Demographic and social-cognitive factors associated with gestational weight gain in an Australian pregnancy cohort

Perceptual Factors Associated with Gestational Weight Gain: A Cross-Sectional Survey

PURPOSE

Recent years have seen an increase in the number of pregnant women whose weight gain during pregnancy exceeds the recommended range. This study was intended to determine the relationships among demographic attributes, key perceptual factors, and gestational weight gain (GWG).

METHODS

This cross-sectional study was conducted between April and July 2022. First-time pregnant women beyond 36 weeks of gestation who were recruited via social media completed an online survey. Data were analyzed using one-way ANOVA, chi-square test, and logistic regression, all performed using SPSS software.

RESULTS

Of the 369 participants, 63 (17.1%) exceeded the recommended GWG guidelines, while 148 (40.1%) fell within the recommended range, and the remaining 158 (42.8%) had inadequate GWG. Being overweight or obese before pregnancy significantly increased the risk of excessive GWG (p < .001). This risk was also significantly greater for women with low internal weight locus of control (OR = 0.58, 95% CI 0.41~0.82), high external weight locus of control (OR = 1.75, 95% CI 1.31~2.34), and negative body image (OR = 0.62, 95% CI 0.51~0.75).

CONCLUSION

The growing trend of excessive GWG among pregnant women is influenced by a combination of prepregnancy body mass index (BMI) and perceptual factors, including weight locus of control and body image. These findings underscore the need to implement weight management intervention strategies before pregnancy, taking into consideration BMI, and to enhance positive body image and internal locus of control.

Excessive Gestational Weight Gain, Independent of Body Mass Index, Is Associated With Child Fat Mass Index at Age 2 Years in the Growing life, Optimizing Wellness Study

BACKGROUND

Excessive gestational weight gain (eGWG) increases risk for pregnancy complications and future obesity for pregnant persons and children. Yet, it is unclear whether eGWG leads to higher child adiposity at 2 years, independent of the pregnant person's body mass index (BMI) while considering important covariates. Moreover, understanding the characteristics of pregnant persons experiencing eGWG will help design future targeted interventions.

OBJECTIVE

The objectives of the analyses were to assess the association between eGWG and childhood adiposity at age 2 years, while controlling for pregnant persons' BMI and other important covariates and to describe the characteristics of pregnant persons who experience eGWG during their second pregnancy.

DESIGN

This is a secondary analysis of 221 pregnant persons and their children aged 2 years who were enrolled in the Growing Life, Optimizing Wellness longitudinal observational study.

PARTICIPANTS/SETTING

Participants were recruited between 2011 and 2014 in central Arkansas. Participants were secundigravida persons with BMI 18.5 to 35, older than age 20 years, and who conceived without assistance.

MAIN OUTCOME MEASURES

The main outcome measure was fat mass index of children aged 2 years measured by quantitative nuclear magnetic resonance imaging. Secondary outcomes included first pregnancy GWG, dietary and physical activity characteristics between pregnancies, second pregnancy nausea levels, and motivation level to adhere to the GWG guidelines.

STATISTICAL ANALYSIS PERFORMED

Multivariable regression analyses were used to examine the associations between GWG and childhood fat mass index at age 2 years. Pearson correlations and Wilcoxon rank sum tests were used to identify the characteristics of pregnant persons who experienced eGWG.

RESULTS

Pregnant persons' eGWG (β = .503; P = .03) was positively associated with child adiposity at age 2 years independent of maternal BMI (P = 0.3). Pregnant persons who experienced eGWG during their second pregnancy had greater odds of eGWG during first pregnancies (odds ratio 7.5; P < .001), dieting behavior (odds ratio 14.3; P = .02), and low motivation to adhere to the GWG guidelines (odds ratio 11.2; P = .009). Fewer participants had eGWG during their second pregnancy (52.5%) compared with their first pregnancy (66.8%), which was different by BMI groups (BMI 18.5 to 24.9: 23.6% decrease in participants who gained eGWG, BMI 25 to 29.9: 20.0% decrease, and BMI ≥ 30: 37.9% decrease).

CONCLUSIONS

eGWG among pregnant persons is associated with child adiposity at age 2 years. Pregnant persons who experienced eGWG during their second pregnancy reported low motivation to gain weight within guidelines, eGWG in first pregnancy, and reported prior dieting behavior. Future research focusing on patients with these characteristics may increase success of interventions designed to limit eGWG.

Association Between Body Image Before and During Pregnancy and Gestational Weight Gain in Japanese Women: A Prospective Cohort Study

OBJECTIVES

More than half of women do not achieve appropriate gestational weight gain. Maternal body image may be an important factor associated with gestational weight gain. However, this association has not been thoroughly evaluated. We aimed to elucidate whether body image parameters before and during pregnancy are associated with gestational weight gain in Japanese women.

METHODS

This prospective cohort study was conducted at a hospital in Osaka, Japan from March 2020 to March 2021. We recruited women with singleton pregnancies in their second and third trimesters. Body image was assessed using the Pregnancy and Weight Gain Attitude Scale and additional questions. Gestational weight gain was classified as insufficient, appropriate, or excessive based on recommended ranges in Japan. One-way analysis of variance, chi-square tests, and multinomial logistic regression analyses were performed to identify factors associated with insufficient or excessive weight gain.

RESULTS

Of 266 enrolled women, 47 had insufficient weight gain and 100 had excessive weight gain during pregnancy. Risk factors for excessive gestational weight gain included a history of dietary restriction before pregnancy, negative attitudes toward gestational weight gain, and perception of body shape as fat and body shape dissatisfaction during pregnancy. Perception of body shape as thin during pregnancy was identified as a risk factor for insufficient gestational weight gain.

CONCLUSIONS

Body image before and during pregnancy may be an important factor in preventing insufficient or excessive gestational weight gain in Japanese women. Healthcare professionals should consider body image when providing health guidance on weight management to pregnant women.

Impact Evaluation of the Get Healthy in Pregnancy Program: Evidence of Effectiveness

The efficacy of lifestyle interventions for reduced gestational weight gain (GWG) is established, but evidence of their effectiveness is limited. The Get Healthy in Pregnancy (GHiP) program is a telephone health coaching program supporting healthy GWG delivered state-wide in New South Wales, Australia. This evaluation explores the impact of GHiP on behavioural outcomes and GWG, analysing GHiP participant data (n = 3702 for 2018-2019). We conducted McNamar's tests to explore within-individual change for behavioural outcomes and logistic regression to assess associations between demographic characteristics, participant engagement and behavioural and weight outcomes for women who completed the program. Participants who completed ten coaching calls made significant improvements (all p < 0.001) in more health-related behaviours (walking, vigorous physical activity, vegetable consumption, takeaway meals and sweetened drink consumption) than those who completed fewer calls. Among women with valid weight change data (n = 245), 31% gained weight below, 33% gained weight within, and 36% gained weight above GWG guidelines. Pre-pregnancy BMI was the only factor significantly associated with meeting GWG guidelines. Women with pre-pregnancy overweight and obesity had lower odds than those with a healthy weight of having GWG within the guidelines. The majority of these women did not gain weight above the guidelines. A higher proportion of women with pre-pregnancy obesity gained weight below the guidelines (33.8%) than above the guidelines (28.5%). GHiP has the potential to support all pregnant women, including those with pre-pregnancy obesity, to achieve a healthier pregnancy.

Exploring body dissatisfaction in pregnancy and the association with gestational weight gain, obesity, and weight stigma

OBJECTIVE

Body dissatisfaction in pregnancy has been associated with negative psychological maternal outcomes, including increased risk of postpartum depression. This study aimed to explore weight-related factors that influence body dissatisfaction in pregnancy, including gestational weight gain (GWG), weight stigma, obesity, and weight loss attempts before pregnancy.

DESIGN

Secondary analysis of a larger cross-sectional study.

SETTING

Online survey administered via Qualtrics.

PARTICIPANTS

≥12 weeks pregnant, ≥18 years of age, having a singleton pregnancy and residing in Canada.

MEASUREMENTS AND FINDINGS

A battery of questionnaires were completed, including the Body Image in Pregnancy Scale (BIPS) sub-scale. The BIPS scores were compared based on experiences of weight stigma in pregnancy, perception towards their GWG, weight loss attempts before pregnancy, obesity, and GWG category classified as excessive or not referring to Institute of Medicine (2009) guidelines. Significant differences were entered into a linear regression model with BIPS scores as the dependent variable. Significance was accepted as p<0.05. A total of 182 participants completed the survey. There were no differences in BIPS scores based on GWG category (p = 0.160), or obesity (p = 0.230). Poorer BIPS scores were reported by those who felt they had gained 'too much' pregnancy weight than 'appropriate' (p<0.001), and among those who were trying to lose weight before pregnancy compared to those who were not (p = 0.002). Poorer BIPS scores were also reported by individuals who indicated they had experienced weight stigma during pregnancy compared to those who had not (p<0.001). Regression results showed that significant variables were perceptions towards GWG (p = 0.003) and experiencing weight stigma in pregnancy (p = 0.011).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Perceptions towards GWG and experiencing weight stigma can influence body dissatisfaction in pregnancy. Given the detrimental physical and psychological consequences of body dissatisfaction, effective strategies to reduce prenatal weight stigma are needed, such as training maternal healthcare providers to offer sensitive preconception and prenatal weight counselling.

Exploring the diets of mothers and their partners during pregnancy: Findings from the Queensland Family Cohort pilot study

AIM

Modifiable behaviours during the first 1000 days of life influence developmental trajectories of adult chronic diseases. Despite this, sub-optimal dietary intakes during pregnancy and excessive gestational weight gain are common. Very little is known about partners' dietary patterns and the influence on women's pregnancy dietary patterns. We aimed to examine dietary intake during pregnancy among women and their partners, and gestational weight gain patterns in the Queensland Family Cohort pilot study.

METHODS

The Queensland Family Cohort is a prospective, observational study piloted at a Brisbane (Australia) tertiary maternity hospital from 2018 to 2021. Participant characteristics, weight gain, dietary and nutrient intake were assessed.

RESULTS

Data were available for 194 pregnant women and their partners. Poor alignment with Australian Guide to Healthy Eating recommendations was observed. Highest alignment was for fruit (40% women) and meat/alternatives (38% partners) and lowest for breads/cereals (<1% women) and milk/alternatives (13% partners). Fewer women (4.4%-60.3%) than their partners (5.4%-92.3%) met guidelines for all micronutrient intakes from food alone, particularly folic acid, iodine, and iron. Women were more likely to meet daily recommendations for fruit, vegetables, dairy, bread/cereals, and meat/alternatives when their partners also met recommendations. Women with a higher pre-pregnancy body mass index were more likely to gain above recommended weight gain ranges.

CONCLUSIONS

In this contemporary cohort of pregnant women and their partners, sub-optimal dietary patterns and deficits in some nutrients were common. There is an urgent need for evidence-informed public health policy and programs to improve diet quality during pregnancy due to intergenerational effects.

Inadequacies of gestational weight gain: prevalence and association with sociodemographic characteristics and the living environment

ABSTRACT Objective To assess the association of gestational weight gain inadequacies with sociodemographic indicators and characteristics of the living environment. Methods Cross-sectional study conducted in 2019 with a probabilistic sample of 3580 postpartum women who gave birth in maternity hospitals of the Unified Health System in the State of Santa Catarina. Prevalence was calculated and, using logistic regression models, odd ratios of inadequate and adequate gestational weight gain were estimated according to sociodemographic and health indicators (Body Mass Index, age, marital status, race/skin color and education); and characteristics of the neighborhood (violence, social cohesion, encouragement to practice physical activity and access to healthy food). Results It was observed that 29.6% of the mothers had adequate gestational weight gain, 29.3% insufficient and 41.1% excessive gestational weight gain. Lower chances of adequate weight gain were found in women with pre-pregnancy body mass index classified as overweight (43.0%) and obesity (58.0%) and who lived in an environment with social cohesion (25.0%). In contrast, the chances of adequate weight gain were 43.0% higher among women with 12 years of schooling or more when compared to those with 8 years or less. Conclusion Inadequate gestational weight gain is associated with high pre-pregnancy body mass index, with social cohesion in the living environment and with a low level of education of the pregnant woman, requiring public policies that go beyond prenatal care.

Pregnancy weight gain a balancing act: The experience and perspectives of women participating in a pilot randomised controlled trial

BACKGROUND

Supporting women to achieve healthy gestational weight gain is a global health challenge. Inadequate and excessive gestational weight gains are associated with short and long-term adverse maternal and infant health outcomes. Qualitative studies suggest that symptoms of pregnancy, health professional attitudes, lack of guidance, personal knowledge and beliefs, lack of support, weight stigma, and lack of time and money, are barriers to achieving healthy weight gain. Less is known about women's perceptions and experience of gestational weight gain within normal body mass index categories with even less known about the experience of women motivated to participate in pregnancy weight management intervention trials.

AIM

To describe the experience and perspectives of women participating in an Australian weight management pilot randomised controlled trial.

METHODS

Five women from regional New South Wales enrolled in the Eating 4 Two trial, participated in semi - structured interviews during the post-natal period. A qualitative descriptive methodology and inductive thematic analysis was applied.

FINDINGS

Two main themes emerged: 1) Addressing weight gain in pregnancy; and 2) Pregnancy weight the balancing act. Women identified weight gain as an important topic, the need for improvements within maternity services, responsive feedback and realistic support strategies. Women identified pregnancy symptoms, occurring during early and late pregnancy as barriers to achieving healthy weight gain.

CONCLUSION

Further investigation into the effects of pregnancy symptoms on eating and physical activity patterns across pregnancy is warranted. Both qualitative and quantitative research is needed to monitor the translation of guideline recommendations into clinical practice.

Translation of the Weight-Related Behaviours Questionnaire into a Short-Form Psychosocial Assessment Tool for the Detection of Women at Risk of Excessive Gestational Weight Gain

The identification and measurement of psychosocial factors that are specific to pregnancy and relevant to gestational weight gain is a challenging task. Given the general lack of availability of pregnancy-specific psychosocial assessment instruments, the aim of this study was to develop a short-form psychosocial assessment tool for the detection of women at risk of excessive gestational weight gain with research and clinical practice applications. A staged scale reduction analysis of the weight-related behaviours questionnaire was conducted amongst a sample of 159 Australian pregnant women participating in the Women and Their Children’s Health (WATCH) pregnancy cohort study. Exploratory factor analysis, univariate logistic regression, and item response theory techniques were used to derive the minimum and most predictive questions for inclusion in the short-form assessment tool. Of the total 49 questionnaire items, 11 items, all 4 body image items, n = 4 attitudes towards weight gain, and n = 3 self-efficacy items, were retained as the strongest predictors of excessive gestational weight gain. These within-scale items were highly correlated, exhibiting high item information function value statistics, and were observed to have high probability (p < 0.05) for excessive gestational weight gain, in the univariate analysis. The short-form questionnaire may assist with the development of tailored health promotion interventions to support women psychologically and physiologically to optimise their pregnancy weight gain. Confirmatory factor analysis is now required.

Diet, Physical Activity and Gestational Weight Gain Patterns among Pregnant Women Living with Obesity in the North East of England: The GLOWING Pilot Trial

Maternal diet, physical activity (PA) behaviours, and gestational weight gain (GWG) are important for optimum health of women and their babies. This secondary analysis of the GLOWING pilot cluster trial explored these among women living with obesity in high deprivation. Pregnant women completed food frequency, PA and psychosocial questionnaires. Weights were retrieved from medical records and measured during routine appointments with midwives. Descriptive and regression analyses were stratified by obesity class. A total of 163 women were recruited; 54.0% had class 1 obesity, 25.8% class 2, 20.2% class 3, and 76.1% lived in the two most deprived quintiles. Women had suboptimal dietary intake, particularly for oily fish, fruit and vegetables. PA was predominantly light intensity, from household, care and occupational activities. Most women gained weight outside of Institute of Medicine (IOM) guideline recommendations (87.8%); women in class 3 obesity were most likely to have inadequate GWG below IOM recommendations (58.3%, p < 0.01) and reduced odds of excessive GWG compared with class 1 (AOR 0.13, 95% 0.04-0.45). Deprived women with obesity have a double inequality as both increase pregnancy risks. This population requires support to meet guideline recommendations for diet, PA and GWG. Further research exploring obesity classes would inform policies and care to achieve the best pregnancy outcomes.

Healthcare Professional Training Regarding Gestational Weight Gain: Recommendations and Future Directions

PURPOSE OF REVIEW

The aim of this review was to summarise recent evaluations of healthcare professional training regarding gestational weight gain and provide recommendations for future training.

RECENT FINDINGS

A number of evaluated healthcare professional training sessions regarding gestational weight gain show promising results in terms of increased participant confidence and knowledge and impact on women's outcomes. It is clear that the interventions which have also implemented resources in the practice environment to support training are the ones most likely to influence gestational weight gain. Support from healthcare professionals are key to influence pregnant women's weight gain and should be offered within the standard curriculum and through mandatory training. Factors influencing this support include women's and healthcare professional characteristics, interpersonal and healthcare system and policy factors. All of these need to be considered when developing healthcare professional training to support women with their gestational weight gain.