Behavioral counseling interventions for pregnancy weight

Clinicians should offer pregnant women effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain during pregnancy, according to a recommendation by the U.S. Preventive Services Task Force (USPSTF).

Aaron Caughey, MD, MPP, MPH, PhD

“Promoting healthy weight gain during pregnancy is important for both pregnant people and their babies,” said Task Force member Aaron Caughey, MD, MPP, MPH, PhD, a professor and chair of ob/gyn at Oregon Health & Science University in Portland.

The recommendation statement in JAMA represents the first time the Task Force reviewed the evidence on how to help pregnant women maintain a healthy weight. “We found that counseling is effective and can be incorporated into prenatal care,” Caughey told Contemporary OB/GYN®.

The incidence of overweight and obesity has increased among women of childbearing age and those who are pregnant. In 2015, nearly half of all women began their pregnancy overweight (24%) or obese (24%).

Reported rates of overweight and obesity are higher among Black, Alaska Native/American Indian and Hispanic women, compared to White and Asian women.

While gaining a healthy amount of weight is an important component of pregnancy, “gaining too much weight can be harmful for pregnant people and their babies, which can lead to a higher risk of gestational diabetes, cesarean deliveries and babies who are born with a birth weight that is too high,” Caughey said. “The good news is that effective behavioral counseling interventions can help pregnant people gain a healthy amount of weight and avoid gaining too much weight.”

Counseling should occur throughout the pregnancy, rather than in a single discussion, according to Caughey, who also serves as associate dean for Women’s Health Research and Policy at the university. “After reviewing many different ways to support women who are pregnant in managing their weight, we found that effective counseling can include discussions during routine office visits, as well as strategies like nutrition education and exercise classes.”

The recommendation statement advocates that clinicians engage with their patients to determine an intervention that best fits the patient’s individual circumstance.

In general, counseling should start at the end of the first trimester or the beginning of the second trimester and end prior to delivery. Each encounter can vary from 15 minutes to 2 hours, comprising highly diverse interventionists, including clinicians, registered dietitians, qualified fitness specialists, physiotherapists and health coaches, across different settings like a local community fitness center.

“The health of all people nationwide is the Task Force’s main priority, and we recognize the challenges related to implementing recommendations in areas with limited access to health care and related services,” Caughey said.

Although effective counseling can help pregnant women gain a healthy amount of weight throughout their pregnancy, “important research gaps still exist,” Caughey said. “More research is needed to determine which types of counseling are most effective, the ideal number and length of counseling sessions, whether interventions should be tailored to specific populations, and any potential harms of counseling.”

Caughey also said that while these interventions can improve some health outcomes like gestational diabetes and unscheduled cesareans, “additional research is required to know how they affect other important outcomes, such as preterm birth.”

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Disclosure

Caughey reports no relevant financial disclosures.

Reference

U.S. Preventive Services Task Force. Behavioral counseling interventions for healthy weight and weight gain in pregnancy: U.S. Preventive Services Task Force recommendation statement. JAMA. 2021;325(20):2087-2093. doi:10.1001/jama.2021.6949