USPSTF: Counseling interventions for weight have moderate benefit in pregnant people

The U.S. Preventive Services Task Force recommends offering pregnant people behavioral counseling interventions to promote healthy weight gain during pregnancy.

Overweight, obesity and excess gestational weight gain are associated with adverse outcomes, including large for gestational age infants, cesarean delivery and preterm birth, according to the task force. In 2015, 24% of all pregnancies began with overweight and 24% began with obesity.

The task force concluded with moderate certainty that implementing the new B recommendation will have a moderate net benefit for pregnant adults and adolescents, with low likelihood for harms.

The authors of a related evidence report wrote that the recommendation statement is based on a meta-analysis of 68 studies that included 25,789 participants. According to Amy G. Cantor, MD, MPH, associate professor of family medicine, medical informatics and clinical epidemiology, and obstetrics and gynecology at Oregon Health & Science University, and colleagues, gestational weight gain interventions were associated with a reduced risk for gestational diabetes (RR = 0.87; 95% CI, 0.79-0.95), emergency cesarean delivery (RR = 0.85; 95% CI, 0.74-0.96), macrosomia (RR = 0.77; 95% CI, 0.65-0.92) and large for gestational age (RR = 0.89; 95% CI, 0.8-0.99) as well as reduced postpartum weight retention at 12 months, with a mean difference of –0.63 kg (95% CI, –1.44 to –0.01).

In a related editorial, D. Yvette LaCoursiere, MD, MPH, a professor of obstetrics, gynecology and reproductive services at the University of California, San Diego Health, wrote that this recommendation “supports the American College of Obstetricians and Gynecologists (ACOG) recommendations that clinicians determine body mass index at intake and counsel patients on appropriate [gestational weight gain], nutrition and exercise throughout pregnancy,” as well as “emphasize the importance of providing individual care for patients with excessive” gestational weight gain.

Nonetheless, according to LaCoursiere, the USPSTF recommendation may be difficult to implement clinically due in part to wide variability of the studies in the meta-analysis.

“The best methods, timing and frequency of the high-yield components are unknown,” LaCoursiere wrote. “Subsequent lines of investigation should identify the most effective components overall and for relevant subgroups.”

Furthermore, she added that “barriers such as time constraints, limited clinician training in behavioral counseling, inadequate ancillary resources and respective funding gaps may limit incorporation of these interventions into routine prenatal care.”

Ultimately, “the success of this intervention will depend on improving resources for clinicians to facilitate provision of direct counseling or to refer patients to skilled professionals and explore novel alternatives,” LaCoursiere wrote.

References:

• Cantor AG, et al. JAMA. 2021;doi:10.1001/jama.2021.4230.
• Davidson KW, et al. JAMA. 2021;doi:10.1001/jama.2021.6949.
• LaCoursiere YV. JAMA. 2021;doi:10.1001/jama.2021.5720.