Open Access Open Badges Research article

Perspectives about and approaches to weight gain in pregnancy: a qualitative study of physicians and nurse midwives

Tammy Chang12*, Mikel Llanes14, Katherine J Gold13 and Michael D Fetters15

Author affiliations

1 Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA

2 University of Michigan, Robert Wood Johnson Clinical Scholars Program, North Campus Research Complex, 2800 Plymouth Road, Building 10 – Room G016, Ann Arbor, MI, 48109-2800, USA

3 Department of Family Medicine, Department of Obstetrics & Gynecology, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA

4 Ypsilanti Health Clinic, University of Michigan, 200 Arnet Street, Suite 200, Ypsilanti, MI, 48198, USA

5 Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA

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Citation and License

BMC Pregnancy and Childbirth 2013, 13:47  doi:10.1186/1471-2393-13-47

Published: 21 February 2013



Over one third of reproductive age women in the US are obese. Pregnancy is a strong risk factor for obesity, with excess weight gain as the greatest predictor of long term obesity. The majority of pregnant women gain more weight than recommended by the Institute of Medicine guidelines. The objective of this study was to understand prenatal care providers’ perspectives on weight gain during pregnancy.


Semi-structured qualitative interviews of 10 prenatal care providers (three family physicians, three obstetricians, and four nurse midwives) at a University Hospital in the Midwest, that included the ranking of important prenatal issues, and open-ended questions addressing: 1) general perceptions; 2) approach with patients; and 3) clinical care challenges.


Providers felt that appropriate weight gain during pregnancy was not a high priority. Many providers waited until patients had gained excess weight before addressing the issue, were not familiar with established guidelines, and lacked resources for patients. Providers also believed that their counseling had low impact on patients, avoided counseling due to sensitivity of the topic, and believed that patients were more influenced by other factors, such as their family, habits, and culture.


Both providers and patients may benefit from increased awareness of the morbidity of excess weight gain during pregnancy. Practice-level policies that support the monitoring and management of weight gain during pregnancy could also improve care. Research that further investigates the barriers to appropriate weight gain is warranted.

Prenatal care; Gestational weight gain; Obesity; Qualitative study; Obstetrics; Certified nurse midwives; Family physician