Elsevier

Obesity Research & Clinical Practice

Volume 8, Issue 6, November–December 2014, Pages e577-e583
Obesity Research & Clinical Practice

Original Article
Behaviours of overweight and obese women during pregnancy who achieve and exceed recommended gestational weight gain

https://doi.org/10.1016/j.orcp.2013.12.254Get rights and content

Summary

Background

Excessive gestational weight gain (GWG) is associated with increased risk of pregnancy-related complications, postpartum weight retention, and long-term obesity. Little is known about the behavioural habits of pregnant women who achieve and exceed recommended GWG.

Method

In 2011, qualitative interviews were conducted in Pennsylvania with postpartum women who were overweight or obese prior to pregnancy to ascertain their behaviours and attitudes regarding dietary habits, physical activity, and self-monitoring during pregnancy. Thematic analysis identified the habits of women who achieved and exceeded recommended GWG guidelines.

Results

Of the 29 women interviewed, 11 had appropriate GWG and 18 had excessive GWG. Women achieving appropriate GWG reported modest increases in caloric intake if at all, with deliberate meal and snack planning, while women with excessive GWG described “eating-for-two.” Nearly all women with excessive GWG reported exercising less during pregnancy (or remaining sedentary), while women with appropriate GWG largely increased or maintained pre-pregnancy physical activity levels. About half of the sample reported self-monitoring weight gain during pregnancy, but women achieving recommended GWG tied their weight monitoring with GWG goals consistent with recommended guidelines.

Conclusions

Women who achieved appropriate GWG reported deliberate dietary habits and physical activity planning, with appropriate GWG goals during pregnancy. Women exceeding recommended GWG described “eating-for-two,” were sedentary, and either had no goals for GWG or intended to gain more weight than recommended.

Introduction

Excessive weight gain during pregnancy predisposes women to postpartum weight retention and increased risk for long-term overweight and obesity [1], [2], [3], [4] making preventing excessive gestational weight gain (GWG) an important target for obesity prevention. Additionally, excessive GWG is associated with risk of premature birth, large-for-gestational age infants, lower breastfeeding initiation rates, thromboembolic events, and cesarean delivery [5], [6], [7], [8]. The 2009 Institute of Medicine (IOM) guidelines recommend that women normal weight, overweight, and obese prior to pregnancy gain 25–35 pounds, 15–25 pounds, and 11–20 pounds, respectively [6]. While gestational weight gain has been increasing among pregnant women in all weight categories, overweight women are especially at risk. Currently, 60% of overweight women exceed the IOM GWG recommendations compared with 40% of normal weight women [9], [10].

Interventions aimed at preventing excessive GWG have had limited success, and none have been effective in women already overweight or obese prior to pregnancy [11], [12], [13], [14]. These trials have included resource-intensive behavioural interventions consisting of calorie restriction, physical activity, or both. Since these approaches have had only modest success in achieving recommended GWG, we propose identifying novel behaviours and attitudes of women who have either successfully achieved recommended GWG on their own or have exceeded recommended GWG [15], [16]. Although the basic principles of healthy nutrition and physical activity apply to both pregnant and non-pregnant persons, pregnancy is influenced by morning sickness, worsening of gastrointestinal reflux symptoms, food cravings and aversions, and the common adage of “eating-for-two.” Federal guidelines recommend at least 150 min of moderate-intensity aerobic activity a week in the absence of absolute contraindications for pregnant and non-pregnant adults alike [17], however, actual prenatal physical activity habits can be influenced by widespread beliefs that exercise during pregnancy can be dangerous, as well as by physical limitations to exercise as women advance through pregnancy. The purpose of this qualitative study is to identify the behaviours and attitudes of overweight and obese women who achieve and exceed current GWG recommendations, which can later be used to inform interventions aimed at preventing excessive GWG.

Section snippets

Materials and methods

In summer 2011, qualitative interviews were conducted with women following the birth of their first child to ascertain their pregnancy experiences related to GWG [18]. The sample was recruited from participants of the Penn State First Baby Study [19], an on-going longitudinal cohort study of women aged 18–35 who were nulliparous and pregnant with a singleton gestation. Women were eligible if they were overweight (body mass index (BMI) 25.0–29.9 kg/m2) or obese (BMI ≥30.0 kg/m2) prior to

Participant characteristics

Participants were 14 women who were overweight and 15 women who were obese prior to pregnancy [median pre-pregnancy BMI of 30.0 kg/m2 (range 25.0–48.7 kg/m2)] (Table 2). Nine of the 14 overweight women and 9 of the 15 obese women exceeded recommended GWG (median GWG was 35 lbs (range 16–60 lbs) and 25 lbs (range 7–55 lbs) for overweight and obese women, respectively). Women were between 4 and 27 months postpartum at the time of the interview. The themes that emerged from the qualitative analysis were

Discussion

The majority of U.S. pregnant women currently exceed the GWG recommendations set forth by the IOM [6]. Using qualitative methodology, this study identifies the habits of overweight and obese women who succeeded at achieving recommended GWG, compared with women with excessive GWG. Women achieving recommended GWG had deliberate dietary plans consisting of small meals and frequent snacks with minimal to no changes in overall calorie intake, and were physically active. Conversely, women with

Conflict of interest

The authors have no conflicts of interest to disclose.

Acknowledgements

This research was supported by a grant from the Association of Faculty and Friends, Penn State College of Medicine. Dr. Chuang was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23 HD051634). Dr. Kraschnewski is supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1RR033184 and KL2RR033180. Further, we acknowledge the support of the

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