Date of Award

2015

Document Type

Open Access Dissertation

Department

Exercise Science

First Advisor

Sara Wilcox

Abstract

Background: The high percentage of women who enter pregnancy overweight or obese and gain excessive weight during pregnancy is a growing public health problem. Health care providers are recommended to counsel women on weight gain, physical activity (PA), and nutrition during pregnancy. However, little is known about patient or provider perceptions of these topics. Purpose: Guided by the Theory of Planned Behavior (TPB), this study examined women’s and health care providers’ perceptions of weight gain, PA, and nutrition in pregnancy. This study also examined the role of the health care provider in optimizing pregnancy weight gain. Methods: Pregnant women between 20-30 weeks gestation were recruited to take part in qualitative interviews (N=30) or to complete an Internet-based survey (N=189) to assess perceptions of weight gain, PA, nutrition, and provider counseling on these topics. Prenatal care providers (N=11) were also recruited to take part in qualitative interviews to assess perceptions of weight gain, PA, and nutrition counseling during prenatal visits. Results: Qualitative interviews with pregnant women (15 African American, 15 White) revealed several gaps in knowledge as well as race differences in perceptions and intentions toward weight gain, PA, and nutrition during pregnancy. The majority of women and providers reported counseling on weight gain and related behaviors during prenatal visits (87-100%). However, provider counseling was limited and many barriers to counseling were discussed. In the separate sample of women who completed the Internet-based survey, the TPB constructs (attitude, subjective norm, and perceived behavioral control) explained 23-39% of the variance in weight gain, PA, and nutrition intentions, and made varying contributions across outcomes. In this sample, fewer women reported provider counseling on weight gain, PA, or nutrition during prenatal visits (52-63%). Patient report of provider counseling on weight gain was largely consistent with existing guidelines while counseling on PA and nutrition was limited in scope. Provider advice was significantly associated with women’s weight-related intentions. Conclusion: We used the TPB framework to examine perceptions of weight gain, PA, nutrition, and provider counseling on these topics during pregnancy using a mixed methods approach in two populations. Findings can be used to help guide the development of future gestational weight gain interventions. Across studies, counseling content was limited and not fully consistent with guidelines. Initial evidence suggests that provider counseling influences women’s weight-related intentions during pregnancy. Future studies are needed to develop and evaluate the efficacy of interventions to help providers overcome perceived barriers and more effectively counsel women on weight and healthy lifestyles during pregnancy.

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