"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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    • "This may indicate that providers are not discussing exercise with their antenatal patients, or not counselling women in a way that is meaningful. Other qualitative studies have also found women report insufficient or no provider counselling on exercise during pregnancy (Stengel et al., 2012; Ferrari et al., 2013). White women were more likely to cite themselves as influencing their weight gain and exercise, while African American women more frequently discussed their mothers as influencing their exercise and dietary behaviours . "
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    ABSTRACT: Objective: To describe African American and White women's perceptions of weight gain, physical activity, and nutrition during pregnancy and to explore differences in perceptions by race. Design: Qualitative interview study. Setting: Two Ob/Gyn clinics in South Carolina, USA. Participants: Thirty pregnant women (15 African American, 15 White) between 20 and 30 weeks gestation, equally represented across pre-pregnancy BMI categories (10 normal weight, 10 overweight, and 10 obese). Findings: White women more frequently described intentions to meet weight gain, physical activity, and dietary guidelines in pregnancy than African American women. African American women were more concerned with inadequate weight gain while White women more commonly expressed concerns about excessive weight gain. More White women discussed the importance of physical activity for weight management. Regardless of race, few women described risks of excessive weight gain or benefits of physical activity as it relates to the baby's health. The primary cited barrier of healthy eating was the high cost of fresh produce. Key conclusions and implications for practice: Several knowledge gaps as well as race differences were identified in women's perceptions and intentions toward weight gain, physical activity, and nutrition during pregnancy. Future interventions should seek to educate women about common misperceptions. It may be necessary to culturally tailor gestational weight gain interventions to optimise health outcomes.
    Midwifery 11/2015; DOI:10.1016/j.midw.2015.11.005 · 1.57 Impact Factor
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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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