Adopting a healthy lifestyle when pregnant and obese – an interview study three years after childbirth

Abstract

BackgroundObesity during pregnancy is increasing and is related to life-threatening and ill-health conditions in both mother and child. Initiating and maintaining a healthy lifestyle when pregnant with body mass index (BMI) ≥ 30 kg/m2 can improve health and decrease risks during pregnancy and of long-term illness for the mother and the child. To minimise gestational weight gain women with BMI ≥ 30 kg/m2 in early pregnancy were invited to a lifestyle intervention including advice and support on diet and physical activity in Gothenburg, Sweden.The aim of this study was to explore the experiences of women with BMI ≥ 30 kg/m2 regarding minimising their gestational weight gain, and to assess how health professionals’ care approaches are reflected in the women’s narratives.MethodsSemi-structured interviews were conducted with 17 women who had participated in a lifestyle intervention for women with BMI ≥ 30 kg/m2 during pregnancy 3 years earlier. The interviews were digitally recorded and transcribed in full. Thematic analysis was used.ResultsThe meaning of changing lifestyle for minimising weight gain and of the professional’s care approaches is described in four themes: the child as the main motivation for making healthy changes; a need to be seen and supported on own terms to establish healthy routines; being able to manage healthy activities and own weight; and need for additional support to maintain a healthy lifestyle.ConclusionsTo support women with BMI ≥ 30 kg/m2 to make healthy lifestyle changes and limit weight gain during pregnancy antenatal health care providers should 1) address women’s weight in a non-judgmental way using BMI, and provide accurate and appropriate information about the benefits of limited gestational weight gain; 2) support the woman on her own terms in a collaborative relationship with the midwife; 3) work in partnership to give the woman the tools to self-manage healthy activities and 4) give continued personal support and monitoring to maintain healthy eating and regular physical activity habits after childbirth involving also the partner and family.

Being targeted as a “severely overweight pregnant woman” —A qualitative interview study

“…Recollections of the first phase of targeting revolved around the themes of being identified as a target group based on weight, and agreeing to join interventions. In line with previous studies of women partaking in interventions and health‐care initiatives, we found that being approached on the basis of high BMI was remembered, not as something negative, but rather as an offer of help, or as something undertaken through genuine concern about the women and their children. However, in our study, some women also recalled that, in being identified, they felt as though they were negatively stereotyped.…”

“…The mothers in our study found that their participation in the intervention during pregnancy had very little long‐term significance: they had not achieved a lasting lifestyle change for themselves or their families. This finding is supported by a qualitative study from Sweden, which, to our knowledge, is the only other retrospective study on this topic. This, too, found that women had difficulty maintaining lifestyle change post‐natally as a consequence of work, stress, childcare and relationships with their partners .…”

“…This finding is supported by a qualitative study from Sweden, which, to our knowledge, is the only other retrospective study on this topic. This, too, found that women had difficulty maintaining lifestyle change post‐natally as a consequence of work, stress, childcare and relationships with their partners . Like the researchers in the Swedish study, we acknowledge that interventions during pregnancy can lead to short‐term change, but we suggest that if the alleged window of opportunity is to be harnessed to full effect women will need continuing help post‐partum and to share responsibility with their partners and other family .…”

“…This, too, found that women had difficulty maintaining lifestyle change post‐natally as a consequence of work, stress, childcare and relationships with their partners . Like the researchers in the Swedish study, we acknowledge that interventions during pregnancy can lead to short‐term change, but we suggest that if the alleged window of opportunity is to be harnessed to full effect women will need continuing help post‐partum and to share responsibility with their partners and other family . However, it is important to stress that, at present, the notion of pregnancy as a window of opportunity rests on the assumption that mothers have sole responsibility for keeping children healthy and are able single‐handedly to change family routines.…”

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

“…When considering previous studies on determinants of lifestyle behavior conducted in women of childbearing age, survey studies showed that women wishing to become pregnant were interested in lifestyle programs, especially when tailored to the possibilities within the daily life of women [14,15]. During pregnancy, health of the unborn child was an important motivator for adopting a healthy lifestyle [16][17][18]. On the other hand, pregnant women mentioned that being pregnant is a justification for not worrying about weight and pregnancy is a time to eat for two [16].…”