Women's Report of Health Care Provider Advice and Gestational Weight Gain: A Systematic Review.

Inadequate and excessive gestational weight gain (GWG) is associated with adverse health outcomes for mother and child. Health care providers are well positioned to help women achieve appropriate GWG. This systematic review examined associations between women's report of provider advice on GWG and women's compliance with the Institute of Medicine (IOM) GWG guidelines. In March 2019, PubMed, EMBASE, and Cochrane CENTRAL databases were searched. Observational studies were eligible if published from 1990 to 2019, described provider advice on GWG, and determined whether women's target or actual GWG was consistent with the 1990 or 2009 IOM guidelines. Heterogeneity across studies precluded the use of meta-analytic methods. Seventeen cross-sectional and cohort studies of poor to good quality, representing 20,717 women were included. Approximately 69% of women reported provider advice on GWG during pregnancy; however, only 50% reported provider advice consistent with IOM guidelines. Eleven studies found that provider advice on GWG was significantly associated with women's compliance with IOM guidelines, and six studies found no association. While a high percentage of women report provider advice on GWG, accuracy of reported advice is less than optimal. The evidence examining associations of provider advice and women's compliance with guidelines is mixed and limited by methodological concerns. Future studies using more robust methods in diverse populations are needed to confirm the role of provider advice in optimizing GWG. Intervention studies are also necessary to increase the proportion of providers who accurately counsel their patients on appropriate GWG to improve health outcomes.