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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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Shieh C, Ofner S. Weight Variability, Weight Gain Goals, and Biopsychosocial Factors Among Pregnant Women. Clin Nurs Res 2024; 33:104-113. [PMID: 38047460 DOI: 10.1177/10547738231215831] [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] [Indexed: 12/05/2023]
Abstract
This study investigated the pattern of weight variability over 8 weeks and its associations with achieving weight gain goals and five biopsychosocial factors among pregnant women. We conducted a secondary analysis of 117 weeks of data from 16 pregnant women with a body mass index (BMI) ≥25. Weight variability was calculated from the difference of ending and beginning and maximum and minimum weights in a week and percent of each difference from baseline weight. Loess smoother, repeated measures model, and compound symmetric covariance matrix were used for analysis. The variability measure of maximum-minimum weight (overall mean: 2.1 ± 0.4 lbs.) was greater than the ending-beginning weight measure (overall mean: 0.7 ± 0.6 lbs.). Weight variability was negatively associated with achieving weight gain goals but not with biopsychosocial factors. Assessing weight variability is important during pregnancy so that preventive measures or lifestyle counseling can be instituted immediately to prevent excessive weight gain.
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Affiliation(s)
- Carol Shieh
- Indiana University School of Nursing, Indianapolis, USA
| | - Susan Ofner
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, USA
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Perera M, Hawk GS, Nagpal TS, Tinius RA. Social support for exercise from pregnancy to postpartum and the potential impact of a mobile application: A randomized control pilot trial in Southern United States. Prev Med Rep 2023; 36:102485. [PMID: 37954963 PMCID: PMC10637991 DOI: 10.1016/j.pmedr.2023.102485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
This study compared perceived social support among women of all body mass index (BMI) categories with an attempt to assess the efficacy of the BumptUp® mobile application to improve social support for exercise during pregnancy and postpartum. Thirty-five pregnant women living in Southern United States were included in the sample. The intervention group received access to the BumptUp® mobile application that was designed to promote physical activity during pregnancy and postpartum. The control group received an evidence-based educational brochure. Perceived social support for exercise was assessed at four-time points using the social support and exercise survey. Outcomes were evaluated at 23-25, 35-37 gestational weeks, and 6 and 12 weeks postpartum. Based on their pre-pregnancy weight and height, BMI was computed to categorize participants into lean, overweight, and obese groups. Social support across BMI categories and between control and intervention groups were compared using linear mixed-effect models. Women grouped in the overweight and obese BMI categories reported receiving significantly lower levels of social support for exercise than women in the lean category throughout pregnancy and postpartum during mid-pregnancy, late pregnancy, and at 12 weeks postpartum (p < 0.05). Although the intervention group received higher social support than the control group throughout all four assessment points, the difference was not statistically significant (p > 0.05). Women with a pre-pregnancy BMI of overweight and obese received lower social support for exercise during pregnancy and postpartum. The efficacy of BumptUp® to improve perceived social support for exercise in pregnancy and postpartum was not evident in the results.
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Affiliation(s)
- Madhawa Perera
- Exercise Science, Western Kentucky University, Bowling Green, KY 42101, USA
| | - Gregory S. Hawk
- Department of Statistics, University of Kentucky, Lexington, KY 40506, USA
| | - Taniya S. Nagpal
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Rachel A. Tinius
- Exercise Science, Western Kentucky University, Bowling Green, KY 42101, USA
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Calloway EE, Carpenter LR, Gargano T, Sharp JL, Yaroch AL. New measures to assess the "Other" three pillars of food security-availability, utilization, and stability. Int J Behav Nutr Phys Act 2023; 20:51. [PMID: 37101157 PMCID: PMC10134599 DOI: 10.1186/s12966-023-01451-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND In recent reviews of available measures, no existing measures assessed all four pillars of food security and most only assessed one or two pillars-predominantly the access pillar. The purpose of this study was to preliminarily develop novel measures of availability, utilization, and stability that are complementary to the USDA's household food security survey measure (HFSSM). METHODS A formative phase included an expert advisory group, literature scans, and interviews with individuals experiencing food insecurity. From April-June 2021, the new measures were piloted in five states (California, Florida, Maryland, North Carolina, and Washington). The cross-sectional pilot survey included the new measures (perceived limited availability, utilization barriers, and food insecurity stability), scales and items for validation (e.g., food security, and self-reported dietary and health outcomes), and demographic questions. Exploratory factor analysis was used to assess dimensionality, internal consistency was assessed using Kuder-Richardson formula 21 (KR21), and convergent and discriminant validity were assessed using Spearman's correlation coefficients. Also, a brief screener version was created for the utilization barriers measure that may be necessary for certain applications (e.g., clinical intake screening to inform referrals to assistance programs). RESULTS The analytic samples (perceived limited availability (n = 334); utilization barriers (n = 428); food insecurity stability (n = 445)) were around 45 years old on average, most households had children, over two-thirds were food insecure, over three-fourths were women, and the samples were racially/ethnically diverse. All items loaded highly and unambiguously to a factor (factor loadings range 0.525-0.903). Food insecurity stability showed a four-factor structure, utilization barriers showed a two-factor structure, and perceived limited availability showed a two-factor structure. KR21 metrics ranged from 0.72 to 0.84. Higher scores for the new measures were generally associated with increased food insecurity (rhos = 0.248-0.497), except for one of the food insecurity stability scores. Also, several of the measures were associated with statistically significantly worse health and dietary outcomes. CONCLUSIONS The findings support the reliability and construct validity of these new measures within a largely low-income and food insecure sample of households in the United States. Following further testing, such as Confirmatory Factor Analysis in future samples, these measures may be used in various applications to promote a more comprehensive understanding of the food insecurity experience. Such work can help inform novel intervention approaches to address food insecurity more fully.
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Affiliation(s)
- Eric E Calloway
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA.
| | - Leah R Carpenter
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA
| | - Tony Gargano
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA
| | | | - Amy L Yaroch
- The Gretchen Swanson Center for Nutrition, 14301 FNB Parkway, Suite 100, Omaha, NE, 68154, USA
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Physical Activity Beliefs and Behaviors during Pregnancy and their Association with Provider Counseling among Women in the Southern United States. PHYSICAL ACTIVITY AND HEALTH 2022. [DOI: 10.5334/paah.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Rodriguez de Lisenko NC, Gray HL, Bohn J. Optimizing Outcomes: A Systematic Review of Psychosocial Risk Factors Affecting Perinatal Black/African-American Women with Substance Use Disorder in the United States. Matern Child Health J 2022; 26:2090-2108. [PMID: 35947278 DOI: 10.1007/s10995-022-03503-5] [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] [Accepted: 07/18/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite studies having examined and discussed the various multifaceted risk factors affecting perinatal women with substance use disorder (SUD), the limited amount of research on Black/African-American (B/AA) women allows health disparities in this population to widen. Segmenting the needs of the low-income B/AA female population with SUD is crucial when creating multi-layered and multi-faceted innovative upstream evidence-based interventions. This review assesses and examines studies that investigate psychosocial, environmental, and systemic level risk factors related to implicit bias, trauma, toxic stress, food issues, and SUD. METHODS The principal investigator (PI) utilized PubMed, Google Scholar, ProQuest Dissertations and Theses Global to perform a systematic scoping review of the published literature. Research focused on risks factors affecting low-income perinatal B/AA women. The literature review examined articles published January 2010 through December 2020. Inclusion criteria incorporated risk factors, health disparities, and SUD. Studies selected for this review have been published in English and conducted in the USA. RESULTS Our research identified 509 articles, of which we chose to include 75. The literature highlights health disparities influenced by risks factors of implicit biases, trauma, and toxic stress, which construct physical and emotional barriers to healthy food and food resources in B/AA women with SUD. CONCLUSION The PI found limited or non-existent research on innovative interventions targeting perinatal B/AA women with SUD. This review recommends deconstructing hidden psychosocial, environmental, and systematic risk factors to assist in developing novel comprehensive strategies and wraparound support services.
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Affiliation(s)
- Norma C Rodriguez de Lisenko
- Innovative Health Solutions, P.O. Box 183, Benicia, CA, 94510, USA.
- College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
| | - Heewon L Gray
- College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Joseph Bohn
- College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
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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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Zinga J, McKay FH, Lindberg R, van der Pligt P. Experiences of Food-Insecure Pregnant Women and Factors Influencing Their Food Choices. Matern Child Health J 2022; 26:1434-1441. [PMID: 35460501 PMCID: PMC9034444 DOI: 10.1007/s10995-022-03440-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/22/2022]
Abstract
Introduction
Food insecurity (FI), an inadequate access to healthy, affordable food, is a public health concern primarily driven by material hardship. Optimal antenatal nutrition promotes best health outcomes for the mother and baby. Pregnant women experiencing FI are less able to access healthy foods, increasing the risk of complications such as gestational diabetes and preterm labour. Little is known about the experiences of food-insecure pregnant women in obtaining sufficient, nutritious food, their perceptions regarding antenatal nutrition and how this contributes to their food choices. Methods This qualitative study conducted from August to November 2020, during the COVID-19 pandemic, examined the experiences and coping strategies of food-insecure pregnant women, and the factors influencing their food choices. Seven English-speaking food-insecure pregnant women participated in semi-structured interviews. Interview transcripts were thematically analysed, informed by grounded theory methodology. Results Three themes were identified through analysis of the interviews related to strategies that managed household food supply, factors that influenced food choices, and experiences of pregnancy during the COVID-19 pandemic. As a result of a limited food budget, pregnancy symptoms, the cognitive overload that attends the FI experience, and the acute yet significant impact of the pandemic, food-insecure pregnant women in this study defaulted to cheap and convenient food choices despite acknowledging the importance of eating well for pregnancy. Conclusion FI during pregnancy is burdensome, relentless and undermines women’s wellbeing. Supportive strategies within antenatal healthcare settings are urgently required to deliver an equitable health response for vulnerable women. Supplementary Information The online version contains supplementary material available at 10.1007/s10995-022-03440-3.
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Affiliation(s)
- Julia Zinga
- Royal Women's Hospital, Parkville, VIC, Australia.
| | - Fiona H McKay
- School of Health and Social Development, Deakin University, Burwood, VIC, Australia
| | - Rebecca Lindberg
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
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McCarthy M, Houghton C, Matvienko-Sikar K. Women's experiences and perceptions of anxiety and stress during the perinatal period: a systematic review and qualitative evidence synthesis. BMC Pregnancy Childbirth 2021; 21:811. [PMID: 34865642 PMCID: PMC8647378 DOI: 10.1186/s12884-021-04271-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background The perinatal period, from pregnancy to the first year postpartum, is a transitional period that can result in anxiety and stress for some women. Perinatal anxiety and stress can adversely impact the physical and psychological health of women and children. Understanding women’s lived experiences of perinatal anxiety and stress is essential to better support women. The aim of this qualitative evidence synthesis was to examine women’s experiences and perceptions of, and barriers and facilitators to coping with, perinatal anxiety and stress. Methods Databases CINAHL, EMBASE, MEDLINE, PsycINFO and Maternity and Infant Care were searched from inception to June 2020. Eligible studies included women who were pregnant or up to one year postpartum and examined women’s experiences of anxiety and/or stress during the perinatal period. Data were synthesised using thematic synthesis. Results Of 20,318 identified articles, 13 studies met inclusion criteria and were included in this review. Five key themes emerged: Social support, women’s experiences of healthcare, social norms and expectations, factors that impact on coping and mother and baby’s health. Conclusion This review provided a comprehensive synthesis of perinatal anxiety and stress. Findings indicate that increased support for perinatal mental health in antenatal and postpartum care is needed. Addressing unrealistic expectations and conceptualisations of motherhood is also important to better support women. Enhancing women’s social support networks and provision of clear and consistent information are also essential to support women and minimise stress and anxiety in the perinatal period. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04271-w.
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Affiliation(s)
- Megan McCarthy
- School of Public Health, University College Cork, Cork, Ireland.
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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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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Saur AM, Dos Santos MA. Risk factors associated with stress symptoms during pregnancy and postpartum: integrative literature review. Women Health 2021; 61:651-667. [PMID: 34311677 DOI: 10.1080/03630242.2021.1954132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Stressful events during prenatal and postpartum have been associated with an increase in the susceptibility to the onset of various diseases, threatening mental and physical health of mother and baby. The aim of this study was to synthesize and analyze the literature related to risk factors associated with stress symptoms during pregnancy and immediate postpartum by means of an integrative review. The search was conducted from January 2013 to July 2020, consulting the following databases: PubMed, PsycINFO, CINAHL, Web of Science and LILACS. In total, 1,677 studies were identified, resulting in 38 articles included in this review. The risk factors most associated with stress in pregnancy and postpartum were related to emotional factors (including mental health, traumatic events and obstetric complications); social and economic factors; mother's health conditions and life style behaviors, and social support and partner related stress. The results are discussed under the light of the biopsychosocial model, which proposes that biological, psychological, and social domains should be considered in order to minimize psychosocial risk conditions. It is concluded that strategies to promote psychological care, education, additional social support and health behaviors should be considered to prevent adverse birth outcomes and to increase maternal well-being.
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Affiliation(s)
- Adriana Martins Saur
- Department of Psychology, University of São Paulo, Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, Brazil
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Brasington N, Jones P, Bucher T, Beckett EL. Correlations between Self-Reported Cooking Confidence and Creativity and Use of Convenience Cooking Products in an Australian Cohort. Nutrients 2021; 13:1724. [PMID: 34069649 PMCID: PMC8160973 DOI: 10.3390/nu13051724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/09/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Most Australians do not meet vegetable intake recommendations. Vegetables are most often consumed in evening meals. However, they often require preparation and therefore cooking skills. Convenience cooking products such as meal bases/concentrates and ready-made sauces are increasingly common and popular and may help address the barriers to vegetable consumption in terms of cost and time. These products also typically provide recipes, which include vegetables, and as such, may help address the barriers of cooking skills, confidence, and creativity. However, the relationships between the use of these products, cooking confidence, and cooking creativity remain unknown. METHODS Australian adults were surveyed (snowball recruitment, n = 842) on their use of convenience cooking products (meal bases/recipe concentrates, simmer sauces, marinades, and other cooking sauces), cooking confidence (7 item scale) and creativity (6 item scale), and demographic information. RESULTS Overall, 63.2% of participants reported using convenience cooking products. Those using these products had lower mean cooking skills confidence and creativity scores than those who did not, in all product categories assessed. Among users, those who reported "always" following the recipes provided had lower mean cooking confidence and creativity scores than those who followed the recipes less regularly. Conclusions: Therefore, improving the vegetable content of recipes provided with these products may be a tool to increase vegetable intake by users with lower cooking skills (confidence and creativity). This may complement traditional approaches such as education in improving vegetable intake.
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Affiliation(s)
- Natasha Brasington
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW 2258, Australia; (N.B.); (P.J.); (T.B.)
| | - Patrice Jones
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW 2258, Australia; (N.B.); (P.J.); (T.B.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Tamara Bucher
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW 2258, Australia; (N.B.); (P.J.); (T.B.)
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Emma L. Beckett
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, NSW 2258, Australia; (N.B.); (P.J.); (T.B.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia
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Adaptive, behavioral intervention impact on weight gain, physical activity, energy intake, and motivational determinants: results of a feasibility trial in pregnant women with overweight/obesity. J Behav Med 2021; 44:605-621. [PMID: 33954853 DOI: 10.1007/s10865-021-00227-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Interventions have modest impact on reducing excessive gestational weight gain (GWG) in pregnant women with overweight/obesity. This two-arm feasibility randomized control trial tested delivery of and compliance with an intervention using adapted dosages to regulate GWG, and examined pre-post change in GWG and secondary outcomes (physical activity: PA, energy intake: EI, theories of planned behavior/self-regulation constructs) compared to a usual care group. Pregnant women with overweight/obesity (N = 31) were randomized to a usual care control group or usual care + intervention group from 8 to 2 weeks gestation and completed the intervention through 36 weeks gestation. Intervention women received weekly evidence-based education/counseling (e.g., GWG, PA, EI) delivered by a registered dietitian in a 60-min face-to-face session. GWG was monitored weekly; women within weight goals continued with education while women exceeding goals received more intensive dosages (e.g., additional hands-on EI/PA sessions). All participants used mHealth tools to complete daily measures of weight (Wi-Fi scale) and PA (activity monitor), weekly evaluation of diet quality (MyFitnessPal app), and weekly/monthly online surveys of motivational determinants/self-regulation. Daily EI was estimated with a validated back-calculation method as a function of maternal weight, PA, and resting metabolic rate. Sixty-five percent of eligible women were randomized; study completion was 87%; 10% partially completed the study and drop-out was 3%. Compliance with using the mHealth tools for intensive data collection ranged from 77 to 97%; intervention women attended > 90% education/counseling sessions, and 68-93% dosage step-up sessions. The intervention group (6.9 kg) had 21% lower GWG than controls (8.8 kg) although this difference was not significant. Exploratory analyses also showed the intervention group had significantly lower EI kcals at post-intervention than controls. A theoretical, adaptive intervention with varied dosages to regulate GWG is feasible to deliver to pregnant women with overweight/obesity.
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An ecological momentary assessment study of physical activity behaviors among mothers of toddlers from low-income households. BMC WOMENS HEALTH 2021; 21:120. [PMID: 33752659 PMCID: PMC7986017 DOI: 10.1186/s12905-021-01243-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 02/24/2021] [Indexed: 12/15/2022]
Abstract
Background Mothers of young children from low-income communities may be vulnerable to barriers associated with low physical activity. The purpose of this study was to examine associations between home environment factors and maternal physical activity among mothers of toddlers. Methods Mothers of toddlers (n = 200) recruited from low-income communities simultaneously wore an ankle-placed accelerometer and were given a personal digital assistant for ecological momentary assessment. Mothers received randomly prompted questions about their current environment, activity, and social setting several times a day over eight consecutive days. Data were analyzed using linear mixed-effects regression models with random intercepts; within-group and between-group relations between physical activity and environment factors were disaggregated. Results Within-group relations included higher physical activity counts for specific mothers with television off versus on (95% CI = 130.45, 199.17), children absent versus present (95% CI = 82.00, 3.43), engaging with a child versus not (95% CI = 52.66, 127.63), and outside versus inside location (95% CI = 277.74, 392.67). Between-group relations included higher physical activity on average when other adults were absent versus present (95% CI = − 282.63, − 46.95). Recruitment site (urban vs. semi-urban) significantly moderated the within-group relation between being outside versus inside and activity count (β = − 243.12, 95% CI = − 358.74, − 127.47), and showed stronger relations among urban mothers (β = 440.33, 95% CI = 358.41, 522.25), than semi-urban (β = 190.37, 95% CI = 109.64, 271.11). Maternal body weight significantly moderated the within-group relation between being located outside versus inside the home and activity count (β for interaction = − 188.67, 95% CI = − 308.95, − 68.39), with a stronger relation among mothers with normal weight (β = 451.62, 95% CI = 345.51, 557.73), than mothers with overweight/obesity (β = 271.95, 95% CI = 204.26, 339.64). Conclusions This study highlights home environmental factors, including screen time, the presence of others (adults and children), and location (i.e., outside versus inside) that may relate to maternal physical activity behaviors. Understanding factors associated with physical activity could reduce physical activity disparities. Trial registry ClinicalTrials. NCT02615158, April 2006
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Kirzner RS, Robbins I, Privitello M, Miserandino M. 'Listen and learn:' participant input in program planning for a low-income urban population at cardiovascular risk. BMC Public Health 2021; 21:504. [PMID: 33722211 PMCID: PMC7962280 DOI: 10.1186/s12889-021-10423-6] [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: 08/13/2020] [Accepted: 02/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background Poverty increases the risk of cardiac disease, while diminishing the resources available to mitigate that risk. Available prevention programs often require resources that low-income residents of urban areas do not possess, e.g. membership fees, resources to purchase healthy foods, and safe places for physical activity. The aim of this study is to obtain participant input in order to understand the health-related goals, barriers, and strengths as part of planning a program to reduce cardiovascular risk. Methods In a mixed methods study, we used written surveys and focus groups as part of planning an intervention specifically designed to meet the needs of lower income individuals. Based on prior research, we used Self-Determination Theory (SDT) and its core constructs of autonomy, competence, and relatedness as the theoretical framework for analysis. The study collected information on the perspectives of low-income urban residents on their risks of cardiovascular disease, their barriers to and supports for addressing health needs, and how they addressed barriers and utilized supports. Focus group transcripts were analyzed using standard qualitative methods including paired coding and development of themes from identified codes. Results Participants had health goals that aligned with accepted approaches to reducing their cardiovascular risks, however they lacked the resources to reach those goals. We found a lack of support for the three SDT core constructs. The barriers that participants reported suggested that these basic psychological needs were often thwarted by their environments. Conclusions Substantial disparities in both access to health-promoting resources and in support for autonomy, competence, and relatedness must be addressed in order to design an effective intervention for a low-income population at cardiac risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10423-6.
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Affiliation(s)
- Rachel S Kirzner
- School of Social and Behavioral Sciences, Stockton University, 101 Vera King Farris Drive, Galloway, NJ, 08205, USA.
| | - Inga Robbins
- Atlanticare Health Services, 1401 Atlantic Ave, Atlantic City, NJ, 08401, USA
| | - Meghan Privitello
- Sexual Assault Program, AVANZAR, 927 Main Street, Building D, Pleasantville, NJ, 08232, USA
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Okafor UB, Goon DT. Applying the Ecological Model to understand pregnant women's perspectives on the modifiable constraints to physical activity during pregnancy: A qualitative research study. Medicine (Baltimore) 2020; 99:e23431. [PMID: 33285736 PMCID: PMC7717830 DOI: 10.1097/md.0000000000023431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/19/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022] Open
Abstract
The benefits of physical activity (PA) during pregnancy are widely reported; however, PA practice is seemingly not a valued habit among pregnant women attending public antenatal health centres in the Eastern Cape of South Africa. Guided by the ecological model, we sought to explore modifiable barriers to PA among pregnant women.Semi-structured interviews involved a purposive sample of 15 pregnant women. Interview questions were guided by the ecological model constructs at intrapersonal, interpersonal, and environmental level. Thematic analysis was applied to summarise the modifiable barriers to PA during pregnancy.Three main themes emerged, based on the modifiable barriers to PA during pregnancy that belong to the varying Ecological Model constructs. On the intrapersonal level, 5 themes emerged, namely, time-constraint beliefs, feeling of tiredness, low energy, lack of motivation, and a lack of knowledge on benefits and types of PA. Two themes emerged for the interpersonal level, lack of PA advice and lack of information on PA recommendations and guidelines. Another theme defined the environmental level lacking resources. Most themes related to individual factors, which prevent PA-promoting behaviour.Overall, intrapersonal factors relating to tiredness and exhaustion, lack of time beliefs, work and household commitments, and lack of motivation were key modifiable barriers to PA by the women. The findings provide insights into possible interventional strategies to optimise PA during pregnancy among women in this setting. Appropriate knowledge, education and advice on the benefits, types, and intensity of PA in pregnancy are needed.
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Affiliation(s)
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, East London, South Africa
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Ayyala MS, Coughlin JW, Martin L, Henderson J, Ezekwe N, Clark JM, Appel LJ, Bennett WL. Perspectives of pregnant and postpartum women and obstetric providers to promote healthy lifestyle in pregnancy and after delivery: a qualitative in-depth interview study. BMC Womens Health 2020; 20:44. [PMID: 32131832 PMCID: PMC7057562 DOI: 10.1186/s12905-020-0896-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 02/03/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pregnancy provides an opportunity to promote healthy lifestyle behaviors. This study's aim was to explore the perspectives of pregnant and postpartum women and obstetric providers around behavioral lifestyle changes in pregnancy and postpartum. METHODS We conducted a qualitative study with pregnant and postpartum patients recruited from 2 prenatal care clinics at an urban, academic hospital in the United States. In-depth interviews with 23 pregnant or postpartum women and 11 obstetric providers were completed between October 2015-April 2016. Interviews were audio-recorded and transcribed verbatim. We coded transcripts for thematic content and applied the PRECEDE-PROCEED framework for results to directly inform program development. RESULTS Six themes highlighted the predisposing, enabling and reinforcing factors that enable and sustain health behavior changes in pregnancy and postpartum: 1) "Motivation to have a healthy baby" during pregnancy and to "have my body back" after delivery, 2) Pre-pregnancy knowledge and experiences about pregnancy and the postpartum period, 3) Prioritizing wellness during pregnancy and postpartum, 4) The power of social support, 5) Accountability, 6) Integration with technology to reinforce behavior change. CONCLUSIONS In this qualitative study, pregnant and postpartum women and obstetric providers described themes that are aimed at encouraging lifestyle changes to promote healthy weight gain in pregnancy and can directly inform the development of a behavioral weight management intervention for pregnant and postpartum women that is patient-centered and tailored to their needs.
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Affiliation(s)
- Manasa S. Ayyala
- Rutgers New Jersey Medical School, Department of Medicine, Division of General Internal Medicine, 185 South Orange Avenue, MSB B624, Newark, NJ 07103 USA
| | - Janelle W. Coughlin
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Suite 1100, Baltimore, MD 21224 USA
| | - Lindsay Martin
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD 21205 USA
| | - Janice Henderson
- Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, 600 N. Wolfe St, Nelson Building, Baltimore, MD 21287 USA
| | - Nneamaka Ezekwe
- School of Medicine, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - Jeanne M. Clark
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD 21205 USA
| | - Lawrence J. Appel
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD 21205 USA
| | - Wendy L. Bennett
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD 21205 USA
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Connolly CP, Conger SA, Montoye AH, Marshall MR, Schlaff RA, Badon SE, Pivarnik JM. Walking for health during pregnancy: A literature review and considerations for future research. JOURNAL OF SPORT AND HEALTH SCIENCE 2019; 8:401-411. [PMID: 31534815 PMCID: PMC6742678 DOI: 10.1016/j.jshs.2018.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/12/2018] [Accepted: 08/31/2018] [Indexed: 05/04/2023]
Abstract
Walking is the most commonly chosen type of physical activity (PA) during pregnancy and provides several health benefits to both mother and child. National initiatives have promoted the importance of walking in general, but little emphasis is directed toward pregnant women, the majority of whom are insufficiently active. Pregnant women face a variety of dynamic barriers to a physically active lifestyle, some of which are more commonly experienced during specific times throughout the pregnancy experience. Walking is unique in that it appears resistant to a number of these barriers that limit other types of PA participation, and it can be meaningfully integrated into some transportation and occupational activities when leisure-time options are unavailable. Preliminary intervention work suggests that walking programs can be effectively adopted into a typical pregnancy lifestyle. However, a great deal of work remains to administer successful pregnancy walking interventions, including developing and using validated methods of PA and walking assessment. This narrative review discusses the unique advantages of walking during pregnancy, provides recommendations for future intervention work, and outlines the need for pregnancy-focused community walking initiatives. Standard search procedures were followed to determine sources from the literature specific to walking during pregnancy for use in each section of this review.
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Affiliation(s)
- Christopher P. Connolly
- Kinesiology Program, Washington State University, Pullman, WA 99164-1410, USA
- Corresponding Author.
| | - Scott A. Conger
- Department of Kinesiology, Boise State University, Boise, ID 83725, USA
| | - Alexander H.K. Montoye
- Department of Integrative Physiology and Health Science, Alma College, Alma, MI 48801, USA
| | | | - Rebecca A. Schlaff
- Department of Kinesiology, Saginaw Valley State University, University Center, MI 48710, USA
| | - Sylvia E. Badon
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA
| | - James M. Pivarnik
- Department of Kinesiology, Michigan State University, East Lansing, MI 48824-1034, USA
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Chang MW, Schaffir J, Brown R, Wegener DT. Mediation by self-efficacy in the relation between social support and dietary intake in low-income postpartum women who were overweight or obese. Appetite 2019; 140:248-254. [PMID: 31141706 DOI: 10.1016/j.appet.2019.05.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Using baseline data from a prevention of weight gain intervention study, we investigated whether self-efficacy mediated the relations between social support and dietary intake of saturated fat, fast food, fruit and vegetable in low-income postpartum women who were overweight or obese. METHODS Participants (N = 740) completed validated measures of self-reported social support, self-efficacy, and dietary intake of saturated fat, fast food, fruit and vegetable. We performed composite indicator structural equation modeling to test the mediation effect. Effect size was calculated using proportion of maximum possible (POMP) scores in the endogenous variables (e.g., fast food) per unit change in the exogenous variable. RESULTS When including the influence of self-efficacy as a mediator, social support indirectly influenced dietary intake of saturated fat (p ≤ 0.001, POMP = -0.77%), fast food (p ≤ 0.001, POMP = -0.28%), and fruit and vegetable (p ≤ 0.001, POMP = 0.53%). Thus, these data are consistent with self-efficacy mediating the relations between social support and dietary intake of saturated fat, fast food, fruit and vegetable in low-income postpartum women who were overweight or obese. CONCLUSION Dietary interventions aiming to decrease saturated fat and fast food intake and increase fruit and vegetable intake for the target population may consider including practical skills for increasing social support and self-efficacy that can be implemented in daily life.
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Affiliation(s)
- Mei-Wei Chang
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH, 43210, USA.
| | - Jonathan Schaffir
- The Ohio State University Department of Obstetrics & Gynecology, 370 W, 9th Avenue, Columbus, OH, 43210, USA.
| | - Roger Brown
- University of Wisconsin-Madison, School of Nursing, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Duane T Wegener
- The Ohio State University Department of Psychology, 1835 Neil Avenue, Columbus, OH, 43210, USA.
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Savage JS, Hohman EE, McNitt KM, Pauley AM, Leonard KS, Turner T, Pauli JM, Gernand AD, Rivera DE, Symons Downs D. Uncontrolled Eating during Pregnancy Predicts Fetal Growth: The Healthy Mom Zone Trial. Nutrients 2019; 11:E899. [PMID: 31010102 PMCID: PMC6520673 DOI: 10.3390/nu11040899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 12/12/2022] Open
Abstract
Excess maternal weight gain during pregnancy elevates infants' risk for macrosomia and early-onset obesity. Eating behavior is also related to weight gain, but the relationship to fetal growth is unclear. We examined whether Healthy Mom Zone, an individually tailored, adaptive gestational weight gain intervention, and maternal eating behaviors affected fetal growth in pregnant women (n = 27) with a BMI > 24. At study enrollment (6-13 weeks gestation) and monthly thereafter, the Three-Factor Eating Questionnaire was completed. Ultrasounds were obtained monthly from 14-34 weeks gestation. Data were analyzed using multilevel modeling. Higher baseline levels of uncontrolled eating predicted faster rates of fetal growth in late gestation. Cognitive restraint was not associated with fetal growth, but moderated the effect of uncontrolled eating on fetal growth. Emotional eating was not associated with fetal growth. Among women with higher baseline levels of uncontrolled eating, fetuses of women in the control group grew faster and were larger in later gestation than those in the intervention group (study group × baseline uncontrolled eating × gestational week interaction, p = 0.03). This is one of the first intervention studies to use an individually tailored, adaptive design to manage weight gain in pregnancy to demonstrate potential effects on fetal growth. Results also suggest that it may be important to develop intervention content and strategies specific to pregnant women with high vs. low levels of disinhibited eating.
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Affiliation(s)
- Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA 16802, USA.
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Emily E Hohman
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Katherine M McNitt
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park, State College, PA 16802, USA.
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Abigail M Pauley
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Krista S Leonard
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Tricia Turner
- Diagnostic Medical Sonography, South Hills School of Business and Technology, State College, PA 16801, USA.
| | - Jaimey M Pauli
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA 17033, USA.
- Department of Maternal & Fetal Medicine, Penn State College of Medicine, Hershey, PA 17033, USA.
| | - Alison D Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, State College, PA 16802, USA.
| | - Daniel E Rivera
- Control Systems Engineering Laboratory, School for Engineering of Matter, Transport, and Energy, Arizona State University, Tempe, AZ 85287, USA.
| | - Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA 16802, USA.
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA 17033, USA.
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21
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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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Altazan AD, Redman LM, Burton JH, Beyl RA, Cain LE, Sutton EF, Martin CK. Mood and quality of life changes in pregnancy and postpartum and the effect of a behavioral intervention targeting excess gestational weight gain in women with overweight and obesity: a parallel-arm randomized controlled pilot trial. BMC Pregnancy Childbirth 2019; 19:50. [PMID: 30696408 PMCID: PMC6352352 DOI: 10.1186/s12884-019-2196-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/18/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Intensive lifestyle interventions in pregnancy have shown success in limiting gestational weight gain, but the effects on mood and quality of life in pregnancy and postpartum are less known. The purpose was to quantify changes in mental and physical quality of life and depressive symptoms across pregnancy and the postpartum period, to determine the association between gestational weight gain and change in mood and quality of life, and to assess the effect of a behavioral intervention targeting excess gestational weight gain on these outcomes. METHODS A three group parallel-arm randomized controlled pilot trial of 54 pregnant women who were overweight or obese was conducted to test whether the SmartMoms® intervention decreased the proportion of women with excess gestational weight gain. Individuals randomized to Usual Care (n = 17) did not receive any weight management services from interventionists. Individuals randomized to the SmartMoms® intervention (n = 37) were provided with behavioral weight management counseling by interventionists either in clinic (In-Person, n = 18) or remotely through a smartphone application (Phone, n = 19). In a subset of 43 women, mood and mental and physical quality of life were assessed with the Beck Depression Inventory-II and the Rand 12-Item short form, respectively, in early pregnancy, late pregnancy, 1-2 months postpartum, and 12 months postpartum. RESULTS The SmartMoms® intervention and Usual Care groups had higher depressive symptoms (p < 0.03 for SmartMoms® intervention, p < 0.01 for Usual Care) and decreased physical health (p < 0.01) from early to late pregnancy. Both groups returned to early pregnancy mood and physical quality of life postpartum. Mental health did not change from early to late pregnancy (p = 0.8), from early pregnancy to 1-2 months (p = 0.5), or from early pregnancy to 12 months postpartum (p = 0.9), respectively. There were no significant intervention effects. Higher gestational weight gain was associated with worsened mood and lower physical quality of life across pregnancy. CONCLUSION High depressive symptoms and poor quality of life may be interrelated with the incidence of excess gestational weight gain. The behavioral gestational weight gain intervention did not significantly impact these outcomes, but mood and quality of life should be considered within future interventions and clinical practice to effectively limit excess gestational weight gain. TRIAL REGISTRATION NCT01610752 , Expecting Success, Registered 31 May 2012.
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Affiliation(s)
- Abby D. Altazan
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Leanne M. Redman
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Jeffrey H. Burton
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Robbie A. Beyl
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Loren E. Cain
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Elizabeth F. Sutton
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
| | - Corby K. Martin
- Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808 USA
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Relationships between stress, demographics and dietary intake behaviours among low-income pregnant women with overweight or obesity. Public Health Nutr 2019; 22:1066-1074. [PMID: 30621807 DOI: 10.1017/s1368980018003385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify demographic risk factors associated with high stress and examine the relationships between levels of stress, demographics and dietary fat, fruit and vegetable intakes in low-income pregnant women with overweight or obesity. DESIGN A cross-sectional study. SETTING Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, USA.ParticipantsParticipants (n 353) were non-Hispanic Black (black) or White (white). RESULTS Women aged 35 years or older (OR=4·09; 95% CI 1·45, 11·51) and who had high school or less education (OR=1·88; 95% CI 1·22, 2·89) or were unemployed (OR=1·89; 95% CI 1·15, 3·12) were significantly more likely to report high stress than women who were younger, had at least some college education or were employed/homemakers. However, race and smoking status were not associated with level of stress. Women with high stress reported significantly lower fruit and vegetable intakes but not fat intake than women with low stress. Women aged 35 years or older reported significantly higher vegetable but not fat or fruit intake than women who were 18-24 years old. Black women reported significantly higher fat but not fruit or vegetable intake than white women. Education, employment and smoking status were not significantly associated with dietary intake of fat, fruits and vegetables. CONCLUSIONS Nutrition counselling on reducing fat and increasing fruit and vegetable intakes may consider targeting women who are black or younger or who report high stress, respectively.
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Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. J Physiother 2018; 64:24-32. [PMID: 29289592 DOI: 10.1016/j.jphys.2017.11.012] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 12/11/2022] Open
Abstract
QUESTION What are the attitudes, barriers and enablers to physical activity perceived by pregnant women? DESIGN In a systematic literature review, eight electronic databases were searched: AMED, CINAHL, Embase, Joanna Briggs Institute, Medline, PsycInfo, SPORTDiscus (from database inception until June 2016) and PubMed (from 2011 until June 2016). Quantitative data expressed as proportions were meta-analysed. Data collected using Likert scales were synthesised descriptively. Qualitative data were analysed thematically using an inductive approach and content analysis. Findings were categorised as intrapersonal, interpersonal or environmental, based on a social-ecological framework. PARTICIPANTS Pregnant women. INTERVENTION Not applicable. OUTCOME MEASURES Attitudes and perceived barriers and enablers to physical activity during pregnancy. RESULTS Forty-nine articles reporting data from 47 studies (7655 participants) were included. Data were collected using questionnaires, interviews and focus groups. Meta-analyses of proportions showed that pregnant women had positive attitudes towards physical activity, identifying it as important (0.80, 95% CI 0.52 to 0.98), beneficial (0.71, 95% CI 0.58 to 0.83) and safe (0.86, 95% CI 0.79 to 0.92). This was supported by themes emerging in 15 qualitative studies that reported on attitudes (important, 12 studies; beneficial, 10 studies). Barriers to physical activity were predominantly intrapersonal such as fatigue, lack of time and pregnancy discomforts. Frequent enablers included maternal and foetal health benefits (intrapersonal), social support (interpersonal) and pregnancy-specific programs. Few environmental factors were identified. Little information was available about attitudes, barriers and enablers of physical activity for pregnant women with gestational diabetes mellitus who are at risk from inactivity. CONCLUSION Intrapersonal themes were the most frequently reported barriers and enablers to physical activity during pregnancy. Social support also played an enabling role. Person-centred strategies using behaviour change techniques should be used to address intrapersonal and social factors to translate pregnant women's positive attitudes into increased physical activity participation. REGISTRATION PROSPERO CRD42016037643. [Harrison AL, Taylor NF, Shields N, Frawley HC (2018) Attitudes, barriers and enablers to physical activity in pregnant women: a systematic review. Journal of Physiotherapy 64: 24-32].
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Choi J, Fukuoka Y. Spousal influence on physical activity in physically inactive pregnant women: A cross-sectional study. Health Care Women Int 2017; 39:263-274. [PMID: 29116912 DOI: 10.1080/07399332.2017.1402333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Regular physical activity (PA) is recommended during pregnancy, but the prevalence of pregnant women who met the recommended level for PA is very low. In this descriptive study, we examined the association between spousal characteristics (belief, knowledge, social support, and PA level) and pregnant women's PA level in 18 couples living in the San Francisco Bay Area. Among other spousal characteristics, only spousal PA level was a significant predictor of pregnant women's PA level regardless of whether it was unadjusted or adjusted by spouses' age and body index mass (p = .01). Our finding shows a need to develop strategies to incorporate spousal support for PA.
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Affiliation(s)
- JiWon Choi
- a Institute for Health & Aging, Department of Social and Behavioral Sciences , School of Nursing, University of California , San Francisco , CA , USA
| | - Yoshimi Fukuoka
- b Institute for Health & Aging, Department of Physiological Nursing , School of Nursing, University of California , San Francisco , CA , USA
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Psychosocial predictors of gestational weight gain and the role of mindfulness. Midwifery 2017; 56:86-93. [PMID: 29096284 DOI: 10.1016/j.midw.2017.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 09/17/2017] [Accepted: 10/14/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To identify the psychosocial factors (i.e., stress, anxiety, depression, social support) that are associated with gestational weight gain (GWG) and the relationship of mindfulness with GWG during each trimester of pregnancy. DESIGN In this cross-sectional study, an online survey that assessed physical and mental health and wellness practices was administered to pregnant women. PARTICIPANTS Pregnant women ≥8 weeks gestation, ≥18 years old, and could read and write in English. MEASUREMENT AND FINDINGS Women who responded to the survey (N=1,073) were on average 28.7±4.6 years old. Findings from a regression analysis suggest that increased levels of depression may be predictive of increased GWG in the second trimester and decreased levels of mindfulness may be predictive of increased GWG in the first trimester. Anxiety, stress, and overall social support were not associated with GWG in any trimester. KEY CONCLUSIONS Mindfulness-based strategies (e.g., yoga) may have the potential to manage both depression and excessive GWG and may beneficial for and preferred by pregnant women. More research is warranted to determine clear relationships between psychosocial health, mindfulness, and GWG. IMPLICATIONS FOR PRACTICE Health care providers are encouraged to screen for depression in early pregnancy (i.e., first or second trimester) and provide resources to manage symptoms of depression and GWG to promote optimal birth outcomes. Health care providers may want to counsel patients on how to manage depression and/or GWG by suggesting mindfulness-based approaches.
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Chang MW, Brown R, Nitzke S. Fast Food Intake in Relation to Employment Status, Stress, Depression, and Dietary Behaviors in Low-Income Overweight and Obese Pregnant Women. Matern Child Health J 2017; 20:1506-17. [PMID: 26973147 DOI: 10.1007/s10995-016-1949-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective This study explored fast food intake as a potential mediator of the relationships among employment status; stress; depression; and fruit, vegetable, and fat intakes by race (African American vs. Non-Hispanic White) and body mass index (BMI category: overweight vs. obesity). Methods Low-income overweight and obese pregnant women (N = 332) were recruited from the Special Supplemental Nutrition Program for Women, Infants and Children in Michigan. Path analysis was performed to explore mediation effects by race and BMI category. Results Fast food intake mediated the relationship between employment status and fat intake (p = 0.02) in Non-Hispanic White women, but no mediation effect was detected in African American women. For overweight women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04) and the relationship between depression and vegetable intake (p = 0.01). Also, fast food intake partially mediated the relationship between depression and fat intake (p = 0.003). For obese women, fast food intake mediated the relationship between employment status and fat intake (p = 0.04). Conclusion Fast food is an important topic for nutrition education for overweight and obese pregnant women. Future interventions may be more successful if they address issues associated with employment status (e.g., lack of time to plan and cook healthy meals) and depressive mood (e.g., inability to plan meals or shop for groceries when coping with negative emotions).
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Affiliation(s)
- Mei-Wei Chang
- College of Nursing, Ohio State University, 342 Newton Hall, 1585 Neil Avenue, Columbus, OH, 43210, USA.
| | - Roger Brown
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Susan Nitzke
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, WI, USA
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The development and validation of measures to assess cooking skills and food skills. Int J Behav Nutr Phys Act 2017; 14:118. [PMID: 28865452 PMCID: PMC5581465 DOI: 10.1186/s12966-017-0575-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/23/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND With the increase use of convenience food and eating outside the home environment being linked to the obesity epidemic, the need to assess and monitor individuals cooking and food skills is key to help intervene where necessary to promote the usage of these skills. Therefore, this research aimed to develop and validate a measure for cooking skills and one for food skills, that are clearly described, relatable, user-friendly, suitable for different types of studies, and applicable across all sociodemographic levels. METHODS Two measures were developed in light of the literature and expert opinion and piloted for clarity and ease of use. Following this, four studies were undertaken across different cohorts (including a sample of students, both 'Food preparation novices' and 'Experienced food preparers', and a nationally representative sample) to assess temporal stability, psychometrics, internal consistency reliability and construct validity of both measures. Analysis included T-tests, Pearson's correlations, factor analysis, and Cronbach's alphas, with a significance level of 0.05. RESULTS Both measures were found to have a significant level of temporal stability (P < 0.001). Factor analysis revealed three factors with eigenvalues over 1, with two items in a third factor outside the two suggested measures. The internal consistency reliability for the cooking skills confidence measure ranged from 0.78 to 0.93 across all cohorts. The food skills confidence measure's Cronbach's alpha's ranged from 0.85 to 0.94. The two measures also showed a high discriminate validity as there were significant differences (P < 0.05 for cooking skills confidence and P < 0.01 for food skills confidence) between Food preparation novices' and 'Experienced food preparers.' CONCLUSIONS The cooking skills confidence measure and the food skills confidence measure have been shown to have a very satisfactory reliability, validity and are consistent over time. Their user-friendly applicability make both measures highly suitable for large scale cross-sectional, longitudinal and intervention studies to assess or monitor cooking and food skills levels and confidence.
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Women with a BMI ≥ 30kg/m² and their experience of maternity care: A meta ethnographic synthesis. Midwifery 2017; 53:87-95. [PMID: 28779644 DOI: 10.1016/j.midw.2017.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 05/31/2017] [Accepted: 07/15/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE this paper is a report of a systematic review and meta-ethnography of the experiences of women with body mass index (BMI) ≥ 30kg/m² and their experience of maternity care. METHOD systematic review methods identified 12 qualitative studies about women's experiences of maternity care when their BMI ≥ 30kg/m². Findings from the identified studies were synthesised into themes, using metaethnography. SYNTHESIS AND FINDINGS: the meta-ethnography produced four key concepts; Initial encounters, Negotiating risk, Missing out and The positive intervention, which represent the experiences of maternity care for women with BMI ≥ 30kg/m² KEY CONCLUSION: many women with BMI ≥ 30kg/m² appear to be dissatisfied with the approaches taken to discuss weight status during maternity encounters. When weight is not addressed during these encounters women appear to be equally dissatisfied. The absence of open and honest discussions about weight, the feeling of being denied of a normal experience, and an over emphasis on the risks imposed upon pregnancy and childbirth by obesity, leave women feeling dissatisfied and disenfranchised. Sensitive care and practical advice about diet and exercise can help women move towards feeling more in control of their weight management.
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Huberty J, Leiferman JA, Kruper AR, Jacobson LT, Waring ME, Matthews JL, Wischenka DM, Braxter B, Kornfield SL. Exploring the need for interventions to manage weight and stress during interconception. J Behav Med 2017; 40:145-158. [PMID: 27858206 PMCID: PMC5358329 DOI: 10.1007/s10865-016-9813-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 11/12/2016] [Indexed: 12/23/2022]
Abstract
Interventions to manage weight and stress during the interconception period (i.e., time immediately following childbirth to subsequent pregnancy) are needed to promote optimal maternal and infant health outcomes. To address this gap, we summarize the current state of knowledge, critically evaluate the research focused on weight and stress management during the interconception period, and provide future recommendations for research in this area. Evidence supports the importance of weight and stress management during the reproductive years and the impact of weight on maternal and child health outcomes. However, evidence-based treatment models that address postpartum weight loss and manage maternal stress during the interconception period are lacking. This problem is further compounded by inconsistent definitions and measurements of stress. Recommendations for future research include interventions that address weight and stress tailored for women in the interconception period, interventions that address healthcare providers' understanding of the significance of weight and stress management during interconception, and long-term follow-up studies that focus on the public health implications of weight and stress management during interconception. Addressing obesity and stress during the interconception period via a reproductive lens will be a starting point for women and their families to live long and healthy lives.
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Affiliation(s)
- Jennifer Huberty
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA.
| | - Jenn A Leiferman
- Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Abbey R Kruper
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lisette T Jacobson
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
| | - Molly E Waring
- Departments of Quantitative Health Sciences and Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jeni L Matthews
- School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ, USA
| | | | - Betty Braxter
- School of Nursing, University of Pittsburg, Pittsburgh, PA, USA
| | - Sara L Kornfield
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Abstract
To support optimal health outcomes during pregnancy, understanding obstetricians' (OBs) recommendations for and barriers to managing gestational weight gain (GWG) can benefit childbirth educators. This mailed survey examined OBs' practices (n = 63) for managing GWG along with perceived barriers. The most frequent recommendations were (a) increase activity (76.2%), (b) aerobic activity (63.5%), (c) patient education about weight management (61.9%), (d) increase fiber intake (61.3%), and (e) use of guidelines for weight gain (58.7%). Self-tracking weight gain charts were the least used. Greatest barriers to GWG management were (a) patients not interested in changing behavior (77.8%), (b) high relapse rates (66.7%), (c) lack of community resources (60.3%), (d) patients cannot afford referrals (58.7%), and (e) lack of time (53.9%).
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Women's Perceived Reasons for Their Excessive Postpartum Weight Retention: A Qualitative Interview Study. PLoS One 2016; 11:e0167731. [PMID: 27936110 PMCID: PMC5147953 DOI: 10.1371/journal.pone.0167731] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/18/2016] [Indexed: 12/29/2022] Open
Abstract
Introduction Obesity in Sweden has doubled to 14% over the last 20 years. New strategies for treatment and prevention are needed. Excessive gestational weight gain has been found to contribute substantially to obesity, and there is a consistent association between postpartum weight retention and obesity later in life. We aimed to explore what factors women perceive as reasons for having substantial postpartum weight retention, to identify areas for new and improved interventions. Methods Qualitative interview study (semi-structured) using an emergent design. Fifteen women, with a postpartum weight retention ≥ 10 kg, were interviewed by a trained cognitive therapist. Eight women had pre-pregnancy BMI below 30 kg/m2. Interviews were transcribed verbatim and data analysed using inductive manifest content analysis. Salient text passages were extracted, shortened, coded and clustered into categories. Results Participants reported no knowledge of current gestational weight gain recommendations or of risks for adverse pregnancy outcomes with excessive weight gain or postpartum weight retention. Excessive eating emerged as a common strategy to provide relief of psychological, emotional and physical discomfort, such as depression and morning sickness. Women perceived medical staff as being unconcerned about weight, and postpartum weight loss support was scarce or absent. Some women reported eating more due to a belief that breastfeeding would automatically lead to weight loss. Conclusion There is a need to raise awareness about risks with unhealthy gestational weight development and postpartum weight retention in women of childbearing age. The common strategy to cope with psychological, emotional or physical discomfort by eating is an important factor to target with intervention. The postpartum year is a neglected period where additional follow-up on weight and weight loss support is strongly indicated.
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Coll CVN, Domingues MR, Gonçalves H, Bertoldi AD. Perceived barriers to leisure-time physical activity during pregnancy: A literature review of quantitative and qualitative evidence. J Sci Med Sport 2016; 20:17-25. [PMID: 27372276 DOI: 10.1016/j.jsams.2016.06.007] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/24/2016] [Accepted: 06/16/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Identify perceived barriers to leisure-time physical activity during pregnancy to inform future interventions aimed at improving physical activity levels in pregnancy. DESIGN PubMed/Medline and Web of Science databases were systematically searched using a reference period between 1986 and January/2016. METHODS A comprehensive search strategy was developed combining the following keywords: (barriers OR constraints OR perceptions OR attitudes) AND (physical activity OR exercise OR motor activity) AND (pregnancy OR pregnant women OR antenatal OR prenatal). Thematic synthesis was conducted to analyze the data. A socioecological model was used to categorize the reported barriers. RESULTS Twelve quantitative studies and 14 qualitative studies were included. Barriers belonging to the intrapersonal level of the socioecological model were the most reported in the studies and were categorized in five themes as follows: (1) Pregnancy-related symptoms and limitations; (2) Time constraints; (3) Perceptions of already being active, (4) Lack of motivation and (5) Mother-child safety concerns. At the interpersonal level, barriers were coded into two descriptive themes: (1) Lack of advice and information and (2) Lack of social support. Two other themes were used to summarize Environmental, Organizational and Policy barriers: (1) Adverse weather and (2) Lack of resources. CONCLUSIONS A range of relevant barriers to leisure-time physical-activity engagement during pregnancy were identified in this literature review. Pregnancy-related symptoms and limitations barriers were the most reported in studies, regardless of study design. Mother-child safety concerns, lack of advice/information and lack of social support were also important emphasized pregnancy-related barriers to be targeted in future interventions.
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Affiliation(s)
- Carolina V N Coll
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil.
| | - Marlos R Domingues
- Postgraduate Program in Physical Education, Federal University of Pelotas, Brazil
| | - Helen Gonçalves
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
| | - Andréa D Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Brazil
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Chang MW, Brown R, Nitzke S, Smith B, Eghtedary K. Stress, sleep, depression and dietary intakes among low-income overweight and obese pregnant women. Matern Child Health J 2016; 19:1047-59. [PMID: 25102810 DOI: 10.1007/s10995-014-1604-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study investigated the mediating roles of sleep and depression on the relationships between stress, fat intake, and fruit and vegetable intake among low-income overweight and obese pregnant women by trimesters. Participants (N = 213) completed a self-administered survey including stress (exogenous variable), depression, sleep (mediators), fat intake, and fruit and vegetable intake (endogenous variables). Path analysis was performed to compare mediation effects among pregnant women in each trimester. Consistently across three trimesters, stress was related to depression but not sleep duration, night time sleep disturbance, sleep quality, sleep latency or fat intake. Sleep duration was not associated with depression. Depending on trimester, night time sleep disturbance, sleep quality, and sleep latency were related to depression; night time sleep disturbance and depression affected fat intake; stress influenced fruit and vegetable intake. Sleep duration, sleep disturbance, sleep quality, sleep latency and depression did not mediate the relationships between stress, fat intake, and fruit and vegetable intake in the second and third trimesters. However, depression mediated the relationship between stress and fat intake in the first trimester. Stress management interventions may help low-income overweight and obese pregnant women decrease depressive symptoms and therefore contribute to overall nutritional health.
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Affiliation(s)
- Mei-Wei Chang
- College of Nursing, Michigan State University, 1355 Bogue Street, RM C346, East Lansing, MI, 48824, USA,
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