A Qualitative Study to Examine Perceptions and Barriers to Appropriate Gestational Weight Gain among Participants in the Special Supplemental Nutrition Program for Women Infants and Children Program

Abstract

Women of reproductive age are particularly at risk of obesity because of excessive gestational weight gain (GWG) and postpartum weight retention, resulting in poor health outcomes for both mothers and infants. The purpose of this qualitative study was to examine perceptions and barriers to GWG among low-income women in the WIC program to inform the development of an intervention study. Eleven focus groups were conducted and stratified by ethnicity, and each group included women of varying age, parity, and prepregnancy BMI ranges. Participants reported receiving pressure from spouse and family members to “eat for two” among multiple barriers to appropriate weight gain during pregnancy. Participants were concerned about gaining too much weight but had minimal knowledge of weight gain goals during pregnancy. Receiving regular weight monitoring was reported, but participants had inconsistent discussions about weight gain with healthcare providers. Most were not aware of the IOM guidelines nor the fact that gestational weight gain goals differed by prepregnancy weight status. Results of these focus groups analyses informed the design of a pregnancy weight tracker and accompanying educational handout for use in an intervention study. These findings suggest an important opportunity for GWG education in all settings where pregnant women are seen.

Socio-ecological determinants of lifestyle behavior of women with overweight or obesity before, during and after pregnancy: qualitative interview analysis in the Netherlands

“…The determinants in women of childbearing age as found in this study, were comparable to determinants of lifestyle behavior in the general population as found in previous studies [9,16,19,[35][36][37][38]. The findings of period specific determinants are especially relevant when supporting women to adopt a healthy lifestyle continuously in the periods before, during and after pregnancy.…”

“…[35][36][37][38][39] years of age; parity 1; preconception): "Once I have read that when you are overweight, that becoming pregnant could take a longer time […] I would like to prevent that." Participant 18 (20-24 years of age; parity 1; postpartum and preconception): "Actually I only want to become pregnant when my weight is adequate.…”

Focusing on Excessive Gestational Weight Gain through Weight Tracking Among Participants of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Southern California

“…The intervention was designed to help WIC participants avoid gaining weight beyond the IOM recommendations for GWG. Based on extensive qualitative research in which the study team conducted focus groups with pregnant WIC participants (Kim, Koleilat, & Whaley, 2016), the intervention was designed with two major components that could be easily integrated into core WIC services: guidance about monitoring GWG using a pregnancy weight tracker (GWG Tracker) adapted from the IOM (The Institute of Medicine [IOM] & National Research Council of the National Academies, n.d.) and accompanying three oneon-one education sessions with a WIC nutritionist.…”

“…Because weight gain recommendations are not the same for all women, but vary based on their pre-pregnancy weight, dissemination of appropriate materials can be challenging in a busy public health clinic setting. In addition, feedback from focus groups strongly suggested that women prefer information tailored to their specific needs and not generic information that may or may not apply to them (Kim, Koleilat, & Whaley, 2016). To facilitate ease of use as well as personalization of the tracker, we created trafficlight color-coded trackers for each of the four pre-pregnancy BMI groups: green for normal weight women, yellow for overweight women, red for obese women and blue for underweight women.…”

“…An educational four-page handout that contained information about weight gain during pregnancy was designed by the authors based on focus group feedback (Kim, Koleilat, & Whaley, 2016). Topic areas included: the consequences of excessive GWG, healthy meal ideas using WIC foods, ideas on how to fight cravings, and advice regarding exercise during pregnancy.…”