748: Factors associated with appropriate gestational weight gain among obese women

Inappropriate gestational weight gain (iGWG) is linked to poor perinatal outcomes. However, achieving appropriate GWG (aGWG) may be limited by socioeconomic status (SES) which can restrict food options, physical activity, and patient support systems. We aimed to compare dietary and exercise patterns as well as SES factors among obese women (BMI≥30) with aGWG versus iGWG. Low SES women receiving prenatal care at a single tertiary care center from 1/2013-12/2015 were offered individualized nutritional counseling (NC) by a registered dietitian encouraging well-balanced meals using the Department of Agriculture MyPlate guide and 150 minutes/week of exercise. We conducted a retrospective case control study of obese women with singleton gestations with aGWG (11-20 pounds) versus iGWG (< 11 or >20 pounds). Dietary makeup, activity level, and SES factors were compared with chi-square, Fisher’s exact, student’s t-test, and Wilcoxon Rank Sum tests as appropriate, and odds ratios (95% CIs) were calculated (Tables). A subgroup analysis of class III obesity (BMI≥40) was planned. 411 women were analyzed: 22% (n=89) had aGWG and 78% (n=322) had iGWG. Demographics were similar between groups. Women with iGWG were less likely to report physician reinforcement of NC and more inactivity; there were no differences in food diary compliance, or self-reported caloric intake or dietary composition between groups. Those with iGWG were also less likely to be employed (Table 1). When limited to BMI≥40 (n=136), those with iGWG (78%) versus aGWG (22%) were less likely to attend NC, report physician reinforcement of NC, and have adequate caloric and protein intake, and were more likely to be inactive; there were no differences in SES factors (Table 2). Physician reinforcement of NC, greater activity, and employment are associated with aGWG in obese women, with NC and dietary modifications further associated with aGWG in women with BMI≥40. Given the limited impact of SES factors, enhancing exposure to NC and altering nutritional and exercise choices should be utilized to optimize GWG.View Large Image Figure ViewerDownload Hi-res image Download (PPT)