Date of Award

2014-05-01

Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Jane M. Georges, PhD, RN; Kathy S. James, DNSC, APRN, FAAN

Keywords

adverse outcomes, BMI, gestational weight gain, nursing, obesity, pregnancy weight, women

Abstract

Background: Managing gestational weight gain (GWG) remains a global health priority as obesity among women of childbearing age and their children have been linked to excessive GWG. Excessive GWG has been linked to increased rates of cesarean sections, preterm births, hypertensive disorders, gestational diabetes, large for gestational age newborns, postpartum weight retention, long-term obesity for the woman and her children. Conversely, adverse outcomes resulting from weight gain below recommendation could potentially include preterm births, increased rates of neonatal intensive care admission, and newborn morbidity and mortality. Previous studies indicate the need for healthcare providers to help women gain within the recommended guidelines to decrease incidence of adverse outcomes. Purpose: This study explores the concept of gestational weight, describes maternal characteristics of women who adhere to the recommended guidelines, examines correlates of socio-demographic, maternal and newborn characteristics, and gestational weight gain patterns, and identifies women staying within the Institute of Medicine's (IOM) 2009 recommended guidelines for GWG. To adequately address GWG patterns, study aims were achieved through concept analysis and retrospective data collection to: (1) identify GWG patterns among the sample by describing the characteristics of women who gained above, within, or below the IOM's recommended guidelines and (2) examine correlates of GWG patterns. Methods: A descriptive, correlational, cross-sectional design using retrospective data abstracted from medical records was used. A purposive sample of all women (N = 4500) who gave birth between January 1, 2011 and December 31, 2012 at a large multi-community hospital healthcare system in San Diego County provided data for this study. Inclusion criteria: singleton live birth, data on pre pregnancy BMI & GWG, ≥ 4 prenatal visits, and delivered at ≥ 37 weeks gestation. Two hundred ninety women met inclusion criteria. Descriptive and inferential statistics were used to assess characteristics of the sample and examine relationships between the variables. Results: Manuscript #1 titled "Understanding the Concept of Gestational Weight" analyzes the concept of gestational weight and its contributing factors, clarifies its meaning, and addresses implications for practice and the need for future studies. Manuscript #2 titled " Mothers' Characteristics and Gestational Weight Gain Patterns" identifies adherence to GWG recommendations and examines the characteristics of women who gain within, below or above the 2009 IOM GWG guidelines. Manuscript #3 titled " Correlates of Gestational Weight Gain within the 2009 IOM Recommended Guidelines" examines the relationships between women's socio-demographic, maternal and newborn characteristics, and gestational weight gain patterns. Implications: The results of this study show there is an increased need for healthcare providers to provide appropriate guidance and support to women of childbearing age. Providers should offer preconception counseling and surveillance to help women achieve normal pre-pregnancy BMI then continue to work with women during pregnancy to gain weight within the recommended range to decrease incidence of adverse pregnancy outcomes for both women and their children.

Document Type

Dissertation: Open Access

Department

Nursing

Included in

Nursing Commons

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