Maternal and Child Health Journal

, Volume 17, Issue 3, pp 432–440 | Cite as

A Qualitative Study of Factors Affecting Pregnancy Weight Gain in African American Women

  • Kara GoodrichEmail author
  • Mary Cregger
  • Sara Wilcox
  • Jihong Liu


African Americans and overweight or obese women are at increased risk for excessive gestational weight gain (GWG) and postpartum weight retention. Interventions are needed to promote healthy GWG in this population; however, research on exercise and nutritional barriers during pregnancy in African American women is limited. The objective of this qualitative study is to better inform intervention messages by eliciting information on perceptions of appropriate weight gain, barriers to and enablers of exercise and healthy eating, and other influences on healthy weight gain during pregnancy in overweight or obese African American women. In-depth interviews were conducted with 33 overweight or obese African American women in Columbia, South Carolina. Women were recruited in early to mid-pregnancy (8–23 weeks gestation, n = 10), mid to late pregnancy (24–36 weeks, n = 15), and early postpartum (6–12 weeks postpartum, n = 8). Interview questions and data analysis were informed using a social ecological framework. Over 50 % of women thought they should gain weight in excess of the range recommended by the Institute of Medicine. Participants were motivated to exercise for personal health benefits; however they also cited many barriers to exercise, including safety concerns for the fetus. Awareness of the maternal and fetal benefits of healthy eating was high. Commonly cited barriers to healthy eating include cravings and availability of unhealthy foods. The majority of women were motivated to engage in healthy behaviors during pregnancy. However, the interviews also uncovered a number of misconceptions and barriers that can serve as future intervention messages and strategies.


Pregnancy Exercise Healthy eating Perceptions 



The project described was supported by Award Number R21HD061885 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health. We are grateful to the women who took time out of their busy lives to take part in our interviews. We also thank the HIPP staff and the staff at the participating clinics for their assistance with participant recruitment and other study logistics. The study was supported by award number R21HD061885 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The research was conducted in accord with prevailing ethical principles.


  1. 1.
    Flegal, K. M., Carroll, M. D., Ogden, C. L., et al. (2010). Prevalence and trends in obesity among US adults, 1999–2008. JAMA, 303(3), 235–241.PubMedCrossRefGoogle Scholar
  2. 2.
    Gore, S. A., Brown, D. M., & West, D. S. (2003). The role of postpartum weight retention in obesity among women: a review of the evidence. Annals of Behavioral Medicine, 26(2), 149–159.PubMedCrossRefGoogle Scholar
  3. 3.
    Linne, Y., Dye, L., Barkeling, B., et al. (2003). Weight development over time in parous women—the SPAWN study—15 years follow-up. International Journal of Obesity and Related Metabolic Disorders, 27(12), 1516–1522.PubMedCrossRefGoogle Scholar
  4. 4.
    Rooney, B. L., & Schauberger, C. W. (2002). Excess pregnancy weight gain and long-term obesity: One decade later. Obstetrics and Gynecology, 100(2), 245–252.PubMedCrossRefGoogle Scholar
  5. 5.
    Rasmussen, K. M. (2009). Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: National Academy Press.Google Scholar
  6. 6.
    Institute of Medicine. (2007). Influence of pregnancy weight on maternal and child health: Workshop report. Washington, DC: National Academy Press.Google Scholar
  7. 7.
    Viswanathan, M., Siega-Riz, A. M., Moos, M. K., et al. (2008). Outcomes of maternal weight gain. Evidence Reports/Technology Assessments (Full Report), 168, 1–223.Google Scholar
  8. 8.
    Oken, E., Rifas-Shiman, S. L., Field, A. E., et al. (2008). Maternal gestational weight gain and offspring weight in adolescence. Obstetrics and Gynecology, 112(5), 999–1006.PubMedCrossRefGoogle Scholar
  9. 9.
    Olson, C. M. (2008). Achieving a healthy weight gain during pregnancy. Annual Review of Nutrition, 28, 411–423.PubMedCrossRefGoogle Scholar
  10. 10.
    Olson, C. M., & Strawderman, M. S. (2003). Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. Journal of the American Dietetic Association, 103(1), 48–54.PubMedCrossRefGoogle Scholar
  11. 11.
    Parker, J. D., & Abrams, B. (1993). Differences in postpartum weight retention between black and white mothers. Obstetrics and Gynecology, 81(5 (Pt 1)), 768–774.Google Scholar
  12. 12.
    Scholl, T. O., Hediger, M. L., Schall, J. I., et al. (1995). Gestational weight gain, pregnancy outcome, and postpartum weight retention. Obstetrics and Gynecology, 86(3), 423–427.PubMedCrossRefGoogle Scholar
  13. 13.
    Smith, D. E., Lewis, C. E., Caveny, J. L., et al. (1994). Longitudinal changes in adiposity associated with pregnancy. The CARDIA study. Coronary artery risk development in young adults study. JAMA, 271(22), 1747–1751.PubMedCrossRefGoogle Scholar
  14. 14.
    Ohlin, A., & Rossner, S. (1990). Maternal body weight development after pregnancy. International Journal of Obesity, 14(2), 159–173.PubMedGoogle Scholar
  15. 15.
    Siega-Riz, A. M., & Laraia, B. (2006). The implications of maternal overweight and obesity on the course of pregnancy and birth outcomes. Maternal and Child Health Journal, 10(5 Suppl), S153–S156.PubMedCrossRefGoogle Scholar
  16. 16.
    Sarwer, D. B., Allison, K. C., Gibbons, L. M., et al. (2006). Pregnancy and obesity: A review and agenda for future research. Journal of Womens Health (Larchmt), 15(6), 720–733.CrossRefGoogle Scholar
  17. 17.
    Abrams, B., Altman, S. L., & Pickett, K. E. (2000). Pregnancy weight gain: Still controversial. American Journal of Clinical Nutrition, 71(5 Suppl), 1233S–1241S.PubMedGoogle Scholar
  18. 18.
    Hedderson, M. M., Weiss, N. S., Sacks, D. A., et al. (2006). Pregnancy weight gain and risk of neonatal complications: Macrosomia, hypoglycemia, and hyperbilirubinemia. Obstetrics and Gynecology, 108(5), 1153–1161.PubMedCrossRefGoogle Scholar
  19. 19.
    Stotland, N. E., Cheng, Y. W., Hopkins, L. M., et al. (2006). Gestational weight gain and adverse neonatal outcome among term infants. Obstetrics and Gynecology, 108(3 Pt 1), 635–643.PubMedCrossRefGoogle Scholar
  20. 20.
    Cedergren, M. (2006). Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. International Journal of Gynaecology and Obstetrics, 93(3), 269–274.PubMedCrossRefGoogle Scholar
  21. 21.
    DeVader, S. R., Neeley, H. L., Myles, T. D., et al. (2007). Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstetrics and Gynecology, 110(4), 745–751.PubMedCrossRefGoogle Scholar
  22. 22.
    Thorsdottir, I., Torfadottir, J. E., Birgisdottir, B. E., et al. (2002). Weight gain in women of normal weight before pregnancy: Complications in pregnancy or delivery and birth outcome. Obstetrics and Gynecology, 99(5 Pt 1), 799–806.PubMedCrossRefGoogle Scholar
  23. 23.
    Cedergren, M. I. (2007). Optimal gestational weight gain for body mass index categories. Obstetrics and Gynecology, 110(4), 759–764.PubMedCrossRefGoogle Scholar
  24. 24.
    Richter, D. L., Wilcox, S., Greaney, M. L., et al. (2002). Environmental, policy, and cultural factors related to physical activity in African American women. Women and Health, 36(2), 91–109.Google Scholar
  25. 25.
    Griffin, S. F., Wilson, D. K., Wilcox, S., et al. (2008). Physical activity influences in a disadvantaged African American community and the communities’ proposed solutions. Health Promotion Practice, 9(2), 180–190.PubMedCrossRefGoogle Scholar
  26. 26.
    Wilson, D. K., Kirtland, K. A., Ainsworth, B. E., et al. (2004). Socioeconomic status and perceptions of access and safety for physical activity. Annals of Behavioral Medicine, 28(1), 20–28.PubMedCrossRefGoogle Scholar
  27. 27.
    Zenk, S. N., Schulz, A. J., Israel, B. A., et al. (2005). Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. American Journal of Public Health, 95(4), 660–667.PubMedCrossRefGoogle Scholar
  28. 28.
    Cassady, D., Jetter, K. M., & Culp, J. (2007). Is price a barrier to eating more fruits and vegetables for low-income families? Journal of the American Dietetic Association, 107(11), 1909–1915.PubMedCrossRefGoogle Scholar
  29. 29.
    Hosler, A. S., Rajulu, D. T., Fredrick, B. L., et al. (2008). Assessing retail fruit and vegetable availability in urban and rural underserved communities. Preventing Chronic Disease, 5(4), A123.PubMedGoogle Scholar
  30. 30.
    Larson, N. I., Story, M. T., & Nelson, M. C. (2009). Neighborhood environments: disparities in access to healthy foods in the U.S. American Journal of Preventive Medicine, 36(1), 74–81.PubMedCrossRefGoogle Scholar
  31. 31.
    Kumanyika, S. K., Whitt-Glover, M. C., Gary, T. L., et al. (2007). Expanding the obesity research paradigm to reach African American communities. Preventing Chronic Disease, 4(4), A112.PubMedGoogle Scholar
  32. 32.
    Flynn, K. J., & Fitzgibbon, M. (1998). Body images and obesity risk among black females: A review of the literature. Annals of Behavioral Medicine, 20(1), 13–24.PubMedCrossRefGoogle Scholar
  33. 33.
    McLeroy, K. R., Bibeau, D., Steckler, A., et al. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377.PubMedCrossRefGoogle Scholar
  34. 34.
    Sallis, J. F., Bauman, A., & Pratt, M. (1998). Environmental and policy interventions to promote physical activity. American Journal of Preventive Medicine, 15(4), 379–397.PubMedCrossRefGoogle Scholar
  35. 35.
    King, A. C., Jeffery, R. W., Fridinger, F., et al. (1995). Environmental and policy approaches to cardiovascular disease prevention through physical activity: Issues and opportunities. Health Education Quarterly, 22(4), 499–511.PubMedCrossRefGoogle Scholar
  36. 36.
    Fowles, E. R., & Fowles, S. L. (2008). Healthy eating during pregnancy: Determinants and supportive strategies. Journal of Community Health Nursing, 25(3), 138–152.PubMedCrossRefGoogle Scholar
  37. 37.
    US Department of Health and Human Services. (2008). Physical activity guidelines for Americans. Washington, DC: US Department of Agriculture.Google Scholar
  38. 38.
    Stuebe, A. M., Oken, E., & Gillman, M. W. (2009). Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain. American Journal of Obstetrics and Gynecology, 201(1):58 e1–58 e8.Google Scholar
  39. 39.
    Evenson, K. R., Savitz, D. A., & Huston, S. L. (2004). Leisure-time physical activity among pregnant women in the US. Paediatric and Perinatal Epidemiology, 18(6), 400–407.PubMedCrossRefGoogle Scholar
  40. 40.
    Pereira, M. A., Rifas-Shiman, S. L., Kleinman, K. P., et al. (2007). Predictors of change in physical activity during and after pregnancy: Project Viva. American Journal of Preventive Medicine, 32(4), 312–319.PubMedCrossRefGoogle Scholar
  41. 41.
    Clark, M., & Ogden, J. (1999). The impact of pregnancy on eating behaviour and aspects of weight concern. International Journal of Obesity and Related Metabolic Disorders, 23(1), 18–24.PubMedCrossRefGoogle Scholar
  42. 42.
    Ohlin, A., & Rossner, S. (1994). Trends in eating patterns, physical activity and socio-demographic factors in relation to postpartum body weight development. British Journal of Nutrition, 71(4), 457–470.PubMedCrossRefGoogle Scholar
  43. 43.
    Olson, C. M., Strawderman, M. S., Hinton, P. S., et al. (2003). Gestational weight gain and postpartum behaviors associated with weight change from early pregnancy to 1 y postpartum. International Journal of Obesity and Related Metabolic Disorders, 27(1), 117–127.PubMedCrossRefGoogle Scholar
  44. 44.
    Centers for Disease Control and Prevention. (2009). Behavioral risk factor surveillance system survey questionnaire. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Atlanta, GA, pp. 25–27.Google Scholar
  45. 45.
    Artal, R., & O’Toole, M. (2003). Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British Journal of Sports Medicine, 37(1), 6–12.PubMedCrossRefGoogle Scholar
  46. 46.
    Strauss, A. L., & Corbin, J. (1990). Basics of qualitative research. Thousand Oaks, CA: SAGE.Google Scholar
  47. 47.
    Claesson, I. M., Sydsjo, G., Brynhildsen, J., et al. (2008). Weight gain restriction for obese pregnant women: A case-control intervention study. BJOG, 115(1), 44–50.PubMedCrossRefGoogle Scholar
  48. 48.
    Doran, F., & O’Brien, A. P. (2007). A brief report of attitudes towards physical activity during pregnancy. Health promotion Journal of Australia, 18(2), 155–158.PubMedGoogle Scholar
  49. 49.
    Clarke, P. E., & Gross, H. (2004). Women’s behaviour, beliefs and information sources about physical exercise in pregnancy. Midwifery, 20(2), 133–141.PubMedCrossRefGoogle Scholar
  50. 50.
    Cogswell, M. E., Scanlon, K. S., Fein, S. B., et al. (1999). Medically advised, mother’s personal target, and actual weight gain during pregnancy. Obstetrics and Gynecology, 94(4), 616–622.PubMedCrossRefGoogle Scholar
  51. 51.
    Stotland, N. E., Haas, J. S., Brawarsky, P., et al. (2005). Body mass index, provider advice, and target gestational weight gain. Obstetrics and Gynecology, 105(3), 633–638.PubMedCrossRefGoogle Scholar
  52. 52.
    Sallis, J. F., & Saelens, B. E. (2000). Assessment of physical activity by self-report: status, limitations, and future directions. Research Quarterly for Exercise and Sport, 71(2 Suppl), S1–S14.PubMedGoogle Scholar
  53. 53.
    Cioffi, J., Schmied, V., Dahlen, H., et al. (2010). Physical activity in pregnancy: Women’s perceptions, practices, and influencing factors. Journal of Midwifery Womens Health, 55(5), 455–461.CrossRefGoogle Scholar
  54. 54.
    Weir, Z., Bush, J., Robson, S. C., et al. (2010). Physical activity in pregnancy: A qualitative study of the beliefs of overweight and obese pregnant women. BMC Pregnancy Childbirth, 10, 18.PubMedCrossRefGoogle Scholar
  55. 55.
    Evenson, K. R., Moos, M. K., Carrier, K., et al. (2009). Perceived barriers to physical activity among pregnant women. Maternal and Child Health Journal, 13(3), 364–375.PubMedCrossRefGoogle Scholar
  56. 56.
    Duncombe, D., Wertheim, E. H., Skouteris, H., et al. (2007). Factors related to exercise over the course of pregnancy including women’s beliefs about the safety of exercise during pregnancy. Midwifery, 25(4), 430–438.PubMedCrossRefGoogle Scholar
  57. 57.
    Symons Downs, D., & Hausenblas, H. A. (2004). Women’s exercise beliefs and behaviors during their pregnancy and postpartum. Journal of Midwifery Womens Health, 49(2), 138–144.Google Scholar
  58. 58.
    Juhl, M., Olsen, J., Andersen, P. K., et al. (2010). Physical exercise during pregnancy and fetal growth measures: A study within the Danish National Birth Cohort. American Journal of Obstetrics and Gynecology, 202(1), 63 e1–63 e8.Google Scholar
  59. 59.
    Oken, E. (2009). Maternal and child obesity: The causal link. Obstetrics and Gynecology Clinics of North America, 36(2), 361–377, ix–x.Google Scholar
  60. 60.
    May, L. E., Glaros, A., Yeh, H. W., et al. (2010). Aerobic exercise during pregnancy influences fetal cardiac autonomic control of heart rate and heart rate variability. Early Human Development, 86(4), 213–217.PubMedCrossRefGoogle Scholar
  61. 61.
    Hopkins, S. A., Baldi, J. C., Cutfield, W. S., et al. (2010). Exercise training in pregnancy reduces offspring size without changes in maternal insulin sensitivity. Journal of Clinical Endocrinology and Metabolism, 95(5), 2080–2088.PubMedCrossRefGoogle Scholar
  62. 62.
    Mottola, M. F. (2009). Exercise prescription for overweight and obese women: Pregnancy and postpartum. Obstetrics and Gynecology Clinics of North America, 36(2), 301–316, viii.Google Scholar
  63. 63.
    Powell, A. D., & Kahn, A. S. (1995). Racial differences in women’s desires to be thin. International Journal of Eating Disorders, 17(2), 191–195.PubMedCrossRefGoogle Scholar
  64. 64.
    Lynch, E., Liu, K., Spring, B., et al. (2007). Association of ethnicity and socioeconomic status with judgments of body size: The coronary artery risk development in young adults (CARDIA) study. American Journal of Epidemiology, 165(9), 1055–1062.PubMedCrossRefGoogle Scholar
  65. 65.
    Williamson, D. A., Womble, L. G., Zucker, N. L., et al. (2000). Body image assessment for obesity (BIA-O): Development of a new procedure. International Journal of Obesity and Related Metabolic Disorders, 24(10), 1326–1332.PubMedCrossRefGoogle Scholar
  66. 66.
    Baturka, N., Hornsby, P. P., & Schorling, J. B. (2000). Clinical implications of body image among rural African-American women. Journal of General Internal Medicine, 15(4), 235–241.PubMedCrossRefGoogle Scholar
  67. 67.
    Paeratakul, S., White, M. A., Williamson, D. A., et al. (2002). Sex, race/ethnicity, socioeconomic status, and BMI in relation to self-perception of overweight. Obesity Research, 10(5), 345–350.PubMedCrossRefGoogle Scholar
  68. 68.
    Befort, C. A., Thomas, J. L., Daley, C. M., et al. (2008). Perceptions and beliefs about body size, weight, and weight loss among obese African American women: A qualitative inquiry. Health Education & Behavior, 35(3), 410–426.CrossRefGoogle Scholar
  69. 69.
    Kumanyika, S., Wilson, J. F., & Guilford-Davenport, M. (1993). Weight-related attitudes and behaviors of black women. Journal of the American Dietetic Association, 93(4), 416–422.PubMedCrossRefGoogle Scholar
  70. 70.
    Carpenter, R., & Finley, C. (2005). Healthy eating ever day. Champaign: Human Kinetics.Google Scholar
  71. 71.
    Burke, L. E., Wang, J., & Sevick, M. A. (2011). Self-monitoring in weight loss: A systematic review of the literature. Journal of the American Dietetic Association, 111(1), 92–102.PubMedCrossRefGoogle Scholar
  72. 72.
    Pearson, E. S. (2011). Goal setting as a health behavior change strategy in overweight and obese adults: A systematic literature review examining intervention components. Patient Education and Counseling, 87(1), 32–42.PubMedCrossRefGoogle Scholar
  73. 73.
    Thornton, P. L., Kieffer, E. C., Salabarria-Pena, Y., et al. (2006). Weight, diet, and physical activity-related beliefs and practices among pregnant and postpartum Latino women: The role of social support. Maternal and Child Health Journal, 10(1), 95–104.PubMedCrossRefGoogle Scholar
  74. 74.
    Gans, K. M., Kumanyika, S. K., Lovell, H. J., et al. (2003). The development of SisterTalk: A cable TV-delivered weight control program for black women. Preventive Medicine, 37(6 Pt 1), 654–667.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Kara Goodrich
    • 1
    Email author
  • Mary Cregger
    • 1
  • Sara Wilcox
    • 1
  • Jihong Liu
    • 1
  1. 1.University of South CarolinaColumbiaUSA

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