A mixed method study evaluating the integration of pregnancy weight gain charts into antenatal care

Healthcare Professionals' Beliefs and Views towards Exercise during Pregnancy: A Cross-Sectional Study in Greece

BACKGROUND

Healthcare professionals appear to play a key role in shaping pregnant women's views and attitudes towards lifestyle issues, such as exercise. The aim of this study is to investigate the views and beliefs of Greek midwives and obstetricians regarding exercise during pregnancy.

METHODS

This is a cross-sectional study conducted during the period of January 2022-March 2023. For this study, 237 Greek midwives and obstetricians employed in healthcare settings in Attica, Greece completed an anonymous and self-report questionnaire. Four different/independent models of multivariate analyses of variance were conducted.

RESULTS

The vast majority of these healthcare professionals (88.6%) believed that exercise during pregnancy is generally beneficial. According to the multivariate analyses, healthcare professionals with postgraduate/doctoral studies were more likely to believe that (a) exercise is generally beneficial (p = 0.03), (b) pregnant women should be informed about it (p = 0.028), (c) informing pregnant women is necessary/useful (p = 0.023), and (d) pregnant women showed interest in it (p = 0.034). Also, freelance midwives were more likely to believe that pregnant women should be informed about exercise (p = 0.006), and that they showed interest in it (p = 0.034). In addition, (a) freelance midwives (p = 0.050), and those who had experience in antenatal counselling (p = 0.037), as well as (b) obstetricians who were largely experienced in monitoring normal pregnancies (p = 0.001), were less likely to associate exercise during pregnancy with the occurrence of placental abruption.

CONCLUSION

Alongside healthcare professionals' educational level, their professional setting and professional experience emerge as key factors and need to be considered when designing innovative interventions to support exercise during pregnancy.

Receiving gestational weight gain recommendations and associated risks: A qualitative study among low-income women

Appropriate weight gain goals promote healthy gestational weight gain (GWG). Despite receiving recommendations from their providers, most women do not know how much weight they should gain during pregnancy. This study sought to describe the experiences of pregnant women when given GWG recommendations. The research proceeded using a phenomenological approach. With Institutional Review Board approval, primigravida women with a healthy singleton pregnancy at 8-20 weeks gestation were recruited from the community and purposively from a low-income obstetrics clinic. Within 60-minutes, trained interviewers 1) presented GWG recommendations and associated risks; and 2) interviewed participants using a semi-structured guide. Participants received a $40 gift card. Interviews were recorded and transcribed. Two trained coders used Braun and Clarke's (2020) reflexive thematic analysis procedures. When presented with GWG information, participants (n = 29, Mage = 25.5, 4.7 SD) proceeded to: 1) make sense of the information, 2) evaluate the credibility of the information, 3) weigh the importance of the information, 4) predict likely outcomes, and 5) plan behaviors. Participants who were able to understand the information, found it to be credible and important, and who predicted adverse outcomes for failing to adhere to recommendations reported intentions for health promoting behaviors. Future research should test GWG counseling methods based on these cognitive processes. Clinicians should consider these 5 cognitive processes when providing initial GWG counseling.

Antenatal care addressing gestational weight gain (GWG): a cross sectional study of pregnant women's reported receipt and acceptability of recommended GWG care and associated characteristics

BACKGROUND

The Australian Clinical Practice Guidelines for Pregnancy Care recommend that during the first and subsequent antenatal visits all pregnant women are weighed; advised of recommended gestational weight gain (GWG), dietary intake and physical activity; and offered referrals for additional support if needed. The extent to which these recommendations are implemented and women's acceptability of recommended care is unknown. This study examines women's reported receipt and acceptability of guideline care for GWG, and characteristics associated with receipt of such care and its acceptability.

METHODS

From September 2018 to February 2019 a telephone survey was undertaken with women who had recently had a baby and received antenatal care from five public maternity services within a health district in Australia. Women self-reported their demographic characteristics, and receipt and acceptability of recommended GWG care. Receipt and acceptability of such care, and their association with the characteristics of women and the maternity service they attended, were examined using descriptive statistics and multivariable logistic regression analyses.

RESULTS

Of 514 women, 13.1% (95%CI:10.3-16.5) reported that they received an assessment of weight at both their first and a subsequent antenatal visit, and less than one third (30.0%; 95%CI:26.0-33.9) received advice on their recommended GWG range, dietary intake and physical activity. Just 6.6% (95%CI:4.8-9.1) of women reported receiving all assessment and advice components of recommended antenatal care, and 9.9% (95%CI:7.6-12.8) of women reported being referred for extra support. Women who were younger (OR = 1.13;95%CI:1.05-1.21), identifying as Aboriginal and Torres Strait Islander (OR = 24.54;95%CI:4.98-120.94), had a higher pre-pregnancy BMI (OR = 1.13;95%CI:1.05-1.21), were experiencing their first pregnancy (OR = 3.36;95%CI:1.27-8.86), and lived in a least disadvantaged area (compared to mid-disadvantaged area (OR = 18.5;95%CI:2.6-130.5) and most disadvantaged area (OR = 13.1;95%CI:2.09-82.4)) were more likely to receive recommended assessment and advice. Most Aboriginal (92%) and non-Aboriginal (93%) women agreed that recommended GWG care is acceptable.

CONCLUSION

Most women perceive antenatal care for GWG as recommended by the Clinical Practice Guidelines as acceptable, but did not receive it. When provided, such care is not delivered consistently to all women regardless of their characteristics or those of the maternity service they attend. There is a need for service-wide practice change to increase routine GWG care in pregnancy for all women.

Effects of a Comprehensive Dietary Intervention Program, Promoting Nutrition Literacy, Eating Behavior, Dietary Quality, and Gestational Weight Gain in Chinese Urban Women with Normal Body Mass Index during Pregnancy

In urban Chinese women with normal body weight during pregnancy, we implemented a comprehensive dietary intervention program aimed at enhancing nutrition literacy, dietary quality, and gestational weight gain. The methods included both online and offline health education on prenatal nutrition, weekly weight monitoring, family back education practices, and real-time dietary guidance. The intervention was delivered to randomly assigned control and intervention group participants from gestational week 12 to week 24. The intervention group (n = 44; 100% complete data) showed significant differences (mean (SD)) compared to the control group (n = 42; 95.5% complete data) in nutrition literacy (53.39 ± 6.60 vs. 43.55 ± 9.58, p < 0.001), restrained eating (31.61 ± 7.28 vs. 28.79 ± 7.96, p < 0.001), Diet Quality Distance (29.11 ± 8.52 vs. 40.71 ± 7.39, p < 0.001), and weight gain within the first 12 weeks of intervention (4.97 ± 1.33 vs. 5.98 ± 2.78, p = 0.029). However, there was no significant difference in the incidence of gestational diabetes (2 (4.5%) vs. 4 (9.5%), p = 0.629). Participants in the intervention group reported an overall satisfaction score of 4.70 ± 0.46 for the intervention strategy. These results emphasize the positive role of comprehensive dietary intervention in promoting a healthy diet during pregnancy.

A prospective observational evaluation of an online health care professional training program to promote healthy pregnancy weight gain

ISSUE ADDRESSED

A lack of programs to develop clinician knowledge and confidence to address weight gain within pregnancy is a barrier to the provision of evidence-based care.

AIM

To examine the reach and effectiveness of the Healthy Pregnancy Healthy Baby online health professional training program.

METHODS

A prospective observational evaluation applied the reach and effectiveness elements of the RE-AIM framework. Health professionals from a range of disciplines and locations were invited to complete questionnaires before and after program completion assessing objective knowledge and perceived confidence around aspects of supporting healthy pregnancy weight gain, and process measures.

RESULTS

There were 7577 views across all pages over a year period, accessed by participants across 22 Queensland locations. Pre- and post- training questionnaires were completed 217 and 135 times, respectively. The proportion of participants with scores over 85% and of 100% for objective knowledge was higher post training (P ≤ .001). Perceived confidence improved across all areas for 88%-96% of those who completed the post- training questionnaire. All respondents would recommend the training to others.

CONCLUSIONS

Clinicians from a range of disciplines, experience and locations accessed and valued the training, and knowledge of, and confidence in delivering care to support healthy pregnancy weight gain improved after completion. SO WHAT?: This effective program to build the capacity of clinicians to support healthy pregnancy weight gain offers a model for online, flexible training highly valued by clinicians. Its adoption and promotion could standardise the support provided to women to encourage healthy weight gain during pregnancy.

Midwives' experiences of supporting healthy gestational weight management: A mixed methods systematic literature review

BACKGROUND

Excessive levels of gestational weight gain (GWG) are linked with poorer health outcomes for mother and baby, including an increased risk of pregnancy-related hypertension, labour induction, caesarean delivery and increased birth weight.

OBJECTIVE

To explore literature relating to midwives' experiences and challenges and identify interventions relating to GWG.

DESIGN

This review was conducted in accordance with the Joanna Briggs Institute methodology for mixed methods systematic reviews. CINAHL complete, APA PsycArticles, APA PsycInfo, the Cochrane Library and MEDLINE were systematically searched in May 2022. Search terms related to midwives, advice, weight management and experiences were used. A PRISMA approach was taken to identify data, and thematic analysis combined with descriptive statistics allowed synthesis and integration.

FINDINGS

Fifty-seven papers were included and three overarching themes were generated; i) emotion and weight, ii) ability to influence and iii) practical challenges and strategies for success. Weight was consistently described as a sensitive topic. Challenges included level of expertise and comfort, perceptions of ability to influence and an awareness of incongruence of midwives' own weight and the advice they are delivering. Interventions evaluated well with some self-reports of improved knowledge and confidence. There was no evidence of impact on practice or GWG.

KEY CONCLUSIONS

Although addressing maternal weight gain is an international priority due to the significant risks incurred, in this review we have identified multiple challenges for midwives to support women in healthy weight management. Identified interventions targeting midwives do not directly address the challenges identified and are therefore likely to be insufficient to improve existing practice.

IMPLICATIONS FOR PRACTICE

Partnership working and co-creation with women and midwives is essential to ensure knowledge about maternal weight gain is effectively shared across communities to catalyse change.

A Systematic Review of Women's Experiences of Interventions to Prevent Excessive Gestational Weight Gain

OBJECTIVE

To synthesize research on women's experiences of interventions to prevent excessive gestational weight gain.

DATA SOURCES

A systematic search of the following databases was conducted: CINAHL Complete, Maternity and Infant Care Database, American Psychological Association PsycArticles, American Psychological Association PsycInfo, and MEDLINE.

STUDY SELECTION

Studies were included if they involved primary research regarding the experiences of women who were pregnant or up to 1 year postpartum when reflecting on their involvement in interventions to prevent excessive weight gain during pregnancy. Nonempirical studies and those that examined experiences of women who were not pregnant or who were beyond 1 year postpartum were excluded.

DATA EXTRACTION

Information was extracted and captured in a summary table that included the study aim, participants, study design, intervention, findings, and summary score, with exceptions to quality.

DATA SYNTHESIS

Data were synthesized thematically into three themes: (a) Intervention Qualities Valued by Women, (b) Challenges Faced by Women, and (c) Perceived Benefits and Recommendations for Modifications.

CONCLUSION

Interventions intended to help women prevent excessive gestational weight gain should be tailored to individuals' unique needs to ensure that the interventions are acceptable and effective.

Sociodemographic determinants of prepregnancy body mass index and gestational weight gain: The Mutaba'ah study

Objective

This study examined the associations of sociodemographic and lifestyle factors with prepregnancy body mass index (BMI) and gestational weight gain (GWG).

Methods

In the Mutaba'ah Study in the United Arab Emirates, repeated measurements throughout pregnancy from medical records were used to determine prepregnancy BMI and GWG. Associations of sociodemographic and lifestyle factors with prepregnancy BMI and GWG (separately by normal weight, overweight, and obesity status) were tested using multivariable regression models, adjusted for maternal age at delivery.

Results

Among 3536 pregnant participants, more than half had prepregnancy overweight (33.2%) or obesity (26.9%), and nearly three‐quarters had inadequate (34.2%) or excessive (38.2%) GWG. Higher parity (β for 1–2 to ≥5 children = 0.94 to 1.73 kg/m²), lower maternal education (β for tertiary = −1.42), infertility treatment (β = 0.69), and maternal prepregnancy active smoking (β = 1.95) were independently associated with higher prepregnancy BMI. Higher parity was associated with a lower risk for excessive GWG among women with prepregnancy normal weight (odds ratios (ORs) for 1–2 to ≥5 children = 0.61 to 0.39). Higher maternal education was negatively associated with inadequate GWG among women with normal weight and overweight (ORs for tertiary education = 0.75 and 0.69, respectively).

Conclusions

Sociodemographic factors, especially parity and maternal education, were differentially associated with prepregnancy BMI and GWG adequacy across weight status.

A theory driven, pragmatic trial implementing changes to routine antenatal care that supports recommended pregnancy weight gain

Background

Prevention of weight gain outside recommendations is a challenge for health services, with several barriers to best practice care identified. The aim of this pragmatic implementation study with a historical control was to examine the impact of implementing a service wide education program, and antenatal care pregnancy weight gain chart combined with brief advice on women’s knowledge of recommended gestational weight gain (GWG), the advice received and actual GWG.

Methods

The PRECEDE PROCEED Model of Health Program planning guided intervention and evaluation targets and an implementation science approach facilitated service changes. Pregnant women < 22 weeks’ gestation attending the antenatal clinic at a metropolitan birthing hospital in Australia were recruited pre (2010, n = 715) and post (2016, n = 478) implementation of service changes. Weight measurements and questionnaires were completed at recruitment and 36 weeks’ gestation. Questionnaires assessed advice received from health professionals related to healthy eating, physical activity, GWG, and at recruitment only, pre-pregnancy weight and knowledge of GWG recommendations.

Results

Women who correctly reported their recommended GWG increased from 34% (pre) to 53% (post) (p < 0.001). Between pre and post implementation, the advice women received from midwives on recommended GWG was significantly improved at both recruitment- and 36-weeks’ gestation. For normal weight women there was a reduction in GWG (14.2 ± 5.3 vs 13.3 ± 4.7 kg, p = 0.04) and clinically important reduction in excess GWG between pre and post implementation (31% vs 24%, p = 0.035) which remained significant after adjustment (AOR 0.53 [95%CI 0.29–0.96]) (p = 0.005).

Conclusions

Service wide changes to routine antenatal care that address identified barriers to supporting recommended GWG are likely to improve the care and advice women receive and prevent excess GWG for normal weight women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04750-8.

Translation of the Weight-Related Behaviours Questionnaire into a Short-Form Psychosocial Assessment Tool for the Detection of Women at Risk of Excessive Gestational Weight Gain

The identification and measurement of psychosocial factors that are specific to pregnancy and relevant to gestational weight gain is a challenging task. Given the general lack of availability of pregnancy-specific psychosocial assessment instruments, the aim of this study was to develop a short-form psychosocial assessment tool for the detection of women at risk of excessive gestational weight gain with research and clinical practice applications. A staged scale reduction analysis of the weight-related behaviours questionnaire was conducted amongst a sample of 159 Australian pregnant women participating in the Women and Their Children’s Health (WATCH) pregnancy cohort study. Exploratory factor analysis, univariate logistic regression, and item response theory techniques were used to derive the minimum and most predictive questions for inclusion in the short-form assessment tool. Of the total 49 questionnaire items, 11 items, all 4 body image items, n = 4 attitudes towards weight gain, and n = 3 self-efficacy items, were retained as the strongest predictors of excessive gestational weight gain. These within-scale items were highly correlated, exhibiting high item information function value statistics, and were observed to have high probability (p < 0.05) for excessive gestational weight gain, in the univariate analysis. The short-form questionnaire may assist with the development of tailored health promotion interventions to support women psychologically and physiologically to optimise their pregnancy weight gain. Confirmatory factor analysis is now required.

The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy

Women with maternal obesity, an unhealthy lifestyle before and during pregnancy and excess gestational weight gain have an increased risk of adverse pregnancy and birth outcomes that can also increase the risk of long-term poor health for them and their children. Pregnant women have frequent medical appointments and are highly receptive to health advice. Healthcare professionals who interact with women during pregnancy are in a privileged position to support women to make lasting healthy lifestyle changes that can improve gestational weight gain and pregnancy outcomes and halt the intergenerational nature of obesity. Midwives and obstetrical nurses are key healthcare professionals responsible for providing antenatal care in most countries. Therefore, it is crucial for them to build and enhance their ability to promote healthy lifestyles in pregnant women. Undergraduate midwifery curricula usually lack sufficient lifestyle content to provide emerging midwives and obstetrical nurses with the knowledge, skills, and confidence to effectively assess and support healthy lifestyle behaviours in pregnant women. Consequently, registered midwives and obstetrical nurses may not recognise their role in healthy lifestyle promotion specific to healthy eating and physical activity in practice. In addition, practising midwives and obstetrical nurses do not consistently have access to healthy lifestyle promotion training in the workplace. Therefore, many midwives and obstetrical nurses may not have the confidence and/or skills to support pregnant women to improve their lifestyles. This narrative review summarises the role of midwives and obstetrical nurses in the promotion of healthy lifestyles relating to healthy eating and physical activity and optimising weight in pregnancy, the barriers that they face to deliver optimal care and an overview of what we know works when supporting midwives and obstetrical nurses in their role to support women in achieving a healthy lifestyle.

Physical Activity Advice and Counselling by Healthcare Providers: A Scoping Review

Background: Despite scientific evidence on prenatal physical activity and exercise, synthesized evidence is lacking on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers. The scoping review seeks to fill this gap by synthesizing available literature on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers to women during antenatal visits. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) search framework for scoping reviews was applied to retrieve original research articles on the prenatal physical activity and exercise practices of healthcare providers with pregnant women, published between 2010-2020, and available in English. The search databases included Google Scholar, PubMed, Science Direct, Scopus, EMBASE, The Cumulative Index for Nursing and Allied Health Literature (CINAHL), BIOMED Central, Medline and African Journal Online. Studies that fulfilled the eligibility criteria were retrieved for analysis. Results: Out of the 82 articles that were retrieved for review, 13 met the eligibility criteria. Seven of the articles were quantitative, four qualitative, one mixed-method and one controlled, non-randomised study, respectively. Three themes emerged as major findings. Healthcare providers affirmed their responsibility in providing prenatal physical activity advice and counselling to pregnant women; however, they seldom or rarely performed this role. Major barriers to prenatal physical activity and exercise included insufficient time, lack of knowledge and skills, inadequate or insufficient training, and lack of resources. Conclusion: This review highlights salient features constraining the uptake of prenatal physical activity and exercise advice/counselling by prenatal healthcare providers in both community and clinical settings. Prenatal physical activity advice and counselling are key components to the promotion of physical activity adherence during and post-partum pregnancy; this requires adequate knowledge of physical activity prescriptions and recommendations, which are personalised and contextual to environment. Research is needed to examine the prenatal physical activity advice and counselling from prenatal healthcare providers on issues hindering effective delivery of the aforementioned in the context of promoting prenatal physical activity in clinical or community settings.

MAMMA MIA! Norwegian Midwives' Practices and Views About Gestational Weight Gain, Physical Activity, and Nutrition

Objectives

Most studies regarding prevalence of prenatal lifestyle counseling are based on patient report of provider advice. The aim of the present study was to describe midwives' practice and views in promoting three distinct, but importantly related lifestyle factors: gestational weight gain (GWG), regular physical activity (PA), and nutrition.

Design

A cross-sectional study.

Setting

Healthcare clinics in Oslo and Akershus County, Norway.

Participants

Clinics that expressed interest to participate provided an email list of the midwives. Of 107 midwives invited to participate, 65 completed the 15-min electronic survey (SurveyXact), giving a response rate of 60.7%.

Outcome Measures

We developed a new questionnaire based on questions and results from similar studies, as no validated questionnaires existed when we initiated this project in 2014. The final electronic questionnaire included a mix of close-ended questions, semi-close-ended questions, and 11-point Likert scales and covered demographics, personal health behaviors, counseling practice, views, and self-perceived role in lifestyle counseling.

Results

Mean workload in prenatal care was 78%, and mean years practicing was 8.9 (±7.5). Across all three health topics, most (74-95%) reported to give advice on the first meeting, with a mean frequency of 2.2 (±1.4), 2.7 (±1.8), and 2.7 (±2.0) for GWG, PA, and nutrition counseling, respectively. Approximately 40% did not report advice on GWG or give advice discordant with the Institute of Medicine (IOM) recommendations (2009) for at least one prepregnancy body mass index (BMI) category. GWG was rated as more unpleasant to talk about than PA (3.0 ± 2.8 vs. 1.1 ± 2.5, p < 0.001) and nutrition (3.0 ± 2.8 vs. 1.2 ± 2.5, p = 0.002). Also, regarding the importance of giving lifestyle advice, PA (9.6 ± 0.9 vs. 8.3 ± 2.2, p < 0.001) and nutrition (9.9 ± 0.4 vs. 8.3 ± 2.2, p < 0.001) were rated as more important than advice about GWG. Postpartum, nearly 40% gave advice about PA, whereas only two (3.1%) reported to discuss weight/weight retention (p < 0.001).

Conclusion

While most midwives gave advice on GWG, PA, and nutrition at the first meeting and rated lifestyle counseling as an important topic, the advice on GWG was often discordant with IOM recommendations, and the topic was viewed as more unpleasant to talk about than PA and nutrition.

Impact of service-wide initiatives to support healthy pregnancy weight gain on weight-related documentation

BACKGROUND

Excess gestational weight gain is associated with adverse pregnancy outcomes. Addressing barriers to the provision of best practice care that supports healthy pregnancy weight gain could assist staff in clinical care; however, little is known about changes to staff practices after ameliorating barriers.

AIMS

To evaluate if service initiatives to promote healthy pregnancy weight gain improve weight-related documentation by antenatal staff throughout pregnancy care.

MATERIALS AND METHODS

Service initiatives including staff training, familiarisation with a pregnancy weight gain chart and placement of scales in clinic rooms were introduced. Pregnancy health records were audited for deliveries pre- (2014) and post-implementation (2017) to obtain weight-related measures. Measures assessed included the documentation of pre-pregnancy weight, height, pre-pregnancy body mass index (BMI), referral to dietetic services (if overweight) and the accuracy of pre-pregnancy BMI calculation. The proportion of visits with weight recorded during pregnancy was also audited.

RESULTS

A total of 1003 and 1050 records were included from the pre- and post-intervention groups respectively. Significant improvements over time were observed in the documentation of pre-pregnancy weight (P < 0.001), BMI (P < 0.001), accuracy of BMI calculation (P < 0.001) and for obese women proportion of visits with weight recorded (P = 0.02). There was a non-significant increase in the documentation of dietetic referral for overweight women (1.1% vs 2.2%, P = 0.27) and proportion of visits with weight recorded for women across all pre-pregnancy BMI groups (49% vs 51%, P = 0.07).

CONCLUSIONS

Addressing barriers to supporting healthy pregnancy weight gain through service-wide initiatives may improve weight-related documentation by antenatal staff.

Offering weight management support to pregnant women with high body mass index: A qualitative study with midwives

OBJECTIVE

The prevalence of pregnant women with high body mass index is increasing worldwide. High body mass index is associated with health risks for mother and baby and supporting healthy gestational weight gain is important. Midwives play an important role in supporting women to engage in behaviours such as healthy eating and physical activity. The aim of this study was to explore how midwives' support pregnant women with high body mass index to establish a healthy lifestyle with emphasis on nutrition and physical activity in order to minimise gestational weight gain.

METHODS

Semi-structured interviews were conducted with 16 midwives working in antenatal health care in Sweden. Interviews were conducted shortly after new guidelines on care for pregnant women with high body mass index had been introduced. The interviews were recorded, transcribed and analysed by thematic analysis.

RESULTS

Three main themes were identified; use a conscious approach, invite to participate and have a long-term health perspective. Midwives built a relationship with a woman through identifying her concerns and circumstances, before sensitively discussing weight. Some midwives used Motivational Interviewing to help women identify their own resources. To reach long-term health benefits, midwives set achievable goals with the women.

CONCLUSION

These study findings provide practical examples of how midwives can support women with weight management during pregnancy. Through being sensitive when developing a relationship, midwives enabled the women to identify their own resources and achievable goals. Support after the baby is born is needed subsequently to help women maintain their healthy behaviour changes.

A mixed method study evaluating the integration of pregnancy weight gain charts into antenatal care

Monitoring pregnancy weight can reduce excess gestational weight gain (GWG), and is recommended in clinical practice guidelines as part of routine care. This study aimed to evaluate the implementation of routine weight monitoring using a pregnancy weight gain chart (PWGC), and assess health care professionals (HCPs) and pregnant women's attitudes and practices around its use. A semiquantitative survey was conducted with a consecutive sample of antenatal women at 16 and 36 weeks gestation. Women were weighed, and a PWGC audit done at 36 weeks gestation to assess adherence to chart use and GWG. A cross-sectional survey of antenatal HCPs at the Australian facility assessed staff attitudes and practices relating to weight monitoring and PWGC use. Of the 291 women surveyed, 68% reported being given a PWGC. Of the audited PWGCs (n = 258), 54% had less than three weights recorded, 36% had errors, and 3% were unused. All HCPs surveyed (n = 42) were aware of the PWGC, 63% reported using it to track GWG regularly and 26% believed it to be only the woman's responsibility (i.e., not the midwife's role) to complete it. Seventy-six percent reported they needed more training in counselling pregnant women, and insufficient time was a main barrier to weighing and conversing with women. It is feasible to implement a PWGC into routine antenatal care. Clarity over women's and HCPs responsibility for monitoring GWG and completion of the PWGC is needed. Training on correct PWGC use and counselling and workforce engagement are required to overcome barriers and support healthy GWG.