Obesity in Pregnancy: A Qualitative Approach to Inform an Intervention for Patients and Providers

Background: Interventions have not been effective in assisting obese women to meet gestational weight gain (GWG) recommendations. Culturally-tailored prenatal programs may be needed. Objective: To investigate the perceptions of minority pregnant women and their providers about obesity and GWG along with their motivations for and barriers to improving health behaviors during pregnancy and strategies to improve the management of obesity in pregnancy with an emphasis on group programs. Methods: Sixteen primarily non-Hispanic black pregnant women with a prepregnancy body mass index ≥30kg/m2 and 19 prenatal care providers participated in focus groups. Discussion topics included GWG goals, body image, health behaviors, stress management, and group prenatal care for the patients and providers with additional emphasis on education and training needs for the provider. Results: Women frequently stated a target GWG of >20lbs. Women described a body image not in line with clinical recommendations (“200 pounds is not that big.”). They avoided the term “obese” and more commonly used “thick.” They were interested in learning more about nutrition and culturally-specific healthy cooking resources. Women stated they would enjoy massage and exercise in a group setting, though definitions of “exercise” varied. Family members could be helpful, but generational differences posed challenges (Grandmothers would “curse them out” for exercising during pregnancy). As a result, most felt the need to “encourage myself” and “do this for me and the baby.” Providers expressed discomfort discussing GWG and difficulty finding the right words for obesity and this was partially attributed to their own body weight. They gave several examples of the challenges they faced in providing prenatal care to obese women including time constraints, cultural myths, and system issues. They believed that a group setting that provides social support would be an ideal environment to address health behaviors in obese women. Conclusions: Culturally-tailored programs that use acceptable terms for obesity, provide education regarding healthy eating and safe exercise, and encourage appropriate support from social networks may be effective in addressing GWG in obese minority women. Further provider training in communication skills is necessary to appropriately address obesity in pregnancy.