General practitioners and gestational weight management

Abstract

This study aimed to explore the knowledge and practice of New Zealand (NZ) general practitioners (GPs) regarding gestational weight gain (GWG), and identify the current level of involvement NZ GPs have in early pregnancy care. In NZ, the majority of antenatal care is carried out by a midwife lead maternity carer (LMC), with government funding for one first trimester appointment with the woman’s GP. A mixed methods survey was conducted on a randomly selected sample of 470 NZ GPs. Survey responses were analysed using descriptive statistics and a general inductive approach for free text data. A total of 200 GPs (42.5%) responded. Half of the GPs regularly saw women in their early pregnancy, but the discussion of recommended GWG was uncommon. The knowledge and practice regarding GWG was not in keeping with the national guidance. Free text analysis identified time pressures, funding issues, loss of skill and a poor communication with LMCs as the barriers to care. Education, promotion of guidance, appropriate funding and improved communication between carers are critical to address the current shortfalls.

Impact statement

• What is already known on this subject? Excess gestational weight gain (GWG) is a modifiable risk factor for the vast majority of obstetric complications. It is more likely in pregnant women who overestimate the appropriate GWG. Current literature suggests that the antenatal advice on GWG is insufficient. In New Zealand (NZ), there is provision for one funded general practitioner (GP) appointment in the first trimester, in addition to that provided by the lead maternity carer (LMC). GPs are expected to provide a range of services at this appointment including health information and education on nutrition.

• What the results of this study add? The results demonstrate that while GPs are seeing women in early pregnancy, specific GWG discussion is uncommon. The results suggest knowledge gaps are partially responsible for this along with GP self-reported frustrations at lack of time, funding issues, loss of relevant skills, and minimal contact with LMCs.

• What the implications are of these findings for clinical practice and/or further research? Mediocre gestational weight management is not acceptable in our current obesity climate. This research identifies a need to improve GP knowledge on the management of GWG as part of the wider maternity healthcare team, address GP concerns regarding funding for their provision of maternity care, and aid communication between GPs and LMCs.

Keywords:

• Pregnancy
• weight
• obesity
• general practitioner
• BMI
• New Zealand

Additional information

Funding

This work was supported by the SMO Fund, Women’s Health, Southern District Health Board, New Zealand.