Perceptions of risk and influences of choice in pregnant women with obesity. An evidence synthesis of qualitative research

Relph, Sophie; Ong, Melissa; Vieira, Matias C.; Pasupathy, Dharmintra; Sandall, Jane

doi:10.1371/journal.pone.0227325

Cited by 14 publications

(13 citation statements)

References 50 publications

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“…An important consideration proposed by Relph et al [40] who described that discussions around pregnancy risk between women with obesity and their healthcare provider appeared to be avoided unless risk arose, suggesting there may be reluctance from both HCPs and women to initiate discussion about risk. It may be that HCPs are concerned of introducing unwarranted anxiety over potential risks that may not occur [40], although Garrud, Wood, and Stainsby [41] reported that providing detailed risk information was associated with greater knowledge with no increase in anxiety. Limited information provided may give women a false sense of security in their perception of pregnancy risk.…”

Section: Plos Onementioning

confidence: 99%

Perceptions of risk in pregnancy with chronic disease: A systematic review and thematic synthesis

et al. 2021

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Background Women with chronic disease are at increased risk of adverse pregnancy outcomes. Pregnancies which pose higher risk, often require increased medical supervision and intervention. How women perceive their pregnancy risk and its impact on health behaviour is poorly understood. The aim of this systematic review of qualitative literature is to evaluate risk perceptions of pregnancy in women with chronic disease. Methods Eleven electronic databases including grey literature were systematically searched for qualitative studies published in English which reported on pregnancy, risk perception and chronic disease. Full texts were reviewed by two researchers, independently. Quality was assessed using the Critical Appraisal Skills Programme Qualitative checklist and data were synthesised using a thematic synthesis approach. The analysis used all text under the findings or results section from each included paper as data. The protocol was registered with PROSPERO. Results Eight studies were included in the review. Three themes with sub-themes were constructed from the analysis including: Information Synthesis (Sub-themes: Risk to Self and Risk to Baby), Psychosocial Factors (Sub-themes: Emotional Response, Self-efficacy, Healthcare Relationship), and Impact on Behaviour (Sub-themes: Perceived Risk and Objective Risk). Themes fitted within an overarching concept of Balancing Act. The themes together inter-relate to understand how women with chronic disease perceive their risk in pregnancy. Conclusions Women’s pregnancy-related behaviour and engagement with healthcare services appear to be influenced by their perception of pregnancy risk. Women with chronic disease have risk perceptions which are highly individualised. Assessment and communication of women’s pregnancy risk should consider their own understanding and perception of risk. Different chronic diseases introduce diverse pregnancy risks and further research is needed to understand women’s risk perceptions in specific chronic diseases.

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Section: Plos Onementioning

confidence: 99%

Perceptions of risk in pregnancy with chronic disease: A systematic review and thematic synthesis

et al. 2021

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“…As regards capabilities, it was demonstrated that there is need to find consistent ways to broach the topic of overweight. Both health care professionals and pregnant women seem to avoid discussion regarding obesity and weight-management [27]. Health technology, such as smart wearables could be utilized as part of antenatal care and a means of introducing the topic of weight and weight management.…”

Section: Discussionmentioning

confidence: 99%

Identifying target behaviors for weight management interventions for women who are overweight during pregnancy and the postpartum period: a qualitative study informed by the Behaviour Change Wheel

Saarikko

Niela‐Vilén

Rahmani

et al. 2021

BMC Pregnancy Childbirth

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Background Maternal overweight is increasing, and it is associated with several risk factors for both the mother and child. Healthy lifestyle behaviors adopted during pregnancy are likely to impact women’s health positively after pregnancy. The study’s aim was to identify and describe weight management behaviors in terms of the Capability, Opportunity and Motivation Behaviour (COM-B) -model to target weight management interventions from both the perspectives of women who are overweight and maternity care professionals. Methods This qualitative, descriptive study was conducted between 2019 and 2020. Individual interviews with pregnant and postpartum women who were overweight (n = 11) and focus group interviews with public health nurses (n = 5) were undertaken in two public maternity clinics in Southwest Finland. The data were analyzed using deductive content analysis consistent with the COM-B model. Results In the capability category, the women and the public health nurses thought that there was a need to find consistent ways to approach overweight, as it had often become a feature of the women’s identities. The use of health technology was considered to be an element of antenatal care that could be used to approach the subject of weight and weight management. Smart wearables could also support an evaluation of the women’s lifestyles. The opportunity category highlighted the lack of resources for support during perinatal care, especially after birth. Both groups felt that support from the family was the most important facilitating factor besides motivation. The women also expressed a conflict between pregnancy as an excuse to engage in unhealthy habits and pregnancy as a motivational period for a change of lifestyle. Furthermore, the women wanted to be offered a more robust stance on weight management and discreet counseling. Conclusions Our findings offer a theoretical basis on which future research can define intervention and implementation strategies. Such interventions may offer clear advice and non-judgmental support during pregnancy and after delivery by targeting women’s capabilities, opportunities, and motivation. Health technology could be a valuable component of intervention, as well as an implementation strategy, as they provide ways during maternity care to approach this topic and support women.

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“…Women with obesity are already at increased risk of many obstetric complications including preeclampsia, gestational diabetes, venous thromboembolism, and need to deliver by CD, as well as neonatal morbidity and mortality 15 . A recent evidence synthesis regarding perception of pregnancy risks in women with obesity has shown that women with obesity felt fearful of consultations because of the perceived stigma around being obese, which led to perceived over‐inflation of the risks 21 . It is therefore important to clarify to clinicians that obesity is not associated with increased risk of PAS to avoid further unnecessary anxiety.…”

Section: Discussionmentioning

confidence: 99%

The relation between maternal obesity and placenta accreta spectrum: A multinational database study

Vieira

Rijken

Braun³

et al. 2021

Acta Obstet Gynecol Scand

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Introduction It has been suggested that women with obesity have increased risk of developing placenta accreta spectrum (PAS). It is unclear if this is independent of the increased risk of cesarean delivery seen with obesity itself. The aim of this study was to explore the association between maternal obesity and PAS, particularly severe PAS (percreta). Material and methods This is a cohort study based on cases recorded in the International Society for Placenta Accreta Spectrum (IS‐PAS) database between April 2008 and May 2019. Multivariable logistic regression was used to explore the effect of maternal obesity on severity of PAS; this model was adjusted for other known risk factors including previous cesarean deliveries, maternal age, and placenta previa. The estimated rate of obesity in a hypothetical cohort with similar characteristics (previous cesarean delivery and same parity) was calculated and compared with the observed rate of obesity in the women of the PAS cohort (one sample test of proportions). Results Of the 386 included women with PAS, 227 (58.8%) had severe disease (percreta). In univariable analysis, maternal obesity initially appeared to be associated with increased odds of developing the most severe type of PAS, percreta (odds ratio [OR] 1.87; 95% CI 1.14‐3.09); however, this association was lost after adjustment for other risk factors including previous cesarean delivery (OR 1.44; 95% CI 0.85‐2.44). There was no difference in the observed rate of obesity and the rate estimated based on the risk of cesarean delivery from obesity alone (31.3% vs 36.8%, respectively; P = .07). Conclusions Obesity does not seem to be an independent risk factor for PAS or severity for PAS. These findings are relevant for clinicians to provide accurate counseling to women with obesity regarding increased risks related to pregnancy.

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Perceptions of risk and influences of choice in pregnant women with obesity. An evidence synthesis of qualitative research

Cited by 14 publications

References 50 publications

Perceptions of risk in pregnancy with chronic disease: A systematic review and thematic synthesis

Perceptions of risk in pregnancy with chronic disease: A systematic review and thematic synthesis

Identifying target behaviors for weight management interventions for women who are overweight during pregnancy and the postpartum period: a qualitative study informed by the Behaviour Change Wheel

The relation between maternal obesity and placenta accreta spectrum: A multinational database study

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