Skip to main content
Top
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Anna Dencker, Åsa Premberg, Ellinor K. Olander, Christine McCourt, Karin Haby, Sofie Dencker, Anna Glantz, Marie Berg

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

Login to get access

Abstract

Background

Obesity 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.

Methods

Semi-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.

Results

The 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.

Conclusions

To 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.
Literature
1.
go back to reference Marchi J, Berg M, Dencker A, Olander EK, Begley C. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev. 2015;16(8):621–38.CrossRefPubMed Marchi J, Berg M, Dencker A, Olander EK, Begley C. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev. 2015;16(8):621–38.CrossRefPubMed
2.
go back to reference Lof M, Hilakivi-Clarke L, Sandin S, Weiderpass E. Effects of pre-pregnancy physical activity and maternal BMI on gestational weight gain and birth weight. Acta Obstet Gynecol Scand. 2008;87(5):524–30.CrossRefPubMed Lof M, Hilakivi-Clarke L, Sandin S, Weiderpass E. Effects of pre-pregnancy physical activity and maternal BMI on gestational weight gain and birth weight. Acta Obstet Gynecol Scand. 2008;87(5):524–30.CrossRefPubMed
3.
go back to reference Blomberg M. Maternal and neonatal outcomes among obese women with weight gain below the new institute of medicine recommendations. Obstet Gynecol. 2011;117(5):1065–70.CrossRefPubMed Blomberg M. Maternal and neonatal outcomes among obese women with weight gain below the new institute of medicine recommendations. Obstet Gynecol. 2011;117(5):1065–70.CrossRefPubMed
4.
go back to reference Heslehurst N. Identifying ‛at risk’ women and the impact of maternal obesity on National Health Service maternity services. Proc Nutr Soc. 2011;70(4):439–49.CrossRefPubMed Heslehurst N. Identifying ‛at risk’ women and the impact of maternal obesity on National Health Service maternity services. Proc Nutr Soc. 2011;70(4):439–49.CrossRefPubMed
5.
go back to reference Claesson IM, Sydsjo G, Brynhildsen J, Blomberg M, Jeppsson A, Sydsjo A, Josefsson A. Weight after childbirth: a 2-year follow-up of obese women in a weight-gain restriction program. Acta Obstet Gynecol Scand. 2011;90(1):103–10.CrossRefPubMed Claesson IM, Sydsjo G, Brynhildsen J, Blomberg M, Jeppsson A, Sydsjo A, Josefsson A. Weight after childbirth: a 2-year follow-up of obese women in a weight-gain restriction program. Acta Obstet Gynecol Scand. 2011;90(1):103–10.CrossRefPubMed
6.
go back to reference Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol. 2007;110(4):759–64.CrossRefPubMed Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol. 2007;110(4):759–64.CrossRefPubMed
7.
go back to reference Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, Kunz R, Mol BW, Coomarasamy A, Khan KS. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ (Clinical research ed). 2012;344:e2088. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, Kunz R, Mol BW, Coomarasamy A, Khan KS. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ (Clinical research ed). 2012;344:e2088.
8.
go back to reference Mourtakos SP, Tambalis KD, Panagiotakos DB, Antonogeorgos G, Arnaoutis G, Karteroliotis K, Sidossis LS. Maternal lifestyle characteristics during pregnancy, and the risk of obesity in the offspring: a study of 5,125 children. BMC Pregnancy Childbirth. 2015;15:66.CrossRefPubMedPubMedCentral Mourtakos SP, Tambalis KD, Panagiotakos DB, Antonogeorgos G, Arnaoutis G, Karteroliotis K, Sidossis LS. Maternal lifestyle characteristics during pregnancy, and the risk of obesity in the offspring: a study of 5,125 children. BMC Pregnancy Childbirth. 2015;15:66.CrossRefPubMedPubMedCentral
9.
go back to reference IOM: Weight Gain During Pregnancy: Reexamining the Guidelines. National Academy Press, Washington. In.; 2009. IOM: Weight Gain During Pregnancy: Reexamining the Guidelines. National Academy Press, Washington. In.; 2009.
10.
go back to reference Rasmussen KM, Abrams B, Bodnar LM, Butte NF, Catalano PM, Maria Siega-Riz A. Recommendations for weight gain during pregnancy in the context of the obesity epidemic. Obstet Gynecol. 2010;116(5):1191–5.CrossRefPubMedPubMedCentral Rasmussen KM, Abrams B, Bodnar LM, Butte NF, Catalano PM, Maria Siega-Riz A. Recommendations for weight gain during pregnancy in the context of the obesity epidemic. Obstet Gynecol. 2010;116(5):1191–5.CrossRefPubMedPubMedCentral
11.
go back to reference Quinlivan JA, Julania S, Lam L. Antenatal dietary interventions in obese pregnant women to restrict gestational weight gain to Institute of Medicine recommendations: a meta-analysis. Obstet Gynecol. 2011;118(6):1395–401.CrossRefPubMed Quinlivan JA, Julania S, Lam L. Antenatal dietary interventions in obese pregnant women to restrict gestational weight gain to Institute of Medicine recommendations: a meta-analysis. Obstet Gynecol. 2011;118(6):1395–401.CrossRefPubMed
12.
go back to reference Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med. 2012;10:47.CrossRefPubMedPubMedCentral Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med. 2012;10:47.CrossRefPubMedPubMedCentral
13.
go back to reference Heslehurst N, Newham J, Maniatopoulos G, Fleetwood C, Robalino S, Rankin J. Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals’ barriers and facilitators using the theoretical domains framework. Obes Rev. 2014;15(6):462–86.CrossRefPubMed Heslehurst N, Newham J, Maniatopoulos G, Fleetwood C, Robalino S, Rankin J. Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals’ barriers and facilitators using the theoretical domains framework. Obes Rev. 2014;15(6):462–86.CrossRefPubMed
14.
go back to reference Campbell F, Johnson M, Messina J, Guillaume L, Goyder E. Behavioural interventions for weight management in pregnancy: a systematic review of quantitative and qualitative data. BMC Public Health. 2011;11:491.CrossRefPubMedPubMedCentral Campbell F, Johnson M, Messina J, Guillaume L, Goyder E. Behavioural interventions for weight management in pregnancy: a systematic review of quantitative and qualitative data. BMC Public Health. 2011;11:491.CrossRefPubMedPubMedCentral
15.
go back to reference Nyman VM, Prebensen AK, Flensner GE. Obese women’s experiences of encounters with midwives and physicians during pregnancy and childbirth. Midwifery. 2010;26(4):424–9.CrossRefPubMed Nyman VM, Prebensen AK, Flensner GE. Obese women’s experiences of encounters with midwives and physicians during pregnancy and childbirth. Midwifery. 2010;26(4):424–9.CrossRefPubMed
16.
go back to reference Furber CM, McGowan L. A qualitative study of the experiences of women who are obese and pregnant in the UK. Midwifery. 2011;27(4):437–44.CrossRefPubMed Furber CM, McGowan L. A qualitative study of the experiences of women who are obese and pregnant in the UK. Midwifery. 2011;27(4):437–44.CrossRefPubMed
17.
go back to reference Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring). 2009;17(5):941–64.CrossRef Puhl RM, Heuer CA. The stigma of obesity: a review and update. Obesity (Silver Spring). 2009;17(5):941–64.CrossRef
18.
go back to reference Olander EK, Fletcher H, Williams S, Atkinson L, Turner A, French DP. What are the most effective techniques in changing obese individuals' physical activity self-efficacy and behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2013;10:29.CrossRefPubMedPubMedCentral Olander EK, Fletcher H, Williams S, Atkinson L, Turner A, French DP. What are the most effective techniques in changing obese individuals' physical activity self-efficacy and behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2013;10:29.CrossRefPubMedPubMedCentral
19.
go back to reference Olander EK, Atkinson L, Edmunds JK, French DP. The views of pre- and post-natal women and health professionals regarding gestational weight gain: an exploratory study. Sex Reprod Healthc. 2011;2(1):43–8.CrossRefPubMed Olander EK, Atkinson L, Edmunds JK, French DP. The views of pre- and post-natal women and health professionals regarding gestational weight gain: an exploratory study. Sex Reprod Healthc. 2011;2(1):43–8.CrossRefPubMed
20.
go back to reference Heslehurst N, Moore H, Rankin J, Ells LJ, Wilkinson JR, Summberbell CD. How can maternity services be developed to effectively address maternal obesity? A qualitative study. Midwifery. 2011;27(5):e170–177.CrossRefPubMed Heslehurst N, Moore H, Rankin J, Ells LJ, Wilkinson JR, Summberbell CD. How can maternity services be developed to effectively address maternal obesity? A qualitative study. Midwifery. 2011;27(5):e170–177.CrossRefPubMed
21.
go back to reference Olander EK, Berg M, McCourt C, Carlstrom E, Dencker A. Person-centred care in interventions to limit weight gain in pregnant women with obesity - a systematic review. BMC Pregnancy Childbirth. 2015;15:50.CrossRefPubMedPubMedCentral Olander EK, Berg M, McCourt C, Carlstrom E, Dencker A. Person-centred care in interventions to limit weight gain in pregnant women with obesity - a systematic review. BMC Pregnancy Childbirth. 2015;15:50.CrossRefPubMedPubMedCentral
22.
go back to reference Claesson I-M, Josefsson A, Cedergren M, Brynhildsen J, Jeppsson A, Nyström F, Sydsjö A, Sydsjö G. Consumer satisfaction with a weight-gain intervention programme for obese pregnant women. Midwifery. 2008;24(2):163–7.CrossRefPubMed Claesson I-M, Josefsson A, Cedergren M, Brynhildsen J, Jeppsson A, Nyström F, Sydsjö A, Sydsjö G. Consumer satisfaction with a weight-gain intervention programme for obese pregnant women. Midwifery. 2008;24(2):163–7.CrossRefPubMed
23.
go back to reference Jewell K, Avery A, Barber J, Simpson DS. The healthy eating and lifestyle in pregnancy (HELP) feasibility study. Br J Midwifery. 2014;22(10):727–36.CrossRef Jewell K, Avery A, Barber J, Simpson DS. The healthy eating and lifestyle in pregnancy (HELP) feasibility study. Br J Midwifery. 2014;22(10):727–36.CrossRef
24.
go back to reference Atkinson L, Olander EK, French DP. Acceptability of a weight management intervention for pregnant and postpartum women with BMI >/=30 kg/m2: a qualitative evaluation of an individualized, home-based service. Matern Child Health J. 2016;20(1):88–96.CrossRefPubMed Atkinson L, Olander EK, French DP. Acceptability of a weight management intervention for pregnant and postpartum women with BMI >/=30 kg/m2: a qualitative evaluation of an individualized, home-based service. Matern Child Health J. 2016;20(1):88–96.CrossRefPubMed
25.
go back to reference Heslehurst N, Dinsdale S, Sedgewick G, Simpson H, Sen S, Summerbell CD, Rankin J. An evaluation of the implementation of maternal obesity pathways of care: a mixed methods study with data integration. PLoS One. 2015;10(5), e0127122.CrossRefPubMedPubMedCentral Heslehurst N, Dinsdale S, Sedgewick G, Simpson H, Sen S, Summerbell CD, Rankin J. An evaluation of the implementation of maternal obesity pathways of care: a mixed methods study with data integration. PLoS One. 2015;10(5), e0127122.CrossRefPubMedPubMedCentral
26.
go back to reference Haby K, Glantz A, Hanas R, Premberg A. Mighty mums - an antenatal health care intervention can reduce gestational weight gain in women with obesity. Midwifery. 2015;31(7):685–92.CrossRefPubMed Haby K, Glantz A, Hanas R, Premberg A. Mighty mums - an antenatal health care intervention can reduce gestational weight gain in women with obesity. Midwifery. 2015;31(7):685–92.CrossRefPubMed
27.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
28.
go back to reference Olander EK, Darwin ZJ, Atkinson L, Smith DM, Gardner B. Beyond the 'teachable moment' - A conceptual analysis of women's perinatal behaviour change. Women Birth. 2016;29(3):e67–71.CrossRefPubMed Olander EK, Darwin ZJ, Atkinson L, Smith DM, Gardner B. Beyond the 'teachable moment' - A conceptual analysis of women's perinatal behaviour change. Women Birth. 2016;29(3):e67–71.CrossRefPubMed
29.
go back to reference Sui Z, Turnbull D, Dodd J. Enablers of and barriers to making healthy change during pregnancy in overweight and obese women. Australasian Med J. 2013;6(11):565–77.CrossRef Sui Z, Turnbull D, Dodd J. Enablers of and barriers to making healthy change during pregnancy in overweight and obese women. Australasian Med J. 2013;6(11):565–77.CrossRef
30.
go back to reference Amorim Adegboye AR, Linne YM. Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database Syst Rev. 2013;7, CD005627.PubMed Amorim Adegboye AR, Linne YM. Diet or exercise, or both, for weight reduction in women after childbirth. Cochrane Database Syst Rev. 2013;7, CD005627.PubMed
31.
go back to reference Arden MA, Duxbury AM, Soltani H. Responses to gestational weight management guidance: a thematic analysis of comments made by women in online parenting forums. BMC Pregnancy Childbirth. 2014;14:216.CrossRefPubMedPubMedCentral Arden MA, Duxbury AM, Soltani H. Responses to gestational weight management guidance: a thematic analysis of comments made by women in online parenting forums. BMC Pregnancy Childbirth. 2014;14:216.CrossRefPubMedPubMedCentral
32.
go back to reference Harman V, Cappellini B. Mothers on display: lunchboxes. Social Class and Moral Accountability Sociology. 2015;49(4):764–81. Harman V, Cappellini B. Mothers on display: lunchboxes. Social Class and Moral Accountability Sociology. 2015;49(4):764–81.
33.
go back to reference Furness PJ, McSeveny K, Arden MA, Garland C, Dearden AM, Soltani H. Maternal obesity support services: a qualitative study of the perspectives of women and midwives. BMC Pregnancy Childbirth. 2011;11:69.CrossRefPubMedPubMedCentral Furness PJ, McSeveny K, Arden MA, Garland C, Dearden AM, Soltani H. Maternal obesity support services: a qualitative study of the perspectives of women and midwives. BMC Pregnancy Childbirth. 2011;11:69.CrossRefPubMedPubMedCentral
34.
go back to reference Merrill E, Grassley J. Women’s stories of their experiences as overweight patients. J Adv Nurs. 2008;64(2):139–46.CrossRefPubMed Merrill E, Grassley J. Women’s stories of their experiences as overweight patients. J Adv Nurs. 2008;64(2):139–46.CrossRefPubMed
36.
go back to reference Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, Carlsson J, Dahlin-Ivanoff S, Johansson IL, Kjellgren K, et al. Person-centered care--ready for prime time. Eur J Cardiovasc Nurs. 2011;10(4):248–51.CrossRefPubMed Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, Carlsson J, Dahlin-Ivanoff S, Johansson IL, Kjellgren K, et al. Person-centered care--ready for prime time. Eur J Cardiovasc Nurs. 2011;10(4):248–51.CrossRefPubMed
37.
go back to reference National Institute for Health and Clinical Excellence. NICE Clinical guideline 62. Antentatal care: Routine care for the healthy pregnant woman. London: National Institute for Health and Clinical Excellence 2008(modified: December 2014): 4-58 National Institute for Health and Clinical Excellence. NICE Clinical guideline 62. Antentatal care: Routine care for the healthy pregnant woman. London: National Institute for Health and Clinical Excellence 2008(modified: December 2014): 4-58
39.
go back to reference Grahn P, Stigsdotter UA. Landscape planning and stress. Urban For Urban Green. 2003;2(1):1–18.CrossRef Grahn P, Stigsdotter UA. Landscape planning and stress. Urban For Urban Green. 2003;2(1):1–18.CrossRef
40.
go back to reference Egger G, Swinburn B. An “ecological” approach to the obesity pandemic. BMJ (Clinical research ed). 1997;315(7106):477–80.CrossRefPubMedCentral Egger G, Swinburn B. An “ecological” approach to the obesity pandemic. BMJ (Clinical research ed). 1997;315(7106):477–80.CrossRefPubMedCentral
41.
go back to reference Atkinson L, Olander EK, French DP. Why don’t many obese pregnant and post-natal women engage with a weight management service? J Reproductive Infant Psychol. 2013;31(3):245–56.CrossRef Atkinson L, Olander EK, French DP. Why don’t many obese pregnant and post-natal women engage with a weight management service? J Reproductive Infant Psychol. 2013;31(3):245–56.CrossRef
42.
go back to reference Olander EK, Atkinson L. Obese women’s reasons for not attending a weight management service during pregnancy. Acta Obstet Gynecol Scand. 2013;92(10):1227–30.PubMed Olander EK, Atkinson L. Obese women’s reasons for not attending a weight management service during pregnancy. Acta Obstet Gynecol Scand. 2013;92(10):1227–30.PubMed
Metadata
Title
Adopting a healthy lifestyle when pregnant and obese – an interview study three years after childbirth
Authors
Anna Dencker
Åsa Premberg
Ellinor K. Olander
Christine McCourt
Karin Haby
Sofie Dencker
Anna Glantz
Marie Berg
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-0969-x

Other articles of this Issue 1/2016

BMC Pregnancy and Childbirth 1/2016 Go to the issue