Table 4.

Overarching categories and key concepts emerging from qualitative content analysis of interviews with healthcare providers

Category	Concept	Representative quote(s)
Practices	The first visit involves a large amount of information sharing	“That’s the trouble with prenatal care. There’s so much information that women need, especially in the first trimester. Genetic screening, and lifestyle, and alcohol, and smoking, and family, and you know, on and on and on.” (General Practitioner)
	Weight is assessed routinely, but not discussed in detail unless there is a concern	“Weight is something I would bring up with everyone at the first visit and only - well, I always check the weight every single other visit. But if there’s no problem, I wouldn’t bring it up. I might make a comment like, ‘Oh, your weight looks good.’” (General Practitioner)
	Midwives have a different approach to gestational weight gain	“We are aware of their weight gain. But more important to us than their weight gain is their nutrition and how they’re feeling about it and, you know, providing encouragement, support and education so that they can be empowered to make healthy choices.” (Midwife) “I feel like it’s really important to discuss healthy eating and exercise, but the actual focus on the weight gain and the number of pounds that a woman should gain, I don’t really feel that’s important at all, that piece of it.” (Midwife)
Individual-level influences on practice	Priority level	“But certainly there are definitely times where I feel constricted by time. I think nutrition and exercise is a huge priority, so that’s just my personal opinion. I think that I wouldn’t - I don’t know, I would make the time.” (Midwife)
	Sensitivity of the discussion	“Any discussion around weight can be a very charged issue and, depending on the woman and her BMI, and her history, she may have had a history of an eating disorder or whatever. You don’t always know what issues she’s had in the past and they can be very significant, so there could be a lot of anxiety on the patient’s side around weight gain and so that will always cover a conversation, especially if you don’t know her very well.” (General Practitioner)
	General knowledge of gestational weight gain, nutrition and physical activity	“I do find that nutrition is not covered at all in my medical school and through residency. I don’t remember any teaching sessions at all on weight gain in pregnancy, obesity in pregnancy or that. We have one teaching session every two years for an hour on it.” (Obstetrician)
	Detailed knowledge of practice guidelines	“I have to know so many rules about all sorts of things. I always kind of go by, you know, 5, 10, 15. So those three numbers I remember, 5, 10, 15. If you’re overweight, if your BMI is higher than, you know, 26 or 27, or higher than 28 or so, I would say, 5 kilos. If your weight is pretty well normal I’d say 10 kilos. And if your weight is under I’d say 15 kilos.” (General practitioner)
System-level influences on practice	Time and compensation	“And that’s a different model for us because we’re not billing per fee code. So when I see a woman, I can talk to her or counsel her or do anything in that visit, it doesn’t – so, it’s different than the physicians, I guess, because they’re constrained by billing for what they’re talking to the people about.” (Midwife) “I guess the biggest structural problem is the short prenatal visit and the amount of information that has to be gathered and disseminated in that visit, which is typically anything from ten to 15 min long.” (General Practitioner)
	Access to allied health services	“So I find the most successful story of patients achieving their [weight] goals and continuing postpartum, were women who I initially brought up the topic [with], referred to our dietitian and psychologist and they [women] continued to follow up with me and with them. So they had that longer term follow-up and this goal setting and checking in with someone.” (Obstetrician)