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Peng J, Xu T, Tan X, He Y, Zeng Y, Tang J, Sun M. Eating Styles Profiles and Correlates in Chinese Postpartum Women: A Latent Profile Analysis. Nutrients 2024; 16:2299. [PMID: 39064741 PMCID: PMC11280277 DOI: 10.3390/nu16142299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/27/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Postpartum women present a high risk of disordered eating behaviors, but the heterogeneity between groups was not identified. This cross-sectional study aimed to identify eating styles profiles in postpartum women and explore the correlates based on demographic characteristics and psychosocial factors. Questionnaires were administered to 507 Chinese postpartum women. Latent profile analysis (LPA) was conducted to identify eating styles profiles. Multinomial logistic regression was used to investigate the correlates of these profiles among postpartum women. The LPA identified three eating styles profiles: postpartum women with low emotional, external, and restrained eating (Profile 1, 6.9%); postpartum women with medium emotional, external, and restrained eating (Profile 2, 66.1%); and postpartum women with high emotional, external, and restrained eating (Profile 3, 27.0%). Compared to Profile 1, higher postpartum depression (PPD) and body mass index (BMI) were more likely to be associated with Profile 2 and Profile 3, whereas higher postpartum weight retention (PPWR) was more likely to be associated with Profile 1. Compared to Profile 2, higher PPD and BMI were more likely associated with Profile 3. Disordered eating behaviors in postpartum women with three eating styles were associated with BMI, PPD, and PPWR. This study can guide healthcare professionals in developing targeted interventions to improve maternal and child health globally.
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Affiliation(s)
- Jiayuan Peng
- Xiangya School of Nursing, Central South University, No.172 Tongzipo Road, Yuelu District, Changsha 410013, China; (J.P.); (T.X.); (Y.H.); (Y.Z.); (J.T.)
| | - Tian Xu
- Xiangya School of Nursing, Central South University, No.172 Tongzipo Road, Yuelu District, Changsha 410013, China; (J.P.); (T.X.); (Y.H.); (Y.Z.); (J.T.)
| | - Xiangmin Tan
- School of Rural Health, Monash University, 15 Sargeant Street, Warragul, VIC 3820, Australia;
| | - Yuqing He
- Xiangya School of Nursing, Central South University, No.172 Tongzipo Road, Yuelu District, Changsha 410013, China; (J.P.); (T.X.); (Y.H.); (Y.Z.); (J.T.)
| | - Yi Zeng
- Xiangya School of Nursing, Central South University, No.172 Tongzipo Road, Yuelu District, Changsha 410013, China; (J.P.); (T.X.); (Y.H.); (Y.Z.); (J.T.)
| | - Jingfei Tang
- Xiangya School of Nursing, Central South University, No.172 Tongzipo Road, Yuelu District, Changsha 410013, China; (J.P.); (T.X.); (Y.H.); (Y.Z.); (J.T.)
| | - Mei Sun
- Xiangya School of Nursing, Central South University, No.172 Tongzipo Road, Yuelu District, Changsha 410013, China; (J.P.); (T.X.); (Y.H.); (Y.Z.); (J.T.)
- School of Nursing, Xinjiang Medical University, No.168 Youyi South Road, Urumqi 830054, China
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Deol S, Ferdinands A, Hill B, Incollingo Rodriguez AC, Nutter S, Ramos Salas X, Nagpal TS. Intersecting Expectations when Expecting: Pregnancy-Related Weight Stigma in Women of Colour. J Immigr Minor Health 2024:10.1007/s10903-024-01619-0. [PMID: 39017811 DOI: 10.1007/s10903-024-01619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2024] [Indexed: 07/18/2024]
Abstract
Weight stigma is a social justice issue that can lead to weight-based discrimination and mistreatment. In pregnancy, emerging evidence has highlighted that weight stigma predominantly affects individuals who have larger bodies and is associated with postpartum depression and avoidance of healthcare. Racial and ethnic background will influence perceptions of, and responses to, weight stigma and therefore it is necessary to ensure diverse voices are represented in our understanding of weight stigma. Semi-structured interviews were conducted with ten women who were within one year postpartum; nine identified as Black or African American and one as Hawaiian. Thematic analysis led to identification of three themes: (1) sources of weight stigma and their response to it, (2) support systems to overcome weight stigma, and (3) intersectional experiences. Women reported that sources of weight stigma included unsolicited comments made about their weight often coming from strangers or healthcare professionals that resulted in emotional distress. Support systems identified were family members and partners who encouraged them to not focus on negative remarks made about weight. Intersectional accounts included comparing their bodies to White women, suggesting that they may carry their weight differently. Women shared that, although they felt immense pressure to lose weight quickly postpartum, motherhood and childcare was their utmost priority. These findings inform further prospective examination of the implications of weight stigma in pregnancy among diverse populations, as well as inform inclusive public health strategies to mitigate weight stigma.
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Affiliation(s)
- Simrit Deol
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - Alexa Ferdinands
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Briony Hill
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Sarah Nutter
- Educational Psychology and Leadership Studies, University of Victoria, Victoria, Canada
- Institute on Aging and Lifelong Health, University of Victoria, Victoria, Canada
| | | | - Taniya S Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 116 St & 85 Ave, Edmonton, AB, T6G 2R3, Canada.
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Call CC, Hawkins MS, Shah VK, Frank D, Niemi S, Jouppi RJ, Ferguson E, Conlon RPK, Levine MD. A longitudinal investigation of breastfeeding planning, initiation, and duration among individuals with pre-pregnancy overweight or obesity. Appetite 2024; 197:107333. [PMID: 38570117 PMCID: PMC11104448 DOI: 10.1016/j.appet.2024.107333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024]
Abstract
Individuals with a body mass index (BMI)≥25 kg/m2 are less likely to initiate and continue breastfeeding than are those with BMIs<25. Given the intergenerational health benefits of breastfeeding, it is important to understand breastfeeding behaviors and their correlates among individuals with BMIs≥25. Thus, in an observational cohort with BMI≥25 (N = 237), we aimed to characterize longitudinal relationships among breastfeeding planning, initiation, and duration and their sociodemographic/clinical correlates and determine if pre-pregnancy BMI predicts breastfeeding planning, initiation, and duration. Breastfeeding behaviors, weight/BMI, and sociodemographic/clinical characteristics were assessed in early, mid, and late pregnancy, and at six-months postpartum. Most participants planned to (84%) and initiated (81%) breastfeeding, of which 37% breastfed for ≥6 months. Participants who were married, first-time parents, higher in education/income, and had never smoked tobacco were more likely to plan, initiate, and achieve ≥6 months of breastfeeding. Higher pre-pregnancy BMI was not associated with breastfeeding planning or initiation but was associated with lower adjusted odds of breastfeeding for ≥6 months relative to <6 months. Findings suggest that support aimed at extending breastfeeding among those with elevated pre-pregnancy BMI may be warranted. Future interventions should also address sociodemographic and clinical inequities in breastfeeding.
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Affiliation(s)
- Christine C Call
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Marquis S Hawkins
- University of Pittsburgh, Department of Epidemiology, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Vrusha K Shah
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - David Frank
- University of Pittsburgh, Department of Epidemiology, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Sarah Niemi
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Riley J Jouppi
- University of Pittsburgh, Department of Psychology, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
| | - Emma Ferguson
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Rachel P K Conlon
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Michele D Levine
- University of Pittsburgh, Department of Psychiatry, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA; University of Pittsburgh, Department of Psychology, 210 South Bouquet Street, Pittsburgh, PA, 15260, USA
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Nagpal TS, Pearce N, Adamo KB. Presentation of a weight bias internalization tool for use in pregnancy and a call for future research: A commentary. OBESITY PILLARS 2024; 10:100107. [PMID: 38524875 PMCID: PMC10957497 DOI: 10.1016/j.obpill.2024.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
Background Emerging evidence has shown that weight stigma is a concern during pregnancy, with several studies documenting common sources including healthcare, the media and interpersonal networks. Experiencing weight stigma may lead to weight bias internalization (WBI), whereby individuals accept and self-direct negative weight-related stereotypes, and limited research has assessed this in the context of pregnancy. Pregnancy is unique in terms of weight changes as many individuals will experience gestational weight gain (GWG). Accordingly, a WBI tool that accounts for GWG may be a more population-specific resource to use. Methods This commentary presents a pregnancy-specific WBI tool that accounts for GWG. The validated Adult WBI scale was modified to include 'pregnancy weight gain'. This commentary also presents a brief summary of research that has assessed WBI in pregnancy and recommendations for future work. Results Recommended future work includes validation of the pregnancy-specific WBI tool and prospective examinations of weight stigma and WBI in pregnancy and implications on maternal and newborn outcomes. Conclusion Ultimately this research may inform development of interventions and resources to mitigate weight stigma and WBI in pregnancy and overall may contribute to improving prenatal outcomes and experiences.
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Affiliation(s)
- Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
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Hailu H, Skouteris H, Incollingo Rodriguez AC, Galvin E, Hill B. Drivers and facilitators of weight stigma among preconception, pregnant, and postpartum women: A systematic review. Obes Rev 2024; 25:e13710. [PMID: 38343332 DOI: 10.1111/obr.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 04/18/2024]
Abstract
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.
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Affiliation(s)
- Haimanot Hailu
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Warwick Business School, The University of Warwick, Coventry, UK
| | - Angela C Incollingo Rodriguez
- Psychological and Cognitive Sciences, Department of Social Science and Policy Studies, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
| | - Emma Galvin
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hailu H, Skouteris H, Incollingo Rodriguez AC, Hill B. SWIPE: a conceptual, multi-perspective model for understanding and informing interventions for weight stigma in preconception, pregnancy, and postpartum. Health Psychol Rev 2024:1-17. [PMID: 38560922 DOI: 10.1080/17437199.2024.2333801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
Weight stigma is salient across the preconception, pregnancy, and postpartum (PPP) periods because of prevailing prescriptive norms and expectations about weight and weight gain during the reproductive period. Weight stigma is associated with negative physical and psychological health outcomes for mother and child. A clearly defined, multi-level conceptual model for interventions, research, and policy is critical to mitigating the adverse effects of weight stigma in PPP populations. Conceptual models of weight stigma towards PPP women have advanced our understanding of this issue and guided evidence accumulation but there remains a gap in informing the translation of evidence into action. Guided by evidence-based paradigms for conceptual model development, this paper has two primary objectives. First, we review and summarise theories, frameworks, and models from the PPP population and general literature to inform our understanding of the development and perpetuation of weight stigma for PPP women. Second, we propose a novel comprehensive intervention-guiding conceptual model that draws from and synthesises across multiple disciplines - the SWIPE (Stigma of Weight In the PPP Experience) model. This conceptual model will help to plan coordinated, multi-layered, and effective strategies to reduce and ultimately eliminate weight stigma for PPP women.
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Affiliation(s)
- Haimanot Hailu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helen Skouteris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Warwick Business School, The University of Warwick, Coventry, UK
| | - Angela C Incollingo Rodriguez
- Psychological & Cognitive Sciences, Department of Social Science & Policy Studies, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Briony Hill
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Binder A, Kilian C, Hanke S, Banabak M, Berkenhoff C, Petersen KU, Batra A. Stigma and self-stigma among women within the context of the german "zero alcohol during pregnancy" recommendation: A qualitative analysis of online forums and blogs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104331. [PMID: 38241887 DOI: 10.1016/j.drugpo.2024.104331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND In many countries, including Germany, it is recommended to abstain from alcohol during pregnancy to avoid harm to the baby. In this qualitative research study, analysis of online forums was conducted to explore women's perception of the German "zero alcohol during pregnancy" recommendation with regard to stigma and self-stigma. METHODS We used a grounded theory approach to analyze online forum discussions on alcohol use during pregnancy. Data consisted of 9 discussion threads from 5 different forums and blogs involving 115 participants in total. We used key concepts developed during analysis and the theory of stigma to interpret the posts. RESULTS We identified five key themes: (1) Low alcohol health literacy as a breeding ground for stigmatization; (2) The widespread assumption that maternal abstinence is a prerequisite for being considered a "good mother"; (3) Interpersonal role conflicts and a guilty conscience as a result of stigmatization or self-stigmatization; (4) Paying little attention to the role of psychosocial factors in alcohol consumption, especially regarding partner responsibility during pregnancy.; (5) Understanding the "zero alcohol during pregnancy" recommendation as a complete ban, associated with loss of autonomy. CONCLUSION The current method of communicating the "zero alcohol during pregnancy" recommendation may have unintended consequences. Specifically, misconceptions about the harm associated with low alcohol consumption and setting high expectations of motherhood are factors that can contribute to stigma or self-stigma and potentially undermine self-efficacy, help-seeking behavior, and overcoming the barriers to alcohol health literacy.
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Affiliation(s)
- Annette Binder
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany; DZPG (German Center for Mental Health), partner site Tübingen, Tübingen, Germany.
| | - Carolin Kilian
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sara Hanke
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Meryem Banabak
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Clara Berkenhoff
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Kay Uwe Petersen
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Anil Batra
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany; DZPG (German Center for Mental Health), partner site Tübingen, Tübingen, Germany
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Perera M, Hawk GS, Nagpal TS, Tinius RA. 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. Prev Med Rep 2023; 36:102485. [PMID: 37954963 PMCID: PMC10637991 DOI: 10.1016/j.pmedr.2023.102485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
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.
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Affiliation(s)
- Madhawa Perera
- Exercise Science, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Gregory S. Hawk
- Department of Statistics, University of Kentucky, Lexington, KY 40506, USA
| | - Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Rachel A. Tinius
- Exercise Science, Western Kentucky University, Bowling Green, KY 42101, USA
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Hoch M, Meloncelli N, de Jersey S. Examining Enhanced Implementation of Routine Antenatal Care Practices to Support Healthy Pregnancy Weight Gain. J Midwifery Womens Health 2023; 68:449-457. [PMID: 36789484 DOI: 10.1111/jmwh.13477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Current antenatal guidelines advocate for regular weighing of women during their pregnancy, with supportive conversations to assist healthy gestational weight gain (GWG). To facilitate overcoming weight monitoring barriers, a pregnancy weight gain chart (PWGC), coupled with brief intervention advice, was implemented in 2016 to guide provider and woman-led routine weight monitoring. This study aimed to examine the extent to which the use of PWGCs and routine advice provision were normalized into routine antenatal care following enhanced implementation strategies and whether this led to a change in GWG. METHODS This pre-post study included data from 2010 (preimplementation), 2016, and 2019 (postimplementation). A retrospective audit of health records and PWGCs was undertaken to assess adherence to chart use and evaluate GWG outcomes. A survey was sent to women in 2010 and repeated in 2019 to understand the advice women received from health care professionals. RESULTS Compared with the preimplementation cohort (2010), more women achieved a healthy GWG in 2019 (42% vs 31%, P = .04). In 2019, having 3 or more weights recorded was associated with a reduction in excess GWG (P = .028). More women reported receiving helpful advice about healthy GWG in 2019 compared with 2010, although minimal changes to advice received about nutrition and physical activity were observed. DISCUSSION Enhanced implementation strategies and ongoing efforts to optimize supportive antenatal care practices are required to effect positive change in GWG. Further evaluation of the perspectives of pregnant women and counseling practices of health professionals is needed.
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Affiliation(s)
- Mikeeley Hoch
- School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia
| | - Nina Meloncelli
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Susan de Jersey
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Hill IF, Angrish K, Nutter S, Ramos-Salas X, Minhas H, Nagpal TS. Exploring body dissatisfaction in pregnancy and the association with gestational weight gain, obesity, and weight stigma. Midwifery 2023; 119:103627. [PMID: 36804829 DOI: 10.1016/j.midw.2023.103627] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/30/2022] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Body dissatisfaction in pregnancy has been associated with negative psychological maternal outcomes, including increased risk of postpartum depression. This study aimed to explore weight-related factors that influence body dissatisfaction in pregnancy, including gestational weight gain (GWG), weight stigma, obesity, and weight loss attempts before pregnancy. DESIGN Secondary analysis of a larger cross-sectional study. SETTING Online survey administered via Qualtrics. PARTICIPANTS ≥12 weeks pregnant, ≥18 years of age, having a singleton pregnancy and residing in Canada. MEASUREMENTS AND FINDINGS A battery of questionnaires were completed, including the Body Image in Pregnancy Scale (BIPS) sub-scale. The BIPS scores were compared based on experiences of weight stigma in pregnancy, perception towards their GWG, weight loss attempts before pregnancy, obesity, and GWG category classified as excessive or not referring to Institute of Medicine (2009) guidelines. Significant differences were entered into a linear regression model with BIPS scores as the dependent variable. Significance was accepted as p<0.05. A total of 182 participants completed the survey. There were no differences in BIPS scores based on GWG category (p = 0.160), or obesity (p = 0.230). Poorer BIPS scores were reported by those who felt they had gained 'too much' pregnancy weight than 'appropriate' (p<0.001), and among those who were trying to lose weight before pregnancy compared to those who were not (p = 0.002). Poorer BIPS scores were also reported by individuals who indicated they had experienced weight stigma during pregnancy compared to those who had not (p<0.001). Regression results showed that significant variables were perceptions towards GWG (p = 0.003) and experiencing weight stigma in pregnancy (p = 0.011). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Perceptions towards GWG and experiencing weight stigma can influence body dissatisfaction in pregnancy. Given the detrimental physical and psychological consequences of body dissatisfaction, effective strategies to reduce prenatal weight stigma are needed, such as training maternal healthcare providers to offer sensitive preconception and prenatal weight counselling.
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Affiliation(s)
- Isabelle F Hill
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, ON, Canada
| | - Kirina Angrish
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, ON, Canada
| | - Sarah Nutter
- Department of Educational Psychology and Leadership Studies, University of Victoria, BC, Canada
| | | | - Harneet Minhas
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, ON, Canada
| | - Taniya S Nagpal
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, ON, Canada; Faculty of Kinesiology, Sport and Recreation, University of Alberta, AB, Canada.
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Nagpal TS, Nippert KE, Velletri M, Tomiyama AJ, Incollingo Rodriguez AC. Close Relationships as Sources of Pregnancy-Related Weight Stigma for Expecting and New Mothers. Int J Behav Med 2023; 30:297-303. [PMID: 35486351 DOI: 10.1007/s12529-022-10083-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Experiencing weight stigma during pregnancy is detrimental to psychosocial health outcomes, including increasing maternal stress and undermining engagement in health behaviors. Guided by a recent socioecological framework, close interpersonal relationships are integral in pregnancy to facilitate healthy behaviors and protect maternal mental health, but they may also be sources that project weight stigma. The purpose of this study was to characterize weight stigma experienced during pregnancy and postpartum from close relationships including partners, immediate family, extended family, and friends. METHOD Women who were pregnant or up to 1 year postpartum completed a survey that assessed sources of weight stigma since becoming pregnant. A thematic analysis was performed to code open-ended responses to understand the lived experiences of pregnancy-related weight stigma experienced from close relations. RESULTS Of the 501 women who completed the online survey, 157 indicated experiencing weight stigma from close relations. Average frequency of weight stigma from close relations was 1.83 ("less than once a month" to "a few times a month"). Weight-stigmatizing examples from close relations during pregnancy included negative assumptions about maternal or fetal health and maternal lifestyle behaviors based on weight gain; comparing women to pregnant body ideals; and making comments that resulted in women judging themselves poorly as a pregnant individual or mother. CONCLUSIONS Close relationships can be sources of pregnancy-related weight stigma. This may not only increase risk for adverse stigma-related consequences, but also could cut off the important benefits of maternal social support resulting in poor mental health outcomes and health behaviors.
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Affiliation(s)
- Taniya S Nagpal
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, Canada
| | - Kathryn E Nippert
- Psychological & Cognitive Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Mia Velletri
- Psychological & Cognitive Sciences, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | - Angela C Incollingo Rodriguez
- Psychological & Cognitive Sciences, Worcester Polytechnic Institute, Worcester, MA, USA.
- Salisbury Labs 317B, 100 Institute Road, Worcester, MA, 01609, USA.
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Chen HH, Lee CF, Huang JP, Hsiung Y, Chi LK. Effectiveness of a nurse-led mHealth app to prevent excessive gestational weight gain among overweight and obese women: A randomized controlled trial. J Nurs Scholarsh 2023; 55:304-318. [PMID: 36121127 DOI: 10.1111/jnu.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To explore the effectiveness of a nurse-led mobile health (mHealth) intervention to prevent excessive gestational weight gain (GWG) in overweight and obese women. METHODS A randomized controlled trial with an experimental study design. Ninety-two pregnant women with body mass index (BMI) ≥25 kg/m2 at less than 17 weeks gestation were recruited from two prenatal clinics in northern Taiwan from January to June 2020. The experimental group used the MyHealthyWeight (MHW) app and a wearable activity tracker (WAT), and the controls received standard antenatal treatments with no mHealth-based elements. Two hospital follow-up visits were scheduled at 24-26 weeks in the second trimester and 34-36 weeks in the third trimester. A generalized estimating equation (GEE) was used to examine the trajectories and the effectiveness of mHealth on GWG. RESULTS No difference in GWG was found between the intervention and control groups at baseline (p > 0.05). The GWG trajectory in the entire cohort of women with obesity exhibited a quadratic pattern (ß = 1.8, 95% confidence interval [CI] = 1.27-2.32), and intervention participants' weekly GWG was gained significantly lower than their controls in the second trimester (p < 0.05). Throughout the pregnancy, the mHealth intervention group had a significantly lower proportion of individuals who exceeded their GWG in both total (21.6% vs. 32.6%) and weekly weight gain (first trimester = 58.7% vs. 65.2%; second trimester = 45% vs. 67.4%; third trimester = 48.6% vs. 55.1%). In particular, among obese women in the third trimester, those in the intervention group gained less gestational weight than their controls. The adjusted body weight difference was 5.44 kg (p = 0.023), signifying the total GWG difference (3.30 vs. 8.74 kg) between the means of the two groups. The GEE model indicated that obese women who were aged 35 years, had prepregnancy exercise habits, perceived self-efficacy of diet, and more physical activity tended to have low GWG (p < 0.05). CONCLUSIONS The nurse-led mHealth-based intervention shows promising results in significantly preventing excessive GWG among high-BMI women. More effectiveness was found among the obese subgroup. CLINICAL RELEVANCE The mHealth-based intervention would be successfully implemented by nurses to help high-BMI women maintain their optimal body weight and promote healthy behavioral changes, particularly in diet and physical activity during pregnancy.
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Affiliation(s)
- Hung-Hui Chen
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Fang Lee
- Department of Nursing, MacKay Medical College, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yvonne Hsiung
- Department of Nursing, MacKay Medical College, Taipei, Taiwan
| | - Li-Kang Chi
- Department of Physical Education, National Taiwan Normal University, Taipei, Taiwan
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Heslehurst N, Evans EH, Incollingo Rodriguez AC, Nagpal TS, Visram S. Newspaper media framing of obesity during pregnancy in the UK: A review and framework synthesis. Obes Rev 2022; 23:e13511. [PMID: 36268693 PMCID: PMC9788256 DOI: 10.1111/obr.13511] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022]
Abstract
Two thirds of women report experiencing weight stigma during pregnancy. Newspaper media is powerful in framing health issues. This review synthesized UK newspaper media portrayal of maternal obesity. NexisUni was searched to identify newspaper articles, published January 2010 to May 2021, reporting content on obesity during pregnancy. Framework synthesis integrated quantitative and qualitative analysis of the content of articles. There were 442 articles included (59% tabloids and 41% broadsheets). Three overarching themes with interacting sub-themes were as follows: (1) Women were blamed for their weight, risks, and NHS impact. (2) Women were solely responsible for solving obesity, gendered from school age. (3) Women with obesity were a burden on individuals (e.g., themselves, their children, and health professionals), to society, and the NHS. Catastrophizing language framed the "problem," "scale," and "public health concern" of maternal obesity, emphasizing risk, and danger and was alarmist, aggressive, and violent as to elicit fear or devalue women. Articles platformed 'expert' voices rather than women's lived experiences. This review identified that UK newspaper media negatively frames and oversimplifies the topic of maternal obesity. Exposure to blaming and alarmist messaging could increase women's guilt, stigma, and internalized weight bias. The newspaper media should be harnessed to de-stigmatize maternal obesity and promote maternal well-being.
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Taniya S Nagpal
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Canada
| | - Shelina Visram
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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14
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Nagpal TS, Salas XR, Vallis M, Piccinini-Vallis H, Alberga AS, Bell RC, da Silva DF, Davenport MH, Gaudet L, Rodriguez ACI, Liu RH, Myre M, Nerenberg K, Nutter S, Russell-Mayhew S, Souza SCS, Vilhan C, Adamo KB. Exploring weight bias internalization in pregnancy. BMC Pregnancy Childbirth 2022; 22:605. [PMID: 35906530 PMCID: PMC9338529 DOI: 10.1186/s12884-022-04940-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/22/2022] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Taniya S Nagpal
- Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada.
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada.
| | | | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Angela S Alberga
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Sciences, Faculty of ALES, University of Alberta, Edmonton, AB, Canada
| | - Danilo F da Silva
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Margie H Davenport
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Laura Gaudet
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON, Canada
| | - Angela C Incollingo Rodriguez
- Psychological & Cognitive Sciences, Social Science and Policy Studies, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Rebecca H Liu
- Women's College Hospital Institute for Health System Solutions and Virtual Care (WIHV), Toronto, ON, Canada
| | - Maxine Myre
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | - Kara Nerenberg
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarah Nutter
- Department of Educational Psychology and Leadership Studies, University of Victoria, Victoria, BC, Canada
| | | | - Sara C S Souza
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Candace Vilhan
- Obesity Canada, Patient Advocate Volunteer, Edmonton, AB, Canada
| | - Kristi B Adamo
- Department of Agricultural, Food and Nutritional Sciences, Faculty of ALES, University of Alberta, Edmonton, AB, Canada
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Abstract
The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the 'patient voice'. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.
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Vázquez-Osorio IM, Vega-Sánchez R, Maas-Mendoza E, Heller Rouassant S, Flores-Quijano ME. Exclusive Breastfeeding and Factors Influencing Its Abandonment During the 1st Month Postpartum Among Women From Semi-rural Communities in Southeast Mexico. Front Pediatr 2022; 10:826295. [PMID: 35252066 PMCID: PMC8894443 DOI: 10.3389/fped.2022.826295] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/24/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION In this study we describe breastfeeding practices among women from semi-rural communities in southeast Mexico, and explore which factors, modifiable or not, are associated with such practices. MATERIALS AND METHODS This was a formative cross-sectional study that included 143 mothers with infants 4-6 months old, from semi-rural communities in Tabasco, Mexico. We collected data on two categories of factors: (1) women's sociodemographic characteristics, and (2) maternal / infant factors. We first analyzed the frequency of various breastfeeding practices. Then, we classified participants into the up to 1 month of exclusive breastfeeding group ( ≤ 1 m-EBF) and the beyond 1 month EBF group (>1 m-EBF), if they practiced EBF for less or more than 1 month, respectively. We compared the two categories of factors between groups and then, using logistic regression models, explored which factors were associated with practicing >1 m-EBF. RESULTS By the end of the 1st month postpartum, 51.7% of participants had abandoned EBF, introduced milk formula (35%), other food (9.1%), non-nutritive liquids (7.7%), or had stopped breastfeeding completely. In the next months, EBF practice fell sharply and mixed feeding grew importantly.Logistic regression models showed that women were more likely to be in the >1 m-EBF group if they lived with the baby's father, had complications during pregnancy, delivered vaginally and attended a health center at least three times postpartum. To the contrary, women were less likely to be practice >1 m-EBF if they gave infants other liquids during their hospital stay; experienced pain or discomfort in breasts/nipples, or used a pacifier after hospitalization; had larger bodies (i.e., higher BMI); and believed that you should give the infant powdered milk or some other food when the baby is not full. CONCLUSION Many factors associated with abandoning EBF, particularly in the early postpartum period, are modifiable and can be altered through timely interventions that include giving correct information and ensuring its comprehension; assertive personal counseling and accompaniment must be provided to mothers; and reinforcement during the early postpartum at health facilities and other settings.
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Affiliation(s)
- Inocente Manuel Vázquez-Osorio
- Licenciatura de Nutrición, División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Mexico.,Jurisdicción Sanitaria 4 del Municipio de Centro, Secretaría de Salud, Villahermosa, Mexico
| | - Rodrigo Vega-Sánchez
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico
| | - Eric Maas-Mendoza
- Licenciatura de Nutrición, División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Mexico
| | - Solange Heller Rouassant
- Departamento de Nutrición y Bioprogramación, Instituto Nacional de Perinatología, Mexico City, Mexico.,Private Practitioner, Naucalpan, Estado de México, Mexico, Mexico
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Nagpal TS, Liu RH, Myre M, Gaudet L, Cook J, da Silva DF, Adamo KB. Weight stigma and prenatal physical activity: Exploring the perspectives of pregnant women living with obesity. Midwifery 2021; 104:103186. [PMID: 34788725 DOI: 10.1016/j.midw.2021.103186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify sources of weight stigma in physical activity (PA)-related milieus reported by pregnant women living with obesity. We also report person-informed strategies to improve the delivery of PA promotions and prescriptions to prevent weight stigma and improve maternal PA. DESIGN This is a qualitative descriptive study and semi-structured interviews were conducted. SETTING AND PARTICIPANTS Purposive sampling including pregnant women living with obesity, with a body mass index ≥35.0 kg/m2, ≥18 years of age, and receiving specialized prenatal care were recruited from an obstetrics clinic in Kingston, Canada. MEASUREMENT AND FINDINGS Data were assessed by a content analysis, whereby coded themes represented sources of weight stigma related to prenatal PA. Demographic characteristics (pre-pregnancy body mass index, age, gestational age) were summarized and presented as means and standard deviations. In-depth interview data were collected from eight women. Average pre-pregnancy BMI, age, and gestational age were 44.6±4.8 kg/m2, 32.0±4.1 years, 31.1±5.8 weeks, respectively. Two sources of weight stigma related to prenatal PA were identified: 1. Lack of visual representation - online images and images found in exercise promotional material do not include women who have obesity; 2. Lack of individualized recommendations - currently available prenatal PA guidelines and/or recommendations from healthcare providers do not always consider individual physical barriers or health goals women may have. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE By increasing body positive representation of pregnant women exercising and offering person-centered prenatal PA recommendations, maternal PA may improve including women living with obesity. Findings from this work can inform future PA interventions, health promotion programming, and prescriptions from prenatal care providers to implement person-oriented strategies to prevent weight stigma and improve the delivery of care for pregnant women living with obesity.
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Affiliation(s)
- Taniya S Nagpal
- Faculty of Health Sciences, University of Ottawa, Ottawa K1N 6N5, Canada; Society of Obstetricians and Gynaecologists of Canada, Ottawa K1B 1A7, Canada.
| | - Rebecca H Liu
- Women's College Hospital, Institute for Health System Solutions & Virtual Care, Toronto, Ontario, M5G 1N8, Canada.
| | - Maxine Myre
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, T6G 2R3, Canada.
| | - Laura Gaudet
- Department of Obstetrics and Gynecology, Queen's University, Kingston K7L 3N6, Canada.
| | - Jocelynn Cook
- Society of Obstetricians and Gynaecologists of Canada, Ottawa K1B 1A7, Canada; Department of Obstetrics and Gynecology, University of Ottawa, Ottawa K1N 6N5, Canada.
| | - Danilo F da Silva
- Faculty of Health Sciences, University of Ottawa, Ottawa K1N 6N5, Canada.
| | - Kristi B Adamo
- Faculty of Health Sciences, University of Ottawa, Ottawa K1N 6N5, Canada.
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