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Table 2 Outcomes in whole study sample

From: Documentation of guideline adherence in antenatal records across maternal weight categories: a chart review

Variable

Number and proportion (%) of study sample

Number and proportion (%) for normal weight (BMI = 18.5-24.9)

Number and proportion (%) for overweight (BMI = 25.0-29.9 kg/m2)

Number and proportion (%) for obese (BMI ≥ 30 kg/m2)

P value

 

N = 3001

N = 126

N = 79

N = 82

N/A

Pre-pregnancy BMI recorded in chart 2

159 (53.0%)

71 (56.3%)

42 (53.2%)

39 (47.6%)

0.71

Weight recorded at antenatal visits

    

0.88

 Always

277 (92.3%)

115 (91.3%)

74 (93.7%)

77 (93.9%)

 Never

4 (1.3%)

1 (0.8%)

0 (0.0%)

1 (1.2%)

 Sometimes

19 (6.3%)

10 (7.9%)

5 (6.3%)

4 (4.9%)

Documented recommendation of weight gain 2

41 (13.7%)

20 (13.7%)

7 (8.9%)

14 (17.1%)

0.26

Obesity correctly identified a risk factor 8

76/82 (92.7%)

0 (0.0%)

4 (5.1%)

76 (92.7%)

N/A

Papanicolaou test

    

0.87

 Documented within last year

197 (65.7%)

84 (66.7%)

53 (67.1%)

52 (63.4%)

 Documented greater than 1 year ago

28 (9.3%)

10 (7.9%)

6 (7.6%)

11 (13.4%)

 Not documented anywhere in chart

54 (18.0%)

24 (19.0%)

14 (17.7%)

13 (15.9%)

 Date not legible

21 (7.0%)

8 (6.3%)

6 (7.6%)

6 (7.3%)

Gonorrhea and chlamydia tests

    

0.67

 Documented as swabbed

162 (54.0%)

70 (55.6%)

44 (55.7%)

42 (51.2%)

 Documented as not swabbed

6 (2.0%)

4 (3.2%)

0 (0.0%)

2 (2.4%)

 Not documented anywhere in chart

131 (43.7%)

51 (40.5%)

35 (44.3%)

38 (46.3%)

 Not legible

1 (0.3%)

1 (0.8%)

0 (0.0%)

0 (0.0%)

Prenatal genetic screening 3

    

0.37

 Documented accepted5

153 (51.0%)

68 (54.0%)

32 (40.5%)

46 (56.1%)

 Documented declined or too late for tests

90 (30.0%)

35 (27.8%)

31 (39.2%)

21 (25.6%)

 No results or offer documented anywhere in chart

35 (11.7%)

13 (10.3%)

10 (12.7%)

11 (13.4%)

 Unclear (documented as both accepted and declined or too late4)

22 (7.3%)

10 (7.9%)

6 (7.6%)

4 (4.9%)

First ultrasound scan

     

 Documented in first trimester

212 (70.7%)

89 (70.6%)

54 (68.3%)

60 (73.2%)

0.09

Second trimester 18–22 week ultrasound scan for anatomy 2

255 (85%)

109 (86.5%)

69 (87.3%)

65 (79.3%)

0.27

 No ultrasounds documented anywhere in chart

8 (2.7%)

5 (4.0%)

0 (0.0%)

2 (2.4%)

 Unclear (dates not legible or discrepant documentation5)

1 (0.3%)

1 (0.8%)

0 (0.0%)

0 (0.0%)

Gestational diabetes testing 2 (Glucose challenge test and/or Glucose tolerance test)

    

0.09

 Documented as completed

207 (69.0%)

90 (71.4%)

60 (75.9%)

51 (62.2%)

 Documented as not completed

28 (9.3%)

15 (11.9%)

6 (7.6%)

6 (7.3%)

 Not documented anywhere in chart

65 (21.7%)

21 (16.7%)

13 (16.5%)

25 (30.5%)

Group B streptococcus screening

    

0.05

 Documented as swabbed6

259 (86.3%)

109 (86.5%)

69 (87.3%)

71 (86.6%)

 Documented as not swabbed7

21 (7.0%)

13 (10.3%)

6 (7.6%)

2 (2.4%)

 Not documented anywhere in chart

20 (6.7%)

4 (3.2%)

4 (5.1%)

9 (11.0%)

Primary health care provider during pregnancy

    

0.01

 Shared antenatal care9

125 (41.7%)

51 (40.5%)

42 (53.2%)

28 (34.1%)

 Exclusive care by Obstetrician

121 (40.3%)

46 (36.5%)

24 (30.4%)

45 (54.9%)

 Exclusive care by Midwife

53 (17.7%)

28 (22.2%)

13 (16.5%)

9 (11.0%)

 Exclusive care by Family Physician

1 (0.3%)

1 (0.8%)

0 (0.0%)

0 (0.0%)

Counseling and education topics

     

 Discussion of exercise checked off or written in chart2

40 (13.3%)

17 (13.5%)

14 (17.7%)

6 (7.3%)

0.14

 Discussion of preterm labor checked off or written in chart

50 (16.7%)

26 (20.6%)

10 (12.7%)

11 (13.4%)

0.22

 Discussion of fetal movement checked off or written in chart

293 (97.7%)

123 (97.6%)

78 (98.7%)

80 (97.6%)

1.00

 Discussion of prenatal classes checked off or written in chart

41 (13.7%)

20 (15.9%)

12 (15.2%)

7 (8.5%)

0.28

 Discussion of birth plans checked off or written in chart

116 (38.7%)

47 (37.3%)

31 (39.2%)

37 (45.1%)

0.52

 Discussion of pain management checked off or written in chart

32 (10.7%)

15 (11.9%)

6 (7.6%)

8 (9.8%)

0.60

 Discussion of breastfeeding checked off or written in chart

33 (11.0%)

16 (12.7%)

6 (7.6%)

10 (12.2%)

0.50

  1. 1No available BMI or weight for 2/300 women who were excluded from these analyses; 11/300 underweight were excluded from these analyses due to the small number; therefore, total included in these analyses N = 287.
  2. 2Indicates a recommendation within the obesity guidelines, while the remainder of the outcomes are part of standard antenatal care for all women regardless of weight category, as noted on the mandatory antenatal records (with regard to gestational diabetes, the guideline recommends advising obese women that they are at risk for medical complications including gestational diabetes).
  3. 3Integrated prenatal screen (IPS), or maternal serum screen (MSS) or Chorionic villus sampling/amniocentesis for Down Syndrome.
  4. 4Documented as both completed and declined or too late on first page of antenatal record, but no documentation confirming decision elsewhere in chart.
  5. 5Documented as scheduled in visit notes on second page of antenatal record, but no documentation confirming completion elsewhere in chart.
  6. 6“Positive” or “Negative” for Group B streptococcus or “Yes” documented for “Group B streptococcus at 35–37 weeks?” in maternal record.
  7. 7“No” documented for “Group B streptococcus at 35–37 weeks?” in maternal record.
  8. 8Obesity was incorrectly identified as a risk factor in 4/79 overweight women.
  9. 9Any combination of Obstetrician, Maternal-Fetal Medicine, Family Physician, Midwife and/or Nurse Practitioner.
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