Stephanie Mattfeld Beaudette M.Ed., RDProject Coordinator

Colorado Department of Public Health & EnvironmentPrevention Services Division / Women’s Health Section

Colorado & Low Birth Weight

• Colorado has one of the highest low birth weight rates in the nation.

High Altitude States

2002 LBW rates

Colorado 8.9%

Oregon 5.8%

Washington 5.9%

Utah 6.4%

Healthy People 2010 Goal is 5%

Inadequate Maternal Weight Gain in Colorado

• One out of every four Colorado women gains less than the recommended amount of weight during pregnancy

• In Colorado, more low birth weight babies are born to mothers who do not gain weight adequately than to mothers who smoke

• Inadequate weight gain is modifiable with intervention!

Body Mass Index (BMI) Total weight gain

• Low BMI (<19.8) 28-40 pounds• Normal BMI (19.8-26) 25-35 pounds• High BMI (26-29) 15-25 pounds• Obese BMI (>29) 15 pounds• Twins (any BMI) 35-45 pounds

*Based on pre-pregnancy weight & height

Institute of Medicine’s Recommended Ranges for Total Pregnancy Weight

Gain

How did we figure this out?

• How do we know that inadequate weight gain is so important in Colorado?

• Isn’t the main problem the high altitude?

• After altitude, isn’t the main problem smoking?

Tipping the Scales:Weighing in on Solutions to the Low Birth Weight Problem in Colorado

• Analyzed all 166,191 births to residents in 1995-1997; results reported in 2000

• PAR analysis combines the prevalence of a condition (e.g.. smoking) with the severity of the condition (smoking doubles the risk of LBW)

• PAR analysis yields a percentage that describes how much of the LBW rate can be “attributed” to a given risk

http://www.cdphe.state.co.us/ps/mch/mchadmin/tippingthescales.pdf

Top Population Attributable Risks (PAR)

• Multiple gestation• Among singleton births:

– # 1 Inadequate Weight Gain PAR 12.8%

– # 2 Maternal Smoking PAR 11.9%– # 3 PROM PAR 9.1%– # 16 Altitude >10,000 feet PAR 0.8%– Inadequate Wt. Gain and/or Smoking PAR

34.4%

Campaign Purpose & Goals

• To decrease the number of pregnant women in Colorado who gain an inadequate amount of weight during pregnancy.

•  To decrease the number of low birth weight births in Colorado due to inadequate prenatal weight gain.

Campaign Process

Advertising agency selected

Initial consumer and providerFocus groups

Materials created, testedAnd revised

Campaign promotion& next steps!

Campaign Efforts

• Provider training and education• Campaign materials

– Combined BMI/gestational wheel– Chart-ready weight gain grids– BMI wall chart– Provider pocket counseling card– Patient brochures/posters in English and

Spanish

• Web site coming this Fall!• Consumer campaign in 2005

How to implement the campaign in your agency

• Add prenatal weight gain grid to all new OB charts

• Include patient education brochure in all new OB education packets

• Display campaign posters in waiting and exam rooms

• Post BMI cut-off chart by scale or in exam room

Practice Recommendations

• Determine woman’s BMI category• Advise woman of weight gain

recommendations for her BMI category

• Plot weight gain at each visit on prenatal weight gain grid

• Monitor weight gain trends• Counsel and refer as appropriate

The 5 A’s for Prenatal Weight Gain Counseling

• ASK: what are her weight gain goals/concerns• ASSESS: BMI determination and plotting on

grid• ADVISE: provide strong, clear, personalized

weight gain information based on BMI category

• ASSIST: problem solve and educate on components of weight gain

• ARRANGE: referrals as appropriate

•BMI assessment and corresponding weight gain recommendations provided on wheel

Combined BMI calculator / gestational wheel

•Graphic depiction of weight gain makes weight gain trends much clearer

•Grid lines represent minimum weight gain

•Good education tool to use with women gaining outside IOM guidelines (above or below)

Prenatal Weight Gain Grid

Body Mass Index (BMI) Wall Chart

Patient Education Brochure

For more information contact:Stephanie Beaudette R.D.,M.Ed. at

303-692-2487 or stephanie.beaudette@state.co.us

CDPHE-Prevention Services DivisionWomen’s Health Section

4300 Cherry Creek Drive SouthDenver, CO 80246-1530