherence to the six guidelines and mean total adherence were similar for certified nurse-midwife and obstetrician–gynecologist patients except for weight goals discussed (41.5% certified nurse-midwife compared with 25.5% obstetrician–gynecologist, P=.01; Table 1). None of the guidelines were adhered to for 39.6% certified nurse-midwife and 43.6% obstetrician–gynecologist patients. Certified nurse-midwife patients had obesity recorded on the problem list similar to obstetrician–gynecologists (29.2% compared with 27.7%, P=.80) but had depression screening more often (67% compared with 49%, P=.01).
Overall adherence to American College of Obstetricians and Gynecologists guidelines for obesity management in pregnancy was low (less than 20%) for both health care provider types. Health care provider education and training may be necessary to improve their adherence. Further research is necessary to determine whether these guidelines improve outcomes for obese women.