Of the 292 women who responded to the questionnaire, 116 (40%) had no gestational weight gain goal, 112 (39%) had a goal concordant with IOM guidelines and 61 (21%) had a goal discordant with guidelines. Seventy-six women (30%) had an annual household income of less than $70,000 per year, 130 (46%) had never given birth before, 177 (62%) were between the ages of 25 and 35, 190 (65%) were white and 106 (36%) were overweight or obese (BMI ≥ 25 kg/m2) (). Almost half of the women reported actively trying to lose weight the year prior to getting pregnant, 90% agreed that obesity is an important problem in society, and 35% were satisfied with their weight prior to pregnancy. Most (95%) reported trusting the weight gain advice they received from their doctor ().
Characteristics and attitudes of 292 pregnant women in Massachusetts, according to gestational weight gain (GWG) goal concordance with current Institute of Medicine (IOM)
The final variables included in the logistic regression models were: income, race, agreeing with `if I gain too much weight one month, I try to keep from gaining the next', `as long as I am eating well, I don't care how much I gain' and `I tried to keep my weight down to not look pregnant', sugar sweetened beverage consumption, and moderate physical activity. Notably, age, pre-pregnancy BMI, parity, weight satisfaction, weight loss efforts before pregnancy, and intake of fast food or fruits and vegetables, were not independent predictors of having a weight gain goal. Women who had an annual household income of greater than $100,000 per year were more likely to have a gestational weight gain goal (OR = 2.8, 95%CI: 1.3, 5.9) compared with women with lower income, and women who were non-white were less likely to have a gestational weight gain goal (OR = 0.3, 95%CI: 0.2, 0.6) compared with white women ().
Predictors of having a gestational weight gain goal and having a goal discordant or concordant with Institute of Medicine guidelines, compared to no goal, using multinomial logistic regression
We then used multinomial logistic regression to examine associations of these predictors with the three level outcome: no gestational weight gain goal, goal discordant with IOM guidelines and goal concordant with IOM guidelines (). Many factors were similarly associated with an increased likelihood of having either a concordant or discordant goal, including higher income, white race/ethnicity, less sugar sweetened beverage consumption, and more physical activity (). However, responses to two questions were associated with having a discordant, but not concordant goal and for one question was associated with a having a concordant but not discordant goal. Women who agreed that `as long as I am eating well, I don't care how much I gain' were 70% less likely to have a discordant gestational weight gain goal vs. no weight gain goal (OR = 0.3, 95%CI: 0.2, 0.8). Also, women who agreed that they `if I gain too much weight one month, I try to keep from gaining the next' were 4 times more likely to have a discordant gestational weight gain goal (OR = 4.1, 95%CI: 1.6, 10.4) and those who agreed with `tried to keep weight down to not look pregnant' were 14 times more likely to have a concordant gestational weight gain goal compared to having no goal (OR = 14.3, 95%CI: 1.4, 140.5).
Only 111 (40%) women reported having received a weight gain recommendation from their doctor. Among these 111 women, those who received a weight gain recommendation from their doctor that was consistent with IOM guidelines were 5 times more likely to have a concordant goal, compared to those that did not have a goal (OR = 5.3, 95%CI: 1.5, 18.6) after adjusting for gestational age, race and income. Similarly, of the 199 women who saw a midwife, those who received a gestational weight gain recommendation from their midwife consistent with IOM guidelines (49%) were more likely to have a concordant weight gain goal (OR = 18.9, 95%CI: 2.0, 176.9).
Among the subset of 99 women who provided consent for access to their medical record, 48 (49%) had a concordant goal, 26 (26%) had a discordant goal and 25 (25%) had no goal. Of those who had a concordant goal, 22 (46%) had an actual gestational weight gain within the IOM guidelines, 18 (37%) excessive gain and 8 (17%) inadequate gain. For those with a discordant goal, 9 (35%) gained within the IOM guidelines, 14 (50%) excessive and 4 (15%) inadequate. For women who did not have a gestational weight gain goal, 6 (24%) had adequate gain, 14 (56%) excessive, and 5 (20%) inadequate. In unadjusted analysis, compared with women who had no weight gain goal, women who had a concordant goal were 65% less likely to have excessive weight gain (OR = 0.35, 95%CI: 0.1, 1.1) although confidence intervals included a null effect in this small subset. Results were similar in analysis adjusted for race and income (OR = 0.42, 95%CI: 0.1, 1.4).