Prenatal care experiences among pregnant women with obesity in Wisconsin, United States: a qualitative quality improvement assessment

Danielle J Hurst,Kathleen M Antony,Corrine I Voils,Nicholas B Schmuhl

doi:10.1186/s12884-021-03629-4

Abstract

BackgroundStigma and bias experienced during prenatal care can affect quality of care and, ultimately, the health of pregnant women with obesity and their infants. We sought to 1) better understand the bias and stigma that women with BMIs ≥40 kg/m2 experience while receiving prenatal care, 2) gauge women’s interest in group prenatal education for women with obesity, and 3) gather feedback about their preferred weight-related terminology.MethodsWe conducted and thematically content-analyzed 30 semi-structured interviews of women with BMIs ≥40 kg/m2 who received prenatal care at a university-affiliated teaching hospital in the Midwest region of the United States.ResultsAll women recalled positive experiences during their perinatal care during which they felt listened to and respected by providers. However, many also described a fear of weight-related bias or recalled weight-based discrimination. Women reacted favorably to a proposed group prenatal care option for pregnant women with obesity that focused on nutrition, physical activity, and weight management. Women rated “weight” and “BMI” as the most desirable terms for describing weight, while “large size” and “obesity” were rated least desirable.ConclusionsMany pregnant women with BMIs ≥40 kg/m2 experience bias in the prenatal care setting. Potential steps to mitigate bias towards weight include improving provider awareness of the experiences and perspectives of this population, expanding prenatal care options targeted towards women with high BMIs, including group care, and using patient-preferred weight-related terminology. Through the remainder of this manuscript, wherever possible, the term “high BMI” will be used in place of the term “obesity” to describe women with BMI ≥ 30 kg/m2 in order to respect the preferred terminology of the women we interviewed.

Highlights

Stigma and bias experienced during prenatal care can affect quality of care and, the health of pregnant women with obesity and their infants
We found that most women dislike the term “obesity.” This aligns with seven other studies which aimed to understand what language is preferred among adults with high body mass index (BMI) discussed in a recent systematic review [18]
Health care teams can take steps to increase the inclusivity of clinic environments and care for pregnant women with high BMIs

Summary

Introduction

Stigma and bias experienced during prenatal care can affect quality of care and, the health of pregnant women with obesity and their infants. Women with high BMIs are more likely to struggle with poor mental health, breast feeding, and post-partum weight management [7] For these reasons, many pregnant women with high BMIs are considered high-risk and receive specialized care to improve maternal and fetal health outcomes [8]. Depression resulting from stigma and bias are associated with delayed fetal growth, low birth weight, and premature births [12] These concerns are compounded by the fact that healthcare providers often feel inadequately trained to discuss weight and obesity with pregnant women [13]. Existing studies show that stigma pertaining to weight has both short and long-term effects on patients in general [17] The effects of these experiences include, but are not limited to, poor outcomes, long term stress exposures, and avoidance of clinical care [17]

Objectives

Methods

Results

Discussion

Conclusion