Date of Award

Spring 5-23-2020

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Mary Barger PHD, MPH, BSN


This evidence-based pilot project was implemented to optimize gestational weight gain (GWG) among women enrolled for prenatal care at a private practice. Evidence from meta-analyses and large studies show: 1) an association between excess GWG and increased risk of fetal macrosomia and increased cesarean delivery; 2) 66% of women do not know their healthy GWG target; 3) a 20% reduction in excess GWG in women receiving diet or exercise interventions or both. In addition, visual plotting of weight gain has helped overweight adults reduce and maintain weight loss over a one-year period. Nutrition assessment using a validated nutritional screening questionnaire called starting the conversation (STC) was utilized to screen women for their dietary habits, measure readiness for change, and set individualized dietary change goals at the first prenatal appointment. Women were provided verbal and written education on increasing physical activity and exercise to at least 150 minutes per week at moderate intensity. An individualized visual plot of gestational weight gain was created and shown to woman at every visit with anticipatory guidance on expected weight gain for upcoming prenatal visits. Data was collected retrospectively and reviewed from patients’ charts a year prior to intervention and compared to intervention year. The data was assessed for (1) Change in nutritional assessment score at 36 weeks in comparison to score at first prenatal visit (2). Proportion of women gaining appropriate weight. Only 7% screened positive for needing further nutritional education by scoring greater than seven on the STC pre-screening, and none screened positive on the STC post-screening. Only 35% of participants exceeded the recommended weight gain, compared to 64% the year prior.