Table 6.
Barriers and related facilitators to appropriate gestational weight gain identified by pregnant women
| Barrier to: | Barrier category | Specific barrier | Related facilitators |
|---|---|---|---|
| Eating habits | Knowledge | Do not understand how to operationalize directive to “eat healthy” | Community‐based cooking and nutrition class geared to pregnancy and young families. |
| Lack of cooking skills | No facilitators mentioned | ||
| Nutrition advice not culturally relevant | No facilitators mentioned | ||
| Nutrition info contradictory, confusing, changing | No facilitators mentioned | ||
| Beliefs | Assume quick postpartum weight loss | Experience of excess gestational weight gain from a previous pregnancy | |
| Pregnancy is a vacation from worrying about weight | Information about fetal and maternal health benefits of weight control | ||
| Pregnancy is a time to enjoy foods normally avoided | No facilitators mentioned | ||
| Concern about providing enough nutrients for baby | No facilitators mentioned | ||
| Pregnancy is a time to eat for two | No facilitators mentioned | ||
| Quality, not quantity of food is what is important | No facilitators mentioned | ||
| Cravings, aversions determined by baby, body's way of communicating what food to eat or avoid | No facilitators mentioned | ||
| Physical | Intense hunger | No facilitators mentioned | |
| Nausea and aversions | No facilitators mentioned | ||
| Sugar helps overcome fatigue | No facilitators mentioned | ||
| Cravings | No facilitators mentioned | ||
| Social | Frequently eating outside the home | No facilitators mentioned | |
| Encouragement from friends/family to overeat or gain weight | Education that includes friends/family | ||
| Family members have preference for unhealthy food | No facilitators mentioned | ||
| Judgement about diet, weight gain from family members/friends | No facilitators mentioned | ||
| Loneliness, isolation, lack of social support | |||
| Logistic | Lack of time for planning, shopping, cooking | Healthy recipes that are cheap and quick to prepare | |
| Emotional/psychosocial | Compensating for other deprivations (alcohol, cigarettes) with junk food | No facilitators mentioned | |
| Emotional eating as a reaction to stress, depression | Mindfulness and stress‐reduction interventions | ||
| Pleasure from junk food | No facilitators mentioned | ||
| Structural | Accessibility, prevalence of fast food | No facilitators mentioned | |
| Financial | No facilitators mentioned | ||
| Difficulty accessing healthy, fresh food | No facilitators mentioned | ||
| Chronic stress | Mindfulness and stress‐reduction interventions | ||
| Physical Activity (PA) | Knowledge | Do not know suitable exercises, intensity, duration for pregnancy | Exercise classes for pregnant women |
| Do not know about importance of exercise in pregnancy | Counselling about PA from health care provider | ||
| Health care provider advises very conservative exercise regimen | Seeking alternative sources of information | ||
| Beliefs | Activity of everyday life is sufficient PA | Finding ways to include more activity in everyday routine | |
| PA can harm fetus | Counselling about PA from health care provider | ||
| Gentle exercise (e.g., walking or stretching) is sufficient | No facilitators mentioned | ||
| Pregnancy is a time for rest | No facilitators mentioned | ||
| Not motivated to exercise | Recognizing positive physical feelings after exercise | ||
| Physical | Fatigue | No facilitators mentioned | |
| Nausea | Exercise classes for pregnant women | ||
| Pregnancy‐related soreness, pain, mobility limitation | |||
| Shortness of breath | No facilitators mentioned | ||
| Social | Stigma of exercising while obese/overweight | Exercise classes for overweight pregnant women | |
| Family/partner preventing activity, removing active tasks | Information aimed at family, partners | ||
| Loneliness, isolation, lack of social support that encourages activity | Exercise classes for pregnant women | ||
| Logistic | Childcare | Community‐based exercise programs that have childcare, exercise ideas for the whole family | |
| Lack of time | Finding ways to include more activity in everyday routine | ||
| Sedentary job | |||
| Weather prohibitive to outdoor activity | Free, safe, accessible indoor places for exercise | ||
| Structural | Finances | Free, safe, community‐based locations for exercise | |
| General | Knowledge | Do not understand importance of weight control | HCP forthcoming with sensitive advice about weight, regularly, starting early in pregnancy |
| Inconsistent messages about weight from health care providers | No facilitators mentioned | ||
| Information received too late in pregnancy | No facilitators mentioned | ||
| Do not understand how to achieve weight control | No facilitators mentioned | ||
| Information alone not sufficient to motivate change | Other motivators: health of fetus, feeling good, maintaining function, easier postpartum weight loss | ||
| Beliefs | Disagree with health care provider advice about weight control in pregnancy | Build trust with HCP | |
| Health of baby determines appropriate weight gain | HCP forthcoming with evidence‐based, clear, sensitive advice about weight that takes individual circumstances into consideration | ||
| Big babies are healthy babies | No facilitators mentioned | ||
| Lifestyle, listening to body is more important than scale | No facilitators mentioned | ||
| Understanding of weight target inconsistent with Institute of Medicine guidelines | No facilitators mentioned | ||
| Inaccurate understanding of pre‐pregnancy weight status | No facilitators mentioned | ||
| Desire for individualized recommendations | No facilitators mentioned | ||
| Weight gain and retention is uncontrollable | No facilitators mentioned | ||
| Physical | Genetics | No facilitators mentioned | |
| Maternal age | No facilitators mentioned | ||
| Medical conditions | No facilitators mentioned | ||
| Social | Crude or cruel comments from others | Education opportunities that include family members | |
| Pressure to follow family advice over HCP advice | No facilitators mentioned | ||
| Stigma of weight affects interactions with health care professionals | No facilitators mentioned | ||
| Logistic | Rely on HCP to alert to a weight issue | HCP forthcoming with sensitive advice about weight, regularly, starting early in pregnancy | |
| No regular weight monitoring | No facilitators mentioned | ||
| Struggle to maintain lifestyle changes over time | No facilitators mentioned | ||
| Emotional | Feelings of guilt and blame for weight lead to overeating | No facilitators mentioned | |
| Not ready to change lifestyle while pregnant | Recognizing positive effects of making change in pregnancy |
Note. HCP = health care providers.