A Qualitative Study of Factors Affecting Pregnancy Weight Gain in African American Women

Abstract

African Americans and overweight or obese women are at increased risk for excessive gestational weight gain (GWG) and postpartum weight retention. Interventions are needed to promote healthy GWG in this population; however, research on exercise and nutritional barriers during pregnancy in African American women is limited. The objective of this qualitative study is to better inform intervention messages by eliciting information on perceptions of appropriate weight gain, barriers to and enablers of exercise and healthy eating, and other influences on healthy weight gain during pregnancy in overweight or obese African American women. In-depth interviews were conducted with 33 overweight or obese African American women in Columbia, South Carolina. Women were recruited in early to mid-pregnancy (8–23 weeks gestation, n = 10), mid to late pregnancy (24–36 weeks, n = 15), and early postpartum (6–12 weeks postpartum, n = 8). Interview questions and data analysis were informed using a social ecological framework. Over 50 % of women thought they should gain weight in excess of the range recommended by the Institute of Medicine. Participants were motivated to exercise for personal health benefits; however they also cited many barriers to exercise, including safety concerns for the fetus. Awareness of the maternal and fetal benefits of healthy eating was high. Commonly cited barriers to healthy eating include cravings and availability of unhealthy foods. The majority of women were motivated to engage in healthy behaviors during pregnancy. However, the interviews also uncovered a number of misconceptions and barriers that can serve as future intervention messages and strategies.

Excess Gestational Weight Gain in Low-Income Overweight and Obese Women: A Qualitative Study

“…Our findings identified several barriers to healthy GWG that have also been suggested by previous research, including the powerful effect of family members and cultural and social norms promoting the desirability of large babies and the need to “eat for two,” 28 the challenge of coping with food cravings during pregnancy, 29,30 and poor food environments, including ubiquitous fast food and unhealthy foods, and lack of transportation. 29 Our findings also corroborate previous reports that a desire to return to a thinner pre-pregnancy weight is a strong motivating factor and may reduce risk for excess GWG, 31,32 that women are motivated to eat healthy for the sake of their babies, 32 and that personal experience with excess GWG and postpartum weight retention during a prior pregnancy is a salient motivator of healthy GWG.…”

Racial/Ethnic Disparities in Inadequate Gestational Weight Gain Differ by Pre-pregnancy Weight

“…This suggests that excessive GWG needs to be addressed in all women, however, there is evidence that, key barriers to and perceptions of GWG vary by race/ethnicity (63-65). In particular, Black (64,65) and Hispanic (66,67) women are more influenced by familial perceptions of weight gain and lack of provider advice. Minority women also report less physical activity during pregnancy due to less social support (63,64,68) and fear of hurting the baby (64,67).…”

“…In particular, Black (64,65) and Hispanic (66,67) women are more influenced by familial perceptions of weight gain and lack of provider advice. Minority women also report less physical activity during pregnancy due to less social support (63,64,68) and fear of hurting the baby (64,67). Additionally, women with lower acculturation rely more heavily on family members' recommendations (63,66), who advise gaining more weight than health care providers recommend.…”

Psychological factors and trimester-specific gestational weight gain: a systematic review

“…The first trimester is of particular interest given that early pregnancy provides a unique opportunity for healthcare providers to counsel pregnant women since many women improve their health behaviors in early pregnancy [9], and their motivation to engage in healthy behaviors during pregnancy is influenced by their perception of personal health benefit and that of their fetus [10]. Furthermore, identification of an increased likelihood of excess GWG in first and second trimester of pregnancy is important to allow sufficient time for potential interventions to improve adherence to recommendations for GWG.…”