SAN FRANCISCO — During prenatal visits at the University of California, San Francisco, pregnant women meet not only with clinicians but with a new “Video Doctor” designed to help them stay fit and avoid excessive weight gain during pregnancy.
The women use a laptop and headphones in the clinic to view video clips of an actress who plays a physician and asks them about their diet and physical activities and then provides motivational counseling in an interactive format.
“This really is a nice adjunct to the counseling that we do in the clinic,” Dr. Naomi E. Stotland said at a conference on antepartum and intrapartum management sponsored by the University of California, San Francisco.
The Video Doctor program prints a “Provider Alert” sheet that the woman can bring to her clinician “so the clinician can see what's going on and reinforce the counseling,” said Dr. Stotland of the university.
She said she hopes the Video Doctor experiment will provide an effective, low-cost way of implementing basic strategies to limit excessive weight gain in pregnancy.
Recent studies suggest that working with a dietitian plus intensified monitoring and counseling by an ob.gyn. may reduce excessive weight gain in pregnancy in some populations, but these interventions are expensive and time consuming, she noted.
One randomized, controlled trial found that stepped-care behavioral interventions reduced excessive weight gain, compared with routine care, but only in women who had a normal body mass index before they became pregnant, she said.
Another study compared women who received provider counseling, plus a mailed patient-education newsletter, with historical controls and found that the intervention reduced the rate of excessive weight gain during pregnancy only in low-income women.
Most recently, investigators randomized 100 pregnant women to intensive dietary and lifestyle counseling or routine care with no extra counseling.
The intervention was similar to recommendations by the American College of Obstetricians and Gynecologists for routine weight gain monitoring and counseling.
Patients in the intervention group gained significantly less weight in pregnancy than did controls (29 vs. 36 pounds) but did not meet the primary outcome of a significant improvement in the percentage of women whose gestational weight gain fell within limits recommended by the Institute of Medicine (Am. J. Obstet. Gynecol. 2009;113:305-12).
“We have a long way to go,” Dr. Stotland said, “and these are kind of expensive things to implement. It's much, much more intensive counseling” than usual.
The Video Doctor may help with this, but a preliminary study showed only partial promise.
When used as a one-time intervention around the 20th week of pregnancy in a randomized, controlled trial, the Video Doctor was not associated with a difference in weight gain, but the women in the Video Doctor group did report better diets and physical activity behaviors and increased discussions about these topics at follow-up visits, Dr. Stotland said.
A new study will use a revised version of the Video Doctor that starts earlier in pregnancy and engages pregnant women in a serial fashion throughout pregnancy. The study also will incorporate other strategies such as self-monitoring of weight.
“We're hoping that as a package, this will reduce excessive weight gain in pregnancy, but we need to do more research,” she said.
A large proportion of U.S. women gain excessive weight during pregnancy.
In a recent study of nearly 53,000 women in the United States who gave birth to term singletons in 2004-2005, 42% of those who were normal weight at baseline and 64% of those who were overweight at baseline gained more pounds during pregnancy than were recommended in the 1990 Institute of Medicine guidelines.
Among women who were obese at baseline, 46% gained more than 25 pounds above the Institue of Medicine-recommended amount (Am. J. Obstet. Gynecol. 2009;200:271.e1-7).
The Institute of Medicine in May 2009 revised its recommendations for weight gain in pregnancy to add an upper limit to recommendations for pregnant women who are obese at baseline.
In a comparison of the Institute of Medicine guidelines with 2002-2003 data from the Pregnancy Risk Assessment Monitoring System, overweight women gained a median of 30 pounds during pregnancy, compared with 20 pounds recommended by the IOM, and obese women gained 25 pounds, compared with the recommended median of 15.5 pounds, the Institute of Medicine found.
Dr. Stotland reported that she has no conflicts of interest related to these topics.
'This really is a nice adjunct to the counseling that we do in the clinic.'
Source Dr. Stotland
A woman in a prenatal clinic connects with the Video Doctor for counseling on weight gain during pregnancy.