Purpose for the program: Women who gain excessively in pregnancy have increased risk for macrosomia, gestational diabetes, hypertension, prolonged labor, instrumental birth, shoulder dystocia, cesarean birth, lactation complications, and raising obese children. Weight gain within IOM guidelines lowers risk for complications and postpartum weight retention. Typical prenatal care provides limited opportunity and time to offer the counseling and support many require to encourage the behavioral changes needed to optimize prenatal weight gain.

Proposed change: Group prenatal care is a model of care in which women of similar gestational ages are scheduled for prenatal care at the same time for 1 1/2 to 2 hours. This model provides opportunity for individual exam and group counseling. It encourages active engagement in health care and social support from the group. This model was adapted to assist women in maintaining weight gain within the 2009 Institute of Medicine (IOM) Prenatal Weight Gain Guidelines.

Implementation, outcomes and evaluation: Over four meetings, registration and scheduling for group meetings was developed, group meeting space was reserved, and medical assistants were prepared for group prenatal visits. Referrals come from nurse-midwives and obstetricians. A CNM organizes and facilitates the group. Women of any pregravid weight without chronic disease and under 20 weeks gestation are eligible for group participation. Women are given a detailed personalized nutrition plan from the choosemyplate.gov website. They plot weight gain at each visit and set a goal for the next month. A physical therapist discusses physical activity in pregnancy. A lactation consultant presents the benefits of breastfeeding in return to pregravid weight. Group size is limited to eight women with similar due dates. Findings/Outcomes: Ten groups are currently in progress or completed with an average of 5 participants. We are continuously recruiting for new groups. Members have used techniques learned in group although weight management is still challenging. Group members have gained within IOM recommendations or have slowed weight gain when excessive.

Implications for nursing practice: Advanced practice nurses offering prenatal care should consider the feasibility of offering prenatal care in a group setting. This model promotes social support, active engagement and educational counseling. Some of the tools utilized may also be applied to the typical prenatal care setting.

Keywords: Obesity, Pregnancy, Group Prenatal Care