"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

Penn State College of Medicine, Hershey, Pennsylvania.
Women s Health Issues (Impact Factor: 1.61). 11/2012; 22(6):e535-40. DOI: 10.1016/j.whi.2012.09.004
Source: PubMed


Appropriate gestational weight gain (GWG) is vital, as excessive GWG is strongly associated with postpartum weight retention and long-term obesity. How health care providers counsel overweight and obese pregnant women on appropriate GWG and physical activity remains largely unexplored.
We conducted semistructured interviews with overweight and obese women after the birth of their first child to ascertain their experiences with GWG. A grounded theory approach was used to identify themes on provider advice received about GWG and physical activity during pregnancy.
Twenty-four women were included in the analysis. Three themes emerged in discussions regarding provider advice on GWG: 1) Women were advised to gain too much weight or given no recommendation for GWG at all, 2) providers were perceived as being unconcerned about excessive GWG, and 3) women desire and value GWG advice from their providers. On the topic of provider advice on exercise in pregnancy, three themes were identified: 1) Women received limited or no advice on appropriate physical activity during pregnancy, 2) women were advised to be cautious and limit exercise during pregnancy, and 3) women perceived that provider knowledge on appropriate exercise intensity and frequency in pregnancy was limited.
This study suggests that provider advice on GWG and exercise is insufficient and often inappropriate, and thus unlikely to positively influence how overweight and obese women shape goals and expectations in regard to GWG and exercise behaviors. Interventions to help pregnant women attain healthy GWG and adequate physical activity are needed.

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Available from: Kristen Kjerulff, Oct 12, 2015
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    • "Furthermore, previous studies have also shown that pregnant women experience lack of information regarding physical activity, advice on appropriate gestational weight gain, and physical exercise during pregnancy. In addition, they often perceive the caregivers’ knowledge as limited [13]. A qualitative study concludes that pregnant women need unambiguous advice regarding healthy lifestyle, diet, and exercise during pregnancy [14]. "
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    ABSTRACT: Background In Sweden, midwives play prominent supportive role in antenatal care by counselling and promoting healthy lifestyles. This study aimed to explore how Swedish midwives experience the counselling of pregnant women on physical activity, specifically focusing on facilitators and barriers during pregnancy. Also, addressing whether the midwives perceive that their own lifestyle and body shape may influence the content of the counselling they provide. Methods Eight focus group discussions (FGD) were conducted with 41 midwives working in antenatal care clinics in different parts of Sweden between September 2013 and January 2014. Purposive sampling was applied to ensure a variation in age, work experience, and geographical location. The FGD were digitally recorded, transcribed verbatim, and analyzed using manifest and latent content analysis. Results The main theme– “An on-going individual adjustment” was built on three categories: “Counselling as a challenge”; “Counselling as walking the thin ice” and “Counselling as an opportunity” reflecting the midwives on-going need to adjust their counselling depending on each woman’s specific situation. Furthermore, counselling pregnant women on physical activity was experienced as complex and ambiguous, presenting challenges as well as opportunities. When midwives challenged barriers to physical activity, they risked being rejected by the pregnant women. Despite risking rejection, the midwives tried to promote increased physical activity based on their assessment of individual needs of the pregnant woman. Some participants felt that their own lifestyle and body shape might negatively influence the counselling; however, the majority of participants did not agree with this perspective. Conclusions Counselling on physical activity during pregnancy may be a challenging task for midwives, characterized by on-going adjustments based on a pregnant woman’s individual needs. Midwives strive to find individual solutions to encourage physical activity. However, to improve their counselling, midwives may benefit from further training, also organizational and financial barriers need to be addressed. Such efforts might result in improved opportunities to further support pregnant women’s motivation for performance of physical activity.
    BMC Pregnancy and Childbirth 09/2014; 14(343). DOI:10.1186/1471-2393-14-343 · 2.19 Impact Factor
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    • "Negative attitudes towards obesity have been suggested to result in less than adequate provision of weight management guidance and advice by health professionals [23] and negative experiences of treatment by overweight and obese individuals [23]. Some women in our sample felt they received inappropriate comments or lack of advice regarding their weight and gestational weight gain, which is in line with findings from previous investigators [24-26]. Thus there is a significant need to address both obesity stigma and skills and confidence in providing weight management advice to overweight pregnant women amongst health professionals. "
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    ABSTRACT: Background The National Institute for Health and Clinical Excellence (NICE) published guidance on weight management in pregnancy in July 2010 (NICE public health guidance 27: 2010), and this received considerable press coverage across a range of media. This offered an opportunity to examine how gestational weight management guidance was received by UK women. Methods A thematic analysis was conducted of 400 posts made in UK-based parenting internet forums in the week following the publication of the NICE guidance. This allowed us to examine the naturally occurring comments from 202 women who posted about the guidance on public forums. Results Three main themes were identified and explored: i) Perceived control/responsibility ii) Risk perception iii) Confused messages. Conclusions Women differed in their perceptions of the level of control that they had over being overweight with some feeling responsible and motivated to maintain a healthy lifestyle. Others felt there were multiple factors influencing their weight issues beyond their control. There were reports of feeling guilty about the impact of weight on the growing baby and experiencing significant obesity stigma from the public and health professionals. Information about the risks of overweight and obesity in pregnancy were difficult messages for women to hear, and for health professionals to deliver. Women reported being confused by the messages that they received. Health messages need to be delivered sensitively to women, and health professionals need support and training to do this. Risk information should always be accompanied with clear advice and support to help women to manage their weight in pregnancy.
    BMC Pregnancy and Childbirth 06/2014; DOI:10.1186/1471-2393-14-216 · 2.19 Impact Factor
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    • "I have questions to ask her but she has no time'. This lack of attention to the issue of maternal weight gain by physicians has been reported elsewhere (Tovar et al. 2010; Stengel et al. 2012), although given the recent attention to the issue of excessive pregnancy weight gain in both the medical and popular literature, one wonders if this situation will begin to change. Only a few participants noted the purported danger of excessive weight gain for the health of the foetus, although they appeared to be convinced of the risks. "
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    ABSTRACT: In this article, we use qualitative methodology to explore how 15 low-income women of diverse sociocultural location construct and experience health and weight gain during pregnancy, as well as how they position themselves in relation to messages pertaining to weight gain, femininity and motherhood that they encounter in their lives. Discussing the findings through a feminist poststructuralist lens, we conclude that the participants are complex, fragmented subjects, interpellated by multiple and at times conflicting subject positions. While the discourse of maternal responsibility (i.e. managing personal behaviours for the baby's health) is very much in evidence in their narratives, embodied experiences of pregnancy, lived experiences of financial constraints and religious beliefs provided some with an alternative discourse and resistant subject position. Participants also had mixed emotions about weight gain; they recognized the need to gain weight in order to have a healthy pregnancy, but weight gain was also not welcome as participants reproduced the dominant discourse of obesity and the discourse of 'feminine' bodily norms. Based on our results, we advocate for change to recent clinical guidelines and social discourses around pregnancy and weight gain, as well as for policies that provide pregnant women with a range of health-promoting resources.
    Nursing Inquiry 12/2013; 21(3). DOI:10.1111/nin.12052 · 1.44 Impact Factor
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