Investigating weight-related lifestyle choices in pregnant women who are overweight

There are serious health implications associated with pregnant women being overweight (BMI 25-29kg/m2) (Lewis, 2007). Despite 'overweight/obesity' in pregnancy being highlighted in key government documents and research, the predominant focus is often on obesity (BMI ≥ 30kg/m2). Women who are overweight (WO) tend to exceed the IOM weight gain guidelines (Phelan et al., 2011), compared to normal weight or obese women. Therefore, understanding the issues influencing dietary and physical activity choices for WO is crucial. Maternity staff can potentially influence behaviour change, so their experiences of providing support to WO, and the advice they provide to them was explored. When reviewing maternal literature, gaps were identified highlighting that WO had adverse health risks during pregnancy, but limited guidelines/policies, clinical practices and resources were available specifically with them, as either a preventative measure or a treatment option. Therefore, qualitative evidence was synthesised to explore WO experiences of the barriers/facilitators when attempting to follow a healthy lifestyle. No papers could be identified that met this aim. In the first study, two focus groups (10 Obstetricians/GPs; 8 midwives) explored factors influencing whether staff raised the issue of weight with WO, and the advice provided. Results indicated that staff struggled to discuss weight with WO and that ambiguity surrounds the term 'overweight', how it is defined/ recognised, and what information is provided to WO as a result. The second study (a survey) aimed to establish what staff (n=81) understood about the term ‘overweight’, what advice they provide to WO and factors influencing whether they raise the issue of weight. ‘Overweight’ was not correctly identified, rather the term was used interchangeably when having weight-related discussions with obese pregnant women. There were variation in the factors reported which influenced whether weight was raised with WO, and why some staff provided the advice they did. Whether WO follow a healthy lifestyle during pregnancy, the advice staff provide to them, and the impact of weight-related discussion during consultations with staff was explored in study 3 (7 interviews). Numerous factors influenced healthy dietary and physical activity choices for pregnant WO. Advice from staff focussed on foods to avoid during pregnancy, rather than managing excessive gestational weight gain. Whether these factors were exclusively experienced by WO, or shared by women within other weight categories, remained unanswered. This was the focus of the final study. Structured interviews, based on the Theoretical Domains Framework, were conducted with 18 women (6 normal weight, 6 overweight, 6 obese). No specific factors influencing lifestyle decisions applied exclusively to WO. Rather there were a number of domains shared between women across all weight categories.