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Banafshe E, Javadifar N, Abbaspoor Z, Karandish M, Ghanbari S. Factors Influencing Weight Management in Pregnant Women with Overweight or Obesity: A Meta-Synthesis of Qualitative Studies. J Acad Nutr Diet 2024; 124:964-994.e1. [PMID: 38648889 DOI: 10.1016/j.jand.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Overweight and obesity have multiple negative consequences for the health of both the mother and the child. Interventions to prevent excessive weight gain during pregnancy have had varying success, and the proportion of pregnant women who exceed national guidelines for weight gain continues to increase. OBJECTIVE To investigate the influence of factors on weight management among pregnant women with overweight or obesity. METHODS This meta-synthesis of qualitative studies involved searching databases PubMed, Embase, Cochrane, Scopus, and Web of Science. The databases were searched on October 4, 2022, and the search was updated on April 21, 2023. The screening of titles, abstracts, and full texts was conducted utilizing Covidence software. The quality assessment of the articles was performed using the Critical Appraisal Skills Programme checklist. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement was used to enhance transparency in reporting. A meta-aggregation approach was used to guide the data extraction and synthesis. RESULTS A total of 46 studies with appropriate Critical Appraisal Skills Programme scores were included for qualitative synthesis. Findings were extracted and integrated into 4 themes: psychological factors (personally driven negative emotions and society-driven negative emotions), social factors (societal attitudes and beliefs and social support resources), factors related to education and counseling (information provision and communication), and factors associated with effective care (provided care components and the method of providing effective care). CONCLUSIONS To improve weight management during pregnancy, health care providers should provide tailored and individualized recommendations that take into consideration the factors influencing these women.
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Affiliation(s)
- Elahe Banafshe
- Midwifery Department, Nursing & Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nahid Javadifar
- Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Zahra Abbaspoor
- Department of Midwifery, Reproductive Health Promotion Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Karandish
- Nutrition and Metabolic Diseases Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Ghanbari
- Department of Biostatistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Raju S, Cowdell F, Dyson J. Barriers and facilitators to healthy gestational weight gain amongst pregnant women from ethnic minority groups: A systematic search and narrative synthesis. Midwifery 2024; 135:104051. [PMID: 38870776 DOI: 10.1016/j.midw.2024.104051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/02/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
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.
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Affiliation(s)
- Sereena Raju
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham B15 3TN, England, UK.
| | - Fiona Cowdell
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham B15 3TN, England, UK
| | - Judith Dyson
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham B15 3TN, England, UK
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Daglas V, Kostopoulos N, Mrvoljak-Theodoropoulou I, Mitrotasios M, Dagla M, Lykeridou A, Antoniou E. Healthcare Professionals' Attitudes and Practices According to Their Recommendations on Exercise during the First Trimester of Pregnancy: A Greek Cross-Sectional Study. Sports (Basel) 2024; 12:173. [PMID: 39058064 PMCID: PMC11281032 DOI: 10.3390/sports12070173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The aim of this study is to investigate healthcare professionals' attitudes and practices when it comes to their recommendations on exercise during the first trimester of pregnancy and to highlight the factors that influence or predict these attitudes. METHODS This cross-sectional study was conducted between January 2022 and March 2023, on a sample of 237 Greek healthcare professionals (midwives and obstetricians) employed in healthcare settings in Attica/Greece. In the statistical analysis, eight independent models of multivariate analyses of variance were conducted. RESULTS Only half of the participants (54.89%) report that they recommend exercise to pregnant women in the first trimester of pregnancy. The majority do not routinely recommend a specific frequency and duration of exercise. Participants who believe that exercise during pregnancy is of little benefit to pregnant women were less likely to recommend the following, in the first trimester of pregnancy: (a) exercise in general (p = 0.002), (b) resistance/muscle strengthening exercises (p = 0.039), (c) relaxation exercises (p = 0.002), and (d) a specific exercise duration (p = 0.011). Those who report being very familiar with the international guidelines are (a) more likely to recommend exercise in general (p = 0.013), as well as aerobic exercises (p = 0.023); (b) less likely to not recommend a specific frequency (p = 0.027); and (c) more likely to recommend a duration of 30-45 min of exercise in the first trimester (p = 0.017). CONCLUSIONS I this study, a significant proportion of health professionals' attitudes appear to diverge from the recommendations set forth by international scientific bodies regarding exercise during pregnancy. Furthermore, health professionals' beliefs regarding the benefits of exercise during pregnancy, along with their familiarity with international guidelines, appear to influence their usual practices in recommending exercise during the first trimester of pregnancy to pregnant women.
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Affiliation(s)
- Vasileios Daglas
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.D.); (A.L.); (E.A.)
| | - Nikolaos Kostopoulos
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (N.K.); (M.M.)
| | | | - Michalis Mitrotasios
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (N.K.); (M.M.)
| | - Maria Dagla
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.D.); (A.L.); (E.A.)
| | - Aikaterini Lykeridou
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.D.); (A.L.); (E.A.)
| | - Evangelia Antoniou
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.D.); (A.L.); (E.A.)
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Wilcox S, Dahl AA, Boutté AK, Liu J, Day K, Turner-McGrievy G, Wingard E. Process evaluation methods and results from the Health in Pregnancy and Postpartum (HIPP) randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:794. [PMID: 36289464 PMCID: PMC9607747 DOI: 10.1186/s12884-022-05107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Excessive gestational weight gain has increased over time and is resistant to intervention, especially in women living with overweight or obesity. This study described the process evaluation methods and findings from a behavioral lifestyle intervention for African American and white women living with overweight and obesity that spanned pregnancy (≤ 16 weeks gestation) through 6 months postpartum. Methods The Health in Pregnancy and Postpartum (HIPP) study tested a theory-based behavioral intervention (vs. standard care) to help women (N = 219; 44% African American, 29.1 ± 4.8 years) living with overweight or obesity meet weight gain guidelines in pregnancy and lose weight in postpartum. Participants completed process evaluation surveys at 32 weeks gestation (n = 183) and 6 months postpartum (n = 168) regarding their perceptions of most and least helpful aspects of the intervention. A database tracked delivery and receipt of intervention components (in-depth counseling session, telephone calls, podcasts). Descriptive statistics are used to report fidelity, dose, and participants’ perceptions. We also tested whether dose of behavioral intervention components was associated with gestational weight gain and 6-month postpartum weight retention with linear regression models controlling for baseline age and gestational weeks, receipt of Medicaid, race, parity, and marital status. A content analysis was used to code and analyze responses to open-ended survey questions. Results Over 90% of participants (both groups) would recommend the program to a friend. Implementation fidelity was moderately high and greater in pregnancy than postpartum for all intervention components. Dose received and participants’ ratings of the in-depth counseling session and telephone calls were more favorable than podcasts. The Facebook group was not perceived to be very helpful, likely because of low participant interaction. Although podcasts were created to reinforce call topics, this redundancy was viewed negatively by some. More calls completed and more podcasts downloaded related to lower gestational weight gain (p < .05). Conclusion Study findings underscore challenges in engaging this important but busy population, especially during the postpartum period. Trial registration: The study was registered at clinicaltrials.gov (NCT02260518) on 10/09/2014. https://clinicaltrials.gov/ct2/show/NCT02260518.
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Affiliation(s)
- Sara Wilcox
- grid.254567.70000 0000 9075 106XPrevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 29208 Columbia, SC USA ,grid.254567.70000 0000 9075 106XDepartment of Exercise Science, Arnold School of Public Health, University of South Carolina, 29208 Columbia, SC USA
| | - Alicia A. Dahl
- grid.266859.60000 0000 8598 2218Department of Public Health Sciences, University of North Carolina at Charlotte, 28105 Charlotte, NC USA
| | - Alycia K. Boutté
- grid.254567.70000 0000 9075 106XPrevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 29208 Columbia, SC USA ,grid.254567.70000 0000 9075 106XDepartment of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 29208 Columbia, SC USA
| | - Jihong Liu
- grid.254567.70000 0000 9075 106XDepartment of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 29208 Columbia, SC USA
| | - Kelsey Day
- grid.254567.70000 0000 9075 106XPrevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 29208 Columbia, SC USA ,grid.254567.70000 0000 9075 106XDepartment of Exercise Science, Arnold School of Public Health, University of South Carolina, 29208 Columbia, SC USA
| | - Gabrielle Turner-McGrievy
- grid.254567.70000 0000 9075 106XDepartment of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 29208 Columbia, SC USA
| | - Ellen Wingard
- grid.254567.70000 0000 9075 106XPrevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, 29208 Columbia, SC USA
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Waselewski M, Plegue M, Sonneville K, Resnicow K, Ghumman A, Ebbeling C, Mahmoudi E, Sen A, Wolfson JA, Chang T. Grocery Delivery to Support Healthy Weight Gain Among Pregnant Young Women With Low Income: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e40568. [PMID: 35930351 PMCID: PMC9391971 DOI: 10.2196/40568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 01/12/2023] Open
Abstract
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.
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Affiliation(s)
- Marika Waselewski
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melissa Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kendrin Sonneville
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Ken Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Aisha Ghumman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Cara Ebbeling
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MI, United States
| | - Elham Mahmoudi
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Julia A Wolfson
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
- Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
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McKeough R, Blanchard C, Piccinini-Vallis H. Pregnant and Postpartum Women's Perceptions of Barriers to and Enablers of Physical Activity During Pregnancy: A Qualitative Systematic Review. J Midwifery Womens Health 2022; 67:448-462. [PMID: 35621324 DOI: 10.1111/jmwh.13375] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/29/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Regan McKeough
- Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Christopher Blanchard
- Department of Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Helena Piccinini-Vallis
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
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Bianchi CM, Mariotti F, Reulet E, Le Goff G, Lluch A, Verger EO, Huneau JF, Gurviez P. Perceptions of Tailored Dietary Advice to Improve the Nutrient Adequacy of the Diet in French Pregnant Women. Nutrients 2021; 14:nu14010085. [PMID: 35010960 PMCID: PMC8747067 DOI: 10.3390/nu14010085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
Tailored dietary counseling could be specifically efficient during pregnancy, a period accompanied by a rise in nutrition awareness, but little is known about the expectations of pregnant women in this regard. We studied these expectations regarding tailored dietary advice in French women during their pregnancy, as well as their motivations and the perceived barriers and enablers. In French pregnant women, we evaluated the perceptions of tailored dietary advice provided by stepwise dietary counseling based on three types of dietary changes, consisting of: (1) a modification of the amounts consumed, (2) substitutions within the food subgroups, and (3) substitutions between food subgroups. A sequential explanatory mixed-method approach was designed. Using qualitative data from a focus group study (n = 40), we intended to explore in depth the women’s expectations regarding dietary advice and adherence to a tailored approach. These were combined with quantitative and qualitative data from a 6-week online longitudinal study (n = 115), using questionnaires designed to assess the modifications of dietary habits during pregnancy and to evaluate each type of dietary change. Both studies confirmed that most women in our samples did indeed intend to institute changes regarding healthier dietary practices during pregnancy. The principal motivation behind changes to their habits was to ensure the health and well-being of both their babies and themselves. The proposal of dietary advice that is tailored to both the current diet and the specific needs of pregnant women, but that is also positive and credible, was perceived as enabling implementing healthier dietary practices during pregnancy. Regarding the implementation of the dietary changes proposed, the enablers and barriers identified differed between modifications of the amounts consumed and substitutions. The women displayed interest in all types of dietary changes. This gave relevance to combining different types of changes in order to propose dietary counseling during pregnancy. Tailored dietary counseling was identified by French pregnant women in our samples as enabling them to adopt a healthier diet. However, perceived barriers might limit the implementation of dietary changes, especially when they involved marked modifications to their usual diet.
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Affiliation(s)
- Clélia M. Bianchi
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
| | - François Mariotti
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
- Correspondence:
| | - Elodie Reulet
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
| | - Gaëlle Le Goff
- AgroParisTech, INRAE, UMR SayFood, Université Paris-Saclay, 91700 Massy, France; (G.L.G.); (P.G.)
| | - Anne Lluch
- Alimentation Science Department, Danone Nutricia Research, Centre Daniel Carasso, RD 128, 91737 Palaiseau, France;
| | - Eric O. Verger
- MoISA, University Montpellier, CIRAD, CIHEAM-IAMM, INRAE, Institut Agro, IRD, 34394 Montpellier, France;
| | - Jean-François Huneau
- AgroParisTech, INRAE, UMR PNCA, Université Paris-Saclay, 75005 Paris, France; (C.M.B.); (E.R.); (J.-F.H.)
| | - Patricia Gurviez
- AgroParisTech, INRAE, UMR SayFood, Université Paris-Saclay, 91700 Massy, France; (G.L.G.); (P.G.)
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Mehrabi F, Ahmaripour N, Jalali-Farahani S, Amiri P. Barriers to weight management in pregnant mothers with obesity: a qualitative study on mothers with low socioeconomic background. BMC Pregnancy Childbirth 2021; 21:779. [PMID: 34789171 PMCID: PMC8597093 DOI: 10.1186/s12884-021-04243-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal obesity is a public health issue that could affect both women's and children's health. This qualitative study aimed to identify barriers to weight management of pregnant women with obesity and low socioeconomic backgrounds. METHODS The current qualitative study has been conducted using a grounded theory approach by analyzing data collected from in-depth interviews with clients of Tehran's public health care centers for prenatal care. The criteria for selecting participants were excessive weight gain during the first two trimesters of pregnancy, low socioeconomic status, and willingness to share their experiences. A semi-structured guide consisting of open-ended questions was asked in a private room. Open, axial, and selective coding were applied to the data. FINDINGS Four main themes emerged from data, each of which has some subcategories: 1) personal factors (unpleasant emotions and feelings, personal tastes/hobbies, workload and responsibilities, and history of diseases), 2) pregnancy status (unintended and high-risk pregnancy), 3) interpersonal relationships and support (lack of a spouse's support and unhealthy role modeling of relatives), 4) socio-cultural factors/influences (social norms and values, lack of access to health services, and unreliable information channels). CONCLUSIONS This study provides an overview of the barriers to the weight management of pregnant women from low socioeconomic backgrounds. The results could help develop appropriate health strategies for low socioeconomic women with obesity. Also, health care providers for this group of women could use these findings as a guide to consider their conditions and background.
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Affiliation(s)
- Fahimeh Mehrabi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Najva Ahmaripour
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Sara Jalali-Farahani
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran.
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Super S, Beulen YH, Koelen MA, Wagemakers A. Opportunities for dietitians to promote a healthy dietary intake in pregnant women with a low socio-economic status within antenatal care practices in the Netherlands: a qualitative study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:35. [PMID: 34332642 PMCID: PMC8325401 DOI: 10.1186/s41043-021-00260-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 07/12/2021] [Indexed: 05/14/2023]
Abstract
Background A healthy dietary intake during pregnancy is important for maternal and child health. However, pregnant women with a low socio-economic status often fail to meet dietary guidelines and requirements for healthy nutrition. Dietitians may play an important role in providing nutritional advice during pregnancy because midwives often experience a lack of nutritional knowledge, time and skills to provide adequate advice. However, there is limited research on the support that dietitians can offer in antenatal care practices for pregnant women. Therefore, this study aims to explore the opportunities for dietitians to support pregnant women with a low socio-economic status in concurrent antenatal care practices in the Netherlands. Methods In-depth interviews were conducted with 14 pregnant women with a low socio-economic status and 13 dietitians to identify barriers for healthy eating for pregnant women and the associated opportunities for dietitians to support these women in making healthy dietary changes. Results Four opportunities for dietitians to support pregnant women in making dietary changes could be discerned: (1) creating awareness of healthy and unhealthy eating patterns, (2) providing reliable and personally relevant information, (3) help identifying barriers and solutions for healthy eating and (4) making healthy eating manageable. Dietitians indicated that supporting pregnant women with a low socio-economic status in consuming a healthy diet requires the investment of sufficient time, effort and money. Conclusions Dietitians are trained and well-equipped to provide extensive support to pregnant women to promote a healthy dietary intake, especially when the complex interplay of barriers that pregnant women with a low socio-economic status experience for healthy eating needs to be addressed. In addition, there is a strong need for strengthening the collaboration between dietitians and midwives because midwives are the primary care provider for pregnant women in the Netherlands, but they often lack sufficient opportunities to provide adequate nutrition support. Strengthening this collaboration could promote that nutrition becomes a recurring and standard topic in antenatal care.
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Affiliation(s)
- Sabina Super
- Health and Society, Social Sciences Group, Wageningen University & Research, Postbus 8130, 6700 KN Wageningen, the Netherlands
| | - Yvette H. Beulen
- Health and Society, Social Sciences Group, Wageningen University & Research, Postbus 8130, 6700 KN Wageningen, the Netherlands
| | - Maria A. Koelen
- Health and Society, Social Sciences Group, Wageningen University & Research, Postbus 8130, 6700 KN Wageningen, the Netherlands
| | - Annemarie Wagemakers
- Health and Society, Social Sciences Group, Wageningen University & Research, Postbus 8130, 6700 KN Wageningen, the Netherlands
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Okafor UB, Goon DT. Physical Activity Advice and Counselling by Healthcare Providers: A Scoping Review. Healthcare (Basel) 2021; 9:609. [PMID: 34069474 PMCID: PMC8159082 DOI: 10.3390/healthcare9050609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Despite scientific evidence on prenatal physical activity and exercise, synthesized evidence is lacking on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers. The scoping review seeks to fill this gap by synthesizing available literature on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers to women during antenatal visits. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) search framework for scoping reviews was applied to retrieve original research articles on the prenatal physical activity and exercise practices of healthcare providers with pregnant women, published between 2010-2020, and available in English. The search databases included Google Scholar, PubMed, Science Direct, Scopus, EMBASE, The Cumulative Index for Nursing and Allied Health Literature (CINAHL), BIOMED Central, Medline and African Journal Online. Studies that fulfilled the eligibility criteria were retrieved for analysis. Results: Out of the 82 articles that were retrieved for review, 13 met the eligibility criteria. Seven of the articles were quantitative, four qualitative, one mixed-method and one controlled, non-randomised study, respectively. Three themes emerged as major findings. Healthcare providers affirmed their responsibility in providing prenatal physical activity advice and counselling to pregnant women; however, they seldom or rarely performed this role. Major barriers to prenatal physical activity and exercise included insufficient time, lack of knowledge and skills, inadequate or insufficient training, and lack of resources. Conclusion: This review highlights salient features constraining the uptake of prenatal physical activity and exercise advice/counselling by prenatal healthcare providers in both community and clinical settings. Prenatal physical activity advice and counselling are key components to the promotion of physical activity adherence during and post-partum pregnancy; this requires adequate knowledge of physical activity prescriptions and recommendations, which are personalised and contextual to environment. Research is needed to examine the prenatal physical activity advice and counselling from prenatal healthcare providers on issues hindering effective delivery of the aforementioned in the context of promoting prenatal physical activity in clinical or community settings.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, 50 Church Street, East London 5021, South Africa
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London 5021, South Africa;
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11
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Liu J, Wilcox S, Wingard E, Turner-McGrievy G, Hutto B, Burgis J. A Behavioral Lifestyle Intervention to Limit Gestational Weight Gain in Pregnant Women with Overweight and Obesity. Obesity (Silver Spring) 2021; 29:672-680. [PMID: 33619910 PMCID: PMC9206885 DOI: 10.1002/oby.23119] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/06/2020] [Accepted: 12/19/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effects of an antenatal behavioral lifestyle intervention on total gestational weight gain (GWG) and perinatal outcomes. METHODS Pregnant women with overweight and obesity in South Carolina were recruited into a theory-based randomized controlled trial (n = 112 intervention, n = 105 standard care), which was designed to target weight self-monitoring, increased physical activity, and improved dietary practices. RESULTS Participants were racially/ethnically diverse (44% African American). Intervention and standard care participants had similar total GWG at delivery (12.9 ± 6.9 vs. 12.4 ± 8.3 kg, respectively), but intervention participants had a smaller standard deviation (P = 0.04) in total GWG. The treatment effects were moderated by race/ethnicity and prepregnancy BMI. Among African American participants with overweight, intervention participants gained 4.5 kg less, whereas, among African American women with obesity, intervention participants gained 4.1 kg more than standard care participants. Total GWG among White participants was similar regardless of weight status and group assignment. Fewer intervention participants than standard care participants had adverse pregnancy outcomes (P ≤ 0.01). CONCLUSIONS The behavioral lifestyle intervention favorably impacted GWG in African American participants with overweight but not African American participants with obesity. The intervention's overall favorable impact on perinatal outcomes suggests that the mechanisms beyond total GWG may drive these outcomes.
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Affiliation(s)
- Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Ellen Wingard
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Gabrielle Turner-McGrievy
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Judith Burgis
- Department of Obstetrics and Gynecology, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
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12
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Moore AP, Flynn AC, Adegboye ARA, Goff LM, Rivas CA. 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. Front Public Health 2021; 9:637800. [PMID: 33681136 PMCID: PMC7925838 DOI: 10.3389/fpubh.2021.637800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Amanda P Moore
- Department of Nutrition, Kings College London, London, United Kingdom
| | - Angela C Flynn
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | | | - Louise M Goff
- Department of Nutrition, Kings College London, London, United Kingdom
| | - Carol A Rivas
- UCL Social Research Institute, University College London (UCL), London, United Kingdom
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13
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Hojaji E, Aghajani M, Zavoshy R, Noroozi M, Jahanihashemi H, Ezzeddin N. Household food insecurity associations with pregnancy hypertension, diabetes mellitus and infant birth anthropometric measures: a cross-sectional study of Iranian mothers. Hypertens Pregnancy 2021; 40:109-117. [PMID: 33476216 DOI: 10.1080/10641955.2021.1874010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: The purpose of this study was to determine the associations between food insecurity on pregnancy and its outcomes.Materials and methods: This cross-sectional study was carried out on 700 Iranian mothers. Household socioeconomic status, prenatal information and household food security status were assessed using questionnaires. Data analysis was applied by SPSS version 22.Results: The results of the study showed a significant association between food insecurity with gestational diabetes mellitus. The results also showed a significant association between birth weight, and height with pregnancy-induced hypertension.Conclusion: food insecure women should be recognized, and receive appropriate training and assistance.
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Affiliation(s)
- Elham Hojaji
- Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran.,Department of Human Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mobina Aghajani
- Gastrointestinal and Liver Disease Research Center (GILDRC), Iran University of Medical Sciences, Tehran, Iran.,Department of Exercise Physiology, Faculty of Sport Science, University of Mazandaran, Babolsar, Iran
| | - Rosa Zavoshy
- Department of Human Nutrition, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mostafa Noroozi
- Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hassan Jahanihashemi
- Children Growth Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Neda Ezzeddin
- Department of Community Nutrition, Faculty of Nutrition science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Blau LE, Hormes JM. Preventing Excess Gestational Weight Gain and Obesity in Pregnancy: the Potential of Targeting Psychological Mechanisms. Curr Obes Rep 2020; 9:522-529. [PMID: 33145706 DOI: 10.1007/s13679-020-00415-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Overweight and obesity are now the most common high-risk conditions in pregnancy in the United States and increase risk of adverse outcomes during pregnancy, delivery, and the postpartum. Importantly, excess gestational weight gain is highly predictive of maternal postpartum weight retention and risk of overweight and obesity in mothers and their children later in life. This makes pregnancy a unique window of opportunity in the fight against obesity across the lifespan. This narrative review critically evaluates research on the efficacy of interventions targeting excess gestational weight gain, highlighting the potential of targeting psychological mechanisms to facilitate positive weight-related behavior change specifically in pregnancy. The PUBMED and PsycInfo databases were searched for relevant articles, including meta-analyses, systematic reviews, and randomized controlled trials with the primary or secondary aim of reducing gestational weight gain. RECENT FINDINGS There is currently no gold standard for preventing excess gestational weight gain, especially in women with pre-pregnancy overweight and obesity. Existing interventions primarily target diet and physical activity but lack broad empirical support and typically have only modest effects on weight gain in pregnancy, with few successfully preventing excess weight gain. Furthermore, interventions that successfully target gestational weight gain have minimal positive impact on weight- and diet-related maternal and fetal health outcomes. A growing evidence points to the utility of targeting psychological mechanisms in the prevention of excess gestational weight gain, including cognitive and affective factors, food cravings, and self-efficacy. Given the lack of broad evidence to support the efficacy of interventions targeting diet and physical activity, there is a notable need for research to develop and evaluate interventions targeting psychological factors that could positively impact diet- and weight-related behavioral change in pregnancy.
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Affiliation(s)
- Lauren E Blau
- Department of Psychology, Social Sciences 399, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY, 12222, USA.
| | - Julia M Hormes
- Department of Psychology, Social Sciences 399, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY, 12222, USA
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15
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Taylor RM, Wolfson JA, Lavelle F, Dean M, Frawley J, Hutchesson MJ, Collins CE, Shrewsbury VA. Impact of preconception, pregnancy, and postpartum culinary nutrition education interventions: a systematic review. Nutr Rev 2020; 79:1186-1203. [PMID: 33249446 DOI: 10.1093/nutrit/nuaa124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CONTEXT Frequent consumption of home-prepared meals is associated with higher diet quality in children and adults. Therefore, increasing the culinary skills of women and couples during their childbearing years may be an effective strategy for the prevention of overweight and obesity. OBJECTIVE To determine the impact of culinary nutrition-education interventions for women with or without their partners during preconception, pregnancy, or postpartum (PPP) on parental cooking skills, nutrition knowledge, parent/child diet quality, or health outcomes. DATA SOURCES Eligibility criteria were defined using a PICOS framework. A systematic search strategy was developed to identify eligible studies and was implemented in 11 electronic databases. Reference lists of selected systematic reviews were manually searched for additional studies. DATA EXTRACTION Study characteristics and outcomes were extracted from eligible studies by 1 reviewer and checked by a second reviewer. DATA ANALYSIS A narrative synthesis of the findings of eligible studies was prepared including descriptive statistics. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and Synthesis Without Meta-Analysis in systematic reviews reporting guideline. RESULTS A total of 6951 articles were identified from the search strategy and 31 studies during pregnancy or postpartum were included. By category, the number of studies with a favorable outcome per total number of studies measuring outcome were as follows: parental food/cooking skills (n = 5 of 5), nutrition knowledge (n = 6 of 11), parent/child diet quality (n = 10 of 19), infant feeding (n = 6 of 11), eating behavior (n = 2 of 5), maternal (n = 2 of 5) and child anthropometry (n = 6 of 10), mental health and development n = (2 of 3), and clinical indictors (n = 1 of 1). CONCLUSIONS Culinary nutrition-education interventions during pregnancy and the postpartum period show promise in improving cooking skills, diet quality, and a variety of health-related outcomes. The precise effect of these interventions during PPP is limited by the quality and heterogeneity of study designs to date. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42020154966.
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Affiliation(s)
- Rachael M Taylor
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia
| | - Julia A Wolfson
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Fiona Lavelle
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Moira Dean
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia.,Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - Julia Frawley
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia.,Nutrition & Dietetics Service, Frawley Nutrition, Lambton, NSW, Australia
| | - Melinda J Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia
| | - Vanessa A Shrewsbury
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, New South Wales (NSW), Australia
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16
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Okafor UB, Goon DT. Physical activity and exercise during pregnancy in Africa: a review of the literature. BMC Pregnancy Childbirth 2020; 20:732. [PMID: 33238920 PMCID: PMC7691114 DOI: 10.1186/s12884-020-03439-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, 50 Church Street, 5201, East London, South Africa.
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 05 Oxford Street, East London, South Africa
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Bonnevie E, Rosenberg SD, Goldbarg J, Ashley-West A, Smyser J. Building Strong Futures: The Feasibility of Using a Targeted Digital Media Campaign to Improve Knowledge About Pregnancy and Low Birthweight Among Black Women. Matern Child Health J 2020; 25:127-135. [PMID: 33190192 PMCID: PMC7666713 DOI: 10.1007/s10995-020-03068-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Erika Bonnevie
- The Public Good Projects, 33 Irving Pl, Third Floor, New York, NY, 10003, USA.
| | - Sarah D Rosenberg
- The Public Good Projects, 33 Irving Pl, Third Floor, New York, NY, 10003, USA
| | - Jaclyn Goldbarg
- The Public Good Projects, 33 Irving Pl, Third Floor, New York, NY, 10003, USA
| | - Atalie Ashley-West
- Orange County Government, 6101 Lake Ellenor Dr., Orlando, FL, 32809, USA
| | - Joe Smyser
- The Public Good Projects, 33 Irving Pl, Third Floor, New York, NY, 10003, USA
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Competing priorities: a qualitative study of how women make and enact decisions about weight gain in pregnancy. BMC Pregnancy Childbirth 2020; 20:507. [PMID: 32883236 PMCID: PMC7470685 DOI: 10.1186/s12884-020-03210-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/25/2020] [Indexed: 01/20/2023] Open
Abstract
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.
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19
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Faucher MA, Mirabito AM. Pregnant Women with Obesity Have Unique Perceptions About Gestational Weight Gain, Exercise, and Support for Behavior Change. J Midwifery Womens Health 2020; 65:529-537. [DOI: 10.1111/jmwh.13094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 12/16/2022]
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Computer-based tailored dietary counselling improves the nutrient adequacy of the diet of French pregnant women: a randomised controlled trial. Br J Nutr 2019; 123:220-231. [PMID: 31625483 DOI: 10.1017/s0007114519002617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
During pregnancy, mothers-to-be should adapt their diet to meet increases in nutrient requirements. Pregnant women appear to be keener to adopt healthier diets, but are not always successful. The objective of the present study was to determine whether a guided, stepwise and tailored dietary counselling programme, designed using an optimisation algorithm, could improve the nutrient adequacy of the diet of pregnant women, beyond generic guidelines. Pregnant women (n 80) who attended Notre-Dame-de-Bon-Secours Maternity Clinic were randomly allocated to the control or intervention arm. Dietary data were obtained twice from an online 3-d dietary record. The nutrient adequacy of the diet was calculated using the PANDiet score, a 100-point diet quality index adapted to the specific nutrient requirements for pregnancy. Women were supplied with generic dietary guidelines in a reference booklet. In the intervention arm, they also received nine sets of tailored dietary advice identified by an optimisation algorithm as best improving their PANDiet score. Pregnant women (n 78) completed the 12-week dietary follow-up. Initial PANDiet scores were similar in the control and intervention arms (60·4 (sd 7·3) v. 60·3 (sd 7·3), P = 0·92). The PANDiet score increased in the intervention arm (+3·6 (sd 9·3), P = 0·02) but not in the control arm (-0·3 (sd 7·3), P = 0·77), and these changes differed between arms (P = 0·04). In the intervention arm, there were improvements in the probabilities of adequacy for α-linolenic acid, thiamin, folate and cholesterol intakes (P < 0·05). Tailored dietary counselling using a computer-based algorithm is more effective than generic dietary counselling alone in improving the nutrient adequacy of the diet of French women in mid-pregnancy.
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21
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Blau LE, Lipsky LM, Dempster KW, Eisenberg Colman MH, Siega-Riz AM, Faith MS, Nansel TR. 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. J Acad Nutr Diet 2019; 120:815-824. [PMID: 31813756 DOI: 10.1016/j.jand.2019.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023]
Abstract
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.
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22
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Nagourney EM, Goodman D, Lam Y, Hurley KM, Henderson J, Surkan PJ. Obese women's perceptions of weight gain during pregnancy: a theory-based analysis. Public Health Nutr 2019; 22:2228-2236. [PMID: 31134872 PMCID: PMC10260617 DOI: 10.1017/s1368980019000703] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/27/2018] [Accepted: 02/06/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Excess gestational weight gain (GWG) in obese women is linked to adverse maternal outcomes and is particularly pervasive among African Americans, who have the highest obesity rates in the USA. A better understanding of culturally relevant attitudes and perceptions of GWG is needed to develop targeted interventions to prevent excess GWG among this group. DESIGN Using the constructs of Social Cognitive Theory, we explored attitudes and perceptions surrounding diet and exercise among low-income obese African-American pregnant women in Baltimore. We conducted twenty-one semi-structured in-depth interviews with pregnant adult women. SETTING Participants were recruited from a referral clinic for obese pregnant women at a large urban hospital in Baltimore, MD, USA. PARTICIPANTS Twenty-one low-income African-American adult females in the first two trimesters of pregnancy with BMI > 30·0 kg/m2. RESULTS Lack of knowledge was not the main obstacle to healthy behaviours during pregnancy. Rather, food cravings and fatigue, an unhealthy physical food environment, limited self-efficacy for controlling excessive GWG, and a lack of adequate emotional and informational support impacted women's agency. While digital technology was discussed as a vehicle to promote maintenance of a healthy weight in pregnancy, further research is needed to test how it can be used to empower women to engage in healthy behaviours during pregnancy. CONCLUSION Interventions to prevent excess GWG among African-American pregnant women should harness support from partners and family and must go beyond sharing of clinical knowledge to also include strategies that improve the food environment, diet quality and self-efficacy.
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Affiliation(s)
- Emily M Nagourney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Dina Goodman
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Yukyan Lam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Kristen M Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Janice Henderson
- Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
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Kinser P, Jallo N, Thacker L, Aubry C, Masho S. Enhancing Accessibility of Physical Activity During Pregnancy: A Pilot Study on Women's Experiences With Integrating Yoga Into Group Prenatal Care. Health Serv Res Manag Epidemiol 2019; 6:2333392819834886. [PMID: 30993148 PMCID: PMC6449809 DOI: 10.1177/2333392819834886] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction: Health guidelines suggest that pregnant women should participate in daily physical
activity, yet rarely do they meet these guidelines. Means to enhance accessibility of
physical activity for pregnant women are required, and yoga has been suggested as a
possible method to enhance women’s sense of confidence and competence with physical
activity. In this pilot study, our primary aim is to evaluate pregnant women’s
perceptions about their lived experience of an intervention which integrates a
low-intensity form of physical activity, yoga, into prenatal care; our secondary aim is
to evaluate changes in participants’ self-efficacy for physical activity and time spent
in physical activity over time. Methods: Held in an outpatient obstetrics department of an urban hospital system in the United
States, this pilot study enrolled 16 pregnant women to participate in the intervention
throughout their pregnancy. We explored participants’ lived experience of the
intervention using qualitative methods (phenomenology). Means, variances, and
covariances were calculated for the 2 measures (self-efficacy and time spent in physical
activity) over the intervention period. Results: Qualitative findings from focus groups suggest that it is acceptable for prenatal yoga
to be integrated into group prenatal care classes and women reported increased
confidence with physical activity during pregnancy. Participants did not consider the
intervention to fit within the traditional definition of exercise. Women reported
increased amounts of time spent in physical activity from baseline to the end of
pregnancy, but there were no statistically significant changes in self-efficacy over
time. Discussion: The integration of gentle physical activity into the group prenatal care model warrants
further attention for potential benefits with regard to maternal physical and mental
wellness.
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Affiliation(s)
- Patricia Kinser
- Department of Family and Community Health Nursing, Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Nancy Jallo
- Department of Family and Community Health Nursing, Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Leroy Thacker
- Department of Biostatistics, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Christine Aubry
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Saba Masho
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
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DeJonckheere M, Nichols LP, Vydiswaran VGV, Zhao X, Collins-Thompson K, Resnicow K, Chang T. Using Text Messaging, Social Media, and Interviews to Understand What Pregnant Youth Think About Weight Gain During Pregnancy. JMIR Form Res 2019; 3:e11397. [PMID: 30932869 PMCID: PMC6462892 DOI: 10.2196/11397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/30/2018] [Accepted: 01/27/2019] [Indexed: 12/22/2022] Open
Abstract
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.
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Affiliation(s)
- Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lauren P Nichols
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - V G Vinod Vydiswaran
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States.,School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Xinyan Zhao
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Kenneth Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
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Pickett S, McCoy TP. Regional Differences in Body Image Perception Among Young African American Women Living in the United States. J Psychosoc Nurs Ment Health Serv 2019; 57:25-31. [PMID: 30272807 DOI: 10.3928/02793695-20180925-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/26/2018] [Indexed: 11/20/2022]
Abstract
The current study examined regional differences in body image perceptions and body mass index (BMI) among young African American women. Three hundred forty-one African American women, 18 to 40 years old, living in three regions of the United States were recruited. Pulver's Figure Rating scale was used to identify body image perceptions. Weight and height were measured for BMI calculation. Analysis of covariance was used to examine body image perception differences. The sample mean age was 27.8 years and mean BMI was 30.3 kg/m2. Participants' body image perceptions were significantly smaller among participants living in the Northeast compared to the Southeast (mean difference = -0.65, 95% confidence interval [CI] [-1.18, -0.11], p = 0.018) and Midwest (mean difference = -0.64, 95% CI [-1.16, -0.12], p = 0.015). No significant differences in BMI were found among regions (F(8,318) = 1.17, p = 0.314). Clinical implications of these findings are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(3), 25-31.].
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McDowell M, Cain MA, Brumley J. Excessive Gestational Weight Gain. J Midwifery Womens Health 2018; 64:46-54. [PMID: 30548447 DOI: 10.1111/jmwh.12927] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 09/15/2018] [Accepted: 09/27/2018] [Indexed: 02/01/2023]
Abstract
Excessive gestational weight gain (GWG) is associated with an increasing incidence of maternal and neonatal complications, including hypertensive disorders of pregnancy, fetal macrosomia, and increased cesarean birth rates. In the United States, it is recommended that health care providers use an individualized approach to counsel a woman about pregnancy weight gain goals that is based on the woman's initial body mass index (BMI) and to track GWG throughout the pregnancy by evaluating maternal weight at each visit. Studies have shown that women entering pregnancy with a higher BMI are at increased risk for excessive GWG and postpartum weight retention. Research also demonstrates an increased risk of childhood obesity in children born to women with excessive GWG. Specific counseling about exercise and diet, as well as technology and motivational interviewing, are some tools prenatal care providers can use that have been shown to be effective in reducing excessive GWG. This article reviews the current research regarding maternal and neonatal risks associated with excessive GWG, as well as the interventions that have demonstrated promise for addressing this problem.
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27
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Blau LE, Orloff NC, Flammer A, Slatch C, Hormes JM. Food craving frequency mediates the relationship between emotional eating and excess weight gain in pregnancy. Eat Behav 2018; 31:120-124. [PMID: 30253292 DOI: 10.1016/j.eatbeh.2018.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/20/2018] [Accepted: 09/14/2018] [Indexed: 11/28/2022]
Abstract
An estimated 50% of pregnancies in the U.S. are associated with maternal weight gain that exceeds Institute of Medicine recommendations. The numerous adverse consequences of obesity in gestation, delivery and the postpartum have been widely documented. The role of excess gestational weight gain (GWG) as a predictor of lifetime obesity risk in mothers and their children is also increasingly recognized. Cravings and negative affect are commonly cited triggers of overconsumption in pregnant women. We sought to examine the role of food craving frequency as a mediator in the relation between emotional eating and excess GWG. In this cross-sectional study, pregnant women (n = 113) completed the Dutch Eating Behavior Questionnaire, a measure of "restrained," "emotional," and "external" eating styles, along with the Food Craving Inventory, which quantifies cravings for "high fat foods," "fast food fats," "carbohydrates/starches," and "sweets." Participants also reported on pre-pregnancy weight and height, and GWG at the time of survey completion. Data supported the hypothesized mediation model, with frequency of "high fat foods" cravings fully mediating the relationship between "emotional" eating and excess GWG (Sobel test z = 2.40, p = .016). This study addresses the striking dearth of research examining potentially modifiable psychosocial predictors of excess GWG. Future longitudinal research should examine if salient affective states trigger food cravings, thus placing pregnant women at increased risk of excess weight gain. Findings have implications for treatment interventions targeting excess GWG, suggesting a need to teach skills to help patients better manage low moods and cravings.
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Affiliation(s)
- Lauren E Blau
- University at Albany, State University of New York, United States of America.
| | - Natalia C Orloff
- University at Albany, State University of New York, United States of America
| | - Amy Flammer
- Albany Medical College, United States of America
| | | | - Julia M Hormes
- University at Albany, State University of New York, United States of America; Albany Medical College, United States of America
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Zanardo V, Volpe F, Giliberti L, Severino L, Soldera G, Giustardi A, Straface G. Prepregnancy Body Mass Index shift across gestation: primary evidence of an association with eating disorders. J Matern Fetal Neonatal Med 2018; 33:415-420. [PMID: 29950130 DOI: 10.1080/14767058.2018.1494709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Previous studies indicated that gestational weight gain-related disorders share many similarities with feeding and eating disorders (EDs).Design: To examine the association of prepregnancy Body Mass Index (BMI), defined according to 2009 Institute of Medicine (IOM), and its shift across gestation with symptoms of feeding and EDs, defined by EDE-Q.Setting: This prospective cohort study took place at the Division of Perinatal Medicine of Policlinico Abano Terme, Italy, from Jannuary 2015 to October 2015.Population and sample: The sample included 655 healthy at term puerperae.Main outcomes measures: We correlated gestational BMI in different women categories to EDE-Q Global score and Restrain, Eating concern, Shape concern, and Weight concern subscales, by Spearman's correlation test.Results: Among 655 women, 59 (9.0%) were categorized as underweight, 463 (70.7%) normal weight, 98 (15.0%) overweight, and 35 (5.3%) as obese in prepregnancy period. At the end of gestation, underweight women category disappeared, normal weight women lightened to one third, overweight women tripled, and obese women doubled. At the same time, EDE-Q global scores increased from normal weight (0.25 ± 0.41), to overweight (0.47 ± 0.58), and to obese (0.72 ± 0.70) puerperae. In addition, EDE-Q global scores were significantly correlated with gestational BMI increase in Global score (rho = 0.326; p < .001) and in the four subscales: Restrain (rho = 0.161; p < .001), Eating concern (rho = 0.193; p < .001), Shape concern (rho = 0.335; p < .001), and Weight concern (rho = 0.365; p < .001), respectively.Conclusions: It was found that the shift of woman BMI across an uncomplicated pregnancy is a warning indicator of unhealthy eating and feeding symptoms.
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Affiliation(s)
- Vincenzo Zanardo
- Division of Perinatal Medicine, Policlinico AbanoTerme, AbanoTerme, Italy
| | - Francesca Volpe
- Division of Perinatal Medicine, Policlinico AbanoTerme, AbanoTerme, Italy
| | - Lara Giliberti
- Division of Perinatal Medicine, Policlinico AbanoTerme, AbanoTerme, Italy
| | - Lorenzo Severino
- Division of Perinatal Medicine, Policlinico AbanoTerme, AbanoTerme, Italy
| | - Gino Soldera
- Division of Perinatal Medicine, Policlinico AbanoTerme, AbanoTerme, Italy
| | - Arturo Giustardi
- Division of Perinatal Medicine, Policlinico AbanoTerme, AbanoTerme, Italy
| | - Gianluca Straface
- Division of Perinatal Medicine, Policlinico AbanoTerme, AbanoTerme, Italy
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Flannery C, McHugh S, Anaba AE, Clifford E, O'Riordan M, Kenny LC, McAuliffe FM, Kearney PM, Byrne M. Enablers and barriers to physical activity in overweight and obese pregnant women: an analysis informed by the theoretical domains framework and COM-B model. BMC Pregnancy Childbirth 2018; 18:178. [PMID: 29783933 PMCID: PMC5963099 DOI: 10.1186/s12884-018-1816-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/01/2018] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- C Flannery
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.
| | - S McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - A E Anaba
- School of Public Health, University College Cork, Cork, Ireland
| | - E Clifford
- Department of Nutrition & Dietetics, South Infirmary Victoria University Hospital, Cork, Ireland
| | - M O'Riordan
- Department Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - L C Kenny
- Department of Women's and Children's Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - F M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - P M Kearney
- School of Public Health, University College Cork, Cork, Ireland
| | - M Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
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30
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Walker C, Mills H, Gilchrist A. Experiences of physical activity during pregnancy resulting from in vitro fertilisation: an interpretative phenomenological analysis. J Reprod Infant Psychol 2018. [PMID: 29517377 DOI: 10.1080/02646838.2017.1313968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To explore the qualitative experiences and decision-making processes surrounding physical activity (PA) for women who have undergone IVF treatment. BACKGROUND PA during pregnancy is safe for both mother and fetus in the majority of cases, including for women who have undergone in vitro fertilisation (IVF) treatment; however, there is a paucity of research into decision-making and PA in this population. METHODS Eight women, who had undergone successful IVF treatment and were currently pregnant or had given birth within the last two years, participated in semi-structured interviews about their experiences of infertility and PA during pregnancy. Interview transcripts were analysed using interpretative phenomenological analysis. RESULTS Three superordinate themes emerged from the data: 'navigating away from childlessness and towards motherhood', 'negotiating a safe passage' and 'balancing the challenges of pregnancy with the needs of the self'. Ten subthemes indicated the processes adopted to navigate experiences of infertility, the IVF process, and subsequent decision-making about PA during pregnancy. CONCLUSION PA during pregnancy was experienced as a way to soothe the self and control the experience of pregnancy; however, this was mediated by concerns about safety and physical limitations on PA. Limitations of the study are considered, as well as implications for clinical practice and directions for future research.
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Affiliation(s)
- Chloe Walker
- a Adult Psychology , North Kensington & Chelsea Community Mental Health Team , London , UK
| | - Hayley Mills
- b School of Human and Life Sciences , Canterbury Christ Church University , Canterbury , UK
| | - Angela Gilchrist
- c School of Psychology, Politics and Sociology , Canterbury Christ Church University , Canterbury , UK
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Wilcox S, Liu J, Addy CL, Turner-McGrievy G, Burgis JT, Wingard E, Dahl AA, Whitaker KM, Schneider L, Boutté AK. A randomized controlled trial to prevent excessive gestational weight gain and promote postpartum weight loss in overweight and obese women: Health In Pregnancy and Postpartum (HIPP). Contemp Clin Trials 2018; 66:51-63. [PMID: 29371061 PMCID: PMC5841597 DOI: 10.1016/j.cct.2018.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/18/2018] [Accepted: 01/21/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Interventions to prevent excessive gestational weight gain and promote postpartum weight loss have yielded modest results, particularly in overweight and obese women. OBJECTIVES To examine the impact of a theory-based lifestyle intervention on gestational weight gain, postpartum weight loss, and related maternal and child outcomes and to examine race differences in these outcomes. DESIGN A randomized controlled trial (target N=400; 200 intervention, 200 standard care; 200 African American, 200 white). METHODS Overweight and obese African American and white women ≤16weeks gestation are recruited from obstetrics and gynecology clinics in South Carolina. Intervention participants receive two in-depth counseling sessions (early pregnancy and postpartum), telephone counseling, behavioral podcasts, and social media support that target weight self-monitoring and increasing physical activity and healthy dietary behavior practices, guided by Social Cognitive Theory. Standard care participants receive monthly mailings and a matched number of podcasts on non-weight related topics. All intervention activities last from ≤18weeks gestation to 6months after delivery. Gestational weight gain is the primary outcome. Secondary outcomes are meeting gestational weight gain guidelines (inadequate, adequate, excessive), weekly rate of gestational weight gain, postpartum weight retention, physical activity and dietary behaviors, health-related quality of life, and offspring adiposity. Participants are assessed at baseline (≤16weeks gestation), 32weeks gestation, and 6 and 12months postpartum, and offspring are assessed at 6 and 12months. SUMMARY HIPP is an innovative study that addresses significant gaps in the literature. Primary outcome results are expected in 2019.
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Affiliation(s)
- Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
| | - Cheryl L Addy
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Gabrielle Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Judith T Burgis
- Department of Obstetrics and Gynecology, University of South Carolina, Columbia, SC, United States
| | - Ellen Wingard
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Alicia A Dahl
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Kara M Whitaker
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Lara Schneider
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Alycia K Boutté
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Lindberg SM, DeBoth A, Anderson CK. Effect of a Best Practice Alert on Gestational Weight Gain, Health Services, and Pregnancy Outcomes. Matern Child Health J 2017; 20:2169-78. [PMID: 27395382 DOI: 10.1007/s10995-016-2052-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Sara M Lindberg
- Population Health Institute, Department of Population Health Sciences, University of Wisconsin - Madison, 610 Walnut St, Madison, WI, 53726, USA.
| | - Alexa DeBoth
- Center for Women's Health and Health Disparities Research, Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
| | - Cynthie K Anderson
- Department of Obstetrics and Gynecology, University of Wisconsin - Madison, Madison, WI, USA
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Nunnery D, Ammerman A, Dharod J. Predictors and outcomes of excess gestational weight gain among low-income pregnant women. Health Care Women Int 2017; 39:19-33. [PMID: 29068777 DOI: 10.1080/07399332.2017.1391263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Danielle Nunnery
- a Department of Human Nutrition , Winthrop University , Rock Hill , SC , USA
| | - Alice Ammerman
- b Department of Nutrition , Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Jigna Dharod
- c Department of Nutrition , University of North Carolina at Greensboro , Greensboro , NC , USA
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Vanstone M, Kandasamy S, Giacomini M, DeJean D, McDonald SD. Pregnant women's perceptions of gestational weight gain: A systematic review and meta-synthesis of qualitative research. MATERNAL & CHILD NUTRITION 2017; 13:e12374. [PMID: 27873484 PMCID: PMC6866018 DOI: 10.1111/mcn.12374] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/25/2016] [Accepted: 08/10/2016] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
- Meredith Vanstone
- Department of Family MedicineMcMaster UniversityHamiltonOntarioCanada
- Centre for Health Economics and Policy AnalysisMcMaster UniversityHamiltonOntarioCanada
| | - Sujane Kandasamy
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonOntarioCanada
| | - Mita Giacomini
- Centre for Health Economics and Policy AnalysisMcMaster UniversityHamiltonOntarioCanada
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonOntarioCanada
| | - Deirdre DeJean
- Centre for Health Economics and Policy AnalysisMcMaster UniversityHamiltonOntarioCanada
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonOntarioCanada
| | - Sarah D. McDonald
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonOntarioCanada
- Departments of Obstetrics and Gynecology, RadiologyMcMaster UniversityHamiltonOntarioCanada
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Behaviour change in overweight and obese pregnancy: a decision tree to support the development of antenatal lifestyle interventions. Public Health Nutr 2017; 20:2642-2648. [PMID: 28691650 DOI: 10.1017/s136898001700129x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Antenatal healthy lifestyle interventions are frequently implemented in overweight and obese pregnancy, yet there is inconsistent reporting of the behaviour-change methods and behavioural outcomes. This limits our understanding of how and why such interventions were successful or not. DESIGN The current paper discusses the application of behaviour-change theories and techniques within complex lifestyle interventions in overweight and obese pregnancy. The authors propose a decision tree to help guide researchers through intervention design, implementation and evaluation. The implications for adopting behaviour-change theories and techniques, and using appropriate guidance when constructing and evaluating interventions in research and clinical practice are also discussed. CONCLUSIONS To enhance the evidence base for successful behaviour-change interventions during pregnancy, adoption of behaviour-change theories and techniques, and use of published guidelines when designing lifestyle interventions are necessary. The proposed decision tree may be a useful guide for researchers working to develop effective behaviour-change interventions in clinical settings. This guide directs researchers towards key literature sources that will be important in each stage of study development.
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Thompson EL, Vamos CA, Daley EM. Physical activity during pregnancy and the role of theory in promoting positive behavior change: A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:198-206. [PMID: 30356571 PMCID: PMC6189011 DOI: 10.1016/j.jshs.2015.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/16/2015] [Accepted: 07/10/2015] [Indexed: 05/28/2023]
Abstract
BACKGROUND Physical activity (PA) during pregnancy provides physical and psychological benefits for mother and child. U.S. guidelines recommend ≥30 min of moderate exercise for healthy pregnant women most days of the week; however, most women do not meet these recommendations. Theory assists in identifying salient determinants of health behavior to guide health promotion interventions; however, the application of theory to examine PA among pregnant women has not been examined cohesively among multiple levels of influence (e.g., intrapersonal, interpersonal, neighborhood/environmental, and organizational/political). Subsequently, this systematic review aims to identify and evaluate the use of health behavior theory in studies that examine PA during pregnancy. METHODS Articles published before July 2014 were obtained from PubMed and Web of Science. Inclusion criteria applied were: (1) empirically-based; (2) peer-reviewed; (3) measured factors related to PA; (4) comprised a pregnant sample; and (5) applied theory. Fourteen studies were included. Each study's application of theory and theoretical constructs were evaluated. RESULTS Various theories were utilized to explain and predict PA during pregnancy; yet, the majority of these studies only focused on intrapersonal level determinants. Five theoretical frameworks were applied across the studies-all but one at the intrapersonal level. Few determinants identified were from the interpersonal, neighborhood/environmental, or organizational/political levels. CONCLUSION This systematic review synthesized the literature on theoretical constructs related to PA during pregnancy. Interpersonal, community, and societal levels remain understudied. Future research should employ theory-driven multi-level determinants of PA to reflect the interacting factors influencing PA during this critical period in the life course.
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Lundqvist A, Sandström H, Bäckström T. The relationship between weight gain during pregnancy and allopregnanolone levels: a longitudinal study. Endocr Connect 2017; 6:253-259. [PMID: 28381564 PMCID: PMC5632720 DOI: 10.1530/ec-17-0046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/05/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Large weight gain during pregnancy is a risk factor for complications for mother and fetus. Hunger and satiety are regulated in the hypothalamus, where the gamma-amino-butyric acid system (GABA) has an important role. Allopregnanolone, a progesterone metabolite, increases during pregnancy and is a potent GABA-A receptor modulating steroid. Allopregnanolone has been shown to induce overeating in rodents. The aim was to investigate whether there is a relationship between weight gain and allopregnanolone concentrations during pregnancy in humans. DESIGN A longitudinal, cohort study. METHODS Pregnant women (n = 56) were recruited in primary care in northern Sweden. Allopregnanolone concentrations in plasma were measured using radioimmunoassay and weight was measured in gestational weeks 12 and 35. RESULTS Weight increase correlated significantly to allopregnanolone in late pregnancy increase (rs = 0.320; P = 0.016), indicating a positive relationship between weight increase and allopregnanolone increase. A positive relationship was also noted between allopregnanolone in the 35th gestational week and weight increase. Women who gained ≥11 kg during pregnancy showed higher allopregnanolone concentrations in week 35 and higher increase compared to women who increased <11 kg (P = 0.006 and P = 0.009 resp.). There was no difference in weight or allopregnanolone concentrations at the onset of pregnancy. CONCLUSIONS The results show a relationship between weight gain during pregnancy and increase in allopregnanolone concentrations.
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Affiliation(s)
- Anette Lundqvist
- Department of Public Health and Clinical MedicineFamily Medicine, Umeå University, Umeå, Sweden
| | - Herbert Sandström
- Department of Public Health and Clinical MedicineFamily Medicine, Umeå University, Umeå, Sweden
| | - Torbjörn Bäckström
- Department of Clinical SciencesObstetrics and Gynecology, Umeå University, Umeå, Sweden
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Experiences of a lifestyle intervention in obese pregnant women – A qualitative study. Midwifery 2017; 44:1-6. [DOI: 10.1016/j.midw.2016.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 09/21/2016] [Accepted: 10/26/2016] [Indexed: 11/23/2022]
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Abdolaliyan N, Shahnazi H, Kzemi A, Hasanzadeh A. Determinants of the self-efficacy of physical activity for maintaining weight during pregnancy: The application of the health belief model. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2017; 6:93. [PMID: 29114560 PMCID: PMC5651666 DOI: 10.4103/jehp.jehp_175_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 05/23/2017] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Pregnancy is one of the high-risk periods for women's health that the lack of attention to healthy behaviors such as weight control behaviors can lead to adverse consequences on the health of women and also the fetus. Therefore, the aim of this paper was to explore the determinants of weight control self-efficacy among pregnant women using Health Belief Model (HBM). MATERIALS AND METHODS In this cross-sectional study were enrolled 202 pregnant women referring to Health Care Center in Isfahan city, Iran. Sampling method was multistage random. A researcher-made instrument based on HBM structures was used after confirming the valid and reliable. Data were analyzed by software SPSS 21 and descriptive statistics were represented with (frequency, mean and standard deviation) and analytical (Pearson correlation, independent t and liner regression) at the significant level of <0.05. RESULTS The average age of participants was 27.80 ± 5.08. HBM structures were able explained 31% of variance of weight control self-efficacy. Also, of the studied structures, perceived benefits, perceived barriers were statistically significant predictors of weight control self-efficacy, within which perceived barriers (β = 0.391) was the most significant predictor. CONCLUSION The findings of current study showed that the HBM model could be as a suitable framework to identify effective factors for designing educational intervention to improve weight control behaviors among pregnant women.
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Affiliation(s)
- Nafise Abdolaliyan
- Department of Health Education, School of Public Health, Isfahan University of Medical Science, Isfahan, Iran
| | - Hossein Shahnazi
- Department of Health Education, School of Public Health, Isfahan University of Medical Science, Isfahan, Iran
- Address for correspondence: Dr. Hossein Shahnazi, School of Public Health, Isfahan University of Medical Science, Isfahan, Iran. E-mail:
| | - Ashraf Kzemi
- Department of Midwifery, School of Nursing and Midwifery, Isfahan University of Medical Science, Isfahan, Iran
| | - Akbar Hasanzadeh
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Science, Isfahan, Iran
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Bianchi CM, Huneau JF, Le Goff G, Verger EO, Mariotti F, Gurviez P. Concerns, attitudes, beliefs and information seeking practices with respect to nutrition-related issues: a qualitative study in French pregnant women. BMC Pregnancy Childbirth 2016; 16:306. [PMID: 27729021 PMCID: PMC5059968 DOI: 10.1186/s12884-016-1078-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Clélia M. Bianchi
- UMR Physiologie de la Nutrition et du Comportement Alimentaire, AgroParisTech, INRA, Université Paris-Saclay, 16, rue Claude Bernard, 75005 Paris, France
| | - Jean-François Huneau
- UMR Physiologie de la Nutrition et du Comportement Alimentaire, AgroParisTech, INRA, Université Paris-Saclay, 16, rue Claude Bernard, 75005 Paris, France
| | - Gaëlle Le Goff
- UMR Ingénierie Procédés Aliments, AgroParisTech, INRA, Université Paris-Saclay, 1, avenue des Olympiades, 91300 Massy, France
| | - Eric O. Verger
- IRD (Institut de Recherche pour le Développement), UMR NUTRIPASS IRD-UM-SupAgro, 34000 Montpellier, France
| | - François Mariotti
- UMR Physiologie de la Nutrition et du Comportement Alimentaire, AgroParisTech, INRA, Université Paris-Saclay, 16, rue Claude Bernard, 75005 Paris, France
| | - Patricia Gurviez
- UMR Ingénierie Procédés Aliments, AgroParisTech, INRA, Université Paris-Saclay, 1, avenue des Olympiades, 91300 Massy, France
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Gestational Weight Gain: Results from the Delta Healthy Sprouts Comparative Impact Trial. J Pregnancy 2016; 2016:5703607. [PMID: 27595023 PMCID: PMC4993958 DOI: 10.1155/2016/5703607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/16/2016] [Accepted: 07/12/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction. Delta Healthy Sprouts trial was designed to test the comparative impact of two home visiting programs on weight status, dietary intake, and health behaviors of Southern African American women and their infants. Results pertaining to the primary outcome, gestational weight gain, are reported. Methods. Participants (n = 82), enrolled early in their second trimester of pregnancy, were randomly assigned to one of two treatment arms. Gestational weight gain, measured at six monthly home visits, was calculated by subtracting measured weight at each visit from self-reported prepregnancy weight. Weight gain was classified as under, within, or exceeding the Institute of Medicine recommendations based on prepregnancy body mass index. Chi-square tests and generalized linear mixed models were used to test for significant differences in percentages of participants within recommended weight gain ranges. Results. Differences in percentages of participants within the gestational weight gain guidelines were not significant between treatment arms across all visits. Conclusions. Enhancing the gestational nutrition and physical activity components of an existing home visiting program is feasible in a high risk population of primarily low income African American women. The impact of these enhancements on appropriate gestational weight gain is questionable given the more basic living needs of such women. This trial is registered with ClinicalTrials.gov NCT01746394, registered 4 December 2012.
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Groth SW, Simpson AH, Fernandez ID. The Dietary Choices of Women Who Are Low-Income, Pregnant, and African American. J Midwifery Womens Health 2016; 61:606-612. [PMID: 27448099 DOI: 10.1111/jmwh.12463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 01/24/2016] [Accepted: 01/28/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Multiple factors influence the dietary choices of pregnant women that may increase the risk of excessive gestational weight gain. Several of these factors converge for African American women who are low income and reside in an urban setting. The objective of this study was to gain an understanding of how factors previously identified affect dietary decision making and determine the barriers that impede adoption of a healthy diet for this population. METHODS Twenty-five in-depth semistructured interviews were conducted with African American women who were low income, pregnant, and residing in an urban setting. The participants were recruited from a university obstetric clinic in a medium-sized urban northeastern city. Interviews were digitally recorded and transcribed. Analysis was a recursive process such that data analysis was done continually during data collection. Individual interviews were conducted until informational redundancy was reached. A directed content analysis approach was used, building from prior research and themes that emerged from focus groups with a similar population. Data were coded and grouped into meaningful clusters. RESULTS The participants indicated that food cravings, taste, and appetite influenced their food choices. Limited knowledge about healthy foods, cravings for unhealthy foods, time, and finances were barriers to making healthy dietary choices. Women indicated that if healthy food tasted better, they got more rest, and their schedules were regular, it would help them make the best possible food choices. DISCUSSION Women who are low income, African American, and pregnant could benefit from interventions targeting food cravings, taste, and appetite, and information about what constitutes a healthy diet. Cravings for calorie-dense, nutrient-poor foods were a driver of dietary choice and potentially increased the risk of excessive gestational weight gain. The complexities of cravings, taste, and appetite that converge with limited funds, tight schedules, and a knowledge deficit of important dietary information are critical to consider when providing care to pregnant women from this population.
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Whitaker KM, Wilcox S, Liu J, Blair SN, Pate RR. African American and White women׳s perceptions of weight gain, physical activity, and nutrition during pregnancy. Midwifery 2016; 34:211-220. [PMID: 26612000 PMCID: PMC4792697 DOI: 10.1016/j.midw.2015.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/29/2015] [Accepted: 11/02/2015] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Kara M Whitaker
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
| | - Sara Wilcox
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA; Prevention Research Center, University of South Carolina, Columbia, SC, USA.
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.
| | - Steven N Blair
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.
| | - Russell R Pate
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA.
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Da Costa D, Zelkowitz P, Bailey K, Cruz R, Bernard JC, Dasgupta K, Lowensteyn I, Khalifé S. Results of a Needs Assessment to Guide the Development of a Website to Enhance Emotional Wellness and Healthy Behaviors During Pregnancy. J Perinat Educ 2016; 24:213-24. [PMID: 26834443 DOI: 10.1891/1058-1243.24.4.213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In preparation for developing a website to enhance emotional wellness and healthy lifestyle during the perinatal period, this study examined women's informational needs and barriers. Seventy-four women who were pregnant or had given birth completed an online survey inquiring about information needs and preferred sources related to psychosocial aspects and lifestyle behaviors. Information related to healthy diet choices and weight management, followed by exercise, was rated highly as a need. Information related to depression, stress, and anxiety was also rated as important. Health-care providers and the Internet were found to be preferred sources of information. Evidence-based websites can serve as a powerful low-cost educational resource to support and reinforce the health promotion advice received from their health-care providers.
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Beliefs, Barriers, and Preferences of European Overweight Women to Adopt a Healthier Lifestyle in Pregnancy to Minimize Risk of Developing Gestational Diabetes Mellitus: An Explorative Study. J Pregnancy 2016; 2016:3435791. [PMID: 26885396 PMCID: PMC4738738 DOI: 10.1155/2016/3435791] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/10/2015] [Accepted: 09/03/2015] [Indexed: 12/16/2022] Open
Abstract
Introduction. We explored beliefs, perceived barriers, and preferences regarding lifestyle changes among overweight European pregnant women to help inform the development of future lifestyle interventions in the prevention of gestational diabetes mellitus. Methods. An explorative mixed methods, two-staged study was conducted to gather information from pregnant European women (BMI ≥ 25 kg/m2). In three European countries 21 interviews were conducted, followed by 71 questionnaires in six other European countries. Content analysis and descriptive and chi-square statistics were applied (p < 0.05). Results. Women preferred to obtain detailed information about their personal risk. The health of their baby was a major motivating factor. Perceived barriers for physical activity included pregnancy-specific issues such as tiredness and experiencing physical complaints. Insufficient time was a barrier more frequently reported by women with children. Abstaining from snacking was identified as a challenge for the majority of women, especially for those without children. Women preferred to obtain support from their partner, as well as health professionals and valued flexible lifestyle programs. Conclusions. Healthcare professionals need to inform overweight pregnant women about their personal risk, discuss lifestyle modification, and assist in weight management. Lifestyle programs should be tailored to the individual, taking into account barriers experienced by overweight first-time mothers and multipara women.
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Kapadia MZ, Gaston A, Van Blyderveen S, Schmidt L, Beyene J, McDonald H, McDonald S. Psychological factors and trimester-specific gestational weight gain: a systematic review. J Psychosom Obstet Gynaecol 2015; 36:15-22. [PMID: 25541218 DOI: 10.3109/0167482x.2014.993311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with numerous adverse pregnancy outcomes. Early pregnancy provides a unique opportunity for counseling pregnant women since many women are motivated to engage in healthy behaviors. A systematic review was conducted to summarize the relation between psychological factors and trimester-specific GWG, i.e. GWG measured at the end of each trimester. Eight databases were searched for affect, cognition and personality factors. The guidelines on meta-analysis of Observational Studies in Epidemiology were followed. The methodological quality of each study was assessed using a modified Newcastle-Ottawa Scale. Of 3620 non-duplicate titles and abstracts, 74 articles underwent full-text review. Two cohort studies met the inclusion criteria. Distress was negatively associated with first trimester GWG among both adolescents and non-adolescents. Body image dissatisfaction was associated with second trimester GWG only among non-adolescents. No association emerged between perceived stress, state and trait anxiety and body image dissatisfaction among adolescents and trimester-specific GWG. The relation between trimester-specific GWG and a number of weight-related and dietary-related cognitions, affective states and personality traits remain unexplored. Given the limited number of studies, further high-quality evidence is required to examine the association between psychological factors and trimester-specific GWG, especially for cognitive and personality factors.
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Affiliation(s)
- Mufiza Zia Kapadia
- Department of Obstetrics and Gynecology, McMaster University , Hamilton, Ontario , Canada
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Preventing excessive weight gain during pregnancy and promoting postpartum weight loss: a pilot lifestyle intervention for overweight and obese African American women. Matern Child Health J 2015; 19:840-9. [PMID: 25051907 DOI: 10.1007/s10995-014-1582-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
To test the feasibility and acceptability of a theory-based lifestyle intervention designed to prevent excessive weight gain during pregnancy and promote weight loss in the early postpartum period in overweight and obese African American women. Sixteen pregnant women (≤18 weeks gestation) were recruited from prenatal clinics in Columbia, South Carolina in 2011 and assigned to a lifestyle intervention program. The intervention, guided by formative research, consisted of an individual counseling session followed by eight group sessions alternated with telephone counseling contacts that continued through 36 weeks of gestation. At 6-8 weeks postpartum, participants received a home visit and up to three counseling calls through week 12. Medical charts were reviewed for 38 contemporary controls who met the same inclusion criteria and attended the same prenatal clinics. Compared to controls, study participants gained less total weight, had a smaller weekly rate of weight gain across the 2nd and 3rd trimesters (0.89 vs. 0.96 lbs), and were less likely to exceed weight gain recommendations (56.3 vs. 65.8 %). At 12 weeks postpartum, study participants retained 2.6 lbs from their prepregnancy weight, half of study participants were at their prepregnancy weight or lower, and only 35 % retained ≥5 lbs. The intervention also demonstrated success in promoting physical activity and reducing caloric intake, and was well-received by participants. The initial results were promising. The lessons learned can help inform future studies. The efficacy of our intervention will be tested in a large randomized controlled trial.
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The perspectives of obese women receiving antenatal care: A qualitative study of women's experiences. Women Birth 2015; 29:189-95. [PMID: 26563638 DOI: 10.1016/j.wombi.2015.10.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/09/2015] [Accepted: 10/17/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The prevalence of overweight and obesity is increasing amongst women of child bearing age. Maternal obesity has implications for both mother and baby including increased health risks from gestational hypertensive disorders, caesarean section and stillbirth. Despite the increasing prevalence of maternal obesity little is known of the experiences of these women within the health care system. The aim of this research was to investigate the perspectives of pregnant women with a body mass index (BMI) of ≥30kg/m(2) receiving antenatal care. METHODS A qualitative study using individual interviews was undertaken. Sixteen pregnant women with a BMI ≥30kg/m(2) participated. Interviews were audio recorded, transcribed, cross checked for consistency and then entered into a word processing document for analysis. Data was analysed using Interpretative Phenomenological Analysis. In any phenomenological study the researcher's objective is to elicit the participant's views on their lived experiences. FINDINGS Four major themes emerged: (1) obese during pregnancy as part of a long history of obesity; (2) lack of knowledge of the key complications of obesity for both mother and child; (3) communication about weight and gestational weight gain can be conflicting, confusing and judgmental; (4) most women are motivated to eat well during pregnancy and want help to do so. CONCLUSION Specialist lifestyle interventions for obese women should be a priority in antenatal care. Extra support is required to assist obese women in pregnancy achieve recommended nutritional and weight goals. Health professionals should approach the issue of maternal obesity in an informative but non-judgmental way.
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Anderson CK, Walch TJ, Lindberg SM, Smith AM, Lindheim SR, Whigham LD. Excess Gestational Weight Gain in Low-Income Overweight and Obese Women: A Qualitative Study. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:404-11.e1. [PMID: 26187348 PMCID: PMC4590982 DOI: 10.1016/j.jneb.2015.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 05/19/2015] [Accepted: 05/31/2015] [Indexed: 06/04/2023]
Abstract
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.
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Affiliation(s)
- Cynthie K Anderson
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI
| | - Tanis J Walch
- Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, ND
| | - Sara M Lindberg
- Center for Women's Health and Health Disparities Research, University of Wisconsin, Madison, WI
| | | | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Reproductive Endocrine Infertility, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Leah D Whigham
- Paso del Norte Institute for Healthy Living, El Paso, TX.
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Headen I, Mujahid MS, Cohen AK, Rehkopf DH, Abrams B. Racial/Ethnic Disparities in Inadequate Gestational Weight Gain Differ by Pre-pregnancy Weight. Matern Child Health J 2015; 19:1672-86. [PMID: 25652057 PMCID: PMC4503500 DOI: 10.1007/s10995-015-1682-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Irene Headen
- University of California Berkeley, School of Public Health, Division of
Epidemiology, 101 Haviland Hall, Berkeley, CA, USA
| | - Mahasin S. Mujahid
- University of California Berkeley, School of Public Health, Division of
Epidemiology, 101 Haviland Hall, Berkeley, CA, USA
| | - Alison K. Cohen
- University of California Berkeley, School of Public Health, Division of
Epidemiology, 101 Haviland Hall, Berkeley, CA, USA
| | - David H. Rehkopf
- Stanford University, School of Medicine, Division of General Medical
Disciplines, Stanford, CA, USA
| | - Barbara Abrams
- University of California Berkeley, School of Public Health, Division of
Epidemiology, 101 Haviland Hall, Berkeley, CA, USA
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