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The Journal of Perinatal Education logoLink to The Journal of Perinatal Education
. 2016;25(4):242–256. doi: 10.1891/1058-1243.25.4.242

Gestational Weight Gain Through a Health Literacy Lens: A Scoping Review

Sara Champlin, Lorraine O Walker, Michael Mackert
PMCID: PMC6310904  PMID: 30643371

ABSTRACT

Few women gain the recommended amount of weight during pregnancy, which has health implications for mothers and their newborns. Work in this area focuses on factors that are difficult to change. The purpose of this project was to review literature on a more patient-centered concept—health literacy. A scoping review was conducted to determine whether aspects of health literacy are included in gestational weight gain (GWG) research. Thirty articles were selected for review. Although these studies included health literacy aspects indirectly, only 2 directly measured health literacy using existing measures. Work that incorporates health literacy in a GWG context is needed. Health literacy may be a critical, yet understudied, factor in understanding why GWG falls outside of the recommendations.

Keywords: gestational weight gain, pregnancy, health literacy, emerging trends, concept development

INTRODUCTION

Gaining a healthy amount of weight during pregnancy is important for beneficial health outcomes of mothers and their newborns. Inadequate gestational weight gain (GWG) increases the likelihood of low birth weight (Siega-Riz et al., 2009); in contrast, excessive or high GWG is associated with macrosomia, cesarean birth, perinatal complications, and increases in maternal weight after pregnancy (Fortner, Pekow, Solomon, Markenson, & Chasan-Taber, 2009; Hernandez, 2012; Siega-Riz et al., 2009; Stotland, Cheng, Hopkins, & Caughey, 2006; Stotland, Hopkins, & Caughey, 2004). Unfortunately, few women have GWG that falls into the recommended ranges (see Table 1, which presents the most recent Institute of Medicine [IOM] guidelines for GWG). Various estimates indicate that about one quarter of women gain inadequate amounts and nearly half gain excessive amounts of GWG (Headen, Davis, Mujahid, & Abrams, 2012; Hunt, Alanis, Johnson, Mayorga, & Korte, 2013). Misleading or absent health-care provider advice about GWG may partially explain why some women have inadequate or excessive gains (Stotland et al., 2005); however, recent research indicates provider advice may only modestly influence women’s actual GWG (Ferrari & Siega-Riz, 2013).

TABLE 1. New Recommendations for Total and Rate of Weight Gain During Pregnancy, by Prepregnancy Body Mass Index.

Prepregnancy Body Mass Index Total Weight Gain Rates of Weight Gaina
Second and Third Trimesters
Range (kg) Range (lb) M (Range) in kg/week M (Range) in lb/week
Underweight (<18.5 kg/m2) 12.5–18.0 28–40 0.51 (0.44–0.58) 1.00 (1.00–1.30)
Normal weight (18.5–24.9 kg/m2) 11.5–16.0 25–35 0.42 (0.35–0.50) 1.00 (0.80–1.00)
Overweight (25.0–29.9 kg/m2) 7.0–11.5 15–25 0.28 (0.23–0.33) 0.60 (0.50–0.70)
Obese (≥30.0 kg/m2) 5–9 11–20 0.22 (0.17–0.27) 0.50 (0.40–0.60)
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aCalculations assume a 0.50–2.00 kg (1.10–4.40 lb) weight gain in the first trimester (based on Siega-Riz, Adair, & Hobel, 1994; Abrams, Carmichael, & Selvin, 1995; Carmichael, Abrams, & Selvin, 1997).

From Weight Gain During Pregnancy: Reexamining the Guidelines, by Institute of Medicine, 2009, Washington, DC: The National Academies Press. Copyright 2009 by the National Academies Press. Adapted with permission.

Inadequate gestational weight gain (GWG) increases the likelihood of low birth weight; in contrast, excessive or high GWG is associated with macrosomia, cesarean birth, perinatal complications, and increases in maternal weight after pregnancy.

Consider the following hypothetical case study (Part 1): Caitlin, a mom-to-be, told Jane, her childbirth educator, that she was worried about gaining too much weight during this pregnancy and ending up overweight afterward. That happened to Caitlin’s own mom who thought she should “eat for two.” Although Caitlin’s prenatal care provider had given her a goal weight to reach at the end of pregnancy, her friends said they were given lower, and in some cases higher, weight gain goals. Thus, although Caitlin was trying to “eat healthy,” she was unsure about her GWG goal, how to manage her weight gain and how it might affect her, the baby, and the birth process, especially since she had been hearing about obesity on the TV.

Although conceptual models have been proposed in an effort to explain psychosocial and contextual determinants of GWG such as those outlined in the case study (Davis, Stange, & Horwitz, 2012; Hill et al., 2013), these have focused on only excessive GWG and mainly on distal or mediating concepts, such as stress, body image, and social support, which may be difficult to alter. Health literacy (Nielsen-Bohlman, Panzer, & Kindig, 2004) is a more proximal and patient-centered concept that has been linked to many health outcomes in adults including rates of hospitalization, receiving cancer screenings and flu vaccines, use of emergency care, and ability to understand and use prescription medications (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011). In general, adults with low health literacy have poorer overall health (Berkman et al., 2011; DeWalt, Berkman, Sheridan, Lohr, & Pignone, 2004; HLS-EU Consortium, 2012; Peterson et al., 2011).

Moreover, a systematic review of literature on the impact of parent health literacy on child health outcomes emphasizes that children of parents with low health literacy are at a greater risk for poorer health outcomes than children of parents with adequate health literacy (DeWalt & Hink, 2009). Thus, health literacy may offer an alternative perspective to understanding why many women have lower or higher GWGs than have been recommended in U.S. national guidelines (American College of Obstetricians and Gynecologists, 2013; IOM, 1990, 2009). That is, the inability to find, understand, and/or apply important health information may contribute to inadequate or excessive GWG outcomes.

Although health literacy has been linked to health outcomes, its definition is not without ambiguity. One current definition of health literacy, proposed after reviewing the literature and identifying 13 different definitions of health literacy, is

the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions. (Berkman, Davis, & McCormack, 2010, p. 16)

One current definition of health literacy is “the degree to which individuals can obtain, process, understand, and communicate about health-related information needed to make informed health decisions.”

This definition points to four distinct sets of skills thought to comprise health literacy, including abilities to obtain, process, understand, and communicate about health-related information. One advantage of this definition is that it adds the important component of communication, which was missing from earlier definitions (Nielsen-Bohlman et al., 2004). In addition, this definition assumes health literacy to be a composite of four sets of skills that apply generally across health topics and contexts, thus comparing them to demographic features such as gender, race, and age. As such, some scholars argue that health literacy is a “general” concept, not to be tied with specific health topics or contexts (Mackert, Champlin, Su, & Guadagno, 2015).

In contrast, other veins of public health and communications research view health literacy as a concept that is indeed dependent on a specific health topic or context. As a result, health domain–specific conceptualizations of health literacy have been proposed (e.g., diabetes health literacy; Calderón et al., 2014) and (maternal health literacy; Kohan, Ghasemi, & Dodangeh, 2007). One of the contributions of this approach to health literacy is the ability to understand health literacy in the context of a health situation as well as draw attention to health literacy as it relates to a particular health issue (Jorm, 2015). Jorm’s (2000) concept of mental health literacy is one of the most developed articulations of a domain-specific health literacy and includes six aspects thought to comprise mental health literacy, such as knowledge and beliefs about causes and attitudes related to aspects of mental health (see Figure 1). Jorm’s work thus elaborates on the components of health literacy that may be important in managing specific health conditions (Jorm, 2000) rather than looking at health literacy more generally.

Figure 1. Definition and relevant health literacy constructs.

Figure 1

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GWG = gestational weight gain.

In this review exploring health literacy related to GWG, we used concepts from both general health literacy and a domain-specific perspective for several reasons. First, pregnancy is a life event that is invested with both biomedical as well as everyday health beliefs (e.g., “eating for two”), and we thought capturing the full scope of these beliefs and knowledge was important to understanding GWG from a health literacy perspective. Second, our preliminary literature search for studies using the terminology of “health literacy” related to GWG resulted in locating only three articles; however, when we applied concepts (knowledge, beliefs, and attitudes) drawn from Jorm’s (2000) domain-specific framework for mental health literacy, a number of relevant studies were located. Finally, to our knowledge, these perspectives of health literacy have not previously been integrated, and doing so might provide a meaningful lens from which to view health literacy related to GWG.

Our goal in this scoping review was to examine the range of studies related to GWG from the perspective of health literacy. Our hope was to better understand how women’s health literacy relates to GWG to improve practice and guide future research on this important dimension of care of childbearing women. To this end, we asked the following:

  1. How is the “general” definition of health literacy applied to GWG research (women’s capacity to find, understand, make use of, and communicate about GWG)?

  2. How is the “health domain–specific” conceptualization of health literacy applied to GWG research (women’s knowledge, beliefs, and attitudes specific to GWG)?

METHODS

This review draws heavily from the methods of scoping reviews set forth by Arksey and O’Malley (2005). Scoping reviews are appropriate for purposes such as delineating the “extent, range, and nature” of studies on a topic, summarizing studies on a topic, or determining what gaps in studies currently exist on a topic (Arksey & O’Malley, 2005, p. 21). Scoping and systematic reviews are similar in using search strategies, having inclusion and exclusion criteria, and systematically extracting data from studies, but they differ in that scoping reviews generally are more fluid, iterative, and comprehensive in focus. Furthermore, because scoping reviews are aimed at creating a panoramic view of a topic of interest, the rating of studies for potential design biases is generally not done (Arksey & O’Malley, 2005).

Search Strategy, Eligibility Criteria, and Study Selection

Given the focus of the present review, a comprehensive literature search was conducted using EBSCOhost Online Research Databases, a platform that searches across nearly 100 databases including Academic Search Complete, CINAHL, Communication & Mass Media Complete, ERIC, Health Source, MedicLatina, MEDLINE, and PsycINFO. Initial searches included the term gestational weight gain with each of the following: “health” and “literacy,” “knowledge,” “ability,” “attitudes,” and “beliefs.” These searches presented 362 articles. An additional search was performed outside the EBSCOhost Online Research Databases, which uncovered one additional article found using Google Scholar, for a full initial sample of 363 articles. Exclusion criteria were then applied, narrowing articles to those that focused on our topic of interest (human research reports focused on mothers or mothers-to-be and some aspect of health literacy as it related to GWG) and were published in the past decade (1993–fall 2013). The concept of health literacy first emerged in response to a national assessment of general literacy conducted in 1993, which shed light on large deficits in literacy specifically related to health (Ad Hoc Committee on Health Literacy, 1999). As such, we selected 1993 as a starting point for our scoping review as the term health literacy was just emerging at that time. Because we wanted to examine the full scope of relevant studies related to GWG health literacy, we included those that were qualitative, quantitative, or mixed-methods studies (see Figure 2 for the process of study selection resulting in a final sample of 30 articles).

Figure 2. Flow table of articles exclusions.

Figure 2

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Data Extraction, Organization, and Summarization

After generating a sample of articles related to our research interests, we then constructed a coding guide of items that would capture elements of GWG health literacy (see Table 2 for examples of coding items). Of particular interest were the components of “general” health literacy—patient capacity for finding, understanding, using, and communicating about GWG information. The presence of each of these components was coded separately. The sample of articles was also coded for whether or not health literacy was directly assessed in the study.

TABLE 2. Examples of Coding Items.

Example
General health literacy Finding (Core) “Our goal was to determine the information channels used by pregnant women to obtain information on nutrition and exercise” (Ferraro, Rutherford, Keely, Dubois, & Adamo, 2011, p. 59).
Understanding (Core) “The women in this convenience sample were asked to identify their weight category, their understanding of the complications of obesity and excessive GWG in pregnancy and safe and/or effective weight management strategies in pregnancy” (Shub, Huning, Campbell, & McCarthy, 2013, p. 278).
Making use of (Core) “Women who attended the workshop increased their consumption of serves of fruit, vegetables, met fruit guidelines, had a higher diet quality score, and clinically relevant increases in physical activity . . . ” (Wilkinson & McIntyre, 2012, p. 131).
Communicating about (Peripheral) “They said you can eat cabbage. I don’t eat cabbage, but I eat collard greens. So I told my grandma to make me some cabbage” (Paul, Graham, & Olson, 2013, p. 347).
GWG attitudes Attitudes that facilitate recognition and help seeking (Peripheral) Survey items included “Weight Gain Restrictive Behaviors: If I gain too much weight one month, I try to keep from gaining the next month. I tried to keep my weight down so I didn’t look pregnant earlier on” (Dipietro, Millet, Costigan, Gurewitsch, & Caulfield, 2003, p. 1316).
GWG beliefs/knowledge Ability to recognize (Core) “When asked how much weight a woman should gain during pregnancy, nearly half of the participants gave a number or range within the IOM recommendations for weight gain of normal-BMI women” (Groth & Kearney, 2009, p. 455).
Risk factors/causes (Peripheral) “Frequently, the nutrition knowledge was based on miseducation, misconceptions, and/or ‘a grain of truth’ i.e. folk beliefs” (Everette, 2008, p. 718).
Self-help intervention (Peripheral) “A number of women also believed that performing regular exercise would improve the feeling of well-being, be important in reducing pregnancy complaints and be a factor to prevent excessive weight gain in pregnancy” (Haakstad, Voldner, Henriksen, & Bø, 2009, p. 1270).
Professional help (Peripheral) “Some increased regular physical activity and some said that the encouragement and support provided by dieticians helped them to manage their weight during pregnancy” (Lee, Karpavicius, Gasparini, & Forster, 2012, p. 430).
How to seek information (Peripheral) “Because of lack of information from health professions, “the pregnant women reported relying on the internet to tell them what they needed to know [about weight gain]” (Olander, Atkinson, Edmunds, & French, 2011, p. 45).
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Note. GWG = gestational weight gain; IOM = Institute of Medicine; BMI = body mass index.

In addition to the components of general health literacy, we also included codes based on Jorm’s (2000) health domain–specific view of mental health literacy, which suggests that attitudes and beliefs and knowledge about a health concept contribute to health literacy. As such, we adapted Jorm’s points for mental health literacy to a GWG context, which included attitudes that facilitate help seeking and beliefs and knowledge including one’s ability to recognize recommended GWG, the risk factors and causes of GWG, self-help intervention strategies, and beliefs and knowledge about receiving professional help and how to seek information about GWG. In addition, there exists a standardized measure to capture women’s attitudes toward GWG (Palmer, Jennings, & Massey, 1985) and whether or not researchers used this measure was included as a code in our guide. All items (both general and domain-specific) were coded as either not present in the study at all, a “peripheral” focus of the study (meaning that the study may have addressed the topic briefly or included a few related items in a survey), or a “core” focus of the study (the main purpose of the study).

In addition to these health literacy items, it was also important to outline the context of each study including the number of participants, the data collection and presentation strategies used, where the study took place, the racial/ethnic, and socioeconomic status breakdowns of the sample. If this information was not available in the manuscript, the item was coded as “insufficient.”

RESULTS

Characteristics of Studies and Samples

A sample of 30 articles met the inclusion criteria for the present review (Copper, DuBard, Goldenberg, & Oweis, 1995; de Jersey, Nicholson, Callaway, & Daniels, 2012; Dipietro et al., 2003; Everette, 2008; Ferrari & Siega-Riz, 2013; Ferraro et al., 2011; Gaudet, Gruslin, & Magee, 2011; Groth & Kearney, 2009; Groth, Morrison-Beedy, & Meng, 2012; Gutierrez, 1999; Haakstad et al., 2009; Haruna et al., 2010; Herring, Henry, Klotz, Foster, & Whitaker, 2012; Kohan et al., 2007; Lee et al., 2012; Mehta, Siega-Riz, & Herring, 2011; Mumford, Siega-Riz, Herring, & Evenson, 2008; Olander et al., 2011; Paul et al., 2013; Phelan et al., 2011; Shieh & Weaver, 2011; Shub et al., 2013; Stengel, Kraschnewski, Hwang, Kjerulff, & Chuang, 2012; Stevens-Simon, Nakashima, & Andrews, 1993; Stotland et al., 2005; Sui, Turnbull, & Dodd, 2013; Swann et al., 2009; Tovar et al., 2011; Wilkinson & McIntyre, 2012; Wilkinson, Walker, & Tolcher, 2013). Characteristics of these studies are included in Table 3. Most of the studies included in these articles were descriptive in nature; only three studies focused on designing, piloting, or evaluating an intervention (Lee et al., 2012; Wilkinson & McIntyre, 2012; Wilkinson et al., 2013). Across our sample, studies employed various data collection methods, and some used multiple data collection strategies including paper-and-pencil, electronic, or phone surveys (n = 23), focus groups (n = 5), anthropomorphic/metric measurements (n = 6), reviews of medical records (n = 6), interviews (n = 6), observations (n = 1), and diet recall (n = 1; see Table 3).

TABLE 3. Study and Sample Characteristics.

Study Study Characteristics Sample Characteristics
Sample Size Method of Data Collection Results Longitudinal Location of Study Average Age or Age Range % White % Hispanic % Black % Asian % Other
Copper et al. (1995) 1,000 Survey, anthro, EHRs Quant. Yes United States Insuff.a 31.0 0.0 69.0 0.0 0.0
de Jersey et al. (2012) 664 Survey, anthro Quant. Yes Australia 29.9 Insuff. Insuff. Insuff. Insuff. Insuff.
Dipietro et al. (2003) 130 Survey Quant. No United States 31.3 86.0 0.0 12.0 0.0 2.0
Everette (2008) 119 Interview Qual. No United States 16.0–22.0 0.0 0.0 100.0 0.0 0.0
Ferrari and Siega-Riz (2013) 1,454 Survey, interview Quant. No United States <18.0–35.0+ 72.2 0.0 18.8 0.0 9.1
Ferraro et al. (2011) 147 Survey Quant. No Canada 30.9 78.5 0.0 0.0 0.0 21.5
Gaudet et al. (2011) 117 Survey Quant. No Canada <20.0–40.0+ 72.6 0.0 1.0 21.4 1.7
Groth and Kearney (2009) 49 Interview Both No United States 24.9 24.5 26.5 49.0 0 0
Groth et al. (2012) 26 Survey and focus group Qual. No United States 18.0–39.0 0.0 0.0 92.0 0 8.0
Gutierrez (1999) 46 Survey, 24-hour diet recall Both Yes United States 13.0–18.0 0.0 100.0 0.0 0.0 0.0
Haakstad et al. (2009) 467 Survey Quant. No Norway 31.6 100.0 0.0 0.0 0.0 0.0
Haruna et al. (2010) 9 Focus group Qual. No Japan 33.0 0.0 0.0 0.0 100.0 0.0
Herring et al. (2012) 31 Focus group Qual. No United States 24.0 0.0 0.0 100.0 0.0 0.0
Kohan et al. (2007) 150 Survey, observation Quant. Yes Iran 20.0–28.0 Insuff. Insuff. Insuff. Insuff. Insuff.
Lee et al. (2012) 74 Survey, records Both Yes Australia 32.0 Insuff. Insuff. Insuff. Insuff. Insuff.
Mehta et al. (2011) 1,192 Survey, records Quant. Yes United States 29.1 72.5 0.0 19.3 0.0 0.0
Mumford et al. (2008) 1,223 Survey, records, anthro Quant. Yes United States <20.0–30.0+ 73.0 0.0 19.0 0.0 8.0
Olander et al. (2011) 23 Focus group Qual. No England 18.0–55.0 Insuff. Insuff. Insuff. Insuff. Insuff.
Paul et al. (2013) 26 Focus group Qual. No United States 18.0–35.0 57.7 11.5 42.3 3.8 0.0
Phelan et al. (2011) 401 Survey, anthro, interview Quant. No United States 28.7 65.3 19.0 8.5 0.0 7.2
Shieh and Weaver (2011) 113 Survey Quant. No United States 25.4, 27.3 27.4 0.0 72.6 0.0 0.0
Shub et al. (2013) 364 Survey, anthro Quant. No Australia 28.0–35.0 Insuff. Insuff. Insuff. Insuff. Insuff.
Stengel et al. (2012) 24 Interview, records Qual. Yes United States 21.0–35.0 96.0 0.0 0.0 0.0 4.0
Stevens-Simon et al. (1993) 99 Survey, anthro Quant. No United States 16.3 58.0 15.0 25.0 0.0 2.0
Stotland et al. (2005) 1,198 Survey Quant. Yes United States 18.0–45.0 37.7 29.1 16.6 16.6 0.0
Sui et al. (2013) 490 Survey, interview Both Sequential Australia <20.0–40.0+ 91.5 0.0 0.7 4.6 3.2
Swann et al. (2009) 35,929 Survey, records Quant. Yes Norway 29.9 Insuff. Insuff. Insuff. Insuff. Insuff.
Tovar et al. (2011) 249 Survey, records Quant. Yes United States 25.0–35.0 65.1 0.0 0.0 0.0 34.9
Wilkinson and McIntyre (2012) 360 Survey Quant. Yes Australia 29.5, 29.0 Insuff. Insuff. Insuff. Insuff. Insuff.
Wilkinson et al. (2013) 899 Survey Quant. Yes Australia 29.8, 28.6 (no 2008 data) Insuff. Insuff. Insuff. Insuff. Insuff.
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Note. Anthro = anthropology; EHRs = electronic health records; Quant. = quantitative data collection; Insuff. = insufficient; Qual. = qualitative data collection.

aArticle did not include enough information to determine code.

Nineteen of the studies included only quantitative results and seven included only qualitative results. In addition to these, four studies presented both qualitative and quantitative results (mixed-methods studies). Of the 30 studies included, 16 were considered longitudinal designs. A majority of the studies were conducted in the United States (n = 17); however, several were conducted in other countries such as Australia (n = 6), Canada (n = 2), Norway (n = 2), Japan (n = 1), England (n = 1), and Iran (n = 1). Study sample sizes ranged from 9 (a small scale study that used focus groups) to 35,929 (a large scale study that was able to access birth registries from an entire country; see Table 3).

Participants were typically from a variety of socioeconomic backgrounds (n = 16); however, in only three studies were the participants drawn from socioeconomically disadvantaged backgrounds (Groth et al., 2012; Gutierrez, 1999; Herring et al., 2012). Many of the studies (n = 10) did not include a report of participants’ socioeconomic status, a variable that could play a vital role in understanding factors that impact GWG. Similarly, a substantial number of studies did not include a distribution of participant race/ethnicity (n = 7). Of those that did report this information, most included a majority White sample (n = 13; see Table 3).

General Approach to Health Literacy

Only 2 of the 30 studies directly assessed general health literacy (Kohan et al., 2007; Shieh & Weaver, 2011), and only 1 of those 2 studies (Shieh & Weaver, 2011) employed a commonly used measure (the Short Test of Functional Literacy in Adults). It is important to note that the other study to directly assess health literacy did not have sufficient information and could not be coded for any of the health literacy component variables (i.e., the study did not include this methodological information in the article). Similarly, 10 of the sample studies did not focus on any element of general health literacy (finding, understanding, using, and communicating about GWG information; Table 4). Of the studies that included a focus on finding GWG information (n = 10), only one study had this as its core focus. Similarly, 10 of the articles included in our sample focused on pregnant women’s understanding of GWG information, with only 2 articles with a core focus on this health literacy element. Only nine of the articles focused on women’s use of GWG information (with only one article with this as the core focus) and four focused on how women communicate about GWG information (this element was not the core focus of any study).

TABLE 4. Presence of General Health Literacy Components Related to Gestational Weight Gain.

Study General Health Literacy
Finding Understanding Making Use Of Communicating About
Copper et al. (1995) No No No No
de Jersey et al. (2012) No Peripheral No No
Dipietro et al. (2003) No No No No
Everette (2008) No No No No
Ferrari and Siega-Riz (2013) No No Peripheral No
Ferraro et al. (2011) Core No Peripheral Peripheral
Gaudet et al. (2011) Peripheral Peripheral No No
Groth and Kearney (2009) No No No No
Groth et al. (2012) Peripheral No Peripheral Peripheral
Gutierrez (1999) No No No No
Haakstad et al. (2009) No No Peripheral No
Haruna et al. (2010) Peripheral No No No
Herring et al. (2012) Peripheral No No No
Kohan et al. (2007) Insufficienta Insufficient Insufficient Insufficient
Lee et al. (2012) No Peripheral Peripheral No
Mehta et al. (2011) No No No No
Mumford et al. (2008) No No No No
Olander et al. (2011) Peripheral No No No
Paul et al. (2013) Peripheral No Peripheral Peripheral
Phelan et al. (2011) No Peripheral No No
Shieh and Weaver (2011) Peripheral Peripheral Peripheral No
Shub et al. (2013) No Core No No
Stengel et al. (2012) Peripheral No No Peripheral
Stevens-Simon et al. (1993) No No No No
Stotland et al. (2005) No Peripheral No No
Sui et al. (2013) No No No No
Swann et al. (2009) No No No No
Tovar et al. (2011) No Peripheral Peripheral No
Wilkinson and McIntyre (2012) No Core Core No
Wilkinson et al. (2013) Peripheral Peripheral No No
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aArticle did not include enough information to determine code.

Health Domain–Specific Approach to Health Literacy

Seventeen of the articles in the sample focused on attitudes that facilitate recognition and help seeking for GWG (Table 5). Of these articles, this concept was the core focus of six articles. Most of these articles (12 of the 17) measured attitudes using a survey that was either paper-and-pencil, electronic, or orally administered, whereas the remaining studies assessed attitudes through focus groups (n = 3) or interviews (n = 2; women discussed their attitudes toward GWG). Of the articles that focused on attitudes, eight included Palmer et al.’s (1985) validated scale of attitudes about weight gain during pregnancy. Similarly, many of the articles (n = 7) exhibited a peripheral focus on the concept of attitudes toward GWG that facilitate recognition and help seeking; yet, none of these articles made this a core focus.

TABLE 5. Domain Specific Health Literacy: Gestational Weight Gain Attitudes in Study Based on Adaptation of Jorm’s (2000) Framework.

Study Attitudes
Focus How Measured Palmer Used Measure Created for Study Previously Validated Measure Attitudes That Facilitate Recognition and Help Seeking
Copper et al. (1995) Core Survey Yes No No No
de Jersey et al. (2012) No No No No No No
Dipietro et al. (2003) Core Survey Yes No No Peripheral
Everette (2008) No No No No No No
Ferrari and Siega-Riz (2013) Peripheral Survey Yes No No No
Ferraro et al. (2011) Peripheral Survey No Yes No Peripheral
Gaudet et al. (2011) No No No No No No
Groth and Kearney (2009) Peripheral Interview No Yes No Peripheral
Groth et al. (2012) Peripheral Focus group No No No Peripheral
Gutierrez (1999) Core Survey Yes No No No
Haakstad et al. (2009) No No No No No No
Haruna et al. (2010) Peripheral Focus group No No No No
Herring et al. (2012) No No No No No No
Kohan et al. (2007) No No No No No No
Lee et al. (2012) Peripheral Survey No No No No
Mehta et al. (2011) Peripheral Survey Yes No No No
Mumford et al. (2008) Peripheral Survey Yes No No No
Olander et al. (2011) Peripheral Focus group No No No Peripheral
Paul et al. (2013) No No No No No No
Phelan et al. (2011) No No No No No No
Shieh and Weaver (2011) Core Survey No No Yes Peripheral
Shub et al. (2013) No No No No No No
Stengel et al. (2012) Peripheral Interview No No No Peripheral
Stevens-Simon et al. (1993) Core Survey Yes No No No
Stotland et al. (2005) No No No No No No
Sui et al. (2013) No No No No No No
Swann et al. (2009) Core Survey No Yes No No
Tovar et al. (2011) Peripheral Survey Yes No No No
Wilkinson and McIntyre (2012) No No No No No No
Wilkinson et al. (2013) No No No No No No
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Another domain-specific concept adapted from Jorm (2000) included beliefs and knowledge about GWG. This topic was the focus of 22 of the articles included in our review, and 12 of these articles made beliefs and knowledge about GWG a core focus of the study (Table 6). Two articles had insufficient information available to code many of the items included in this category. Eighteen articles assessed beliefs and knowledge through surveys or interviews; the remaining studies assessed this concept using a focus group strategy. Fifteen of the articles that made this topic a focus of their study included emphasis on the beliefs and knowledge women have about how to recognize inadequate or excessive GWG (three of these studies made this concept a core focus of the study). Fourteen included a peripheral focus on examining women’s beliefs and knowledge about the risk factors and causes of GWG (although none of the studies made this a core focus). About one third (31.8%) of the articles focused on self-help interventions and beliefs and knowledge about professional help on the topic of GWG. Finally, only eight of the articles included any focus on women’s beliefs and knowledge about how to seek information on this important health topic.

TABLE 6. Domain Specific Health Literacy: Gestational Weight Gain Beliefs/Knowledge in Study Based on Adaptation of Jorm’s (2000) Framework.

Study Beliefs/Knowledge
Focus How Measured Measure Created for Study Previously Validated Measure Ability to Recognize Risk Factors/Causes Self-Help Intervention Professional Help How to Seek Information
Copper et al. (1995) No No No No No No No No No
de Jersey et al. (2012) Insufficienta Survey Insufficient Insufficient Insufficient Insufficient Insufficient Insufficient Insufficient
Dipietro et al. (2003) No No No No No No Peripheral No No
Everette (2008) Core Interview No No Peripheral Peripheral No No No
Ferrari and Siega-Riz (2013) No No No No No No No No No
Ferraro et al. (2011) Peripheral Survey Yes No No Peripheral Peripheral No No
Gaudet et al. (2011) Peripheral Survey Yes No Peripheral No No Peripheral Peripheral
Groth and Kearney (2009) Core Interview Yes No Core Peripheral No No No
Groth et al. (2012) Core Focus group No No Peripheral Peripheral No Peripheral Peripheral
Gutierrez (1999) Peripheral Survey Yes No No Peripheral No No No
Haakstad et al. (2009) Peripheral Survey Yes No No Peripheral Peripheral No No
Haruna et al. (2010) Core Focus group No No Peripheral Peripheral No Peripheral Peripheral
Herring et al. (2012) Core Focus group No No Peripheral Peripheral No Peripheral Peripheral
Kohan et al. (2007) Core Survey Insuff. Insuff. Insuff. Insuff. Insuff. Insuff. Insuff.
Lee et al. (2012) Peripheral Survey Yes No No Peripheral No Peripheral No
Mehta et al. (2011) No No No No No No No No No
Mumford et al. (2008) No No No No No No No No No
Olander et al. (2011) Core Focus group No No Peripheral No No No Peripheral
Paul et al. (2013) Peripheral Focus group No No Peripheral Peripheral Peripheral No No
Phelan et al. (2011) Core Survey No Yes No No No No No
Shieh and Weaver (2011) Peripheral Survey No Yes No No No No Peripheral
Shub et al. (2013) Core Survey Yes No Peripheral Peripheral Peripheral No No
Stengel et al. (2012) Peripheral Interview Yes No Peripheral Peripheral No Core Core
Stevens-Simon et al. (1993) No No No No No No No No No
Stotland et al. (2005) Core Survey Yes No Core No No No No
Sui et al. (2013) Core Survey and interview Yes No Peripheral Peripheral Peripheral No No
Swann et al. (2009) No No No No No No No No No
Tovar et al. (2011) Peripheral Survey No No Peripheral Peripheral No No No
Wilkinson and McIntyre (2012) Peripheral Survey No Yes Core Insufficient Peripheral No No
Wilkinson et al. (2013) Core Survey Yes No Peripheral Insufficient No Peripheral Peripheral
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aArticle did not include enough information to determine code.

DISCUSSION

Previous research suggests that low health literacy is associated with negative health outcomes (Berkman et al., 2011; DeWalt et al., 2004; DeWalt & Hink, 2009; HLS-EU Consortium, 2012; Peterson et al., 2011); as such, it was expected that the application of this concept would be found in GWG research. However, this scoping review uncovers an important issue: Health literacy is rarely applied to explain GWG outcomes. In our large scoping review, only two articles measured general health literacy directly in a GWG research context. Indeed, health literacy was not mentioned in an extensive report to the Agency for Healthcare Research and Quality on research related to GWG (McKoy, Hartmann, Jerome, Andrews, & Penson, 2010). Given both the prevalence of GWG outside of the recommendations and the relationship patient health literacy has with overall health outcomes, it is necessary and critical that health literacy be applied to better understand GWG outcomes.

In this study, we incorporated two views of health literacy to capture the greatest number of instances of health literacy paired with GWG research. Under the “general” approach to health literacy, this concept is broadly defined as an individual’s capacity to find, understand, make use of, and communicate about health information in an effort to make informed health decisions (Berkman et al., 2010). Findings from this scoping review suggest that previous work done to understand how pregnant women interact with health information has focused on these components of health literacy separately, with several studies looking at either finding, understanding, using, or communicating about health information as specific concepts.

Efforts to improve all of these health literacy skill sets are needed to ensure that women receive, understand, and can use necessary information about GWG. A broad focus on improving general health literacy may equip patients with a collection of skills necessary for interacting with GWG information rather than choosing only some of these skills and intervening only in those areas (e.g., helping women only understand GWG rather than also including how they can find and use this information). Given previous research on the impact of health literacy on health, it may be that weight gained during pregnancy can also be explained, at least partially, by a patient’s health literacy. We feel that a focus on patient health literacy in a GWG context can be most helpful for these patients and could save health-care providers’ time and resources.

In the present review, we also included a domain-specific approach to health literacy by using Jorm’s (2000) framework for understanding mental health literacy, which brought the concepts of attitude, beliefs, and knowledge of GWG. Jorm’s concepts were more often the focus of the reviewed studies rather than the components of general health literacy as outlined earlier. A question that stems from work in this area is whether a patient’s health literacy skills should be thought to generalize to all health outcomes or if these skills are context-specific (in this case, does the GWG context require specific health literacy skills?). More work is needed to understand whether GWG necessitates a unique conceptualization comparable to the framework proposed by Jorm, or if a patient’s general health literacy capacities can determine GWG outcomes. Understanding this distinction could not only lead to improved GWG health outcomes for women but could also yield a better understanding of the concept of health literacy as a whole.

In addition, given the results in our scoping review, it seems that the use of validated concepts and scales in this area of research could be improved. For example, despite the availability of the Palmer measurement tool that was previously created to capture women’s attitudes toward GWG (Palmer et al., 1985), less than half of the studies that focused on attitudes toward GWG used this scale designed for this exact purpose. Use of validated measures such as the Palmer scale allows comparisons in findings across studies, which is needed to better understand how GWG outside the recommendations occurs. In the same way, studies in this area should make use of established health literacy instruments to further improve the ability of both researchers and practitioners to compare findings across studies and populations.

It is important to consider how we can better address the concept of health literacy in GWG research because this could shed light on how and why inadequate and excessive GWG occurs. This review also demonstrates the general lack of GWG research across various demographic categories. Broadly, this research should continue to explore GWG across a variety of racial/ethnic and socioeconomic backgrounds rather than focusing on predominately White and adequate socioeconomic status samples because low health literacy is more prominent in racially/ethnic minorities, older adults, and those who did not complete high school (Nielsen-Bohlman et al., 2004).

Implications for Practice

This scoping review provides an important current assessment of the state of health literacy science in the context of GWG. Although this review shows that the link between health literacy and GWG is woefully understudied, the components of general and GWG-specific health literacy offer promise as a framework to enhance practice. In Part 2, here, of the hypothetical case study of Caitlin, the mom-to-be, and her childbirth educator Jane, we illustrate how a health literacy framework might be applied.

First, in drawing on a general health literacy framework, Jane noted that the varied GWG information that Caitlin had received from people in her network, including her prenatal care provider, as well as from TV, left her confused. Because Jane was familiar with the current GWG recommendations for women’s body mass index categories, she explored with Caitlin how she might locate credible source information on GWG—from print or electronic sources, as Caitlin preferred—based on IOM recommendations. Jane helped Caitlin further identify information sources targeting new mothers (vs. health professionals), so that she would be able to easily understand advice on reaching a GWG goal and how to translate that advice into her daily life. For example, Jane helped Caitlin find an easy to use website about the GWG range for her weight group (see resources at IOM & National Research Council, 2016). She also suggested how Caitlin might talk with her prenatal provider to ensure they shared the same goal about a healthy GWG for Caitlin.

Jane also drew on her knowledge of GWG-specific health literacy in working with Caitlin. For example, she addressed Caitlin’s beliefs about the causes of excessive GWG, as expressed by her mother, as well as Caitlin’s uncertainty about how excessive GWG might affect her, her baby, and the birth process. Jane shared with Caitlin that a healthy GWG would help her baby have a healthy birth weight and might reduce the likelihood of certain complications during the birth process. To help her recognize if her GWG remained in the recommended range as her pregnancy progressed, Jane suggested that Caitlin download a GWG tracker on which she could chart her weight and use in conferring with her prenatal care provider. Finally, Jane noted that Caitlin now seemed more confident about her ability to achieve a healthy GWG to benefit her and her baby.

The preceding case study gives a glimpse of how both the general health literacy components (finding, understanding, using, and communicating about) and our adapted framework for domain-specific health literacy related to GWG may delineate important areas for further development relevant to practice. First, it may be that assessing patient health literacy can help to tailor GWG information to a specific patient. Focusing on health literacy may save health-care providers and health educators’ time and resources in the health education of childbearing women. Brief and easily scored assessments of the components of general health literacy applicable to busy practice settings would be ideal.

Second, in the practice context, women also may need specific health literacy capabilities to make appropriate decisions about how to manage GWG over the course of pregnancy. Such decisions involve a complex calculus. Even if health-care providers accurately recommended GWG targets to women, translating those recommendations into daily living varies by whether women are underweight, normal weight, overweight, or obese (Table 1; IOM, 2009). In addition to gains in body fat (which may be dependent on energy intake and expenditure), women’s GWG also includes fetal growth and adaptations in body water, blood, and breast and uterine tissues that change over the course of pregnancy. Ranges for GWG accommodate variations among women; however, the six components of domain-specific health literacy we adapted from Jorm (2000) as well as those outlined through the general approach to health literacy provide additional tools to aid in the complex calculus of understanding and managing GWG. Thus, in a practice context, the GWG health literacy framework we adapted moves the dialogue from a question “Do women know how much weight they should gain?” to “Do women have the knowledge, attitudes, and skills to make appropriate decisions about managing their GWG across the course of pregnancy?” If not, our hypothetical case study illustrates ways in which childbirth educators and others involved in care and education of pregnant women may use a health literacy framework to empower women in reaching healthy GWG goals.

Limitations

Because one of the goals of scoping reviews is to gain an overall understanding of an area or topic of study (Arksey & O’Malley, 2005), it does not include weighting of studies regarding bias in design; thus, this review did not the address strength of evidence for various findings based on strengths and weaknesses of various studies.

CONCLUSION

Despite the known impact of health literacy on various health outcomes, findings from this scoping review highlight the lack of health literacy research in a GWG context. As a more patient-centered concept than others studied in previous GWG research, health literacy might offer a way of more deeply probing patients’ personal understanding and capabilities that affect the various outcomes of adequate, inadequate, or excessive GWG. An initial step for research in this direction is a focus on exploring GWG using general and domain-specific approaches to health literacy. Based on findings from our scoping review, there is already a greater presence of research aimed at domain-specific attributes such as attitudes and beliefs and knowledge toward GWG. It is important that future work include valid and reliable health literacy assessments to establish a better understanding of the relationship between health literacy and GWG, especially in demographically diverse populations.

Despite the known impact of health literacy on various health outcomes, findings from this scoping review highlight the lack of health literacy research in a GWG context.

Biographies

SARA CHAMPLIN is an assistant professor in the Mayborn School of Journalism, University of North Texas, Denton, Texas.

LORRAINE O. WALKER is a professor in the School of Nursing, University of Texas, Austin, Texas.

MICHAEL MACKERT is a Provost’s Teaching Fellow and associate professor in the Stan Richards School of Advertising and Public Relations; adjunct professor at the Health Science Center at Houston School of Public Health; and associate director for the Center for Health Communication, Austin, Texas.

REFERENCES

  1. Abrams B., Carmichael S., & Selvin S. (1995). Factors associated with the pattern of maternal weight gain during pregnancy. Obstetrics and Gynecology, 86(2), 170–176. [DOI] [PubMed] [Google Scholar]
  2. Ad Hoc Committee on Health Literacy. (1999). Health Literacy: Report of the Council on Scientific Affairs. Journal of the American Medical Association, 281, 552–557. [PubMed] [Google Scholar]
  3. American College of Obstetricians and Gynecologists. (2013). ACOG Committee opinion no. 548: Weight gain during pregnancy. Obstetrics & Gynecology, 121, 210–212. [DOI] [PubMed] [Google Scholar]
  4. Arksey H., & O’Malley L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32. [Google Scholar]
  5. Berkman N. D., Davis T. C., & McCormack L. (2010). Health literacy: What is it? Journal of Health Communication, 15(Suppl. 2), 9–19. [DOI] [PubMed] [Google Scholar]
  6. Berkman N. D., Sheridan S. L., Donahue K. E., Halpern D. J., & Crotty K. (2011). Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine, 155, 97–107. [DOI] [PubMed] [Google Scholar]
  7. Calderón J. L., Shaheen M., Hays R. D., Fleming E. S., Norris K. C., & Baker R. S. (2014). Improving diabetes health literacy by animation. The Diabetes Educator, 40, 361–372. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Carmichael S., Abrams B., & Selvin S. (1997). The pattern of maternal weight gain in women with good pregnancy outcomes. American Journal of Public Health, 87(12), 1984–1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Copper R. L., DuBard M. B., Goldenberg R. L., & Oweis A. I. (1995). The relationship of maternal attitude toward weight gain to weight gain during pregnancy and low birth weight. Obstetrics & Gynecology, 85, 590–595. [DOI] [PubMed] [Google Scholar]
  10. Davis E. M., Stange K. C., & Horwitz R. I. (2012). Childbearing, stress and obesity disparities in women: A public health perspective. Maternal and Child Health Journal, 16, 109–118. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. de Jersey S. J., Nicholson J. M., Callaway L. K., & Daniels L. A. (2012). A prospective study of pregnancy weight gain in Australian women. Australian & New Zealand Journal of Obstetrics & Gynaecology, 52, 545–551. [DOI] [PubMed] [Google Scholar]
  12. DeWalt D. A., Berkman N. D., Sheridan S., Lohr K. N., & Pignone M. P. (2004). Literacy and health outcomes: A systematic review of the literature. Journal of General Internal Medicine, 19, 1228–1239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. DeWalt D. A., & Hink A. (2009). Health literacy and child health outcomes: A systematic review of the literature. Pediatrics, 124(Suppl. 3), S265–S274. [DOI] [PubMed] [Google Scholar]
  14. Dipietro J. A., Millet S., Costigan K. A., Gurewitsch E., & Caulfield L. E. (2003). Psychosocial influences on weight gain attitudes and behaviors during pregnancy. Journal of the American Dietetic Association, 103, 1314–1319. [DOI] [PubMed] [Google Scholar]
  15. Everette M. (2008). Gestational weight and dietary intake during pregnancy: Perspectives of African American women. Maternal and Child Health Journal, 12, 718–724. [DOI] [PubMed] [Google Scholar]
  16. Ferrari R. M., & Siega-Riz A. M. (2013). Provider advice about pregnancy weight gain and adequacy of weight gain. Maternal and Child Health Journal, 17, 256–264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ferraro Z., Rutherford J., Keely E. J., Dubois L., & Adamo K. B. (2011). An assessment of patient information channels and knowledge of physical activity and nutrition during pregnancy. Obstetric Medicine, 4, 59–65. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Fortner R. T., Pekow P., Solomon C. G., Markenson G., & Chasan-Taber L. (2009). Prepregnancy body mass index, gestational weight gain, and risk of hypertensive pregnancy among Latina women. American Journal of Obstetrics & Gynecology, 200, 167.e1–167.e7. [DOI] [PubMed] [Google Scholar]
  19. Gaudet L. M., Gruslin A., & Magee L. A. (2011). Weight in pregnancy and its implications: What women report. Journal of Obstetrics and Gynaecology Canada, 33, 227–234. [DOI] [PubMed] [Google Scholar]
  20. Groth S. W., & Kearney M. H. (2009). Diverse women’s beliefs about weight gain in pregnancy. Journal of Midwifery & Women’s Health, 54, 452–457. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Groth S. W., Morrison-Beedy D., & Meng Y. (2012). How pregnant African American women view pregnancy weight gain. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41, 798–808. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Gutierrez Y. M. (1999). Cultural factors affecting diet and pregnancy outcome of Mexican American adolescents. Journal of Adolescent Health, 25, 227–237. [DOI] [PubMed] [Google Scholar]
  23. Haakstad L. A. H., Voldner N., Henriksen T., & Bø K. (2009). Why do pregnant women stop exercising in the third trimester? Acta Obstericia et Gynecologica Scandinavica, 88, 1267–1275. [DOI] [PubMed] [Google Scholar]
  24. Haruna M., Yeo S., Watanabe E., Matsuzaki M., Ota E., Nakayama K., & Murashima S. (2010). Perceptions of women and health-care providers in Tokyo of appropriate weight gain during pregnancy. Nursing & Health Sciences, 12, 21–26. [DOI] [PubMed] [Google Scholar]
  25. Headen I. E., Davis E. M., Mujahid M. S., & Abrams B. (2012). Racial-ethnic differences in pregnancy-related weight. Advances in Nutrition, 3, 83–94. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Hernandez D. C. (2012). Gestational weight gain as a predictor of longitudinal body mass index transitions among socioeconomically disadvantaged women. Journal of Women’s Health, 21, 1082–1090. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Herring S. J., Henry T. Q., Klotz A. A., Foster G. D., & Whitaker R. C. (2012). Perceptions of low-income African-American mothers about excessive gestational weight gain. Maternal and Child Health Journal, 16, 1837–1843. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Hill B., Skouteris H., McCabe M., Milgrom J., Kent B., Herring S. J., . . . Gale J. (2013). A conceptual model of psychosocial risk and protective factors for excessive gestational weight gain. Midwifery, 29, 110–114. [DOI] [PubMed] [Google Scholar]
  29. HLS-EU Consortium. (2012). Comparative report on health literacy in eight EU member states. The European Health Literacy Survey HLS-EU. Retrieved from http://ec.europa.eu/chafea/documents/news/comparative_report_on_health_literacy_in_eight_EU_member_states.pdf
  30. Hunt K. J., Alanis M. C., Johnson E. R., Mayorga M. E., & Korte J. E. (2013). Maternal pre-pregnancy weight and gestational weight gain and their association with birthweight with a focus on racial differences. Maternal and Child Health Journal, 17, 85–94. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Institute of Medicine. (1990). Nutrition during pregnancy. Washington, DC: The National Academies Press. [Google Scholar]
  32. Institute of Medicine. (2009). Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: The National Academies Press. [PubMed] [Google Scholar]
  33. Institute of Medicine & National Research Council. (2016). Healthy weight gain during pregnancy. Retrieved http://www.nationalacademies.org/hmd/About-IOM/Making-a-Difference/Kellogg/~/media/Files/About%20the%20IOM/Pregnancy-Weight/ProvidersBro-Final.pdf
  34. Jorm A. F. (2000). Mental health literacy: Public knowledge and beliefs about mental disorders. British Journal of Psychiatry, 177, 396–401. [DOI] [PubMed] [Google Scholar]
  35. Jorm A. F. (2015). Why we need the concept of “mental health literacy.” Health Communication, 30, 1166–1168. [DOI] [PubMed] [Google Scholar]
  36. Kohan S., Ghasemi S., & Dodangeh M. (2007). Associations between maternal health literacy and prenatal care and pregnancy. Iranian Journal of Nursing and Midwifery Research, 12, 146–152. [Google Scholar]
  37. Lee A., Karpavicius J., Gasparini E., & Forster D. (2012). Implementing a diet and exercise program for limiting maternal weight gain in obese pregnant women: A pilot study. Australian & New Zealand Journal of Obstetrics & Gynaecology, 52, 427–432. [DOI] [PubMed] [Google Scholar]
  38. Mackert M., Champlin S., Su Z., & Guadagno M. (2015). The many health literacies: Advancing the field or fragmentation? Health Communication, 30(12), 1161–1165. [DOI] [PubMed] [Google Scholar]
  39. McKoy J. N., Hartmann K. E., Jerome R. N., Andrews J. C., & Penson D. F. (2010). Future research needs for outcomes of weight gain in pregnancy (Future Research Needs Paper No. 6. AHRQ Publication No. 11-EHC004-EF). Rockville, MD: Agency for Healthcare Research and Quality. [PubMed] [Google Scholar]
  40. Mehta U. J., Siega-Riz A. M., & Herring A. H. (2011). Effect of body image on pregnancy weight gain. Maternal and Child Health Journal, 15, 324–332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Mumford S. L., Siega-Riz A. M., Herring A., & Evenson K. R. (2008). Dietary restraint and gestational weight gain. Journal of the American Dietetic Association, 108, 1646–1653. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Nielsen-Bohlman L., Panzer A., & Kindig D. (Eds.). (2004). Health literacy: A prescription to end confusion. Washington, DC: The National Academies Press. [PubMed] [Google Scholar]
  43. Olander E. K., Atkinson L., Edmunds J. K., & French D. P. (2011). The views of pre- and post-natal women and health professionals regarding gestational weight gain: An exploratory study. Sexual & Reproductive Healthcare, 2, 43–48. [DOI] [PubMed] [Google Scholar]
  44. Palmer J. L., Jennings G. E., & Massey L. (1985). Development of an assessment form: Attitude toward weight gain during pregnancy. Journal of the American Dietetic Association, 85, 946–949. [PubMed] [Google Scholar]
  45. Paul K. H., Graham M. L., & Olson C. M. (2013). The web of risk factors for excessive gestational weight gain in low income women. Maternal and Child Health Journal, 17, 344–351. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Peterson P. N., Shetterly S. M., Clarke C. L., Bekelman D. B., Chan P. S., Allen L. A., . . . Masoudi F. A. (2011). Health literacy and outcomes among patients with heart failure. Journal of the American Medical Association, 305, 1695–1701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Phelan S., Phipps M. G., Abrams B., Darroch F., Schaffner A., & Wing R. R. (2011). Practitioner advice and gestational weight gain. Journal of Women’s Health, 20, 585–591. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Shieh C., & Weaver M. T. (2011). Comparisons in perceived importance of and needs for maternal gestational weight information between African American and Caucasian pregnant women. The Journal of Perinatal Education, 20, 100–107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Shub A., Huning E. Y., Campbell K. J., & McCarthy E. A. (2013). Pregnant women’s knowledge of weight, weight gain, complications of obesity and weight management strategies in pregnancy. BMC Research Notes, 6, 278–283. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Siega-Riz A. M., Adair L. S., & Hobel C. J. (1994). Institute of Medicine maternal weight gain recommendations and pregnancy outcomes in a predominantly Hispanic population. Obstetrics and Gynecology, 84(4), 565–573. [PubMed] [Google Scholar]
  51. Siega-Riz A. M., Viswanathan M., Moos M. K., Deierlein A., Mumford S. L., Knaack J., . . . Lohr K. N. (2009). A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: Birthweight, fetal growth, and postpartum weight retention. American Journal of Obstetrics & Gynecology, 201, 339.e1–339.e14. [DOI] [PubMed] [Google Scholar]
  52. Stengel M. R., Kraschnewski J. L., Hwang S. W., Kjerulff K. H., & Chuang C. H. (2012). “What my doctor didn’t tell me:” Examining health care provider advice to overweight and obese pregnant women on gestational weight gain and physical activity. Women’s Health Issues, 22, e535–e540. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Stevens-Simon C., Nakashima I. I., & Andrews D. (1993). Weight gain attitudes among pregnant adolescents. Journal of Adolescent Health, 14, 369–372. [DOI] [PubMed] [Google Scholar]
  54. Stotland N. E., Cheng Y. W., Hopkins L. M., & Caughey A. B. (2006). Gestational weight gain and adverse neonatal outcome among term infants. Obstetrics & Gynecology, 108(3, Pt. 1), 635–643. [DOI] [PubMed] [Google Scholar]
  55. Stotland N. E., Haas J. S., Brawarsky P., Jackson R. A., Fuentes-Afflick E., & Escobar G. J. (2005). Body mass index, provider advice, and target gestational weight gain. Obstetrics & Gynecology, 105, 633–638. [DOI] [PubMed] [Google Scholar]
  56. Stotland N. E., Hopkins L. M., & Caughey A. B. (2004). Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas. Obstetrics & Gynecology, 104, 671–677. [DOI] [PubMed] [Google Scholar]
  57. Sui Z., Turnbull D. A., & Dodd J. M. (2013). Overweight and obese women’s perceptions about making healthy change during pregnancy: A mixed method study. Maternal and Child Health Journal, 17, 1879–1887. [DOI] [PubMed] [Google Scholar]
  58. Swann R. A., Von Holle A., Torgersen L., Gendall K., Reichborn-Kjennerud T., & Bulik C M. (2009). Attitudes toward weight gain during pregnancy: Results from the Norwegian mother and child cohort study (MoBa). International Journal of Eating Disorders, 42, 394–401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Tovar A., Guthrie L. B., Platek D., Stuebe A., Herring S. J., & Oken E. (2011). Modifiable predictors associated with having a gestational weight gain goal. Maternal and Child Health Journal, 15, 1119–1126. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Wilkinson S. A., & McIntyre H. D. (2012). Evaluation of the ‘healthy start to pregnancy’ early antenatal health promotion workshop: A randomized controlled trial. BMC Pregnancy and Childbirth, 12, 131–142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Wilkinson S. A., Walker A., & Tolcher D. (2013). Re-evaluation of women’s nutritional needs, knowledge and behaviours in a tertiary maternity service: Are we meeting women’s needs yet? Nutrition & Dietetics, 70, 181–187. [Google Scholar]

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