Weight management during pregnancy: a systematic review of qualitative evidence

Abstract

Background: increasing overweight and obesity rates in pregnant women present health risks to mother and unborn infant.

Objectives: to identify barriers and facilitators to implementing and carrying out maternal weight management interventions.

Search strategy: searches were carried out in medical, midwifery and nursing databases, augmented by hand searching of midwifery journals.

Selection criteria: articles were included that were published in the UK after 1990, with a focus on women's and health professional's views about weight management during pregnancy.

Data collection and analysis: from 6423 citations, 126 full text papers were retrieved. Of these, 18 (reporting 17 studies) fulfilled the inclusion criteria. Included papers were assessed for quality. Reported findings were analysed and synthesised using thematic analysis.

Main results: a major theme was access to relevant and appropriate information; advice was reported as vague or inadequate. Overweight or obese women reported feelings of stigmatisation during routine examinations. Health professionals reported a reluctance to discuss weight with larger women. Perceived risk to the fetus as well as changes in women's physiological responses to pregnancy, were reported barriers to optimal physical activity and dietary intake. Perceptions of control were related to women's feelings about their body image.

Conclusion: evidence suggests that the complexity of interactions with advice sources, bodily changes, feelings of control, as well as perceived risks may explain the relative ineffectiveness of weight management interventions during pregnancy. Focusing on healthy diet and physical activity levels may be more useful and less stigmatising than focusing on weight.

Keywords: Pregnancy; Qualitative evidence synthesis; Weight management.