Abstract
Worldwide, half of women begin a pregnancy with overweight or obesity, which increases the risk of pregnancy and birth complications and adversely affects the lifelong health of the offspring. In order for metabolic changes to influence the gestational environment, research suggests that weight loss should take place before conception. This study aimed to understand women’s emotional and social contexts, knowledge, motivations, skills and self-efficacy in making healthy change. Semi-structured interviews conducted with twenty-three women with overweight or obesity, informed by the Information–Motivation–Behavioural Skills (IMB) model, were analysed using reflexive thematic analysis. Information-related themes identified included poor health risk knowledge, healthy food decisions and health versus convenience. The Motivation themes comprised taking responsibility, flexible options, social expectations, interpersonal challenges and accountability. Behavioural Skills entailed themes such as the mental battle, time management, self-care and inspiration. An environmental factor was identified in affordability—limiting access to healthier alternatives. Women wanted simple, flexible options that considered family commitments, time and budgetary constraints. Unprompted, several mentioned the importance of psychological support in managing setbacks, stress and maintaining motivation. Strategies for enhancing self-efficacy and motivational support are required to enable longstanding health behaviour change. Findings will inform intervention mapping development of an eHealth solution for women preconception.
Highlights
Worldwide, half of all women of childbearing age have overweight (body mass index (BMI) ≥ 25.0 to 29.9 kg/m2) or obesity (BMI ≥ 30 kg/m2) [1]
Half of all women of childbearing age have overweight (body mass index (BMI) ≥ 25.0 to 29.9 kg/m2) or obesity (BMI ≥ 30 kg/m2) [1]. This figure is significant as retrospective, case-control and cohort studies have found that women who enter pregnancy with obesity are at higher risk of gestational diabetes mellitus (GDM) [2] and pre-eclampsia [2,3]—both associated with long-term morbidities [4]
The infant is more likely to be born with a high birth weight [2], which can result in an increased risk of birth trauma and maternal complications [6] including the need for induction or caesarean birth [2], and higher risk of postpartum haemorrhage [7]
Summary
Half of all women of childbearing age have overweight (body mass index (BMI) ≥ 25.0 to 29.9 kg/m2) or obesity (BMI ≥ 30 kg/m2) [1] This figure is significant as retrospective, case-control and cohort studies have found that women who enter pregnancy with obesity are at higher risk of gestational diabetes mellitus (GDM) [2] and pre-eclampsia [2,3]—both associated with long-term morbidities [4]. Birth cohort longitudinal studies show that maternal obesity is the strongest risk factor for offspring obesity across childhood, adolescence and adulthood [8] Both epidemiological studies and animal models suggest that infants born with a high birthweight are predisposed to metabolic syndrome, which, in turn, increases the risk of heart disease, stroke and type 2 diabetes mellitus in later life [9]. These risks represent a significant public health problem and the resulting costs to both the health system, and society, are considerable [9]
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