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. Author manuscript; available in PMC: 2022 Nov 1.
Published in final edited form as: J Obstet Gynecol Neonatal Nurs. 2021 Aug 31;50(6):669–678. doi: 10.1016/j.jogn.2021.08.097

Influence of Appetite and Perceived Ability to Control Cravings on Excessive Gestational Weight Gain

Susan W Groth 1, Ying Meng 2, Kuan Lin Yeh 3, I Diana Fernandez 4
PMCID: PMC8594632  NIHMSID: NIHMS1749930  PMID: 34474006

Abstract

Objective:

To explore whether appetite is associated with gestational weight gain (GWG) and to assess the effect of perceived ability to control cravings on excessive GWG.

Design:

Secondary data analysis.

Setting:

Rochester NY, USA

Participants:

Women who were pregnant (N = 1005) and participated in a randomized controlled trial to test the effect of electronically mediated interventions to prevent excessive gestational weight gain and postpartum weight retention.

Methods:

We used two questions to assess appetite and perceived ability to control cravings before 28 weeks gestation: “How would you describe your appetite now compared to times when you are not pregnant?” and “How sure are you that you will be able to avoid overeating when you have cravings?” We conducted logistic regression to assess relationships between appetite, perceived ability to control cravings, and excessive GWG.

Results:

More than 47% of participants gained excessive weight during pregnancy. Approximately 62% of participants reported being hungrier, and more than 42% indicated they were unsure they could avoid overeating with cravings. Participants who reported similar/less appetite than before pregnancy were less likely to gain excessive weight (p < 0.05). Participants who were sure they could control cravings were less likely to gain excessive weight (p = 0.02).

Conclusion:

Our results show that appetite and perceived ability to control cravings may affect GWG. Additional research is needed to assess if interventions targeting appetite and craving control could limit GWG.

Keywords: pregnancy, gestational weight gain, appetite, cravings

Precis

Results suggested that appetite and perceived ability to control cravings may have an effect on gestational weight gain.

Approximately 50% of women of childbearing age in the United States are overweight or obese (Deputy et al., 2015; Singh & DiBari, 2019), and nearly 50% of women gain weight in excess of guidelines established by the Institute of Medicine (Rasmussen & Yaktine, 2009). Excess weight gain during pregnancy is particularly prevalent among women who are overweight or obese before pregnancy (Deputy et al., 2015). Furthermore, overweight or obesity before pregnancy and high gestational weight gain (GWG) were predictive of pregnancy complications such as gestational diabetes, hypertensive disorders, preeclampsia (English et al., 2015), and macrosomia (Rasmussen & Yaktine, 2009). High GWG was also predictive of long-term maternal health risks, including weight retention (Groth et al., 2013; Rasmussen & Yaktine, 2009), central adiposity (Fraser et al., 2011), type 2 diabetes, hypertension (Groth et al., 2013; Holland et al., 2015), metabolic syndrome, and negative metabolic profiles (Rooney et al., 2005). These outcomes are in turn associated with future cardiometabolic disease in women (Mosca et al., 2011).

A challenge for care providers and researchers is how best to help women achieve GWG within established guidelines based on current evidence that balances maternal and child outcomes. Interventional approaches have typically incorporated weight management methodologies that primarily focus on dietary intake and/or physical activity levels. As reported by authors of a Cochrane systematic review of 65 studies with a meta-analysis of 49 of the studies, these interventions decreased the risk of excessive GWG by approximately 20%, although the range of decrease was highly heterogeneous (Muktabhant et al., 2015). Specifically, these authors compiled high quality evidence to show that diet, or exercise, or the combination of diet and exercise decreases the risk of excessive GWG (average risk ratio RR = 0.80, 95% CIs [0.73 to 0.87]; N > 7000 from 24 studies). However, factors other than diet and physical activity are likely to contribute to excessive GWG, and the effectiveness of interventions may be limited because interventions do not include strategies that focus on the experiences of women during pregnancy (Hackley et al., 2014). An emerging consideration is food cravings because it is known that cravings are common in pregnancy, and they have been associated with pathology related to eating, body weight, and weight gain in the non-pregnant population (Orloff et al., 2016).

1. Excessive gestational weight gain is a health issue for women, and knowledge of how appetite and food cravings contribute to excessive gestational weight gain is limited.

Food cravings are strong urges for specific foods that are difficult to resist and not necessarily associated with hunger (Blau et al., 2018). Although common in pregnancy, food cravings are not well understood in pregnant women. Worthington-Roberts et al. (1989) reported that the incidence of cravings was as high as 93% in pregnant women. Cravings may be important to study because they appear to alter what women choose to eat while they are pregnant (Farland et al., 2015; Groth & Morrison-Beedy, 2013; Groth et al., 2016; Hill & McCance, 2014; Orloff & Hormes, 2014). Women who are pregnant commonly report cravings as a reason why they increase or add foods to their diets (Forbes et al., 2018), and food cravings were positively correlated with dietary intake of sweets, caloric intake (Hill et al., 2016), and GWG (Orloff et al., 2016). Accordingly, food cravings may contribute to excessive GWG (Allison et al., 2012; Blau et al., 2018; Orloff et al., 2016). However, findings thus far are inconsistent. For example, Hill et al. (2016) found that cravings were not associated with excessive GWG in a sample of 635 pregnant women. These differences in findings could be related to how cravings were measured. Allison et al. (2012) assessed eating habits that might affect GWG, and women were asked to rate how much the items, such as cravings, contributed to their weight gain. Orloff et al. (2016) measured cravings with a food craving inventory that was used to specify foods and to assess frequency of cravings and how often the respondent gave in to cravings. Hill et al. (2016) analyzed responses to a food frequency questionnaire that included a question asking participants to describe any food cravings experienced without providing prompts for types of cravings. In addition to measurement differences, the studies were very different in sample size: Allison et al. (2012) included 120 women, Orloff et al. (2016) included 83 women, and Hill et al. (2016) included 635 women. From a different perspective, Blau et al. (2018) considered women’s cravings in the context of emotional eating (n = 113) and found that craving high fat foods fully mediated the relationship of emotional eating with excessive GWG.

Although researchers examined the association of cravings and GWG, they did not consider whether women believed they could control the impulse to give in to cravings. Self-efficacy, the belief in one’s capacity to carry out a behavior, in this case to control cravings, could be an important variable. Food cravings and limited self-efficacy to control GWG were shown to influence a woman’s ability to carry out healthy eating behaviors while pregnant (Nagourney et al., 2019). The etiology of food cravings specific to pregnancy is unknown, but it is known to be a common experience. At the same time, evidence suggests that the usual response to cravings in pregnancy tends to be to satisfy the cravings (Groth &Morrison-Beedy, 2013; Marshall et al., 2019; Most et al., 2019) rather than to control the impulse.

Appetite or appetite changes during pregnancy potentially affect the amount of GWG. However, there is a paucity of research on the role of appetite in pregnancy. Appetite appeared to modify the dietary intake of minority women who were pregnant. For example, African American women indicated that their appetites varied by day: sometimes less than usual, sometimes more than usual, but their appetites determined what they cooked and ate on a given day (Groth et al., 2016). Hackley et al. (2014) reported that Hispanic, Native American, and Black women believed that heartier appetites interfered with achieving good nutrition.

Appetite was assessed in the context of nausea and vomiting in pregnancy, and findings suggested that women ate less food if they felt less hungry and/or if they had nausea (Crozier et al, 2017). At the same time women sometimes ate more if they felt hungry or as a means to prevent feeling sick. To date, the effects of appetite during pregnancy on GWG have not been directly examined. In two qualitative studies, women discussed how appetite and cravings affected what they ate (Groth et al., 2016; Hackley et al., 2014). However, appetite has not been assessed in relation to cravings in pregnancy. The purpose of our secondary analysis was to explore whether appetite is associated with GWG and to assess the effect of perceived ability to control cravings on excessive GWG.

Methods

We conducted a secondary data analysis of data from the eMoms study, a double-blind randomized controlled trial, which was part of the Early Trials Consortium (Fernandez et al., 2015) and had the goal of slowing weight accumulation in pregnancy and the postpartum period. Briefly, the study was a three-group trial conducted between 2009 and 2014 to test an online intervention based on evidence-based behavioral strategies such as self-monitoring of weight and diet and physical activity goal setting. One group of participants served as control throughout (n = 500), one group received the intervention during pregnancy only (n = 497), and one group received the intervention during pregnancy and the postpartum period (n = 495). Therefore, for our secondary analysis, two-thirds of the sample received the intervention. A total of 1689 women was randomized to the three study arms and included for intention to treat analysis at the 12-month postpartum endpoint. The intervention was not effective in preventing excessive GWG (Olson et al., 2018). The study was approved by the institutional review boards of the University of Rochester and Cornell University.

Setting

Women who enrolled in the eMoms study were recruited from 20 obstetric and family practices and clinics in a Northeastern U.S. city and surrounding region, from obstetric ultrasound settings, and from the larger community (Fernandez et al., 2015). The researchers used a variety of recruitment methods, including face-to-face recruitment and community outreach using newspaper articles, brochures and posters, online ads, radio and bus advertising, participation in community events (e.g. fairs), and mass mailings.

Sample

Women who participated in the randomized controlled trial were between 18 and 35 years of age, consented to participate before 20 weeks gestation, had singleton pregnancies, planned to carry their pregnancies to term, could read and understand English, had body mass indices (BMI) between 18.5 and 35 kg/m2, and did not have any medical conditions or take any medications that could affect GWG. Inclusion criteria for this secondary analysis were Black or White race and complete data on GWG and assessments of appetite and craving control. Non-Black or White women were limited in number so excluded from these analyses. Participants who gave birth at less than 37 weeks gestation were excluded; 1005 participants were included in our secondary analysis.

Measures

Demographic Data

Participants self-reported age, race (White, Black), ethnicity (Hispanic yes/no), marital status (married/living with partner vs. single/separated), parity (0, 1-2, > 2), alcohol use (at least one beverage in last 30 days, yes/no), smoking (yes/no), and illicit drug use (yes/no) via an online survey before 28 weeks gestation, and we confirmed this information using data from the medical record. Medical record data also included maternal hypertension, infant sex, and gestational weeks at birth. We categorized level of education as less than high school, high school, and more than high school. We categorized income as low or high based on being below or above Medicaid eligibility. We categorized treatment groups as control vs. intervention.

Appetite and Craving Control

We derived the measures for appetite and perceived ability to control cravings from responses to two questions participants were asked before 28 weeks gestation. Appetite was measured from the question: “How would you describe your appetite now, compared to times when you are not pregnant?” Responses were provided on a five-point scale and ranged from a lot more hungry = 1 to a lot less hungry = 5. Self-efficacy for the ability to resist overeating with cravings, described as perceived ability to control cravings in our secondary analysis, was measured with the question: “How sure are you that you will be able to avoid overeating when you have cravings?” Responses were provided on a five-point scale and ranged from very sure = 1 to very unsure = 5. We selected these questions for use in the original study based on findings in prior research in which these questions were administered to pregnant women over time and found to be significantly associated with the amount of food eaten, as measured by a food frequency questionnaire, at the corresponding time intervals (Hinton & Olson, 2001).

Gestational Weight Gain

We abstracted early pregnancy weight from the first prenatal visit, weight before 14 weeks gestation, and last recorded weight before birth (≥ 37 weeks gestation) from medical records and used these data to calculate GWG.

Body mass index

We calculated BMI using early pregnancy weight from the medical record and measured height obtained at a postpartum study visit. We categorized the early pregnancy BMI values into underweight (< 18.5 kg/m2), normal weight (≥ 18.5 to < 25 kg/m2), overweight (≥ 25 to < 30 kg/m2), obese class I (≥ 30 to < 35 kg/m2), and obese class II and greater (≥ 35 kg/m2). Women in the obese class II category (n=16) under-reported their weight at enrollment and therefore participated while outside of the original study eligibility criteria. Gestational weight gain classifications (inadequate, adequate, and excessive) were based on the Institute of Medicine guidelines (Rasmussen & Yaktine, 2009). Recommended ranges considered adequate GWG for BMI classifications are 12.5 to 18 kg for underweight, 11.5 to 16 kg for normal weight, 7 to 11.5 kg for overweight, and 5 to 9 kg for obese. Gestational weight gain below these recommended ranges was classified as inadequate and above as excessive. As the number of participants who had inadequate GWGs was less than 5% of the total sample, inadequate and within recommended GWG ranges were combined for analysis.

2. Appetite and perceived ability to control cravings may affect gestational weight gain.

Physical Activity

We assessed the level of physical activity before 28 weeks gestation with the Pregnancy Physical Activity Questionnaire (PPAQ). The PPAQ is used to assess household/caregiving, occupational, sports/exercise, sedentary, light, moderate, and vigorous activities (Chasan-Taber et al., 2004). The duration of time spent in each activity is multiplied by its intensity to arrive at a measure of average weekly energy expenditure (MET-h·week-1). Developers of the PPAQ validated the tool by assessing correlation coefficients between the PPAQ and actigraph data and results ranged from 0.08 to 0.43 for total activity; 0.25 to 0.34 for vigorous activity; 0.20 to 0.49 for moderate activity; and 0.08 to 0.22 for light-intensity activity. In their systematic review, Sattler et al. (2018) indicated that the PPAQ is the best choice to assess self-reported physical activity in pregnancy because it has high reproducibility, albeit it has limitations in construct validity. Physical activity was categorized into tertiles of average weekly energy expenditure (MET-h·week-1).

Procedures

We collected data from participants after randomization via online surveys, medical chart reviews following birth, and in person study measurements at less than 28 weeks gestation, after 32 weeks gestation but before birth, and at visits 6- and 12-months postpartum (Fernandez et al., 2015). For our secondary data analysis, we used data from the first online survey (< 28 weeks gestation) and the medical chart abstraction. Women were enrolled into the study between May 2011 and July 2012 and data were collected through 12-months postpartum.

Data analysis

Descriptive statistics included frequencies and distribution of categorical and continuous variables, respectively. Our data fulfilled the assumptions for logistic regression; the dependent variable was binary, observations were independent from each other, and there was no multicollinearity among the independent variables and covariates. We used logistic regression models to assess the relationships among excessive GWG, appetite, and craving control. Covariates were selected if the variables were potentially associated with GWG at a significance level of 0.2 using a stepwise approach in the logistic regression model. The remaining covariates used in the final analysis included early pregnancy BMI categories, gestational age at birth, race, education, treatment group, physical activity during pregnancy, parity, smoking, illicit drug use, and infant sex. Ethnicity (n = 38 Hispanic) was not found to be related to GWG so was not included in the regression analyses. We conducted four regression models to assess the relationship of excessive GWG with appetite and craving control. In Model 1, the relationships of excessive GWG with appetite and craving control were assessed separately; in Model 2 appetite and craving control were assessed separately adjusting for covariates; in Model 3 appetite and craving control were assessed together; in Model 4 appetite and craving control were assessed together adjusting for covariates. Due to missing data in covariates, we included 980 participants in the regression models adjusting for covariates. A test for trend assessed the potential dose-response effect of different reported levels of our predictors on excessive GWG (Patino & Ferreira, 2016). Spearman’s correlation was used to assess the relationship between appetite and craving control. We conducted all analyses were conducted using STATA 13.0 (StataCorp LLC, College Station, TX).

Results

Characteristics of the study participants are reported in Table 1. Their mean age was 28 (SD = 4.4) years, and nearly half were pregnant with their first children. Among participants, the mean GWG was 13.9 kg (SD = 5.4), and more than 47% of participants experienced excessive GWG. The gestational age at time of birth ranged from 37 to 42 weeks. More than 50% of participants had normal or healthy weight in early pregnancy, and 16% had BMIs in the obese category. More than 62% of participants reported being more hungry during pregnancy, 17% reported no change, and approximately 20% were less hungry than before pregnancy (see Table 2). In terms of perceived ability to control cravings, more than 42% indicated they were not sure they could avoid overeating when they had cravings.

Table 1.

Demographic Characteristics of Sample for the Secondary Data Analysis (N = 1005)

Variable Mean (SD) Frequencies n (%)
Maternal age (years) 28 (4.4)
Race
 Black 198 (19.7)
 White 807 (80.3)
Hispanic 38 (3.8)
Education
 < High school 50 (5.1)
 High school 130 (13.2)
 > High school 802 (81.7)
Marital status
 Married or living with partner 889 (90.6)
Low income 330 (32.8)
Gestational weight gain per Institute of Medicine guidelines
 Inadequate gain 195 (19.4)
 Adequate gain 336 (33.4)
 Excessive gain 474 (47.2)
BMI category (kg/m2)
 Underweight (<18.5) 9 (0.9)
 Healthy weight (≥18.5 - < 25) 546 (54.3)
 Overweight (≥25 - < 30) 288 (28.7)
 Obese (≥30 - <35) 146 (14.5)
 Obese ≥ 35 (class II) 16 (1.6)
Parity
 0 470 (46.8)
 1-2 482 (48.0)
 2+ 53 (5.3)
History of hypertension 12 (1.2)
Smoked during pregnancy 58 (5.8)
Illicit drug use during pregnancy 77 (7.7)
Alcohol use (any in 30 day period) 118 (11.7)
Infant sex
 Female 490 (48.8)
Gestational age at delivery 39.7 (1.0)
Treatment
 Control 340 (33.8)
 Intervention arms 665 (66.2)
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Table 2.

Appetite and Craving Responses

Responses n (%)
Appetite compared to before pregnancy
 A lot more hungry 245 (24.4)
 A little more hungry 379 (37.7)
 About the same 173 (17.2)
 A little less hungry 145 (14.4)
 A lot less hungry 63 (6.3)
Self-efficacy to avoid overeating with cravings
 Very sure 113 (11.2)
 Somewhat sure 252 (25.1)
 Neither sure/unsure 213 (21.2)
 Somewhat unsure 342 (34.0)
 Very unsure 85 (8.5)
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When we assessed the relationship between appetite during pregnancy and excessive GWG, for participants who reported less than or the same appetite as before pregnancy, appetite was significantly associated with GWG in the adjusted model (p < 0.05, see Model 2 in Table 3). These participants were less likely to experience excessive GWG compared to participants who reported being a lot more hungry. Participants who reported the same appetite compared to those who reported being a lot more hungry were significantly less likely to have excessive GWG, OR = 0.62, p = 0.04, 95% CI [0.40-0.97]. Participants who reported being a little less hungry were also significantly less likely than those who reported being a lot more hungry to have excessive GWG, OR = 0.59, p = 0.04, CI [0.37-0.97], as were participants who reported being a lot less hungry, OR = 0.28, p < 0.001, CI [0.15-0.55]. For participants who reported being a little more hungry findings were not significant (OR = 0.85, p = 0.39, CI [0.59-1.23]). The ORs of different appetite levels appeared to indicate a dose-response effect with participants who reported less hunger associated with lower risk of excessive GWG compared to those who reported more hunger (OR = 0.78/per hunger level, p trend = 0.0001, CI [0.69-0.88]).

Table 3.

Logistic Regression Significance Results (p values) of the Effect of Appetite and Self–efficacy for Craving Control on Excessive Gestational Weight Gain

Model 1
(n = 1005)		 Model 2
(n = 980)		 Model 3
(n = 1005)		 Model 4
(n = 980)
OR 95% CI p OR 95% CI p OR 95% CI p OR 95% CI p
Appetite
 A little more hungry 0.93 [0.67, 1.28] .64 0.85 [0.59, 1.23] .39 0.99 [0.71, 1.37] .95 0.89 [0.61, 1.29] .54
 About the same 0.87 [0.59, 1.28] .47 0.62 [0.4, 0.97] .04 0.94 [0.63, 1.39] .75 0.66 [0.42, 1.04] .07
 A little less hungry 0.72 [0.47, 1.08] .12 0.59 [0.37, 0.97] .04 0.77 [0.51, 1.17] .23 0.63 [0.39, 1.02] .06
 A lot less hungry 0.41 [0.23, 0.75] .004 0.28 [0.15, 0.55] < .001 0.45 [0.25, 0.81] .007 0.30 [0.15, 0.58] < .001
 A lot more hungry (ref)
Craving control
 Very sure 0.47 [0.26, 0.83] .01 0.52 [0.26, 1.03] .06 0.50 [0.28, 0.9] .02 0.61 [0.31, 1.22] .17
 Somewhat sure 0.42 [0.26, 0.7] < .001 0.52 [0.29, 0.94] .03 0.44 [0.26, 0.73] .002 0.58 [0.32, 1.04] .07
 Neither sure nor unsure 0.58 [0.35, 0.97] .04 0.61 [0.34, 1.09] .09 0.59 [0.35, 1] .048 0.65 [0.36, 1.17] .15
 Somewhat unsure 0.63 [0.39, 1.03] .07 0.63 [0.36, 1.11] .11 0.65 [0.39, 1.06] .09 0.67 [0.38, 1.19] .17
 Very unsure (ref)
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Note. In Model 1, appetite and craving control were assessed separately; In Model 2, appetite and craving control were assessed separately while adjusting for covariates, including early pregnancy BMI categories, gestational age, race, education, treatment group, physical activity during pregnancy, parity, smoking, illicit drug use and infant sex; In Model 3, appetite and craving control were assessed together; In Model 4, appetite and craving control were assessed together while adjusting for covariates; OR = odds ratio; CI = confidence intervals.

When the relationship between perceived ability to control cravings during pregnancy and excessive GWG was examined, for participants who were somewhat sure that they could control their cravings, craving control was significantly associated with GWG in the adjusted model (p = 0.03, see Model 2 in Table 3). This group of participants was less likely to gain excessively during pregnancy compared to those who were very unsure of their ability to manage their cravings (OR = 0.52, p = 0.03, CI [0.29-0.94]). For participants who were very sure that they could control their cravings, craving control was potentially associated with GWG in the adjusted model (OR = 0.52, p = 0.06, CI [0.26-1.03], see Model 2 in Table 3). When the two categories of very sure and somewhat sure were combined, the odds of gaining weight excessively was lower compared to participants who were very unsure of their ability to manage their cravings (OR = 0.52, p = 0.02, CI [0.30-0.92]).

When appetite and perceived ability to control cravings were both included in the models, the association between participants who reported being a lot less hungry during pregnancy and excessive GWG remained significant even when adjustments were made for covariates (OR = 0.30, p < 0.001, CI [0.15-0.58], see Model 4 in Table 3). The ability to control cravings was nonsignificant. Further analysis showed that appetite and craving control were not independent (χ2 test p = 0.001). Participants who felt more hungry tended to report being more unsure of their ability to control cravings (Spearman’s ρ = −0.13, p < 0.001).

Discussion

In our secondary analysis, participants who experienced a decreased appetite during the first half of pregnancy, particularly those who indicated they were a lot less hungry compared to their non-pregnant state, had a lesser risk of excessive GWG than participants who reported they were a lot hungrier during this stage of pregnancy than when they were not pregnant. Very little is reported in the research literature regarding the effects of appetite in pregnancy in relation to GWG. It makes intuitive sense that if women have a lesser appetite they will eat less and that this could affect the amount of weight they gain over the course of a pregnancy. Qualitative findings suggested that appetite influences eating behaviors among minority women (Groth & Morrison-Beedy, 2013; Groth et al., 2016; Hackley et al., 2014) and that women’s experiences are variable with some reporting increased appetite and others reporting decreased appetite compared to a non-pregnant state. Hackley et al. (2014) indicated women struggled to deal with their heartier appetites, while Groth et al. (2013; 2016) reported that women indicated their appetite determined what and when they ate throughout the day. Our findings are consistent with those reports as only about 17% of the participants in our secondary analysis reported their appetites as being about the same as when they were not pregnant. In addition to changes in appetite, women indicate that appetite also influences the foods they choose to eat (Groth et al., 2016). If the food choices were for calorie dense, nutrient poor foods the effect on GWG would be more weight gain.

We also found that participants’ perceived ability to control food cravings during pregnancy appeared to be associated with their GWG; if participants were fairly confident in their ability to control their cravings they were less likely to experience excessive GWG. Although other researchers have not examined perceived ability to control food cravings they have examined cravings in relation to dietary intake and GWG. Orloff et al. (2016) reported that frequency of food cravings and reported likelihood of giving in to cravings were positively associated with GWG and craving for sweets was the most common craving. The idea of giving in to cravings is similar to that of not being able to control cravings as measured in our study. Allison et al. (2012) reported that eating due to cravings was associated with GWG in overweight African American women and cognitive restraint over eating was low. Alternatively, in a primarily Caucasian sample of women (n = 1639) Hill et al. (2016) did not find an association of cravings with GWG, although they did note that women who craved foods had a higher energy intake. The measurement of food cravings, sample size, and populations varied considerably across these few studies. Our measure was somewhat indirect because we asked participants to assess their ability to avoid overeating when they had cravings rather than asking frequency and type of cravings.

3. Research is needed to assess whether interventions focused on appetite and perceived ability to control food cravings can limit or prevent excessive gestational weight gain.

Implications

Women who are not overwhelmed by an increased appetite during pregnancy or those who have confidence in their ability to control food cravings appear to have a greater likelihood of achieving GWG levels within the guidelines than women who feel hungrier and/or are unsure of their ability to control their cravings. Although there is limited research and evidence regarding appetite and food cravings in relation to GWG, nurses and other care providers may find it helpful when providing prenatal care to assess and discuss what women are experiencing in relation to appetite and food cravings. Providing support and guidance regarding diet, physical activity, and weight gain are important aspects of prenatal care. Bringing appetite alterations and cravings into the conversation opens the possibility of helping a woman set priorities and decide how to manage these very real food-related changes if she is experiencing them. Situating these topics within the context of care legitimizes what a woman may be concerned about and creates the opportunity for the nurse/care provider to guide the woman in making healthy decisions that affect her pregnancy. Recognition of the possibility that lack of perceived ability to control cravings could be an early indicator of high GWG enables the nurse to use this avenue to help women keep their GWG within the guidelines.

Our data were collected before 28 weeks gestation and since some literature suggests that the amount of weight gained in the first half of pregnancy is indicative of total GWG (Moore-Simas et al., 2019) it might be best for nurses to discuss both appetite and cravings during the first part of pregnancy, depending on women’s experiences of nausea and vomiting in the early weeks. High GWG remains a major problem that influences the long-term health of women by increasing their risk of weight retention, progressive increase in their BMI, and adverse metabolic changes. If nurses are able to initiate conversations in the context of prenatal care that deal with what women are experiencing, like cravings they are struggling to control, the experience of pregnancy and possibly outcomes can be enhanced. Further refinement of tools to measure and assess appetite and cravings/cravings control is needed and beyond that, the development of evidence-based interventions for nurses to use. However, based on what is currently known, nurses can take the step of promoting conversation around appetite and cravings as an opportunity to use the ‘teachable moment’ that pregnancy offers to promote healthy behaviors.

Limitations

Our sample included only two racial groups, Black and White, and over 80% was White, which limits generalizability to other groups. At the same time, the sample was diverse in terms of socioeconomic status, BMI, and GWG. The use of two single questions related to our analysis limits in-depth analysis of the effects of appetite and perceived ability to control cravings on GWG. Meanwhile, scales that measure craving control have not been validated in the pregnant population. Additionally, the confidence intervals associated with the appetite and craving control variables were relatively large, which is potentially related to the single item and self-reported nature of our data. A comprehensive assessment of appetite and craving control is needed to validate the relationship between these eating behaviors and GWG.

Conclusion

Our analyses support that appetite and perceived ability to control cravings may have an effect on GWG. Consequently, women who have a higher level of self-efficacy for craving control and are not overwhelmed by an increased appetite have a greater chance of keeping their GWG within the Institute of Medicine guidelines. Additional research is needed to assess if interventions focused on appetite and craving control limit GWG.

Funding

Funded by the National Heart, Lung and Blood Institute and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Grant No. U01HL096760. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Disclosure

The authors report no conflicts of interest or relevant financial relationships.

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Contributor Information

Susan W. Groth, School of Nursing, University of Rochester, Rochester, NY..

Ying Meng, School of Nursing, University of Rochester, Rochester, NY..

Kuan Lin Yeh, School of Nursing, University of Rochester, Rochester, NY..

I. Diana Fernandez, School of Medicine and Dentistry, University of Rochester, Rochester, NY..

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