Perceptions of low-income African-American mothers about excessive gestational weight gain

Efficacy of an mHealth-delivered behavioral intervention on weight loss and cardiometabolic risk in African American postpartum people with overweight or obesity: the SnapBack randomized controlled trial

OBJECTIVE

The objective of this study was to evaluate the efficacy of a mobile health (mHealth)-delivered behavioral intervention on changes in postpartum weight and cardiometabolic risk factors (blood pressure [BP], lipids, and hemoglobin A1c) over 12 months.

METHODS

A randomized controlled trial of 300 African American postpartum people with overweight and obesity enrolled in Philadelphia Women, Infants, and Children (WIC) clinics was conducted. Participants were randomized to usual WIC care (n = 151) or a 12-month mHealth-delivered intervention (n = 149) comprising behavior change goals, interactive self-monitoring text messages, and counseling support.

RESULTS

Intervention and usual-care participants did not significantly differ in 12-month mean postpartum weight change (1.1 vs. 1.6 kg, p = 0.5; difference -0.6 kg, 95% CI: -2.3 to 1.2). However, high intervention engagement led to weight loss compared with weight gain among those who were less engaged (-0.6 vs. 2.4 kg, p = 0.01; difference -3.0 kg, 95% CI: -5.4 to -0.6). The intervention reduced systolic BP relative to usual care (-1.6 vs. 2.4 mm Hg, p = 0.02; difference -4.0 mm Hg, 95% CI: -7.5 to -0.5), but this effect did not extend to other cardiometabolic risk factors.

CONCLUSIONS

Among African American postpartum people enrolled in WIC, an mHealth-delivered intervention reduced systolic BP but not additional cardiometabolic risk factors or weight. Intervention participants with high engagement had significantly better postpartum weight outcomes, and thus, next steps include addressing barriers to engagement.

Barriers and facilitators to healthy gestational weight gain amongst pregnant women from ethnic minority groups: A systematic search and narrative synthesis

BACKGROUND

Excessive weight gain can be detrimental to the health and wellbeing of both mother and child. There is evidence that women from ethnic minority groups are more likely to gain excessive weight during pregnancy. For the purpose of this review, ethnic minority women are defined as those with different national or cultural traditions from the main population.

AIM

Our aim was to identify barriers and facilitators to healthy gestational weight gain in pregnant women in ethnic minority groups.

METHODS

Databases searched were MEDLINE, CINAHL, PsycInfo and PsycArticles between 2011 and 2022. Inclusion criteria were empirical studies of any method considering gestational weight gain in ethnic minority women published in English. Data were extracted according to aim, participants, methods, and findings in relation to barriers and facilitators. Included papers were assessed for quality according to relevant Joanna Briggs Institute checklists.

FINDINGS

Twenty-six studies were identified. Five themes were revealed: (1) knowledge and beliefs, (2) cultural and social influences, (3) confidence, (4) physical experiences, and (5) personal and environmental factors.

DISCUSSION

Some barriers and facilitators were relevant to all groups and others were more specific to ethnic minority groups. The latter included social and cultural influences, which were reported extensively. Our search was comprehensive, although it is possible we may not have captured all relevant papers.

CONCLUSION

We recommend that the barriers and facilitators identified here are considered in designing future, or adjusting current, health care practitioner mediated interventions to support healthy gestational weight gain in ethnic minority women.

Poor Sleep Quality Increases Gestational Weight Gain Rate in Pregnant People: Findings from the MADRES Study

Background

Poor sleep quality is associated with weight gain in non-pregnant populations, but evidence in pregnant people is lacking. Our study examined the association between early-to-mid pregnancy sleep quality and weekly gestational weight gain (GWG) rate during mid-to-late pregnancy by pre-pregnancy body mass index (BMI).

Method

Participants were 316 pregnant participants from the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) study. During early-to-mid pregnancy, participants reported their sleep quality which was used to construct four categories: very poor, poor, good, and very good. Linear growth curve models examined the association between early-to-mid pregnancy sleep quality and weekly rate of GWG (kg/week) during mid-to-late pregnancy (> 20 weeks gestation), with a three-way cross-level interaction between gestational age, sleep quality, and pre-pregnancy BMI category. Models adjusted for ethnicity by birthplace, hypertensive disorders, perceived stress score, and physical activity level.

Results

Overall, poorer early-to-mid pregnancy sleep quality was associated with increased weekly weight gain during mid-to-late pregnancy. For example, amongst normal weight participants, mid-to-late pregnancy weight gain was, on average, 0.39 kg (95% CI: 0.29, 0.48) per week for those with very good sleep quality, 0.53 kg (95% CI: 0.44, 0.61) per week for those with poor sleep quality, and 0.54 kg (95% CI: 0.46, 0.62) per week for those with very poor sleep quality during early-to-mid pregnancy. This difference in GWG rate was statistically significantly comparing very good to poor sleep (0.14 kg/week, 95% CI: 0.01, 0.26) and very good to very poor sleep (0.15kg/week, 85% CI: 0.02, 0.27). This association between sleep quality and GWG rate did not statistically differ by pre-pregnancy BMI.

Conclusion

Our study found very poor early-to-mid pregnancy sleep quality was associated with higher mid-to-late pregnancy GWG rate. Incorporating pregnancy-specific sleep recommendations into routine obstetric care may be a critical next step in promoting healthy GWG.

Grocery Delivery to Support Healthy Weight Gain Among Pregnant Young Women With Low Income: Protocol for a Randomized Controlled Trial

BACKGROUND

Excessive weight gain during pregnancy is associated with complications for both the mother and her infant including gestational diabetes, hypertensive disorders, operative delivery, and long-term obesity. A healthy diet during pregnancy promotes healthy gestational weight gain and determines fetal epigenetic programming in infants that impacts risk for future chronic disease.

OBJECTIVE

This project will examine the impact of grocery delivery during pregnancy on the weight, diet, and health outcomes of young pregnant women and their infants.

METHODS

A three-arm randomized controlled trial design will be performed. A total of 855 young pregnant women, aged 14-24 years, from across the state of Michigan will be enrolled and randomized equally into the three study arms. Participants in arm one (control) will receive usual care from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); arm two will receive WIC plus biweekly grocery delivery; and arm three will receive WIC plus biweekly grocery and unsweetened beverage delivery. Weight will be assessed weekly during pregnancy, and total pregnancy weight gain will be categorized as above, below, or within guidelines. Additionally, dietary intake will be assessed at three time points (baseline, second trimester, and third trimester), and pregnancy outcomes will be extracted from medical records. The appropriateness of pregnancy weight gain, diet quality, and occurrence of poor outcomes will be compared between groups using standard practices for multinomial regression and confounder adjustment.

RESULTS

This study was funded in April 2021, data collection started in December 2021, and data collection is expected to be concluded in 2026.

CONCLUSIONS

This study will test whether grocery delivery of healthy foods improves weight, diet, and pregnancy outcomes of young moms with low income. The findings will inform policies and practices that promote a healthy diet during pregnancy, which has multigenerational impacts on health.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05000645; https://clinicaltrials.gov/ct2/show/NCT05000645.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40568.

Recruitment, Retention, and Engagement Strategies for Exercise Interventions With Rural Antenatal Adolescents: Qualitative Interviews With WIC Providers

Public health stakeholder engagement is integral to developing effective public health interventions. The perspectives of women enrolled in the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC) have often been sought when designing WIC-based interventions; however, the perspectives of WIC providers are underrepresented. The goal of this investigation was to explore the experiences of WIC providers who counsel adolescent clients and to identify strategies for recruitment, retention, and engagement of adolescents in an antenatal exercise intervention. Qualitative interviews were conducted with WIC providers (N = 9) in the Mississippi Delta, a rural, predominantly African American region in northwest Mississippi. From our data emerged 4 themes and 4 hypothesized strategies for recruitment, retention, and engagement of adolescent WIC clients and their parents in a future antenatal exercise intervention that will be implemented through WIC. Engaging the perspectives of WIC providers was a critical first step in understanding the context for this intervention.

A Qualitative Study of Motivators, Strategies, Barriers, and Learning Needs Related to Healthy Cooking during Pregnancy

Nutrition during pregnancy has lifelong impacts on the health of mother and child. However, this life stage presents unique challenges to healthy cooking and eating. Cooking interventions show promising results, but often lack theoretical basis and rigorous evaluation. The objective of this formative, qualitative study was to explore motivators, strategies, and barriers related to healthy cooking during pregnancy. Pregnant individuals’ preferences for a cooking education program were also explored. We conducted five focus groups with pregnant individuals (n = 20) in Southeast Michigan in 2019. Focus groups were audio-recorded and transcribed verbatim, then double coded by two members of the research team. Mean gestational age was 18.3 ± 9.6 weeks. Common motivators included feeding other children, avoiding pregnancy complications, promoting fetal growth, and avoiding foodborne illness. Challenges included pregnancy symptoms, navigating nutrition recommendations, mental energy of meal planning, family preferences, and time constraints. Strategies employed were meal planning and including a variety of foods. Participants identified organizational strategies, recipes, nutrition information, and peer support as important components of a cooking intervention during pregnancy. This study characterized multiple challenges to healthy home cooking during pregnancy, providing novel insight to inform the development of cooking skills education programs during this important life stage.

Recruitment planning for clinical trials with a vulnerable perinatal adolescent population using the Clinical Trials Transformative Initiative framework and principles of partner and community engagement

Recruitment planning is needed to establish a foundation for obesity prevention research with high risk, disadvantaged perinatal adolescent populations. In the context of developing clinical trial protocols, investigators partnered with Mississippi's Nutrition Program for Women, Infants and Children (WIC) and adopted the Clinical Trials Transformative Initiative (CTTI) framework for recruitment planning to identify and mitigate challenges to recruitment early in the clinical trial development process. The recruitment protocol consisted of 20 passive strategies grounded in principles of partner and community engagement and was flexible, accommodating, altruistic, community-focused, and minimally burdensome to partners and participants. The recruitment goal included 150 adolescent-coparticipant dyads and 145 dyads (96.7%) were successfully recruited. Investigators demonstrated the feasibility of recruiting a disadvantaged and vulnerable perinatal adolescent population that is underrepresented in health research, in one of the most persistently impoverished and poor health regions in the U.S. Four important aspects of recruitment planning using the CTTI framework are discussed including: (1) establishing partnerships with trusted community resources is a paramount investment; (2) dedicating time and resources to know and go to your community is invaluable; (3) fostering trust by offering convenient, continuous and clear communication; and (4) encouraging collaboration and participation through limiting partner and participant burden. Establishing organizational and community partnership requires a substantial amount of invaluable time and fosters recruitment success. Following the CTTI recommendations for recruitment planning led to a robust recruitment protocol that will be used in future intervention trials with an understudied perinatal adolescent population with high risk for poor maternal and fetal health outcomes.

Factors Influencing Pregnancy and Postpartum Weight Management in Women of African and Caribbean Ancestry Living in High Income Countries: Systematic Review and Evidence Synthesis Using a Behavioral Change Theoretical Model

Background: Women of black African heritage living in high income countries (HIC) are at risk of obesity and weight-related complications in pregnancy. This review aimed to synthesize evidence concerning attitudes to weight management-related health behaviors in pregnancy and postpartum, in women of black African ancestry, living in high-income countries. Methods: A systematic review of the literature and thematic evidence synthesis using the Capability-Opportunity-Motivation Behavioral change theoretical model (COM-B). Databases searched included MEDLINE, EMBASE, Web of Science, and Scopus. The CASP tool was used to assess quality. Results: Twenty-four papers met the selection criteria, most of which were from the US. Motivational factors were most commonly described as influencers on behavior. Normative beliefs about "eating for two," weight gain being good for the baby, the baby itself driving food choice, as well as safety concerns about exercising in pregnancy, were evident and were perpetuated by significant others. These and other social norms, including a cultural acceptance of larger body shapes, and daily fast food, created a challenge for healthy behavior change. Women also had low confidence in their ability to lose weight in the postpartum period. Behavior change techniques, such as provision of social support, use of credible sources, and demonstration may be useful to support change. Conclusions: The women face a range of barriers to engagement in weight-related health behaviors at this life-stage. Using a theoretical behavior change framework can help identify contextual factors that may limit or support behavior change.

Building Strong Futures: The Feasibility of Using a Targeted Digital Media Campaign to Improve Knowledge About Pregnancy and Low Birthweight Among Black Women

Objective

Low birthweight is one of the main causes of poor health outcomes among newborns, with Black women having a disproportionately high prevalence. A digital intervention targeted Black women in Orange County, Florida with information on positive pregnancy-related knowledge and attitudes related to low birthweight. This paper reports on campaign methods for the first 2.5 years of implementation.

Methods

Campaign content was tailored toward Black women, around a reproductive empowerment lens. Content focused on emphasizing healthy pregnancy-related behaviors and creating positive representations of Black women throughout the various stages of pregnancy through both static images and a web series. Digital metrics gauged campaign engagement. Three cross-sectional online surveys conducted in the intervention county examined Black women’s pregnancy-related knowledge, attitudes, and behaviors.

Results

After two years of campaign implementation, social media accounts showed 1784 followers. While Facebook showed more average monthly impressions, Instagram showed more average monthly engagements. Survey results showed some increases in knowledge about prenatal care, weight gain, exercise, and the health impacts of low birthweight.

Conclusions for Practice

This study highlights the potential for a culturally-appropriate digital intervention to promote positive pregnancy outcomes among at-risk women. Digital interventions offer a potential way to achieve positive pregnancy-related behavior changes on a larger scale. This may be particularly important given that the COVID-19 pandemic may be changing the ways that pregnant women access information. Studies should examine the impact and feasibility of using culturally-appropriate digital interventions that directly address Black women and their specific experiences during pregnancy.

Eating behaviors in relation to gestational weight gain and postpartum weight retention: A systematic review

Preventing obesity is of utmost public health importance. This paper systematically reviews associations between eating behaviors and peripartum weight change. This knowledge is crucial in the development of interventions that reduce long-term obesity, often triggered and boosted in the peripartum. Through MEDLINE, EMBASE, and Web of Science, we identified 20 studies that fulfilled inclusion criteria: studies on food cravings, disinhibition, restrained, external, emotional, uncontrolled, intuitive, or mindful eating in relation to gestational or postpartum weight among adult women. Higher gestational weight gain was associated with lower intuitive eating (in 3/3 studies) and higher restrained eating (in 4/11 studies), external eating (in 2/2 studies), emotional eating (in 3/4 studies), food cravings (in 3/3 studies), and disinhibition (in 1/3 studies). No association with uncontrolled eating was found (in one study). No studies on mindful eating and gestational weight were identified. Higher postpartum weight loss was associated with higher restrained (in 2/4 studies) and intuitive eating (in 1/1 study). No associations between postpartum weight and food cravings, disinhibition, and mindful eating were found. No studies on external, emotional and uncontrolled eating, and postpartum weight were identified. Concluding, certain eating behaviors might be related to peripartum weight change.

Competing priorities: a qualitative study of how women make and enact decisions about weight gain in pregnancy

Background

Despite ample clinical evidence that gaining excess weight in pregnancy results in negative health outcomes for women and infants, more than half of women in Western industrialized nations gain in excess of national guidelines. The influence of socio-demographic factors and weight gain is well-established but not causal; the influence of psychological factors may explain some of this variation.

Methods

This is the qualitative portion of an explanatory sequential mixed-methods study designed to identify predictive psychological factors of excess gestational weight gain (QUAN) and then explain the relevance of those factors (qual). For this portion of the study, we used a qualitative descriptive approach to elicit 39 pregnant women’s perspectives of gestational weight gain, specifically inquiring about factors determined as relevant to excess gestational weight gain by our previous predictive study. Women were interviewed in the latter half of their third trimester. Data were analyzed using a combination of unconstrained deductive content analysis to describe the findings relevant to the predictive factors and a staged inductive content analytic approach to examine the data without a focus on the predictive factors.

Results

Very few participants consistently made deliberate choices relevant to weight gain; most behaviour relevant to weight gain happened with in-the-moment decisions. These in-the-moment decisions were influenced by priorities, hunger, a consideration of the consequence of the decision, and accommodation of pregnancy-related discomfort. They were informed by the foundational information a woman had available to her, including previous experience and interactions with health care providers. The foundational information women used to make these decisions was often incomplete. While women were aware of the guidelines related to gestational weight gain, they consistently mis-applied them due to incorrect understanding of their own BMI. Only one woman was aware that weight gain was linked to maternal and infant health outcomes.

Conclusions

There is an important role for prenatal providers to provide the foundational information to positively influence in-the-moment decisions. Understanding how weight gain guidelines apply to one’s own pre-pregnancy BMI and comprehending the well-established link between gestational weight gain and health outcomes may help women prioritize healthy weight gain amongst many competing factors.

Targeting pregnancy-related weight gain to reduce disparities in obesity: Baseline results from the Healthy Babies trial

BACKGROUND

Obesity affects African American women more than any other group in the US. Pregnancy represents a critical life stage of heightened vulnerability for new or persistent obesity, yet few interventions have been effective in reducing excessive gestational weight gain among African American women. We describe the design and baseline findings of Healthy Babies, a two-arm randomized controlled trial testing a mobile health intervention to minimize excessive gestational weight gain versus usual care in this high risk group.

METHODS

African American women in early pregnancy were recruited from two large obstetric practices as well as Philadelphia Women, Infants, and Children's clinics. Participants randomized to the intervention received behavior change goals, daily text messages with feedback, web-based weight gain graphs, health coaching, and a Facebook support group. Data collection included baseline (<22 weeks' gestation), 36-38 weeks' gestation, and 6-month postpartum anthropometric measures and assessments of demographics, contextual factors and behavioral targets. The primary outcome was prevalence of excessive gestational weight gain.

RESULTS

Among participants at baseline (n = 262), the majority met criteria for obesity (63%), were multiparous (62%), single (77%), and were on average 25.6 ± 5.4 years old with a gestational age of 13.9 ± 4.1 weeks. While 82% completed high school, 61% met criteria for inadequate health literacy. Nearly 20% were food insecure. Eighty-eight percent reported a gestational weight gain goal discordant with Institute of Medicine guidelines. There were no significant differences in baseline characteristics between study arms.

CONCLUSIONS

Participants represent a high-risk group for excessive gestational weight gain with demonstrated need for intervention.

The challenge for global health systems in preventing and managing obesity

Few health crises have been as predictable as the unfolding obesity pandemic. Clinical and public health services remain the front line of efforts to reduce the burden of obesity. While a range of clinical practice guidelines exist, the need for clinical interventions exceeds the capacity of health systems to provide care for those affected with obesity, and routine clinical practices fall far short of guidelines recommendations even in high-income countries. In this manuscript, we discuss current recommendations regarding obesity interventions and key challenges facing global health systems in managing the health needs of people with obesity. Improving the provision of obesity-related health care is a considerable challenge and will require changing existing perceptions of obesity as a matter of personal failure to its recognition as a disease, innovative approaches to health system reform, clinician capacity building and implementation support, a focus on prevention, and wise resource allocation. Leadership from governments, the medical profession, and patient and community groups to address the issues raised in this manuscript is urgently needed to address the growing health concern.

Patient and obstetric provider communication regarding weight gain management among socioeconomically disadvantaged African American women who are overweight/obese

To examine the communication between obstetric providers and their socioeconomically disadvantaged, African American patients who are overweight and obese during pregnancy, and whether this communication relates to outcomes. Pregnant patients and their obstetric providers were surveyed between October 2012 and March 2016 at Washington University School of Medicine in St. Louis, MO. Percent agreement between patients' and obstetric providers' survey responses was analyzed and measured (κ coefficient). Descriptive and multilevel logistic regression analyses aimed at identifying the relation of perceived communication between providers and patients to gestational weight gain, diet, and exercise during pregnancy. A total of 99 pregnant women and 18 obstetric providers participated in the study. Significant lack of agreement was observed between patients and obstetric providers regarding communication about weight gain recommendations, risk factors associated with excessive weight gain, what constitutes adequate exercise per week, exercise recommendations, dietary recommendations, and risk factors associated with a poor diet. Our findings suggest patients were not receiving intended messages from their obstetric providers. Thus, more effective patient-obstetric provider communication is needed regarding gestational weight gain, exercise and dietary recommendations among overweight/obese, socioeconomically disadvantaged, African American women.

Using Text Messaging, Social Media, and Interviews to Understand What Pregnant Youth Think About Weight Gain During Pregnancy

BACKGROUND

The majority of pregnant youth gain more weight than recommended by the National Academy of Medicine guidelines. Excess weight gain during pregnancy increases the risk of dangerous complications during delivery, including operative delivery and stillbirth, and contributes to the risk of long-term obesity in both mother and child. Little is known regarding youth's perceptions of and knowledge about weight gain during pregnancy.

OBJECTIVE

The aim of this study was to describe the feasibility and acceptability of 3 novel data collection and analysis strategies for use with youth (social media posts, text message surveys, and semistructured interviews) to explore their experiences during pregnancy. The mixed-methods analysis included natural language processing and thematic analysis.

METHODS

To demonstrate the feasibility and acceptability of this novel approach, we used descriptive statistics and thematic qualitative analysis to characterize participation and engagement in the study.

RESULTS

Recruitment of 54 pregnant women aged between 16 and 24 years occurred from April 2016 to September 2016. All participants completed at least 1 phase of the study. Semistructured interviews had the highest rate of completion, yet all 3 strategies were feasible and acceptable to pregnant youth.

CONCLUSIONS

This study has described a novel youth-centered strategy of triangulating 3 sources of mixed-methods data to gain a deeper understanding of a health behavior phenomenon among an at-risk population of youth.

The Weight of Things: Understanding African American Women's Perceptions of Health, Body Image, and Attractiveness

Negative attitudes toward being overweight or obese are widespread, and these notions perpetuate into conceptions about one's health. Clinically, being overweight is associated with health problems such as diabetes, hypertension, heart disease, and many other illnesses. African American women, who are generally larger in body size, are a particular target for health interventions. However, these women have resisted the "obesity" label, arguing that dominant measures of health are White norms and oppressive. Through the use of in-depth interviews, this study investigates how African American women understand and experience healthfulness, body image, and barriers to each. Findings show that African American women are ambivalent in their acceptance of dominant markers of health and expressed an almost universal disdain for the thin ideal as a marker of "good" health and a positive body image. Moreover, participants articulated a suspicion of formal medical measurements of obesity.

A Randomized Controlled Feasibility Trial in Behavioral Weight Management for Underserved Postpartum African American Women: The RENEW Study

We aimed to test the feasibility of an in-person behavioral weight-loss intervention for underserved postpartum African American women with overweight or obesity in an urban hospital setting. Participants were randomized to an intervention of a culturally tailored adaptation of the Diabetes Prevention Program or usual care. The primary outcome was program satisfaction. Women who completed the intervention reported higher levels of satisfaction with the program, despite low attendance rates at group meetings. The intervention was not feasible because of these low rates of attendance and high rates of attrition after randomization. Offering the program electronically and off-site for convenience and more psychosocial support for postpartum women with obesity may improve feasibility.

Added Sugar Intake among Pregnant Women in the United States: National Health and Nutrition Examination Survey 2003-2012

BACKGROUND

Despite associations of dietary added sugar with excess weight gain and chronic disease risk, intake among most Americans exceeds the recommended limits (<10% total energy). Maternal diet plays an important role in pregnancy-related outcomes, but little is known about the extent of added sugar intake during pregnancy.

OBJECTIVE

To assess intake and identify the top sources of added sugars in the diets of pregnant vs nonpregnant women in the United States.

DESIGN

Cross-sectional analysis of data from the National Health and Nutrition Examination Survey (NHANES), 2003-2004 to 2011-2012.

PARTICIPANTS

Four thousand one hundred seventy-nine pregnant and nonpregnant women (aged 20 to 39 years) who completed a dietary recall.

STATISTICAL ANALYSES PERFORMED

Survey-weighted analyses were used to estimate means (95% CIs) in total grams and as percentage of total energy for added sugar intake by pregnancy status and by demographic subgroup and to identify leading sources of added sugar.

RESULTS

Added sugar intake trended toward being higher in pregnant compared with nonpregnant women in absolute grams, 85.1 g (95% CI: 77.4 to 92.7) vs 76.7 g (95% CI: 73.6 to 79.9), respectively (P=0.06), but was lower among pregnant women when total energy intake was accounted for, 14.8% (95% CI: 13.8 to 15.7) vs 15.9% (95% CI: 15.2 to 16.6) of total energy, respectively (P=0.03). Among pregnant women, added sugar intake was similar among demographic subgroups. However, in multivariable regression, pregnancy status significantly modified the associations of education and income with added sugar intake, whereby less educated and lower-income women who were pregnant had lower added sugar intakes compared with those who were not pregnant, but more educated or higher-income women did not exhibit this pattern. The top five sources of added sugar for all women were sugar-sweetened beverages; cakes, cookies, and pastries; sugars and sweets; juice drinks and smoothies; and milk-based desserts.

CONCLUSIONS

Although pregnant women had higher energy intakes, this was not attributed to higher intakes of added sugar. Although education and income affected consumption during pregnancy, intake of added sugar among all women, regardless of pregnancy status, exceeded recommendations.

Effect of a Best Practice Alert on Gestational Weight Gain, Health Services, and Pregnancy Outcomes

Objective To examine whether an electronic medical record "best practice alert" previously shown to improve antenatal gestational weight gain patient education resulted in downstream effects on service delivery or patient health outcomes. Methods This study involved secondary analysis of data from an intervention to improve provider behavior surrounding gestational weight gain patient education. Data were from retrospective chart reviews of patients who received care either before (N = 333) or after (N = 268) implementation of the intervention. Pre-post comparisons and multivariable logistic regression were used to analyze downstream effects of the intervention on health outcomes and obesity-related health services while controlling for potential confounders. Results The intervention was associated with an increase in the proportion of prenatal patients who gained weight within Institute of Medicine guidelines, from 28 to 35 % (p < .05). Mean total gestational weight gain did not change, but variability decreased such that post-intervention women had weight gains closer to their gestational weight gain targets. The intervention was associated with a 94 g decrease in mean infant birth weight (p = .03), and an increase in the proportion of overweight and obese women screened for undiagnosed Type 2 diabetes before 20 weeks gestation, from 13 to 25 % (p = .01). Conclusions for Practice The electronic medical record can be leveraged to promote healthy gestational weight gain and early screening for undiagnosed Type 2 diabetes. Yet most patients still need additional support to achieve gestational weight gain within Institute of Medicine guidelines.

Predictors and outcomes of excess gestational weight gain among low-income pregnant women

Low-income women were interviewed and their post-natal records were retrieved (n = 160) to assess prevalence of excess gestational weight gain and its socio-demographic predictors. More than half of the women (64%) gained excess weight during pregnancy, with an average of 10 lbs in excess of Institute of Medicine guidelines. Logistic regression indicated that women that started pregnancy at an obese body mass index; who were African American or having an unplanned pregnancy were at significant risk of gaining excess weight in pregnancy. Intervention to prevent excess weight gain during pregnancy is critical in addressing obesity epidemic in the United States and worldwide.

Pregnant women's perceptions of gestational weight gain: A systematic review and meta-synthesis of qualitative research

Excess gestational weight gain has numerous negative health outcomes for women and children, including high blood pressure, diabetes, and cesarean section (maternal) and high birth weight, trauma at birth, and asphyxia (infants). Excess weight gain in pregnancy is associated with a higher risk of long-term obesity in both mothers and children. Despite a concerted public health effort, the proportion of pregnant women gaining weight in excess of national guidelines continues to increase. To understand this phenomenon and offer suggestions for improving interventions, we conducted a systematic review of qualitative research on pregnant women's perceptions and experiences of weight gain in pregnancy. We used the methodology of qualitative meta-synthesis to analyze 42 empirical qualitative research studies conducted in high-income countries and published between 2005 and 2015. With this synthesis, we provide an account of the underlying factors and circumstances (barriers, facilitators, and motivators) that pregnant women identify as important for appropriate weight gain. We also offer a description of the strategies identified by pregnant women as acceptable and appropriate ways to promote healthy weight gain. Through our integrative analysis, we identify women's common perception on the struggle to enact health behaviors and physical, social, and environmental factors outside of their control. Effective and sensitive interventions to encourage healthy weight gain in pregnancy must consider the social environment in which decisions about weight take place.

Association Between Health Beliefs and Gestational Weight Gain

BACKGROUND

The Institute of Medicine (IOM) provides recommendations for optimal weight gain during pregnancy to minimize complications associated with obesity and excessive weight gain. The Health Belief Model and prior research suggest knowledge of health recommendations and associated risks motivate health behaviors. This study determined whether knowledge of maternal and infant obesity risks during pregnancy (ORDP) and knowledge of IOM gestational weight gain (GWG) recommendations were associated with total GWG and likelihood of adhering to IOM recommendations.

MATERIALS AND METHODS

In this prospective survey study, healthy women with a singleton pregnancy were recruited from prenatal clinic waiting rooms of a university medical center to complete a one-time survey of prepregnancy weight and height, demographic variables, knowledge of infant-related ORDP (e.g., large for gestational age), knowledge of maternal-related ORDP (e.g., Cesarean delivery), and knowledge of IOM GWG recommendations. Total GWG was obtained from clinic medical records. Logistic and multiple regression analyses were performed.

RESULTS

The sample consisted of 159 women with average age of 25 and prepregnancy body mass index of 28. Women in the sample were predominantly African American (57%) and from low socioeconomic conditions. Results showed (1) knowledge of GWG recommendations was inversely related to total GWG among normal and underweight women and (2) knowledge of infant-related ORDP was positively related to total GWG among overweight and obese women and the likelihood of exceeding recommendations among normal and underweight women. Knowledge of maternal-related ORDP was not related to GWG.

CONCLUSION

As the Health Belief Model suggests, knowledge appears to be a modifiable factor in preventing excess GWG. However, there may be misinformation regarding how to adhere to clinical recommendations.

Come On! Using intervention mapping to help healthy pregnant women achieve healthy weight gain

OBJECTIVE

Gaining too much or too little weight in pregnancy (according to Institute of Medicine (IOM) guidelines) negatively affects both mother and child, but many women find it difficult to manage their gestational weight gain (GWG). Here we describe the use of the intervention mapping protocol to design 'Come On!', an intervention to promote adequate GWG among healthy pregnant women.

DESIGN

We used the six steps of intervention mapping: (i) needs assessment; (ii) formulation of change objectives; (iii) selection of theory-based methods and practical strategies; (iv) development of the intervention programme; (v) development of an adoption and implementation plan; and (vi) development of an evaluation plan. A consortium of users and related professionals guided the process of development.

RESULTS

As a result of the needs assessment, two goals for the intervention were formulated: (i) helping healthy pregnant women to stay within the IOM guidelines for GWG; and (ii) getting midwives to adequately support the efforts of healthy pregnant women to gain weight within the IOM guidelines. To reach these goals, change objectives and determinants influencing the change objectives were formulated. Theories used were the Transtheoretical Model, Social Cognitive Theory and the Elaboration Likelihood Model. Practical strategies to use the theories were the foundation for the development of 'Come On!', a comprehensive programme that included a tailored Internet programme for pregnant women, training for midwives, an information card for midwives, and a scheduled discussion between the midwife and the pregnant woman during pregnancy. The programme was pre-tested and evaluated in an effect study.

Advice given by community members to pregnant women: a mixed methods study

Background

Smoking and excess weight gain during pregnancy have been shown to have serious health consequences for both mothers and their infants. Advice from friends and family on these topics influences pregnant women’s behaviors. The purpose of our study was to compare the advice that community members give pregnant women about smoking versus the advice they give about pregnancy weight gain.

Methods

A survey was sent via text messaging to adults in a diverse, low-income primary care clinic in 2015. Respondents were asked what advice (if any) they have given pregnant women about smoking or gestational weight gain and their comfort-level discussing the topics. Descriptive statistics were used to characterize the sample population and to determine response rates. Open-ended responses were analyzed qualitatively using grounded theory analysis with an overall convergent parallel mixed methods design.

Results

Respondents (n = 370) were 77 % female, 40 % black, and 25 % reported education of high school or less. More respondents had spoken to pregnant women about smoking (40 %, n = 147) than weight gain (20 %, n = 73). Among individuals who had not discussed either topic (n = 181), more reported discomfort in talking about weight gain (65 %) compared to smoking (34 %; p < 0.0001). Advice about smoking during pregnancy (n = 148) was frequently negative, recommending abstinence and identifying smoking as harmful for baby and/or mother. Advice about weight gain in pregnancy (n = 74) revealed a breadth of messages, from reassurance about all weight gain (“Eat away” or “It’s ok if you are gaining weight”), to specific warnings against excess weight gain (“Too much was dangerous for her and the baby.”).

Conclusions

Many community members give advice to pregnant women. Their advice reveals varied perspectives on the effects of pregnancy weight gain. Compared to a nearly ubiquitous understanding of the harms of smoking during pregnancy, community members demonstrated less awareness of and willingness to discuss the harms of excessive weight gain. Beyond educating pregnant women, community-level interventions may also be important to ensure that the information pregnant women receive supports healthy behaviors and promotes the long-term health of both moms and babies.

A Qualitative Study to Examine Perceptions and Barriers to Appropriate Gestational Weight Gain among Participants in the Special Supplemental Nutrition Program for Women Infants and Children Program

Women of reproductive age are particularly at risk of obesity because of excessive gestational weight gain (GWG) and postpartum weight retention, resulting in poor health outcomes for both mothers and infants. The purpose of this qualitative study was to examine perceptions and barriers to GWG among low-income women in the WIC program to inform the development of an intervention study. Eleven focus groups were conducted and stratified by ethnicity, and each group included women of varying age, parity, and prepregnancy BMI ranges. Participants reported receiving pressure from spouse and family members to “eat for two” among multiple barriers to appropriate weight gain during pregnancy. Participants were concerned about gaining too much weight but had minimal knowledge of weight gain goals during pregnancy. Receiving regular weight monitoring was reported, but participants had inconsistent discussions about weight gain with healthcare providers. Most were not aware of the IOM guidelines nor the fact that gestational weight gain goals differed by prepregnancy weight status. Results of these focus groups analyses informed the design of a pregnancy weight tracker and accompanying educational handout for use in an intervention study. These findings suggest an important opportunity for GWG education in all settings where pregnant women are seen.

Impact of maternal knowledge of recommended weight gain in pregnancy on gestational weight gain

BACKGROUND

Obesity is prevalent among reproductive-aged women and is associated with increased obstetric complications. Weight gain recommendations exist; however, knowledge of these recommendations is low, and few women gain appropriate weight during their pregnancies. Excessive gestational weight gain is common and is associated with adverse outcomes. Little is known about the relationship between knowledge of gestational weight gain recommendations and actual weight gain.

OBJECTIVES

Our objectives were to assess knowledge of weight gain recommendations in pregnancy and to determine its association with actual weight gain among women who seek care at an urban, regional perinatal center. We hypothesize that low levels of knowledge will predict inappropriate weight gain in this population.

STUDY DESIGN

This is a cross-sectional study with linked chart review of 338 women who sought routine obstetric ultrasound scans at an urban, regional perinatal center that serves a largely low-income population of predominately black women. Descriptive statistics, chi-square test, and analysis of variance were performed.

RESULTS

This population has low rates of accurate knowledge of weight gain recommendations in pregnancy (27%) and low rates of appropriate gestational weight gain (30%). Inappropriate gestational weight gain was highest among women who were obese before pregnancy. Accurate knowledge of gestational weight gain recommendations was associated with appropriate weight gain in pregnancy (P = .02), as was prepregnancy weight category (P = .004) and correct identification of prepregnancy weight category (P = .005).

CONCLUSION

These findings support the need for improvements in educational efforts about weight gain in pregnancy for high-risk, low-income women in an urban setting, which may improve compliance with the recommendations.

Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers

To investigate perceptions of minority pregnant women and providers about obesity and gestational weight gain (GWG), and to explore strategies to improve management of obesity in pregnancy with an emphasis on group prenatal care. Sixteen primarily non-Hispanic black pregnant women with a body mass index ≥ 30 kg/m(2) and 19 prenatal care providers participated in focus groups. Discussion topics included GWG goals, body image, health behaviors, and group prenatal care with additional emphasis on provider training needs. Women frequently stated a GWG goal >20 lbs. Women described a body image not in line with clinical recommendations ("200 pounds is not that big."). They avoided the term "obese". They were interested in learning about nutrition and culturally-acceptable healthy cooking. Women would enjoy massage and exercise in group settings, though definitions of "exercise" varied. Family members could help, but generational differences posed challenges. Most had to "encourage myself" and "do this for me and the baby". Providers expressed discomfort discussing GWG and difficulty finding the right words for obesity, which was partially attributed to their own weight. They noted the challenges they faced during prenatal care including time constraints, cultural myths, and system issues. Providers considered a group setting with social support an ideal environment to address health behaviors in obese women. Culturally-tailored programs that use acceptable terms for obesity, provide education regarding healthy eating and safe exercise, and encourage support from social networks may be effective in addressing GWG in obese minority women. Provider training in communication skills is necessary to address obesity in pregnancy.

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.

Gestational Weight Gain Through a Health Literacy Lens: A Scoping Review

Few women gain the recommended amount of weight during pregnancy, which has health implications for mothers and their newborns. Work in this area focuses on factors that are difficult to change. The purpose of this project was to review literature on a more patient-centered concept-health literacy. A scoping review was conducted to determine whether aspects of health literacy are included in gestational weight gain (GWG) research. Thirty articles were selected for review. Although these studies included health literacy aspects indirectly, only 2 directly measured health literacy using existing measures. Work that incorporates health literacy in a GWG context is needed. Health literacy may be a critical, yet understudied, factor in understanding why GWG falls outside of the recommendations.

Preventing excessive gestational weight gain among African American women: A randomized clinical trial

OBJECTIVE

Evidence is lacking regarding effective weight control treatments in pregnancy for ethnic minority women with obesity. This study evaluated whether a technology-based behavioral intervention could decrease the proportion of African American women with overweight or obesity who exceeded Institute of Medicine (IOM) guidelines for gestational weight gain.

METHODS

We conducted a two-arm pilot randomized clinical trial. Participants were 66 socioeconomically disadvantaged African American pregnant women (12.5 ± 3.7 weeks' gestation; 36% overweight, 64% obesity) recruited from two outpatient obstetric practices at Temple University between 2013 and 2014. We randomized participants to usual care (n = 33) or a behavioral intervention (n = 33) that promoted weight control in pregnancy. The intervention included: (1) empirically supported behavior change goals; (2) interactive self-monitoring text messages; (3) biweekly health coach calls; and (4) skills training and support through Facebook.

RESULTS

The intervention reduced the proportion of women who exceeded IOM guidelines compared to usual care (37% vs. 66%, P = 0.033). Intervention participants gained less weight during pregnancy (8.7 vs. 12.3 kg, adjusted mean difference: -3.1 kg, 95% CI: -6.2 to -0.1). No group differences in neonatal or obstetric outcomes were found.

CONCLUSIONS

The intervention resulted in lower prevalence of excessive gestational weight gain.

Excess Gestational Weight Gain in Low-Income Overweight and Obese Women: A Qualitative Study

OBJECTIVE

Examine factors implicated in gestational weight gain (GWG) in low-income overweight and obese women.

DESIGN

Qualitative study.

SETTING

Community-based perinatal center.

PARTICIPANTS

Eight focus groups with women (black = 48%, white non-Hispanic = 41%, and Hispanic = 10%) in the first half (n = 12) and last half of pregnancy (n = 10) or postpartum (n = 7), 2 with obstetrician-gynecologists (n = 9).

PHENOMENON OF INTEREST

Barriers and facilitators to healthy eating and GWG within different levels of the Social Ecological Model: for example, intrapersonal, interpersonal, and organizational.

ANALYSIS

Coding guide was based on the Social Ecological Model. Transcripts were coded by 3 researchers for common themes. Thematic saturation was reached.

RESULTS

At an intrapersonal level, knowledge/skills and cravings were the most common barriers. At an interpersonal level, family and friends were most influential. At an organizational level, the Special Supplemental Nutrition Program for Women, Infants, and Children and clinics were influential. At the community level, lack of transportation was most frequently discussed. At a policy level, complex policies and social stigma surrounding the Special Supplemental Nutrition Program for Women, Infants, and Children were barriers. There was consensus that ideal intervention approaches would include peer-facilitated support groups with information from experts. Obstetrician-gynecologists felt uncomfortable counseling patients about GWG because of time constraints, other priorities, and lack of training.

CONCLUSIONS AND IMPLICATIONS

There are multilevel public health opportunities to promote healthy GWG. Better communication between nutrition specialists and obstetrician-gynecologists is needed.

Racial/Ethnic Disparities in Inadequate Gestational Weight Gain Differ by Pre-pregnancy Weight

Pre-pregnancy body mass index (BMI) varies by race/ethnicity and modifies the association between gestational weight gain (GWG) and adverse pregnancy outcomes, which disproportionately affect racial/ethnic minorities. Yet studies investigating whether racial/ethnic disparities in GWG vary by pre-pregnancy BMI are inconsistent, and none studied nationally representative populations. Using categorical measures of GWG adequacy based on Institute of Medicine recommendations, we investigated whether associations between race/ethnicity and GWG adequacy were modified by pre-pregnancy BMI [underweight (<18.5 kg/m(2)), normal weight (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)), or obese (≥30.0 kg/m(2))] among all births to Black, Hispanic, and White mothers in the 1979 USA National Longitudinal Survey of Youth cohort (n = 6,849 pregnancies; range 1-10). We used generalized estimating equations, adjusted for marital status, parity, smoking during pregnancy, gestational age, and multiple measures of socioeconomic position. Effect measure modification between race/ethnicity and pre-pregnancy BMI was significant for inadequate GWG (Wald test p value = 0.08). Normal weight Black [risk ratio (RR) 1.34, 95 % confidence interval (CI) 1.18, 1.52] and Hispanic women (RR 1.33, 95 % CI 1.15, 1.54) and underweight Black women (RR 1.38, 95 % CI 1.07, 1.79) experienced an increased risk of inadequate GWG compared to Whites. Differences in risk of inadequate GWG between minority women, compared to White women, were not significant among overweight and obese women. Effect measure modification between race/ethnicity and pre-pregnancy BMI was not significant for excessive GWG. The magnitude of racial/ethnic disparities in inadequate GWG appears to vary by pre-pregnancy weight class, which should be considered when designing interventions to close racial/ethnic gaps in healthy GWG.

Reducing Hispanic children's obesity risk factors in the first 1000 days of life: a qualitative analysis

OBJECTIVES

Modifiable behaviors during the first 1000 days (conception age 24 months) mediate Hispanic children's obesity disparities. We aimed to examine underlying reasons for early life obesity risk factors and identify potential early life intervention strategies.

METHODS

We conducted 7 focus groups with 49 Hispanic women who were pregnant or had children < age 24 months. Domains included influences on childhood obesity risk factors and future intervention ideas. We analyzed data with immersion-crystallization methods until no new themes emerged.

RESULTS

Themes included coping with pregnancy may trump healthy eating and physical activity; early life weight gain is unrelated to later life obesity; fear of infant hunger drives bottle and early solids introduction; beliefs about infant taste promote early solids and sugary beverage introduction; and belief that screen time promotes infant development. Mothers identified physicians, nutritionists, and relatives as important health information sources and expressed interest in mobile technology and group or home visits for interventions.

CONCLUSION

Opportunities exist in the first 1000 days to improve Hispanic mothers' understanding of the role of early life weight gain in childhood obesity and other obesity risk factors. Interventions that link health care and public health systems and include extended family may prevent obesity among Hispanic children.

Maternal perspectives on gestational weight gain: Critical information on developing weight control interventions

BACKGROUND

Our aim was to demonstrate what women reported being counselled about weight gain in pregnancy, their perceptions of inappropriate gestational weight gain (GWG), and plans for weight gain in pregnancy.

MATERIALS AND METHODS

A cross-sectional survey of perceptions of prenatal attendees about inappropriate GWG was conducted at the prenatal clinic of a referral tertiary health facility in south western, Nigeria, between January 1, 2013 and June 30, 2013. Primary outcomes were the perceptions of women about risks involved with inappropriate weight gain and the proportion of women who self-reported being counselled at all on GWG, and had the right knowledge of risk(s) involved with inappropriate weight gain during pregnancy.

RESULTS

Of the 348 women who completed the survey, approximately four-fifths (82.8%) reported GWG being discussed at all by health care provider. Fewer women (29.3%) believed there were maternal risks with excess weight gain compared to inadequate weight gain (34.8%). With respect to perception of risks of inappropriate weight gain to infants, 23.65 and 18.4%, respectively, believed there were infant risks with excess and inadequate GWG. Overweight women [OR 0.39 (95% CI 0.16-0.98)] and those who received GWG information from more than one type of health care provider [OR 4.71 (95% CI 1.64-13.78)] had significant increased rate of correct knowledge of risks involved with inappropriate GWG.

CONCLUSION

The lack of awareness of risks involved with inappropriate GWG by over half of respondents underscores the need for improvement in educational intervention on GWG in our environment.

Falling Short of Guidelines? Nutrition and Weight Gain Knowledge in Pregnancy

OBJECTIVES

The objective of this study was to characterize pregnant women's gestational weight gain (GWG) knowledge and awareness of healthy eating behaviors known to impact GWG.

METHODS

Formative research was conducted including semi-structured individual interviews and focus group interviews. The participants were mostly Caucasian pregnant women (N = 30; Mage = 28 years old) residing in a suburban/rural region of Central Pennsylvania. Descriptive and thematic analyses were used to examine the primary outcomes of GWG and healthy eating knowledge and informational sources.

RESULTS

Many women had no knowledge of how much GWG they should gain in pregnancy (42%). Women appeared to have adequate knowledge on foods they should avoid eating during pregnancy. However, one-fourth of women indicated that they did not feel as though they received adequate information from their healthcare provider about the foods they should be eating and how to meet the healthy eating recommendations. Therefore, one-fourth of women reported using non-healthcare provider resources (e.g., magazines, internet) with questionable reliability to obtain healthy eating guidance.

CONCLUSION

These exploratory findings show that pregnant women have some knowledge of the GWG and healthy eating guidelines; however, most women received this information from a non-healthcare provider resource. Focused efforts are needed to educate pregnant women about GWG and healthy eating using accurate and reliable sources andencourage strategies to meet guidelines in an effort to promote healthy GWG.

Perspectives on weight gain and lifestyle practices during pregnancy among women with a history of macrosomia: a qualitative study in the Republic of Ireland

BACKGROUND

Excessive weight gain during pregnancy is a major risk factor for macrosomia (high birth weight delivery). This study aimed to explore views about weight gain and lifestyle practices during pregnancy among women with a history of macrosomia.

METHODS

A qualitative descriptive study was conducted. Twenty-one second-time mothers whose first infant was macrosomic (>4 kg) were recruited from a randomised trial in a large maternity hospital in the Republic of Ireland. Semi-structured interviews were conducted with participants at both 6 and 12 months after their second pregnancy. Inductive thematic analysis was used to identify distinct themes.

RESULTS

The mothers believed in following their prenatal food cravings to meet their baby's needs, but this led some to eat excessively. Many of the women cut back heavily on physical activity during pregnancy due to perceived risks to the baby. Physical conditions and discomforts during pregnancy often limited maternal control over weight and lifestyle practices. The women were not particularly concerned about weight gain during pregnancy and most did not favour the notion of introducing weight gain guidelines into routine antenatal care. Common differences perceived by the women between their first and second pregnancy included: increased concern about weight gain in their second pregnancy due to prior difficulties with postpartum weight loss and increased time demands in their second pregnancy impeded healthy lifestyle practices. Most women did not alter their perspectives on weight gain and lifestyle practices in their second pregnancy in response to having a macrosomic infant in their first pregnancy.

CONCLUSIONS

This analysis exposed numerous barriers to healthy pregnancy weight gain. The findings suggest that women may need to be advised to follow their prenatal food cravings in moderation. Pregnant women with children already may benefit from education on time-efficient methods of integrating healthy eating practices and physical activity into their lifestyles. Women with a history of macrosomia may need information about the importance of avoiding high weight gain in subsequent pregnancies.

Obesity and Black Women: Special Considerations Related to Genesis and Therapeutic Approaches

Black women in the United States are disproportionately affected by obesity, with almost two-thirds considered obese based on body mass index. Obesity has been directly linked to cardiovascular morbidity and mortality in black women. Therefore, understanding contributors to the genesis of obesity in black women is imperative. While biologic differences likely result in varying obesity prevalence across racial/ethnic groups, behaviors such as post-partum weight retention and limited leisure-time physical activity, may especially contribute to obesity in black women. Black women also appear to be particularly susceptible to cultural, psychosocial, and environmental factors that can promote weight gain. Therapeutic interventions are being tailored to specifically address these social determinants of health and to foster lifestyle modification; however, more work is needed to understand barriers to behavior change for black women. Knowledge gaps also remain in identifying mechanisms by which pharmacologic and surgical treatments for obesity modify cardiovascular risk in black women.

A qualitative study of motivators and barriers to healthy eating in pregnancy for low-income, overweight, African-American mothers

Poor diet quality is common among low-income, overweight, African-American mothers, placing them at high risk for adverse pregnancy outcomes. We sought to better understand the contextual factors that may influence low-income African-American mothers' diet quality during pregnancy. In 2011, we conducted semi-structured interviews with 21 overweight/obese, pregnant African Americans in Philadelphia, PA, all of whom received Medicaid and were eligible for the Special Supplemental Nutrition Program for Women, Infants, and Children. Two readers independently coded the interview transcripts to identify recurrent themes. We identified 10 themes around motivators and barriers to healthy eating in pregnancy. Mothers believed that consuming healthy foods, like fruits and vegetables, would lead to healthy babies and limit the physical discomforts of pregnancy. However, more often than not, mothers chose foods that were high in fats and sugars because of taste, cost, and convenience. In addition, mothers had several misconceptions about the definition of healthy (eg, "juice is good for baby"), which led to overconsumption. Many mothers feared they might "starve" their babies if they did not get enough to eat, promoting persistent snacking and larger portions. Living in multigenerational households and sharing resources also limited the mothers' control over food choices and made consuming healthy foods especially difficult. Despite the good intentions of low-income African-American mothers to improve diet quality during pregnancy, multiple factors worked together as barriers to healthy eating. Interventions that emphasize tasty and affordable healthy food substitutes, address misconceptions, and counsel mothers about true energy needs in pregnancy may improve low-income, African-American, overweight/obese mothers' diet quality.

Perspectives about and approaches to weight gain in pregnancy: a qualitative study of physicians and nurse midwives

Background

Over one third of reproductive age women in the US are obese. Pregnancy is a strong risk factor for obesity, with excess weight gain as the greatest predictor of long term obesity. The majority of pregnant women gain more weight than recommended by the Institute of Medicine guidelines. The objective of this study was to understand prenatal care providers’ perspectives on weight gain during pregnancy.

Methods

Semi-structured qualitative interviews of 10 prenatal care providers (three family physicians, three obstetricians, and four nurse midwives) at a University Hospital in the Midwest, that included the ranking of important prenatal issues, and open-ended questions addressing: 1) general perceptions; 2) approach with patients; and 3) clinical care challenges.

Results

Providers felt that appropriate weight gain during pregnancy was not a high priority. Many providers waited until patients had gained excess weight before addressing the issue, were not familiar with established guidelines, and lacked resources for patients. Providers also believed that their counseling had low impact on patients, avoided counseling due to sensitivity of the topic, and believed that patients were more influenced by other factors, such as their family, habits, and culture.

Conclusions

Both providers and patients may benefit from increased awareness of the morbidity of excess weight gain during pregnancy. Practice-level policies that support the monitoring and management of weight gain during pregnancy could also improve care. Research that further investigates the barriers to appropriate weight gain is warranted.

Psychosocial Characteristics and Gestational Weight Change among Overweight, African American Pregnant Women

Objectives. To describe psychosocial factors identified as contributors of weight gain in the general population and to examine the relationship between these factors and gestational weight gain among low socioeconomic status, African American, overweight pregnant women. Methods. African American women (n = 120) with a pregravid body mass index ≥25 kg/m² completed measures of eating, sleep, and depressed mood between 14 and 24 weeks of gestation. Weight was tracked. Descriptive statistics, correlations, and linear regression modeling were used to characterize the sample and examine predictors of gestational weight gain. Results. Four percent screened positive for night eating syndrome, with 32% consuming at least 25% of their daily caloric intake after dinner (evening hyperphagia). None met criteria for binge eating disorder; 4% reported occasional binge episodes. Cognitive restraint over eating was low. Participants slept 7.1 (SD = 1.9) h per night and reported 4.3 (SD = 3.6) awakenings per week; 18% reported some level of depressed mood. Night and binge eating were related to each other, sleep quality, and depressed mood. Eating due to cravings was the only psychosocial variable to predict gestational weight gain. Conclusions. Depressed mood, night eating, and nighttime awakenings were common in this cohort, while cognitive restraint over eating was low. Most psychosocial variables were not predictive of excess gestational weight gain.