Weight stigma and prenatal physical activity: Exploring the perspectives of pregnant women living with obesity

Drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women: A systematic review

Women in the preconception, pregnant, or postpartum period are susceptible to weight stigma, particularly due to the risk of excess weight gain during the reproductive life period and the negative effects of stigma on the health of both the mother and the child. Identifying the drivers and facilitators of weight stigma will help guide focused weight stigma prevention interventions. This systematic review aimed to identify the drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women. In May 2022, Medline, Embase, PsycINFO, and the Maternity and Infant Care Database were searched for peer-reviewed articles published since 2010 using search terms weight AND stigma AND preconception, OR pregnant, OR postpartum. Of the 1724 articles identified, 34 fulfilled the inclusion criteria and were included in a narrative synthesis. Women reported facing insensitive language, misconceptions about obesity across all settings, and inappropriate media representation. The unavailability of appropriate equipment at facilities was reported by both women and health professionals. Our findings indicate that a rigorous effort by all stakeholders is necessary to promote regulatory, legal, and educational initiatives designed to reduce weight stigma and discrimination against women in the reproductive period.

Social support for exercise from pregnancy to postpartum and the potential impact of a mobile application: A randomized control pilot trial in Southern United States

This study compared perceived social support among women of all body mass index (BMI) categories with an attempt to assess the efficacy of the BumptUp® mobile application to improve social support for exercise during pregnancy and postpartum. Thirty-five pregnant women living in Southern United States were included in the sample. The intervention group received access to the BumptUp® mobile application that was designed to promote physical activity during pregnancy and postpartum. The control group received an evidence-based educational brochure. Perceived social support for exercise was assessed at four-time points using the social support and exercise survey. Outcomes were evaluated at 23-25, 35-37 gestational weeks, and 6 and 12 weeks postpartum. Based on their pre-pregnancy weight and height, BMI was computed to categorize participants into lean, overweight, and obese groups. Social support across BMI categories and between control and intervention groups were compared using linear mixed-effect models. Women grouped in the overweight and obese BMI categories reported receiving significantly lower levels of social support for exercise than women in the lean category throughout pregnancy and postpartum during mid-pregnancy, late pregnancy, and at 12 weeks postpartum (p < 0.05). Although the intervention group received higher social support than the control group throughout all four assessment points, the difference was not statistically significant (p > 0.05). Women with a pre-pregnancy BMI of overweight and obese received lower social support for exercise during pregnancy and postpartum. The efficacy of BumptUp® to improve perceived social support for exercise in pregnancy and postpartum was not evident in the results.

Best practices in prenatal health promotion: Perceptions, experiences, and recommendations of Ottawa, Canada, prenatal key informants

BACKGROUND

Prenatal health promotion includes the provision of evidence-based information and practical skills to optimize maternal-fetal outcomes. Increasingly, prenatal education is delivered by both healthcare professionals and allied childbirth educators, in community- or hospital-based group classes, targeted outreach programs, and online modules.

OBJECTIVES

To better understand how prenatal health promotion relates to a diverse urban community, we assessed the perspectives of Ottawa, Canada prenatal key informants.

DESIGN

This is a qualitative research with key informant interviews.

METHODS

Semi-structured interviews were conducted with 11 prenatal key informants, responsible for the design, delivery, or promotion of publicly available prenatal health services. Interviews explored concepts and delivery of prenatal health promotion, strategies to address existing and emerging prenatal topics, identification of barriers to prenatal health services, and recommendations.

RESULTS

Key informants recommended a lifespan approach to prenatal health promotion, with an emphasis on healthy behaviors, emotional health, labor and delivery, and postpartum/early parenting. Recognizing community health disparities, key informants used community outreach, and intersectoral collaborations for Indigenous and other at-risk communities to mitigate barriers to prenatal service uptake.

CONCLUSIONS

Ottawa key informants conceptualized prenatal health promotion as inclusive, comprehensive, and as an extension of preconception, school-based sexual education. Respondents recommended the design and delivery of prenatal interventions as culturally safe and trauma informed, using online modalities to complement in-person activities. The experience and intersectoral networks of community-based prenatal health promotion programs represent potential capacity to address emergent public health risks to pregnancy, particularly among at-risk populations.

PLAIN LANGUAGE SUMMARY

A broad and diverse community of professionals deliver prenatal education to help people have healthy babies. We interviewed Ottawa, Canada experts in prenatal care/education to learn about the design and delivery of reproductive health promotion. We found that Ottawa experts emphasized healthy behaviors beginning before conception and through pregnancy. Community outreach was identified as a successful strategy to promote prenatal education to marginalized groups.

Exploring weight bias internalization in pregnancy

Background

Recent research has shown that pregnant individuals experience weight stigma throughout gestation, including negative comments and judgement associated with gestational weight gain (GWG). Weight bias internalization (WBI) is often a result of exposure to weight stigma and is detrimental to biopsychological health outcomes. The purpose of this study was to explore WBI in pregnancy and compare scores based on maternal weight-related factors including pre-pregnancy body mass index (BMI), obesity diagnosis and excessive GWG.

Methods

Pregnant individuals in Canada and USA completed a modified version of the Adult Weight Bias Internalization Scale. Self-reported pre-pregnancy height and weight were collected to calculate and classify pre-pregnancy BMI. Current weight was also reported to calculate GWG, which was then classified as excessive or not based on Institute of Medicine (2009) guidelines. Participants indicated if they were diagnosed with obesity by a healthcare provider. Inferential analyses were performed comparing WBI scores according to pre-pregnancy BMI, excessive GWG, and obesity diagnosis. Significance was accepted as p < 0.05 and effect sizes accompanied all analyses.

Result

336 pregnant individuals completed the survey, with an average WBI score of 3.9 ± 1.2. WBI was higher among those who had a pre-pregnancy BMI of obese than normal weight (p = 0.04, η² = 0.03), diagnosed with obesity than not diagnosed (p < 0.001, Cohen’s d = 1.3), and gained excessively versus not (p < 0.001, Cohen’s d = 1.2).

Conclusions

Pregnant individuals who have a higher BMI, obesity and gain excessively may experience WBI. Given that weight stigma frequently occurs in pregnancy, effective person-oriented strategies are needed to mitigate stigma and prevent and care for WBI.