A qualitative study exploring pregnant women's weight-related attitudes and beliefs in UK: the BLOOM study

An online qualitative study exploring wants and needs for a cooking programme during pregnancy in the UK and Ireland

BACKGROUND

Optimal maternal nutrition is associated with better pregnancy and infant outcomes. Culinary nutrition programmes have potential to improve diet quality during pregnancy. Therefore, this research aimed to understand the experiences of cooking and the wants and needs of pregnant women regarding a cooking and food skills programme in the United Kingdom (UK) and Republic of Ireland (ROI).

METHODS

Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. Two researchers conducted a thematic analysis. Seven focus groups with ROI participants (n = 24) and six with UK participants (n = 28) were completed.

RESULTS

Five themes were generated. These were (1) cooking during pregnancy: barriers, motivators and solutions; (2) food safety, stress and guilt; (3) need for cooking and food skills programmes and desired content; (4) programme structure; (5) barriers and facilitators to programme participation. Overall, there was support for a programme focusing on broad food skills, including planning, food storage, using leftovers and to manage pregnancy-specific physiological symptoms such as food aversions. Participants emphasised the importance of inclusivity for a diverse range of people and lifestyles for programme design and content.

CONCLUSIONS

Current findings support the use of digital technologies for culinary nutrition interventions, potentially combined with in-person sessions using a hybrid structure to enable the development of a support network.

Nutritional awareness of pregnant women and the underlying influencing factors

Nutritional awareness is described as having knowledge or understanding of nutrition. It is often related to the ability of an individual to make an accurate estimate of their food intake, which involves comparing their actual nutritional behavior with the recommended food consumption. Nutritional awareness of women during the various phases of pregnancy may vary significantly across countries due to cultural and lifestyle differences. There has been extensive research on nutritional awareness of pregnant women in selected countries or regions; however, relatively few studies have explored it during different stages of pregnancy. To fill this gap, this article reviews the existing literature and draws together insights into the following areas: changes in nutritional awareness during various phases of pregnancy, nutritional awareness of pregnant women and its underlying factors in various nations, and the research methods used to study nutritional awareness of pregnant women.

The Gestational Obesity Weight Management: Implementation of National Guidelines (GLOWING) study: a pilot cluster randomised controlled trial

BACKGROUND

Pregnancy weight management interventions can improve maternal diet, physical activity, gestational weight gain, and postnatal weight retention. UK guidelines were published in 2010 but health professionals report multiple complex barriers to practice. GLOWING used social cognitive theory to address evidence-based barriers to midwives' implementation of weight management guidelines into routine practice. This paper reports the pilot trial outcomes relating to feasibility and acceptability of intervention delivery and trial procedures.

METHODS

GLOWING was a multi-centre parallel-group pilot cluster RCT comparing the delivery of a behaviour change intervention for midwives (delivered as training workshops) with usual practice. The clusters were four NHS Trusts in Northeast England, randomised to intervention or control arms. Blinding of allocation was not possible due to the nature of the intervention. We aimed to deliver the intervention to all eligible midwives in the intervention arm, in groups of 6 midwives per workshop, and to pilot questionnaire data collection for a future definitive trial. Intervention arm midwives' acceptability of GLOWING content and delivery was assessed using a mixed methods questionnaire, and pregnant women's acceptability of trial procedures by interviews. Quantitative data were analysed descriptively and qualitative data thematically.

RESULTS

In intervention arm Trusts, 100% of eligible midwives (n = 67) were recruited to, and received, the intervention; however, not all workshops had the planned number of attendees (range 3-8). The consent rate amongst midwives randomised (n = 100) to complete questionnaires was 74% (n = 74) (95% CI 65%, 83%), and overall completion rate 89% (n = 66) (95% CI 82%, 96%). Follow-up response rate was 66% (n = 49) (95% CI 55%, 77%), with a marked difference between intervention (39%, n = 15) and control (94%, n = 34) groups potentially due to the volume of research activities. Overall, 64% (n = 47) (95% CI 53%, 75%) completed both baseline and follow-up questionnaires. Midwives viewed the intervention as acceptable and directly relevant to routine practice. The least popular components related to scripted role-plays. Pregnant women viewed the recruitment and trial processes to be acceptable.

CONCLUSIONS

This rigorously conducted pilot study demonstrated feasibility intervention delivery and a high level of acceptability amongst participants. It has provided information required to refine the intervention and trial protocol, enhancing confidence that a definitive trial could be carried out.

TRIAL REGISTRATION

ISRCTN46869894; retrospectively registered 25th May 2016, www.isrctn.com/ISRCTN46869894 .

Dietary Patterns and Factors Associated with Food Affinity in Pregnant Women from Quito, Ecuador

Nutrition during pregnancy influences perinatal outcomes and predispositions to chronic diseases. A prospective cohort study was carried out with the objectives of describing the dietary patterns in the pregnant population in the city of Quito, Ecuador and analysing the sociodemographic and lifestyle factors that influence the adherence to each dietary pattern. The body mass index was calculated for each patient, and the patients were classified according to the Atalah criteria. The Global Physical Activity Questionnaire was also applied. The dietary patterns were assessed using a dietary survey with a 24 h recall on two occasions. A total of 535 pregnant women were included. A positive association was found between the pattern "dairy, salads and sweet snacks/dressings" and foreign nationality (β = 0.82 (0.43;1.21)). The "refined carbohydrates" pattern was negatively associated with education equal to or less than 7 years and an income of up to one basic salary (β = -0.59 (-1.05; -0.14)). The "traditional Ecuadorian" pattern showed a positive association with being born in the coastal region of Ecuador (β = 0.62 (0.22; 1.01)). This study identified three dietary patterns in pregnant women and their possible associations with certain sociodemographic factors. More studies are needed to better understand these patterns as well as to analyse their nutritional and caloric properties.

Increased consumption of ultra-processed foods during pregnancy is associated with sociodemographic, behavioral, and obstetric factors: A cohort study

A diet based on ultra-processed food (UPF) does not meet nutritional needs, especially during pregnancy. The aim of this study is to assess the change in UPF consumption from preconception to pregnancy and associated factors. Our hypothesis is that women tend to adopt a healthier eating pattern during pregnancy, decreasing the intake of UPF and increasing the intake of unprocessed/minimally processed foods. A prospective cohort study with 326 participants was carried out from 2016 to 2019 in 2 health units in Rio de Janeiro, Brazil. Pregestational food consumption assessed using the food frequency questionnaire in the prenatal interview in women up to 20 gestational weeks and gestational consumption in the interview 2 months after delivery. Food items classified according to the NOVA system. For the mean variation from preconception to gestational UPF consumption, we used the generalized estimating equations model with linear distribution. Control of confounding variables was based on the literature on factors associated with UPF consumption, using a 3-level hierarchical model. The proportion of UPF energy consumption was 28.9% in preconception and 33% during pregnancy. Older and more educated women had a lower mean variation in the consumption of UPF during the pregnancy. A higher average consumption of UPF observed among women physically inactive before pregnancy, who smoked during pregnancy, were multiparous, and with had a low pregestational weight. These results reflect similar behavior to that of the general population, aggravated by a significant increase during pregnancy. However, older and more educated women and those with healthy behaviors showed lower UPF intake in pregnancy.

A mixed-methods study exploring women's perceptions and recommendations for a pregnancy app with monitoring tools

Digital health tools such as apps are being increasingly used by women to access pregnancy-related information. Conducted during the COVID-19 pandemic, this study investigated: (i) pregnant women's current usage of digital health tools to self-monitor and (ii) their interest in theoretical pregnancy app features (a direct patient-to-healthcare-professional communication tool and a body measurement tool). Using a mixed methods approach, 108 pregnant women were surveyed and 15 currently or recently pregnant women were interviewed online. We found that pregnant women used digital health tools to mainly access pregnancy related information and less so to self-monitor. Most participants were interested and enthusiastic about a patient-to-healthcare-professional communication tool. About half of the survey participants (49%) felt comfortable using a body measurement tool to monitor their body parts and 80% of interview participants were interested in using the body measurement to track leg/ankle swelling. Participants also shared additional pregnancy app features that they thought would be beneficial such as a "Digital Wallet" and a desire for a holistic pregnancy app that allowed for more continuous and personalised care. This study highlights the gaps and needs of pregnant women and should inform all stakeholders designing pregnancy digital healthcare. This study offers a unique insight into the needs of pregnant women during a very particular and unique period in human history.

Prenatal programing of motivated behaviors: can innate immunity prime behavior?

Prenatal programming during pregnancy sets physiological outcomes in the offspring by integrating external or internal stimuli. Accordingly, pregnancy is an important stage of physiological adaptations to the environment where the fetus becomes exposed and adapted to the maternal milieu. Maternal exposure to high-energy dense diets can affect motivated behavior in the offspring leading to addiction and impaired sociability. A high-energy dense exposure also increases the pro-inflammatory cytokines profile in plasma and brain and favors microglia activation in the offspring. While still under investigation, prenatal exposure to high-energy dense diets promotes structural abnormalities in selective brain regions regulating motivation and social behavior in the offspring. The current review addresses the role of energy-dense foods programming central and peripheral inflammatory profiles during embryonic development and its effect on motivated behavior in the offspring. We provide preclinical and clinical evidence that supports the contribution of prenatal programming in shaping immune profiles that favor structural and brain circuit disruption leading to aberrant motivated behaviors after birth. We hope this minireview encourages future research on novel insights into the mechanisms underlying maternal programming of motivated behavior by central immune networks.

The effects of a midwife-led weight management program for pregnant women: A randomized controlled trial

BACKGROUND

Inappropriate weight gain during pregnancy may present risks for maternal and newborn health. Pregnancy is considered the optimal time to intervene on women's health behaviors such as eating habits and physical activity. However, current clinical practice guidelines for weight management during pregnancy were not fully based on randomized trials, thus lacking specific "active intervention ingredients" that are proven effective in achieving appropriate gestational weight gain. Therefore it is essential to develop and implement an evidence-based weight management program for pregnant women.

OBJECTIVE

To examine the effects of a midwife-led weight management program on improving appropriate gestational weight gain, health literacy, experience of antenatal care, and maternal and neonatal outcomes among Chinese pregnant women.

DESIGN

A two-group randomized controlled trial.

SETTINGS AND PARTICIPANTS

A total of 426 pregnant women were recruited from a tertiary women's hospital in eastern China.

METHODS

Participants were randomly allocated to either intervention group (n = 213) or control group (n = 213). Women in the intervention group participated in a midwife-led weight management program during pregnancy, while women in the control group received the conventional obstetrician-led antenatal care. We assessed women at the first antenatal contact, 35-36 weeks gestation and 2-3 days postpartum. Data on gestational weight gain, health literacy, experience of antenatal care, and maternal and neonatal outcomes were compared between the two groups. Dummy variable analysis was conducted to reveal the effect of weight management program on gestational weight gain.

RESULTS

The overall gestational weight gain between the two groups was not statistically different (t = -1.377, P = 0.170). Compared with women in the control group, the odds of having inappropriate gestational weight gain was lower in the intervention group (OR = 0.270, 95%CI 0.169, 0.431). Further subgroup analyses showed that women in the intervention group had lower risk of inadequate gestational weight gain (OR = 0.305, 95%CI 0.180, 0.515) and excessive gestational weight gain (OR = 0.236, 95%CI 0.138, 0.404) than those in the control group. The score of experience of antenatal care was significantly higher in the midwife-led weight management group than that in the control group (193.70 ± 18.51 versus 165.70 ± 28.23, P < 0.001). Women's health literacy score was higher in the intervention group than control group [74.41 (69.57, 81.77) versus 71.88 (66.23, 77.18), P = 0.004].

CONCLUSION

Compared with the conventional antenatal care, the midwife-led weight management program could facilitate appropriate gestational weight gain, enhance health literacy, and promote positive experience of antenatal care for Chinese pregnant women.

Facilitators and barriers influencing weight management behaviours during pregnancy: a meta-synthesis of qualitative research

BACKGROUND

Obesity and overweight are considered risk factors for a range of adverse outcomes, including stillbirth. This study aims to identify factors reported by women influencing weight management behaviours during pregnancy.

METHODS

A systematic search was conducted in five databases from inception to 2019 and updated in 2021. Qualitative studies involving pregnant or post-partum women, from high-income countries, examining women's experiences of weight management during pregnancy were included. Meta-ethnography was used to facilitate the meta-synthesis of 17 studies.

RESULTS

Three themes were identified during the analysis: (1) Awareness and beliefs about weight gain and weight management, which included level of awareness and knowledge about dietary and exercise recommendations, risk perception and decision balance, perceived control over health and weight gain and personal insecurities. (2) Antenatal healthcare, women's experiences of their interactions with healthcare professionals during the antenatal period and the quality of the education received had an effect on women's behaviour. Further, our findings highlight the need for clear and direct information, and improved interactions with healthcare professionals, to better support women's weight management behaviours. (3) Social and environmental influence, the social judgement and stigmatization associated with overweight and obesity also acted as a negative influence in womens' engagement in weight management behaviours.

CONCLUSION

Interventions developed to promote and maintain weight management behaviours during pregnancy should consider all levels of influence over women's behaviours, including women's level of awareness and beliefs, experiences in antenatal care, education provision and social influence.

Pregnant and Postpartum Women's Perceptions of Barriers to and Enablers of Physical Activity During Pregnancy: A Qualitative Systematic Review

INTRODUCTION

Physical activity throughout pregnancy has been shown to have health benefits for the pregnant person, including reductions in the risk of preeclampsia and gestational weight gain and improvements in blood pressure regulation. Despite the benefits, many pregnant women do not meet the guidelines for physical activity throughout pregnancy. Therefore, it is important to determine what influences women's activity levels during pregnancy. This systematic review of the qualitative literature aimed to determine pregnant and postpartum women's perceptions of barriers to and enablers of physical activity, specifically during pregnancy.

METHODS

MEDLINE, PsycINFO, CINAHL, and Embase were searched systematically to identify qualitative studies investigating pregnant or postpartum women's perceptions of barriers to and enablers of physical activity during pregnancy. Included studies were limited to populations of pregnant or postpartum women, the majority of whom were aged 18 to 40 years, and studies published from 1985 onward. Data quality was assessed using the Critical Appraisal Skills Programme Qualitative Studies Checklist. Data were extracted using NVivo software and subsequently mapped on the COM-B framework.

RESULTS

Twenty-five qualitative studies were included in this systematic review. Sixteen themes were identified that mapped onto 6 components of the COM-B framework. Commonly reported barriers to physical activity during pregnancy included pregnancy symptoms, lack of knowledge of what constitutes safe activity, and the opinions of women's social circles. Commonly reported enablers of physical activity during pregnancy were social support and the experienced benefits, including physiologic, psychological, and social benefits.

DISCUSSION

The results of this systematic review have clinical implications for perinatal care providers, as the overall benefits of physical activity during pregnancy have been well documented in previous studies. The authors recommend clinicians aim to explore pregnant women's perspectives on physical activity during pregnancy in order to be able to address their perceived barriers to and enablers of physical activity during pregnancy.

How Do Health Schemas Inform Healthy Behaviours During Pregnancy? Qualitative Findings from the Be Healthy in Pregnancy (BHIP) Study

OBJECTIVE

Excess gestational weight gain (GWG) is associated with adverse long and short-term outcomes for both woman and child, yet evidence demonstrates pregnant women are frequently not engaging in healthy behaviours linked to appropriate weight gain. The purpose of the current study was to explore women's values and beliefs related to weight, nutrition and physical activity during pregnancy and to describe how these beliefs influence their behaviours.

METHODS

As part of a larger randomized controlled trial, we conducted 20 focus groups with 66 pregnant women between 16 and 24-weeks gestation using a semi-structured interview guide. Focus groups were recorded and transcribed verbatim and analyzed using a grounded theory approach.

RESULTS

Three personal health schemas emerged from the findings which illustrated women's diverging beliefs about their health behaviours in pregnancy. 'Interconnected health' described beliefs regarding the impact their health had on that of their growing baby and awareness of risks associated with inappropriate weight gain. 'Gestational weight gain as an indicator of health' illustrated perceptions regarding how GWG impacted health and the utility of guidelines. Finally, 'Control in pregnancy' described the sense of agency over one's body and health.

CONCLUSIONS FOR PRACTICE

Our results showed that health-related behaviours in pregnancy are driven by personal health schemas which are often discordant with clinical evidence. Interventions and health care provider advice aimed at behaviour modification would benefit from first understanding and addressing these schemas. Tackling the conflict between beliefs and behaviour may improve health outcomes associated with appropriate weight gain in pregnancy.

Pre-pregnancy BMI was associated with gestational depressive phenotypes in a population of 12,099 women in Chongqing, China

OBJECTIVE

To investigate the association between pre-pregnancy body mass index (BMI) and gestational depressive phenotypes.

METHODS

The pregnant women receiving the first prenatal examination (4th -13th week of gestation) in Chongqing Health Center for Women and Children were recruited between February 2020 and September 2021. Depressive phenotypes was assessed by the Patient Health Questionnaire (PHQ-9) and the Symptom Checklist 90 (SCL-90) scale at recruitment. Pre-pregnancy weight and height were self-reported by the participants. Demographic and obstetric characteristics were obtained from the hospital information system. The association between pre-pregnancy BMI and the scores of PHQ-9 or SCL-90 scale was investigated by uni-variate analysis with Kruskal-Wallis test and by multi-variate analysis with linear regression model with adjustment of age, parity, smoking, alcohol consumption, and assisted reproduction. The association between pre-pregnancy BMI and PHQ-9 or SCL-90 diagnosed depressive phenotypes was analyzed by Chi-square test and logistic regression respectively.

RESULTS

A total of 12,099 pregnant women were included, where 100% of them filled out the PHQ-9 scale and 99.6% filled out the SCL-90 scale, and 47.26% and 4.62% of the pregnant women had depressive phenotypes, respectively. Women with higher pre-pregnancy BMI had lower depressive phenotypes scores during pregnancy. Multivariable analysis of the PHQ-9 scale showed that overweight/obese subjects had a higher incidence of depressive phenotypes compared with subjects with normal BMI (OR=0.803, 95% CI [0.723, 0.892]). In a stratified analysis assessed by the PHQ-9, women who were overweight/obese prior to pregnancy were less likely to develop depressive phenotypes during pregnancy than women who were normal weight prior to pregnancy, regardless of whether they were nulliparous (OR=0.795, 95%CI[0.696,0.908]) or multiparous (OR=0.809, 95%CI[0.0.681,0.962]), while in the three age groups of 25-29 years, 30-34 years and ≥35 years, pre-pregnancy overweight/obesity were associated with lower risk of gestational depressive phenotypes. However, analysis of the SCL-90 scale showed no statistical association between depressive symptom and BMI. No substantial interaction was observed between BMI and parity or age.

CONCLUSIONS

Increased pre-pregnancy BMI may be associated with reduced risk of gestational depressive phenotypes in Chinese women. Independent studies are warranted to validate the findings of the present study.

Eating Behaviors and Dietary Patterns of Women during Pregnancy: Optimizing the Universal 'Teachable Moment'

Understanding women’s perceptions of eating behaviors and dietary patterns can inform the ‘teachable moment’ model of pregnancy. Our objectives were to describe eating behaviors and dietary patterns in pregnancy. This was a cross-sectional, national electronic survey. Women were ≥18 years of age, living in the United States, currently pregnant or less than two years postpartum, and had internet access. Age, education, race, and marriage were included as covariates in ordinal and binary logistic regressions (significance p < 0.05). Women (n = 587 eligible) made positive or negative changes to their diets, while others maintained pre-existing eating behaviors. The majority of women did not try (84.9 to 95.1% across diets) and were unwilling to try (66.6 to 81%) specific dietary patterns during pregnancy. Concerns included not eating a balanced diet (60.1 to 65.9%), difficulty in implementation without family (63.2 to 64.8%), and expense (58.7 to 60.1%). Helpful strategies included being provided all meals and snacks (88.1 to 90.6%) and periodic consultations with a dietitian or nutritionist (85 to 86.7%). Responses differed across subgroups of parity, body mass index, and trimester, notably in women with obesity who reported healthier changes to their diet (p < 0.05). Our study underscores the importance of tailoring care early to individual needs, characteristics, and circumstances.

Identifying target behaviors for weight management interventions for women who are overweight during pregnancy and the postpartum period: a qualitative study informed by the Behaviour Change Wheel

Background

Maternal overweight is increasing, and it is associated with several risk factors for both the mother and child. Healthy lifestyle behaviors adopted during pregnancy are likely to impact women’s health positively after pregnancy. The study’s aim was to identify and describe weight management behaviors in terms of the Capability, Opportunity and Motivation Behaviour (COM-B) -model to target weight management interventions from both the perspectives of women who are overweight and maternity care professionals.

Methods

This qualitative, descriptive study was conducted between 2019 and 2020. Individual interviews with pregnant and postpartum women who were overweight (n = 11) and focus group interviews with public health nurses (n = 5) were undertaken in two public maternity clinics in Southwest Finland. The data were analyzed using deductive content analysis consistent with the COM-B model.

Results

In the capability category, the women and the public health nurses thought that there was a need to find consistent ways to approach overweight, as it had often become a feature of the women’s identities. The use of health technology was considered to be an element of antenatal care that could be used to approach the subject of weight and weight management. Smart wearables could also support an evaluation of the women’s lifestyles. The opportunity category highlighted the lack of resources for support during perinatal care, especially after birth. Both groups felt that support from the family was the most important facilitating factor besides motivation. The women also expressed a conflict between pregnancy as an excuse to engage in unhealthy habits and pregnancy as a motivational period for a change of lifestyle. Furthermore, the women wanted to be offered a more robust stance on weight management and discreet counseling.

Conclusions

Our findings offer a theoretical basis on which future research can define intervention and implementation strategies. Such interventions may offer clear advice and non-judgmental support during pregnancy and after delivery by targeting women’s capabilities, opportunities, and motivation. Health technology could be a valuable component of intervention, as well as an implementation strategy, as they provide ways during maternity care to approach this topic and support women.

Inability to control gestational weight gain: an interpretive content analysis of pregnant Chinese women

OBJECTIVE

This study aims to explore barriers to controlling gestational weight gain in pregnant Chinese women.

DESIGN

Data were collected through semistructured interviews with pregnant women experiencing excessive gestational weight gain who struggled with weight management, and the data were examined using an interpretive content analysis.

SETTINGS AND PARTICIPANTS

Fifty participants (≥18 years, with excessive gestational weight gain) were recruited when they visited the hospital for antenatal health checkups in Wuhan city (n=36) and Jinan city (n=14) between September and October 2018.

RESULTS

Interpretive content analysis identified 75 barriers after examining diet, physical activity levels and general issues stemming from knowledge and beliefs, and physical, social, logistical, emotional and structural characteristics. Compared with reported deductive codes, this study inductively extracted 15 new codes. The most frequent codes showed that expectant grandparents greatly influenced pregnant women's lifestyles, through overprotection, traditional and conservative ideas and practices, and a lack of reliable knowledge or acceptable guidance on gestational weight control.

CONCLUSIONS

This study provides a better understanding of the most important obstacles faced during decision making about gestational weight control in Chinese settings, especially the influence of traditional ideas/practices and expectant grandparents. Identifying the specific barriers to weight control should facilitate potential tailored supportive interventions. More efforts on health education for the whole family and a better use of maternal handbooks would be particularly beneficial.

Physical activity and exercise during pregnancy in Africa: a review of the literature

BACKGROUND

Pregnancy is an important phase in a woman's life, with health status at this stage affecting both the woman and her child's life. Global evidence suggests that many women engage in low levels of physical activity (PA) and exercise during pregnancy despite its beneficial effects. This is particularly the case in Africa.

METHODS

This article reviews the literature on levels of PA and exercise among pregnant women in Africa, highlighting the level of PA or exercise participation during pregnancy in Africa, including types of PA, factors affecting PA, beliefs about and benefits of prenatal activity, advice or counselling on PA during pregnancy in Africa, and PA interventions proposed to promote the uptake of prenatal PA. Electronic search databases used were Google Scholar, Science Direct, Scopus, EMBASE, ERIC, Medline, Web of Science, EBSCOhost, PubMed, BIOMED Central, and African Journal Online. The basic search terms were: 'Physical activity', 'Exercise', 'Pregnancy', 'Pregnant women' and 'Africa'. A total of 40 references were found. On the basis of an analysis of titles, abstracts and the language of publication (other than English), 11 articles were rejected, and 29 articles were fully read, although two had to be rejected due to a lack of access to the full version. Finally, 27 references were included in the review.

RESULTS

Few studies exist on PA during pregnancy in Africa. The limited data available suggests that, compared to the Western world, pregnant women in Africa do not adhere to the recommendations for PA during pregnancy. Levels of participation in PA during pregnancy are low and decline as the pregnancy progresses. The majority of the studies used direct, objective measures to assess PA during pregnancy. Personal and environmental factors such as lack of time, lack of knowledge, inadequate information from healthcare providers, feelings of tiredness and an absence of social support constituted the main barriers to PA during pregnancy. The types of PA participation among pregnant women varied across studies and geographical settings.

CONCLUSIONS

While published data is limited, it seems clear that the participation of pregnant women in PA during pregnancy in Africa is low and declines with advancing pregnancy. There is a need for more studies to examine the dynamics of PA during pregnancy in Africa to guide contextual interventions to improve and promote maternal health on the continent.

Motivating Pregnant and Breastfeeding Women in Spain to Avoid Persistent Toxic Substances in Their Diet

The objective of this study was to explore what motivates pregnant and breastfeeding women to make changes in their diet, specifically to examine how their perceptions regarding diet facilitate or act as obstacles to introducing healthy eating habits. For the optimal development of the mother, the fetus, or breastfeeding baby, it is important to avoid foods containing substances, such as persistent toxic substances (PTSs), that are harmful to health during pregnancy and after the baby's birth. This study used a qualitative research methodology, based on semi-structured individual interviews, food diaries, free lists, and focus groups with 111 pregnant and breastfeeding women in Spain. This approach was followed by a systematic and exhaustive exploitation of the qualitative data obtained, following the methodological principles of grounded theory. From the study results, we conclude that the motivation for a change in diet to avoid PTSs is based on the desire to promote good health, beliefs about the importance of having a varied diet, and the avoidance of potential risks. The main obstacles to change can be attributed to inadequate information, contradictory discourses, and socioeconomic difficulties.

The accelerator, the brake, and the terrain: associations of reward-related eating, self-regulation, and the home food environment with diet quality during pregnancy and postpartum in the pregnancy eating attributes study (PEAS) cohort

Background

Neurobehavioral factors, including reward-related eating and self-regulation, in conjunction with the food environment, may influence dietary behaviors. However, these constructs have not been examined in pregnancy and postpartum, a time of changing appetite and eating behaviors, and when dietary intake has implications for maternal and child health. This study examined associations of reward-related eating, self-regulation, and the home food environment with pregnancy and postpartum diet quality.

Methods

Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks gestation and followed through one-year postpartum. Pregnancy and postpartum Healthy Eating Index-2015 (HEI-total), and adequacy and moderation scores, respectively, were calculated by pooling 24-h diet recalls administered each trimester and during 2, 6, and 12 months postpartum. Participants completed four measures of reward-related eating – Modified Yale Food Addiction Scale (mYFAS), Power of Food Scale (PFS), Multiple Choice Procedure (MCP), and Reinforcing Value of Food Questionnaire (RVFQ); two measures of self-regulation – Barratt Impulsiveness Scale (BIS) and Delay of Gratification Inventory (DGI); and a Home Food Inventory (HFI), yielding obesogenic (OBES) and fruit/vegetables (FV) scores. Linear regression analyses estimated associations of reward-related eating, self-regulation, and home food environment with diet quality during pregnancy and postpartum, adjusting for sociodemographic characteristics.

Results

Pregnancy HEI-total was inversely associated with PFS (β = − 0.14 ± 0.05, p = 0.009), mYFAS(β = − 0.14 ± 0.06, p = 0.02), 2 of the 5 RVFQ indices, MCP (β = − 0.14 ± 0.05, p = 0.01), and DGI food subscale (β = 0.23 ± 0.05, p < 0.001), but associations of postpartum HEI-total with reward-related eating measures and self-regulation were small and not statistically significant. Pregnancy and postpartum HEI-total were associated inversely with HFI-OBES (β = − 0.17 ± 0.06, p = 0.004 and β = − 0.19 ± 0.07, p = 0.006, respectively), and positively with HFI-FV (β = 0.21 ± 0.05, p < 0.001 and β = 0.17 ± 0.06, p = 0.009, respectively).

Conclusions

Associations of poorer diet quality with greater reward-related eating during pregnancy but not postpartum suggests the need to better understand differences in the determinants of eating behaviors and approaches to circumvent or moderate reward-related eating to facilitate more optimal diet quality across this critical period.

Trial registration

Clinicaltrials.gov. URL – Registration ID – NCT02217462. Date of registration – August 13, 2014.

Pregnant Women Consume a Similar Proportion of Highly vs Minimally Processed Foods in the Absence of Hunger, Leading to Large Differences in Energy Intake

BACKGROUND

The eating in the absence of hunger (EAH) experimental paradigm measures intake of highly palatable, highly processed foods when sated. However, no studies have examined EAH in pregnant women.

OBJECTIVE

The objectives were to investigate whether EAH in pregnant women differs by level of food processing and to examine relationships of EAH with hedonic hunger, addictive-like eating, and impulsivity.

DESIGN

EAH was assessed in a counterbalanced crossover feeding substudy in which participants completed two free-access eating occasions following a standardized meal during their second pregnancy trimester. Hedonic hunger (Power of Food Scale), addictive-like eating (modified Yale Food Addiction Scale), and impulsivity (Barratt Impulsiveness Scale-15) were assessed by self-report during early pregnancy.

PARTICIPANTS AND SETTING

Data were collected from March 2015 through September 2016 from a subsample of participants (n = 46) enrolled at ≤12 weeks gestation in an observational, prospective cohort study (the Pregnancy Eating Attributes Study) in North Carolina.

INTERVENTION

Participants were presented with highly processed and minimally processed foods in two separate assessments.

MAIN OUTCOME MEASURES

Energy intake (EAH-kcal) and percent consumed (EAH-%) (calculated as 100 × [amount consumed (g) / amount served (g)]) was measured overall and separately for sweet and savory foods.

STATISTICAL ANALYSES PERFORMED

Linear mixed models estimated the effect of condition on EAH. Hedonic hunger, addictive-like eating, impulsivity and their interaction were examined separately.

RESULTS

EAH-% was similar across conditions (16.3% ± 1.1% highly processed vs 17.9% ± 1.2% minimally processed; P = 0.76), resulting in 338.5 ± 34.2 kcal greater energy intake in the highly processed vs minimally processed condition (P < 0.001). Hedonic hunger was not significantly associated with EAH; reward-related eating was positively associated with EAH-kcal and EAH-% of savory foods, and Barratt Impulsivity was positively associated with EAH-kcal and EAH-% overall, and with EAH-% of sweet foods (P < 0.05). There was little evidence of an interaction of Barratt Impulsivity with hedonic hunger or reward-related eating.

CONCLUSIONS

EAH in pregnant women occurs for both highly processed and minimally processed foods and correlates positively with self-reported addictive-like eating, but not hedonic hunger. Impulsivity did not modify associations of addictive-like eating with EAH in this sample.

A downturn or a window of opportunity? How Danish and French parents perceive changes in healthy eating in the transition to parenthood

Alarming childhood obesity rates call for research into the factors that influence a child's environment. Although parents have a large influence on children's eating behaviours, surprisingly little research has explored parental healthy eating patterns. We conducted face-to-face interviews with parents of young children (up to 4 years old) living in Denmark (n = 16) and in France (n = 14) to provide insights into how the transition to parenthood affects the perceived healthfulness of eating behaviours. A problem-centred, Life-Course approach was employed, exploring the topics of interest from the perspective of the participants, and then interpreting these on the background of Social Cognitive Theory. From a cross-cultural sample of mostly well-educated parents living in couples, we found that the transition to parenthood represents a turning point for eating behaviour. Marked differences in dietary changes were perceived across four stages: 1) pregnancy, 2) first months with the baby, 3) complementary feeding and 4) child shares family meals. The findings point to an opposite cross-country perception of the impact of parenthood on food behaviours, and to the idea of what we called an "equalizing effect" on individuals' diet, where having a child triggered "unhealthy" eaters to consider dietary improvements while it imposed challenges to "healthy" eaters to maintain their satisfactory food habits. Contrasting differences on perceived behaviour change mainly appeared in terms of food ethics concern, meat consumption, cooking enjoyment, dietary diversity and sugar consumption. The proposition that low food-health-oriented individuals become healthier and (some) more environmentally conscious, reveals an opportunity for effective strategies and public health messages targeting health and food-ethics behaviour. Nevertheless, findings point to a need to consider individualized health support, addressing parental self-care, physiological changes, stress and negative emotions of early parenthood.

Preventive health counselling during antenatal care using the pregnancy risk assessment monitoring system (PRAMS) in Ireland

BACKGROUND

Maternal behaviours during pregnancy have short- and long-term consequences for maternal and infant health. Pregnancy is an ideal opportunity to encourage positive behaviour change. Despite this, limited information exists about the nature and content of lifestyle advice provided by healthcare professionals during antenatal care. Pregnancy Risk Assessment Monitoring System (PRAMS) Ireland is based on the Centers for Disease Control and Prevention (CDC) developed PRAMS that monitors maternal behaviours and experiences before, during and after pregnancy. The aim of the study was to assess the prevalence of preventive health counselling during pregnancy.

METHODS

Secondary data analysis of the PRAMS Ireland study. Using hospital discharge records, a sampling frame of 2424 mother-infant pairs was used to alternately sample 1212 women whom had recently given birth. Preventive health counselling was defined as advice during antenatal care on smoking, alcohol, infant feeding and weight gain. Self-reported maternal behaviours (smoking/alcohol cessation, gestational weight gain, infant feeding). Univariate and multivariable analyses were conducted, adjusting for maternal characteristics.

RESULTS

Among 718 women (61% response rate), the reported counselling rates were 84.8% for breastfeeding (n = 592), 48.4% for alcohol (n = 338), 47.6% for smoking (n = 333) and 31.5% for weight gain (n = 218). Women who smoked pre-pregnancy (23.7%, n = 170) were more likely to receive counselling on its effects compared to non-smokers (Adjusted Odds Ratio (AOR) 2.72 (95% Confidence Interval (CI), 1.84-4.02)). In contrast, women who did not breastfeed (AOR 0.74, 95%CI 0.44-1.26) and those who reported alcohol consumption pre-pregnancy (AOR 0.94, 95%CI 0.64-1.37) were not more likely to receive counselling on these topics.

CONCLUSION

Pregnancy is an ideal opportunity to encourage positive behaviour change. Preventive health counselling during pregnancy is not routinely provided and rates vary widely depending on the health behaviour. This study suggests that additional strategies are needed to promote positive behaviour before and during the unique opportunity provided by pregnancy.

An antenatal wish list: A qualitative systematic review and thematic synthesis of UK dietary advice for weight management and food borne illness

OBJECTIVES

To understand UK women's experiences of antenatal dietary advice for risk of food borne illness and weight gain.

DESIGN

A systematic review and thematic synthesis of peer-reviewed qualitative studies. PubMed, MEDLINE, CINAHL and PMC databases were searched for articles published from January 2008 to June 2018. The search strategy combined terms for pregnancy with terms for body composition, weight change, food safety, nutrition, diet and qualitative terminology. Studies were eligible for inclusion if (1) they explored experiences of implementing advice received during pregnancy for nutrition, physical activity and/or weight gain, and (2) participants were women who had experienced maternity care in the UK. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool.

FINDINGS

Of 25,688 articles identified by the search strategy, 20 studies were identified that met the inclusion criteria. Five major themes were recognised: control, barriers to diet and exercise, motivators, relationship with weight, and information, with a further 12 subthemes. The majority of studies reported on weight gain (n = 10).

KEY CONCLUSIONS

Evidence shows that UK antenatal dietary advice is currently inconsistent, vague and overwhelming despite pregnancy being an excellent time for lifestyle change. Women are primarily driven by the health of their baby and desire support to facilitate positive changes.

IMPLICATIONS FOR PRACTICE

Findings outline a wishlist which highlights a desire for tailored information on preventing weight gain, dietary requirements, safe physical activity and a deprioritisation of food safety guidelines. This provision should be delivered by HCP. e.g. midwives, in a sensitive and supportive way to bridge the gap between women's needs and the current antenatal provision.

Women's Experience and Understanding of Food Cravings in Pregnancy: A Qualitative Study in Women Receiving Prenatal Care at the University of North Carolina-Chapel Hill

BACKGROUND

Although the occurrence of food cravings during pregnancy is well established, there is a paucity of qualitative data on pregnant women's perceptions of and responses to food cravings. This study sought to assess and describe pregnant women's experiences and behaviors pertaining to food cravings.

METHODS

Eight focus groups were conducted with 68 pregnant women in their second trimester from March 2015 to October 2016. Using a semistructured approach, the facilitator asked women open-ended questions regarding their experience of eating behaviors and food cravings. The content from the focus groups was analyzed using a bottom-up approach based on grounded theory and constant comparison analysis.

RESULTS

Participants described cravings as urgent, food-specific, and cognitively demanding occurrences that were differentiated from hunger. They described beliefs surrounding the physiological causes of cravings and rationales for satisfying their cravings. Strategies used to manage cravings included environmental modifications to limit proximity and availability of craved foods, cognitive and behavioral strategies like distraction, and acceptance through satisfying the craving. Participants described food cravings as a psychologically salient aspect of their pregnancy, reporting a variety of emotional precursors and reactions surrounding their cravings.

CONCLUSIONS

A better understanding of food cravings may assist with the development of interventions to improve eating behaviors and reduce eating-related distress during pregnancy. Acceptance regarding food cravings was indicated as a way to diffuse pregnancy-related stress. These findings contribute to our understanding of psychological influences on eating behaviors in pregnant women.

The nutrition-related information seeking behaviours and attitudes of pregnant women with a high BMI: A qualitative study

BACKGROUND

The prevalence of high body mass index is increasing amongst women of child bearing age. High maternal body mass index has ramifications for both mother and baby including increased health risks from gestational diabetes mellitus, caesarean section and stillbirth. Despite the increasing prevalence of high maternal body mass index little is known of the experiences of these women regarding nutrition information access and use during the antenatal period.

METHODS

A qualitative study using individual interviews was undertaken at a tertiary hospital in south-eastern Australia. Twenty-Eight women with a body mass index ≥30kg/m² participated. Interviews were audio recorded, transcribed, cross-checked for consistency and entered into a word processing document for further scrutiny. Data was analysed using interpretative phenomenological analysis (IPA). In any phenomenological study the researcher's objective is to elicit the participant's views on their lived experiences.

FINDINGS

Three major themes emerged: (1) Nutrition-related information attainment; (2) Nutrition-related information management; (3) Nutrition-related information needs and wants.

CONCLUSION

The findings from this study may assist the future development and dissemination of nutrition-related information for pregnant women with a high body mass index. Women want more individualised support regarding nutritional requirements during pregnancy.

Weight management during pregnancy: a qualitative thematic analysis on knowledge, perceptions and experiences of overweight and obese women in Singapore

Background: The effect of maternal weight on pregnancy and birth outcomes is of great public health concern. For example, overweight and obesity among pregnant women is associated with adverse reproductive health outcomes including gestational diabetes, birth defects, macrosomia and infant mortality.

Objectives: To understand the knowledge, perceptions and experiences during pregnancy among overweight and obese women in Singapore.

Methods: This is a cross-sectional study which employed qualitative techniques. The inclusion criteria is as follows: (1) Women who were overweight or obese before or during first trimester of pregnancy, (2) are able to report their specific pre-pregnancy or first trimester Body Mass Index (BMI), or weight and height, (3) had singleton pregnancy when overweight, are post-delivery for the pregnancy in which they were overweight, and (4) are 21 to 55 years old. Fifteen interviews were voice-recorded and transcribed verbatim. Then, two researchers independently performed the thematic analysis of the transcripts.

Results: The findings revealed that women had gaps in knowledge on the adverse effects of maternal overweight and obesity during pregnancy, and various misconceptions on diet and weight management during pregnancy were prevalent. Conflicting data was obtained for perceptions on the importance, difficulty and levels of motivation for weight management during pregnancy.

Conclusion: There is a pressing need to address knowledge gaps and misconceptions of pregnant women who are overweight or obese. The importance of weight management during pregnancy should be emphasized, and enabling factors put in place.

Enablers and barriers to physical activity in overweight and obese pregnant women: an analysis informed by the theoretical domains framework and COM-B model

Background

Obesity during pregnancy is associated with increased risk of gestational diabetes mellitus (GDM) and other complications. Physical activity is a modifiable lifestyle factor that may help to prevent these complications but many women reduce their physical activity levels during pregnancy. Interventions targeting physical activity in pregnancy are on-going but few identify the underlying behaviour change mechanisms by which the intervention is expected to work. To enhance intervention effectiveness, recent tools in behavioural science such as the Theoretical Domains Framework (TDF) and COM-B model (capability, opportunity, motivation and behaviour) have been employed to understand behaviours for intervention development. Using these behaviour change methods, this study aimed to identify the enablers and barriers to physical activity in overweight and obese pregnant women.

Methods

Semi-structured interviews were conducted with a purposive sample of overweight and obese women at different stages of pregnancy attending a public antenatal clinic in a large academic maternity hospital in Cork, Ireland. Interviews were recorded and transcribed into NVivo V.10 software. Data analysis followed the framework approach, drawing on the TDF and the COM-B model.

Results

Twenty one themes were identified and these mapped directly on to the COM-B model of behaviour change and ten of the TDF domains. Having the social opportunity to engage in physical activity was identified as an enabler; pregnant women suggested being active was easier when supported by their partners. Knowledge was a commonly reported barrier with women lacking information on safe activities during pregnancy and describing the information received from their midwife as ‘limited’. Having the physical capability and physical opportunity to carry out physical activity were also identified as barriers; experiencing pain, a lack of time, having other children, and working prevented women from being active.

Conclusion

A wide range of barriers and enablers were identified which influenced women’s capability, motivation and opportunity to engage in physical activity with “knowledge” as the most commonly reported barrier. This study is a theoretical starting point in making a ‘behavioural diagnoses’ and the results will be used to inform the development of an intervention to increase physical activity levels among overweight and obese pregnant women.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1816-z) contains supplementary material, which is available to authorized users.

GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING): a pilot cluster randomised controlled trial of a guideline implementation intervention for the management of maternal obesity by midwives

BACKGROUND

Weight management in pregnancy guidelines exist, although dissemination alone is an ineffective means of implementation. Midwives identify the need for support to overcome complex barriers to practice. An evaluation of an intervention to support midwives' guideline implementation would require a large-scale cluster randomised controlled trial. A pilot study is necessary to explore the feasibility of delivery and evaluation prior to a definitive trial. The GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING) trial aims to test whether it is feasible and acceptable to deliver a behaviour change intervention to support midwives' implementation of weight management guidelines.

METHODS

GLOWING is a multi-centre parallel group pilot cluster randomised controlled trial comparing the delivery of a behaviour change intervention for midwives versus usual practice. Four NHS Trusts (clusters) will be randomised to intervention and control arms, stratified by size of maternity services. The intervention uses social cognitive theory and consists of face-to-face midwifery training plus information resources for routine practice. The main outcomes are whether the intervention and trial procedures are feasible and acceptable to participants and the feasibility of recruitment and data collection for a definitive trial. Target recruitment involves all eligible midwives in the intervention arm recruited to receive the intervention, 30 midwives and pregnant women per arm for baseline and outcome questionnaire data collection and 20 midwives and women to provide qualitative data. All quantitative and qualitative analyses will be descriptive with the purpose of informing the development of the definitive trial.

DISCUSSION

This pilot study has been developed to support community midwives' implementation of guidelines. Community midwives have been selected as they usually carry out the booking appointment which includes measuring and discussing maternal body mass index. A cluster design is the gold standard in implementation research as there would be a high risk of contamination if randomisation was at individual midwife level: community midwives usually work in locality-based teams, interact on a daily basis, and share care of pregnant women. The results of the pilot trial will be used to further develop and refine GLOWING prior to a definitive trial to evaluate effectiveness and cost-effectiveness.

TRIAL REGISTRATION

ISRCTN46869894; retrospectively registered 25th May 2016.

Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review

QUESTION

What are the attitudes, barriers and enablers to physical activity perceived by pregnant women?

DESIGN

In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework.

PARTICIPANTS

Pregnant women.

INTERVENTION

Not applicable.

OUTCOME MEASURES

Attitudes and perceived barriers and enablers to physical activity during pregnancy.

RESULTS

Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity.

CONCLUSION

Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women's positive attitudes into increased physical activity participation.

REGISTRATION

PROSPERO CRD42016037643. [Harrison AL, Taylor NF, Shields N, Frawley HC (2018) Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. Journal of Physiotherapy 64: 24-32].

Body Mass Index Changes during Pregnancy and Perinatal Outcomes - A Cross-Sectional Study

OBJECTIVE

 To evaluate the relation between changes the body mass index (BMI) percentile, reflected in the Atalah curve, and perinatal outcomes.

METHODS

 A cross-sectional study with 1,279 women was performed. Data regarding gestational weight, sociodemographic characteristics and perinatal outcomes were collected through medical charts, prenatal card and interviews in the postpartum period. Women could be classified according to the Atalah curve in the following categories: low weight, adequate weight, overweight, and obese. The BMI was calculated at the first and at the last prenatal care visits, and these values were compared.

RESULTS

 An increase in the BMI category according to the Atalah classification occurred in 19.9% of pregnant women, and an increase of 3.4, 5.8 and 6.4 points of BMI were found for women respectively classified in the adequate weight, overweight and obese categories at the first prenatal visit. Women with high school education presented a lower chance of increasing their BMI (odds ratio [OR] 0:47 [0.24- 0.95]). Women who evolved with an increase in the the Atalah classification were associated with cesarean section (OR 1.97-2.28), fetal macrosomia (OR 4.13-12.54) and large for gestational age newborn (OR 2.88-9.83).

CONCLUSION

 Pregnant women who gained enough weight to move up in their BMI classification according to the Atalah curve had a higher chance of cesarean section and macrosomia. Women classified as obese, according to the Atalah curve, at the first prenatal visit had a high chance of cesarean section and delivering a large for gestational age newborn.

Maternal conception of gestational weight gain among Latinas: A qualitative study

OBJECTIVE

Interventions to support healthy gestational weight gain are often ineffective. The objective was to develop a model of how pregnant Latinas-who have a higher risk of poor maternal and neonatal weight-related outcomes-conceptualize healthy gestational weight gain, providing guidance for future interventions.

METHOD

Ten focus groups with 50 pregnant Latinas were conducted by a native Spanish-speaking female moderator. On the basis of participant responses, we used grounded theory to inductively develop a personal conceptual framework for gestational weight gain.

RESULTS

Commonly identified barriers to being active and healthy eating included negative emotions, body image, physical discomfort, low energy, and lack of motivation. Women identified sociocultural issues such as a sense of isolation from family (among immigrants) and the degree of perceived social support as important contributors to health behaviors. Two personal health schemas emerged from participant responses. The "mother-child health schema" describes the degree to which participants recognized the interrelatedness of health needs for baby and for themselves. The "attention to gestational weight gain schema" describes how a respondent's attention to and perceived importance of gestational weight gain influences health-related behaviors during pregnancy.

CONCLUSIONS

Women's sociocultural and interpersonal context influence weight-related behaviors through the lens of personal health schemas. Understanding how cognitive aspects relate to traditional behavioral determinants suggests several opportunities for intervention, such as focusing on healthy behaviors instead of numerical targets for healthy weight gain. Although derived from Spanish-speaking Latin-American women, these results may also be potential leverage points for other minority groups. (PsycINFO Database Record

Concerns, attitudes, beliefs and information seeking practices with respect to nutrition-related issues: a qualitative study in French pregnant women

BACKGROUND

From a life course perspective, pregnancy leads to a rise in nutrition awareness and an increase in information flow in favour of adopting healthier eating behaviours. This qualitative study was designed to better understand the determinants of eating behaviours in French pregnant women by focusing on their concerns, attitudes and beliefs and their nutrition-related information seeking practices.

METHODS

Seven focus groups were conducted, involving a total of 40 French pregnant women. An inductive thematic approach, adapted from the grounded theory, was adopted to analyse the data. Two major themes were identified: eating behaviour and nutrition-related information behaviour.

RESULTS

The eating behaviour theme was divided into four sub-themes using the attribution theory. Three external causes affected the eating behaviour of pregnant women (food restrictions, physiological changes and weight gain), and led to frustration and a perceived loss of control. By contrast the adoption of a healthier diet was perceived as internal by pregnant women, and resulted in self-fulfilment and empowerment regarding the health and the well-being of their baby and themselves, and their weight gain management. Greater attention was paid to nutrition-related information obtained from healthcare providers, the social environment and the mass media. Information was passively absorbed or actively sought by pregnant women, but most was perceived as contradictory, which led to confusion.

CONCLUSION

Pregnancy is accompanied by a rise in nutrition awareness, substantiated by eating behaviour modifications due to external and internal causes. However, conflicts between and within information sources result in confusion that can limit the adoption of healthier eating behaviour.

"As soon as you've had the baby that's it…" a qualitative study of 24 postnatal women on their experience of maternal obesity care pathways

Background

Maternal obesity is associated with risks to mother and infant, and has implications for healthcare costs. United Kingdom (UK) levels of maternal obesity are rising, with higher prevalence in North East (NE) England, where this study was set. Pregnancy is often seen as an opportune time for intervention – a ‘teachable moment’ - which is ripe for promoting behaviour change. In response to rising obesity levels, a National Health Service (NHS) Foundation Trust in NE England implemented three maternal obesity care pathways contingent on Body Mass Index (BMI) at time of booking: pathway 1 for those with BMI ≥30 kg/m²; pathway 2 for BMI ≥35 kg/m²; and pathway 3 for BMI ≥40 kg/m². These incorporated relevant antenatal, intrapartum and postnatal clinical requirements, and included a focus on weight management intervention. This evaluation explored the accounts of postnatal women who had been through one of these pathways in pregnancy.

Methods

The study used a generic qualitative approach. Semi-structured interviews were carried out to explore the views and experiences of 24 recent mothers (aged 20–42), living in NE England, who had commenced on one of the pathways during pregnancy. Interviews explored experiences of weight management support during and after pregnancy, and perceived gaps in this support. Data were analysed using thematic content analysis.

Results

Three main themes emerged reflecting women’s views and experiences of the pathways: communication about the pathways; treating obese pregnant women with sensitivity and respect; and appropriate and accessible lifestyle services and information for women during and after pregnancy. An overarching theme: differences in care, support and advice, was evident when comparing the experiences of women on pathways 1 or 2 with those on pathway 3.

Conclusions

This study indicated that women were not averse to risk management and weight management intervention during and after pregnancy. However, in order to improve reach and effectiveness, such interventions need to be well communicated and offer constructive, individualised advice and support. The postnatal phase may also offer an opportune moment for intervention, suggesting that the simple notion of seeing pregnancy alone as a window of opportunity or a ‘teachable moment’ should be reconsidered.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3289-1) contains supplementary material, which is available to authorized users.

Maternal obesity in Europe: where do we stand and how to move forward?: A scientific paper commissioned by the European Board and College of Obstetrics and Gynaecology (EBCOG)

Paralleling the global epidemic of obesity figures in the general population, the incidence of maternal obesity (BMI>30kg/m(2) at the start of pregnancy) has been rising over the last world. While most European countries do not systematically report obesity figures in their pregnant population, the prevalence of maternal obesity varies from 7 to 25% and seems strongly related to social and educational inequalities. Obesity during pregnancy represents an important preventable risk factor for adverse pregnancy outcomes and is associated with negative long-term health outcomes for both mothers and offspring. These effects are often aggravated by the high incidence of abnormal glucose tolerance and excessive gestational weight gain found in this group. The main controversies around the management of the obese pregnant women are related to (1) the value of repeated weighing during pregnancy, (2) the optimal gestational weight gain to advise and the lifestyle messages to deliver in order to achieve this, (3) the optimal strategy and timing of screening for gestational diabetes (GDM) and (4) the optimal timing and mode of delivery. These controversies are reviewed in this review, with the exception of screening for gestational diabetes that is discussed extensively elsewhere in this issue (Benhalima et al.). An agenda for research is proposed with the hope that it will catch the attention of policy-makers and funders and ultimately lead to the development of European-wide evidence-based guidelines for clinicians.

African American and White women׳s perceptions of weight gain, physical activity, and nutrition during pregnancy

OBJECTIVE

To describe African American and White women's perceptions of weight gain, physical activity, and nutrition during pregnancy and to explore differences in perceptions by race.

DESIGN

Qualitative interview study.

SETTING

Two Ob/Gyn clinics in South Carolina, USA.

PARTICIPANTS

Thirty pregnant women (15 African American, 15 White) between 20 and 30 weeks gestation, equally represented across pre-pregnancy BMI categories (10 normal weight, 10 overweight, and 10 obese).

FINDINGS

White women more frequently described intentions to meet weight gain, physical activity, and dietary guidelines in pregnancy than African American women. African American women were more concerned with inadequate weight gain while White women more commonly expressed concerns about excessive weight gain. More White women discussed the importance of physical activity for weight management. Regardless of race, few women described risks of excessive weight gain or benefits of physical activity as it relates to the baby's health. The primary cited barrier of healthy eating was the high cost of fresh produce.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Several knowledge gaps as well as race differences were identified in women's perceptions and intentions toward weight gain, physical activity, and nutrition during pregnancy. Future interventions should seek to educate women about common misperceptions. It may be necessary to culturally tailor gestational weight gain interventions to optimise health outcomes.