Unhealthy gestational weight gain: are we neglecting inadequate gestational weight gain?

Objective: To evaluate the prevalence of unhealthy gestational weight gain and analyze the role of women ́s knowledge about the recommendations, expectations, beliefs, counseling, and information pro- vided by midwives as potential factors contributing to failure to meet recommendations. Research design/setting: A retrospective cross-sectional study was performed in a tertiary Hospital in Seville (Spain) between March and September 2019. A sample of 500 singleton pregnant women at or over 37 weeks of gestation completed a self-administered questionnaire during a prenatal visit. Gestational weight gain was categorized as healthy/excessive/inadequate, according to the Institute of Medicine, for 409 women. Descriptive, bivariate, and multivariate analysis was performed. Findings: Inadequate and excessive gestational weight gain were 33.4% and 33.9%, respectively. A multi- variate model for excessive gestational weight gain showed pre-gestational body mass index was a risk factor, while exercise and believing the weight gain was healthy were protective factors. The model for inadequate gestational weight gain showed knowledge of recommendations was a protective factor while believing gestational weight was healthy was a risk factor. Key conclusions: Unhealthy gestational weight gain is common. Inadequate gain from women with healthy pre-pregnancy body mass index who believed their gain was healthy, was almost as common as excessive gestational weight gain. As shown by our predictive model beliefs regarding healthy gestational weight gain may act either as a protective factor, in the excessive gain model, or as a risk factor, in the inadequate gain model, depending on women ́s pre-pregnancy body mass index and despite knowledge of the recommendations. Implications for practice: Inadequate weight gain, and not only excessive gain, should be properly ad- dressed during pregnancy. Healthy gestational weight gain should be approached by midwives with a combination of one-to-one and group antenatal care, where believes regarding healthy gestational weight gain should be addressed. Midwives should remain alert as we may be facing a new trend: increasing numbers of women presenting with inadequate gestational weight gain; with negative health implica- tions for a healthy population. We recommend that midwives pay attention to women with a healthy pre-pregnancy Body Mass Index and who believe that their weight gain is correct because this profile frequently had an inadequate gestational weight gain.