Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

What is the comparative effectiveness of interventions to prevent excessive weight gain during pregnancy?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Interventions to assist women in meeting the IOM guidelines for maternal weight gain:

• Counseling on healthy diet and physical activity (preconception, during pregnancy, and postpartum)
• Education of women on maternal and fetal risks of obesity in pregnancy
• Education of women and providers about IOM guidelines for maternal weight gain
• Referrals to dieticians, physical activity specialists, or other providers
• Monitoring, such as measuring body mass index (BMI) and charting weight at prenatal visits
• Culturally appropriate educational tools
• Settings (outpatient, community)

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Pregnant women (perhaps including the postpartum period) and women planning pregnancy

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

• Pregnant women or women planning pregnancy who have undergone bariatric surgery
• Women who are underweight, overweight, or obese upon conception
• Parity status (nulliparous; primiparous; multiparous)
• Pregnant women with intellectual disabilities have higher prevalence of obesity, looking for approaches that might work better in this population would be valuable

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

• Improvements in achieving maternal weight gain consistent with IOM guidelines
• Decrease in health risks to women and infants
• Improvements in maternal and child health
• Prevention of pregnancy and birth complications
• Prevention of postpartum maternal overweight and obesity
• Ensure healthy birthweight

Describe any health-related risks, side effects, or harms that you are concerned about.

• Harms of outreach (e.g., social stigma)
• Nutritional deprivation of the growing infant and/or mother

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Developmental delays, attention-deficit hyperactivity disorder, and autism
• Functional limitations and disability
• Obesity
• Pregnancy, including preterm birth

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

An increasing number of women are overweight or obese when they become pregnant, and many women gain too much weight during pregnancy. These circumstances put the mother's and her baby's health at risk. Knowing which interventions are most effective in supporting appropriate maternal weight gain will assist women and the organizations who care for them better understand how to prevent excessive weight gain during pregnancy.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

This question was prioritized by stakeholders engaged in the Topic Identification project conducted by the Oregon Evidence-based Practice Center on “Prevention in Women’s Health.”

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Clarify safe and effective interventions to prevent excessive weight gain in pregnancy

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

This report would help women in their preventive healthcare decisionmaking as well as the clinicians and health organizations that care for them

Describe the timeframe in which an answer to your question is needed.

Not aware of a specific timing issue

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Women, minorities, teens, intellectually disabled, low-income, populations disproportionately affected by poor birth outcomes

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

This report would help women in their preventive healthcare decisionmaking as well as the clinicians and health organizations that care for them

Are you making a suggestion as an individual or on behalf of an organization?

Please tell us how you heard about the Effective Health Care Program