The views of pre- and post-natal women and health professionals regarding gestational weight gain: An exploratory study

Abstract

Objectives

To explore the views of pre- and post-natal women and health professionals regarding gestational weight gain. The health professionals’ views concerning their provision to prevent unhealthy weight gain in pregnancy were also elicited. These views may inform the design of future interventions targeting gestational weight gain.

Study design

Focus groups were conducted with pregnant women (n = 9 and one midwife) and post-natal women (n = 14). One focus group (n = 6) and one interview was conducted with health professionals. The focus groups were transcribed verbatim and analysed thematically.

Main outcome measures

Themes concerning women’s and health professionals’ views about gestational weight gain and the health professionals views of their care related to gestational weight gain.

Results

The women expressed a lack of concern regarding their weight in pregnancy. The pregnant women reported not monitoring their weight and commonly assumed they would lose weight post-natally through breastfeeding. The health professionals reported being aware of the women’s views, but lacked information to give to the women regarding healthy weight gain.

Conclusions

Women lacked concern regarding their gestational weight gain at least partly due to not receiving appropriate information from their midwives and other health professionals. The health professionals were in turn unsure of what to advise women regarding appropriate gestational weight gain. By ensuring midwives and other health professionals have the knowledge, skills and opportunity to discuss weight with pregnant women, the women in turn may be more motivated to maintain a healthy weight during pregnancy.

Introduction

Pregnant women are increasingly overweight (body mass index [BMI] 25–29.9) or obese (BMI > 30) in England, with approximately 25% of women overweight and over 15% of women obese during their first trimester [1]. Maternal obesity is therefore one of the greatest future challenges for maternity services in both England [2] and elsewhere [3]. Ironically, it is the weight that women gain during pregnancy but fail to lose after pregnancy that could lead to the onset of obesity [4], or to women starting further pregnancies in an unhealthy weight state [5]. The more weight women gain during pregnancy, the more weight they are likely to retain post-natally [6] and crucially, gestational weight gain has been found to be the most consistent predictor of post-natal weight retention [7]. In addition, excessive weight gain (i.e. more weight gained than recommended based on the woman’s pre-pregnancy weight status as suggested by the American Institute of Medicine [8]) can increase the mother’s risk of preeclampsia, risk of delivering by caesarean section and of giving birth to a large-for-gestational age baby [9], [10].

Recent findings from intervention studies show that gestational weight gain can be kept at a healthy level in both healthy-weight women (BMI 18.5–24.9) [6] and overweight women [11]. In other words, excess gestational weight gain is preventable [12]. However, the factors that influence gestational weight gain are currently poorly understood [13] and more information is needed on women’s views and knowledge regarding weight gain in pregnancy [4].

Past research conducted in England has found that the main sources of information the majority of women encounter during pregnancy is their midwife [14] and the Pregnancy Book published by the Department of Health [15]. Health professionals, including midwives, have previously reported mixed feelings regarding assessing and discussing gestational weight gain with pregnant women [16]. The Pregnancy Book is free to all expectant mothers and, although almost 200 pages long, provides limited information on gestational weight gain. The book merely informs women that ‘If we eat more than we need, this can lead to weight gain.’ (p. 25) and ‘Putting on too much weight can affect your health and increase your blood pressure.’ (p 26). Importantly, there is no mention of the risks to the baby regarding excessive weight gain [15], such as infant macrosomia. If the woman is concerned about her gestational weight gain, it is suggested she speaks to her midwife or doctor (p. 26) [15]. In sum, the information for women regarding gestational weight gain to date has been very limited.

In terms of intervention targets, gestational weight gain may be an easier and more practical target than pre-conception weight as most women do not come into contact with health professionals until they are pregnant. Although a woman’s pre-pregnancy weight may have a greater effect on her and her baby’s health than the amount of weight she gains during pregnancy and thus is an important intervention target, recent UK guidelines state that more research is needed regarding the most effective ways of helping women manage their weight during pregnancy [17]. Additionally, all women, irrespective of pre-pregnancy weight, must be careful to not gain excessive weight in pregnancy [9], thus many women may benefit from an intervention targeting gestational weight gain [18]. It is important to take pregnant women’s views regarding weight into account to be able to develop effective interventions [19] and to increase the chance of intervention success, women need to be positive towards healthy weight management in pregnancy [18], [20]. Consequently, before designing an intervention targeting gestational weight gain we wanted to explore women’s views towards this issue. Although there is emerging evidence that English women are not very concerned about their weight gain in pregnancy [21], most of the research to date has been conducted in USA [22], [23], [24]. Thus, more exploration of English pregnant women’s views of weight gain in pregnancy is necessary [25] as well as the views of health professionals. Health professionals, especially midwives, have an ideal opportunity to provide women with information about how their pregnancy is affected by their weight [2], [19].

Based on this, the aim of this study was to explore English pre- and post-natal women’s and health professionals’ views regarding gestational weight gain. The health professionals’ views about the current provision of care they provide to pregnant women regarding weight gain were also elicited. The current study was commissioned and funded by a local council with the goal of informing future interventions targeting excessive weight gain (i.e. gain more weight than recommended by the Institute of Medicine, see [8] for more details) in pregnancy.