Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers

Abstract

To investigate perceptions of minority pregnant women and providers about obesity and gestational weight gain (GWG), and to explore strategies to improve management of obesity in pregnancy with an emphasis on group prenatal care. Sixteen primarily non-Hispanic black pregnant women with a body mass index ≥ 30 kg/m2 and 19 prenatal care providers participated in focus groups. Discussion topics included GWG goals, body image, health behaviors, and group prenatal care with additional emphasis on provider training needs. Women frequently stated a GWG goal >20 lbs. Women described a body image not in line with clinical recommendations (“200 pounds is not that big.”). They avoided the term “obese”. They were interested in learning about nutrition and culturally-acceptable healthy cooking. Women would enjoy massage and exercise in group settings, though definitions of “exercise” varied. Family members could help, but generational differences posed challenges. Most had to “encourage myself” and “do this for me and the baby”. Providers expressed discomfort discussing GWG and difficulty finding the right words for obesity, which was partially attributed to their own weight. They noted the challenges they faced during prenatal care including time constraints, cultural myths, and system issues. Providers considered a group setting with social support an ideal environment to address health behaviors in obese women. Culturally-tailored programs that use acceptable terms for obesity, provide education regarding healthy eating and safe exercise, and encourage support from social networks may be effective in addressing GWG in obese minority women. Provider training in communication skills is necessary to address obesity in pregnancy.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Flegal, K. M., Carroll, M. D., Kit, B. K., et al. (2012). Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA, 307, 491–497.

    PubMed  Article  Google Scholar 

  2. 2.

    Wang, Y., & Beydoun, M. A. (2007). The obesity epidemic in the United States–gender, age, socioeconomic, racial/ethnic, and geographic characteristics: A systematic review and meta-regression analysis. Epidemiologic Reviews, 29, 6–28.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Weiss, J. L., Malone, F. D., Emig, D., et al. (2004). Obesity, obstetric complications and cesarean delivery rate—A population-based screening study. American Journal of Obstetrics and Gynecology, 190, 1091–1097.

    PubMed  Article  Google Scholar 

  4. 4.

    Chu, S. Y., Kim, S. Y., Lau, J., et al. (2007). Maternal obesity and risk of stillbirth: A metaanalysis. American Journal of Obstetrics and Gynecology, 197, 223–228.

    PubMed  Article  Google Scholar 

  5. 5.

    Stothard, K. J., Tennant, P. W. G., Bell, R., et al. (2009). Maternal overweight and obesity and the risk of congenital anomalies: A systematic review and meta-analysis. JAMA, 301, 636–650.

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Kominiarek, M. A., Vanveldhuisen, P., Hibbard, J., et al. (2010). The maternal body mass index: a strong association with delivery route. Am J Obstet Gynecol., 203(3), 264 e1–264 e7.

    Article  Google Scholar 

  7. 7.

    Gunatilake, R. P., & Perlow, J. H. (2011). Obesity and pregnancy: Clinical management of the obese gravida. American Journal of Obstetrics and Gynecology, 204, 106–119.

    PubMed  Article  Google Scholar 

  8. 8.

    Myles, T. D., Gooch, J., & Santolaya, J. (2002). Obesity as an independent risk factor for infectious morbidity in patients who undergo cesarean delivery. Obstetrics and Gynecology, 100, 959–964.

    PubMed  Article  Google Scholar 

  9. 9.

    Blomberg, M. (2011). Maternal obesity and risk of postpartum hemorrhage. Obstetrics and Gynecology, 118(3), 561–568.

    PubMed  Article  Google Scholar 

  10. 10.

    Institute of Medicine. (2009). Weight gain during pregnancy: Reexamining the guidelines. Washington, DC.

  11. 11.

    Moore Simas, T. A., Doyle Curiale, D. K., Hardy, J., et al. (2010). Efforts needed to provide Institute of Medicine-recommended guidelines for gestational weight gain. Obstetrics and Gynecology, 115(4), 777–783.

    PubMed  Article  Google Scholar 

  12. 12.

    Bodnar, L. M., Siega-Riz, A. M., Simhan, H. N., et al. (2010). Severe obesity, gestational weight gain, and adverse birth outcomes. American Journal of Clinical Nutrition, 91(6), 1642–1648.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  13. 13.

    Krukowski, R. A., Bursac, Z., McGehee, M. A., et al. (2013). Exploring potential health disparities in excessive gestational weight gain. Journal of Women’s Health (Larchmt), 22(6), 494–500.

    Article  Google Scholar 

  14. 14.

    Oteng-Ntim, E., Varma, R., Croker, H., et al. (2012). Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: Systematic review and meta-analysis. BMC Medicine, 10, 47.

    PubMed Central  PubMed  Article  Google Scholar 

  15. 15.

    Dodd, J. M., Grivell, R. M., Crowther, C. A., et al. (2010). Antenatal interventions for overweight or obese pregnant women: A systematic review of randomised trials. BJOG, 117, 1316–1326.

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Campbell, F., Johnson, M., Messina, J., et al. (2011). Behavioural interventions for weight management in pregnancy: A systematic review of quantitative and qualitative data. BMC Public Health, 11, 491.

    PubMed Central  PubMed  Article  Google Scholar 

  17. 17.

    Hui, A., Back, L., Ludwig, S., et al. (2012). Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial. BJOG, 119, 70–77.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Wolff, S., Legarth, J., Vangsgaard, K., et al. (2008). A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. International Journal of Obesity, 32, 495–501.

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Jeffries, K., Shub, A., Walker, S. P., et al. (2009). Reducing excessive weight gain in pregnancy: A randomised controlled trial. Medical Journal of Australia, 191, 429–433.

    PubMed  Google Scholar 

  20. 20.

    Callaway, L. K., Colditz, P. B., Byrne, N. M., et al. (2010). Prevention of gestational diabetes: Feasibility issues for an exercise intervention in obese pregnant women. Diabetes Care, 33, 1457–1459.

    PubMed Central  PubMed  Article  Google Scholar 

  21. 21.

    Guelinckx, I., Devlieger, R., Mullie, P., et al. (2010). Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: A randomized controlled trial. The American Journal of Clinical Nutrition, 91, 373–380.

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Nascimento, S. L., Surita, F. G., Parpinelli, M. Â., et al. (2011). The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: a randomised clinical trial. BJOG, 118, 1455–1463.

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Bechtel-Blackwell, D. A. (2002). Computer-assisted self-interview and nutrition education in pregnant teens. Clinical Nursing Research, 11, 450–462.

    PubMed  Article  Google Scholar 

  24. 24.

    Claesson, I.-M., Sydsjö, G., Brynhildsen, J., et al. (2008). Weight gain restriction for obese pregnant women: A case–control intervention study. BJOG, 115, 44–50.

    PubMed  Article  Google Scholar 

  25. 25.

    Rising, S. (1998). Centering Pregnancy: An interdisciplinary model of empowerment. Journal of Nurse-Midwifery, 43, 46–54.

    CAS  PubMed  Article  Google Scholar 

  26. 26.

    Wolfe, W. (2004). A review: maximizing social support—A neglected strategy for improving weight management with African-American women. Ethnicity and Disease, 14, 212–218.

    PubMed  Google Scholar 

  27. 27.

    Tsai, A. G., & Wadden, T. A. (2005). Systematic review: An evaluation of major commercial weight loss programs in the United States. Annals of Internal Medicine, 142, 56–66.

    PubMed  Article  Google Scholar 

  28. 28.

    Stotland, N. E., Gilbert, P., Bogetz, A., et al. (2010). Preventing excessive weight gain in pregnancy: How do prenatal care providers approach counseling? Journal of Women’s Health (Larchmt), 19(4), 807–814.

    Article  Google Scholar 

  29. 29.

    Power, M. L., Cogswell, M. E., & Schulkin, J. (2006). Obesity prevention and treatment practices of U.S. obstetrician-gynecologists. Obstetrics and Gynecology, 108(4), 961–968.

    PubMed  Article  Google Scholar 

  30. 30.

    Kushner, R. F., & Roth, J. L. (2003). Assessment of the obese patient. Endocrinology and Metabolism Clinics of North America, 32(4), 915–933.

    PubMed  Article  Google Scholar 

  31. 31.

    Gudzune, K. A., Beach, M. C., Roter, D. L., et al. (2013). Physicians build less rapport with obese patients. Obesity, 21(10), 2146–2152.

  32. 32.

    Stotland, N., Tsoh, J. Y., & Gerbert, B. (2012). Prenatal weight gain: Who is counseled? Journal of Women’s Health (Larchmt), 21(6), 695–701.

    Article  Google Scholar 

  33. 33.

    Herring, S. J., Platek, D. N., Elliott, P., et al. (2010). Addressing obesity in pregnancy: What do obstetric providers recommend? Journal of Women’s Health (Larchmt), 19(1), 65–70.

    Article  Google Scholar 

  34. 34.

    Knight, B. A., & Wyatt, K. (2010). Barriers encountered when recruiting obese pregnant women to a dietary intervention. Nursing Times, 17–23, 20–22.

    Google Scholar 

  35. 35.

    Perrin, E. M., Flower, K. B., Garrett, J., et al. (2005). Preventing and treating obesity: Pediatricians’ self-efficacy, barriers, resources, and advocacy. Ambulatory Pediatrics: The Official Journal of the Ambulatory Pediatric Association, 5(3), 150–156.

    Article  Google Scholar 

  36. 36.

    Yancey, A. K., Sallis, R. E., & Bastani, R. (2013). Changing physical activity participation for the medical profession. JAMA, 309(2), 141–142.

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Phelan, S., Phipps, M. G., Abrams, B., et al. (2011). Practitioner advice and gestational weight gain. Journal of Women’s Health (Larchmt), 20(4), 585–591.

    Article  Google Scholar 

  38. 38.

    Stengel, M. R., Kraschnewski, J. L., Hwang, S. W., et al. (2012). “What my doctor didn’t tell me”: Examining health care provider advice to overweight and obese pregnant women on gestational weight gain and physical activity. Women’s Health Issues, 22(6), e535–e540.

    PubMed Central  PubMed  Article  Google Scholar 

  39. 39.

    Roberts, A., & Ashley, G. (1999). What are the characteristics of overweight and obese patients who achieve weight loss and what factors are most helpful? A quantitative and qualitative study of patients and interventions in a rural general practice. Journal of Human Nutrition and Dietetics, 12(s1), 20–27.

    Article  Google Scholar 

  40. 40.

    Halcomb, E. J., Gholizadeh, L., DiGiacomo, M., et al. (2007). Literature review: Considerations in undertaking focus group research with culturally and linguistically diverse groups. Journal of Clinical Nursing, 16(6), 1000–1011.

    PubMed  Article  Google Scholar 

  41. 41.

    Murdaugh, C., Russell, R. B., & Sowell, R. (2000). Using focus groups to develop a culturally sensitive videotape intervention for HIV-positive women. Journal of Advanced Nursing, 32(6), 1507–1513.

    CAS  PubMed  Article  Google Scholar 

  42. 42.

    Krueger, R. C., & Anne, M. (2008). Focus groups: A practical guide for applied research (4th ed.). Thousand Oaks: Sage.

    Google Scholar 

  43. 43.

    Janz, N. K., & Becker, M. H. (1984). The Health Belief Model: A decade later. Health Education Quarterly, 11(1), 1–47.

    CAS  PubMed  Article  Google Scholar 

  44. 44.

    Patton, M. Q. (2002). Qualitative research & evaluation methods (3rd ed.). Thousand Oaks: Sage.

    Google Scholar 

  45. 45.

    Carey, J. W., Morgan, M., & Oxtoby, M. (1996). Inter-coder agreement in analysis of responses to open-ended interview questions: Examples from tuberculosis research. Cultural Anthropology Methods, 8, 1–5.

    Google Scholar 

  46. 46.

    Corbin, J., & Strauss, A. (2007). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd ed.). Thousand Oaks: Sage.

    Google Scholar 

  47. 47.

    Agne, A. A., Daubert, R., Munoz, M. L., et al. (2012). The cultural context of obesity: Exploring perceptions of obesity and weight loss among Latina immigrants. Journal of Immigrant and Minority Health, 14(6), 1063–1070.

    PubMed  Article  Google Scholar 

  48. 48.

    Young, D. R., Gittelsohn, J., Charleston, J., et al. (2001). Motivations for exercise and weight loss among African-American women: Focus group results and their contribution towards program development. Ethnicity and Health, 6(3–4), 227–245.

    CAS  PubMed  Article  Google Scholar 

  49. 49.

    Krans, E. E., & Chang, J. C. (2012). Low-income African American women’s beliefs regarding exercise during pregnancy. Maternal and Child Health Journal, 16(6), 1180–1187.

    PubMed  Article  Google Scholar 

  50. 50.

    Orr, S. T., James, S. A., Garry, J., et al. (2006). Exercise and pregnancy outcome among urban, low-income, black women. Ethnicity and Disease, 16(4), 933–937.

    PubMed  Google Scholar 

  51. 51.

    ACOG Committee opinion. (2002). Number 267, January 2002: Exercise during pregnancy and the postpartum period. Obstetrics and Gynecology, 99(1), 171–173.

    Article  Google Scholar 

  52. 52.

    Torloni, M. R., Fortunato, S. J., Betran, A. P., et al. (2012). Ethnic disparity in spontaneous preterm birth and maternal pre-pregnancy body mass index. Archives of Gynecology and Obstetrics, 285(4), 959–966.

    PubMed  Article  Google Scholar 

  53. 53.

    Torloni, M. R., Betran, A. P., Daher, S., et al. (2009). Maternal BMI and preterm birth: A systematic review of the literature with meta-analysis. Journal of Maternal-Fetal and Neonatal Medicine, 22(11), 957–970.

    PubMed  Article  Google Scholar 

  54. 54.

    Herring, S. J., Henry, T. Q., Klotz, A. A., et al. (2012). Perceptions of low-income African-American mothers about excessive gestational weight gain. Maternal and Child Health Journal, 16(9), 1837–1843.

    PubMed  Article  Google Scholar 

  55. 55.

    Brown, A., & Avery, A. (2012). Healthy weight management during pregnancy: What advice and information is being provided. Journal of Human Nutrition & Dietetics, 25(4), 378–387.

    CAS  Article  Google Scholar 

  56. 56.

    Oken, E., Switkowski, K., Price, S., et al. (2013). A qualitative study of gestational weight gain counseling and tracking. Maternal and Child Health Journal, 17(8), 1508–1517.

  57. 57.

    Smith, D. M., Cooke, A., & Lavender, T. (2012). Maternal obesity is the new challenge; a qualitative study of health professionals’ views towards suitable care for pregnant women with a body mass index (BMI) >/= 30 kg/m(2). BMC Pregnancy and Childbirth, 12, 157.

    PubMed Central  PubMed  Article  Google Scholar 

  58. 58.

    McKee, M. D., Maher, S., Deen, D., et al. (2010). Counseling to prevent obesity among preschool children: Acceptability of a pilot urban primary care intervention. The Annals of Family Medicine, 8(3), 249–255.

    Article  Google Scholar 

  59. 59.

    Ferrari, R. M., Siega-Riz, A. M., Evenson, K. R., et al. (2013). A qualitative study of women’s perceptions of provider advice about diet and physical activity during pregnancy. Patient Education and Counseling, 91(3), 372–377.

    PubMed Central  PubMed  Article  Google Scholar 

  60. 60.

    Sui, Z., Turnbull, D. A., & Dodd, J. M. (2013). Overweight and obese women’s perceptions about making healthy change during pregnancy: A mixed method study. Maternal and Child Health Journal, 17(10), 1879–1887.

  61. 61.

    Shieh, C., & Weaver, M. T. (2011). Comparisons in perceived importance of and needs for maternal gestational weight information between African American and caucasian pregnant women. The Journal of Perinatal Education, 20(2), 100–107.

    PubMed Central  PubMed  Article  Google Scholar 

  62. 62.

    Mills, A., Schmied, V. A., & Dahlen, H. G. (2013). ‘Get alongside us’, women’s experiences of being overweight and pregnant in Sydney, Australia. Maternal & Child Nutrition, 9(3), 309–321.

    Article  Google Scholar 

  63. 63.

    Johnson, M., Campbell, F., Messina, J., et al. (2013). Weight management during pregnancy: A systematic review of qualitative evidence. Midwifery, 29(12), 1287–1296.

  64. 64.

    Heslehurst, N., Moore, H., Rankin, J., et al. (2011). How can maternity services be developed to effectively address maternal obesity? A qualitative study. Midwifery, 27(5), e170–e177.

    PubMed  Article  Google Scholar 

  65. 65.

    Gittelsohn, J., Evans, M., Helitzer, D., et al. (1998). Formative research in a school-based obesity prevention program for Native American school children (Pathways). Health Education Research, 13(2), 251–265.

    CAS  PubMed  Article  Google Scholar 

  66. 66.

    Fitzgibbon, M. L., Tussing-Humphreys, L. M., Porter, J. S., et al. (2012). Weight loss and African-American women: A systematic review of the behavioural weight loss intervention literature. Obesity Reviews, 13(3), 193–213.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  67. 67.

    Novick, G. (2004). CenteringPregnancy and the current state of prenatal care. Journal of Midwifery & Women’s Health, 49(5), 405–411.

    Article  Google Scholar 

  68. 68.

    Novick, G., Reid, A. E., Lewis, J., et al. (2013). Group prenatal care: model fidelity and outcomes. Am J Obstet Gynecol, 209(2), 112 e1–112 e6.

    Article  Google Scholar 

Download references

Acknowledgments

Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number K23HD076010. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

The authors have no conflicts of interest to report.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Michelle A. Kominiarek.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kominiarek, M.A., Gay, F. & Peacock, N. Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers. Matern Child Health J 19, 1698–1712 (2015). https://doi.org/10.1007/s10995-015-1684-3

Download citation

Keywords

  • Prenatal care
  • Obesity
  • Provider education
  • Health disparities