Keely Alice, Cunningham-Burley Sarah, Elliott Lawrie, Sandall Jane, Whittaker Anne
Edinburgh Napier University, Health & Social Care, UK.
Centre for Population Health Sciences, University of Edinburgh, UK.
Midwifery. 2017 Jun;49:87-94. doi: 10.1016/j.midw.2016.09.016. Epub 2016 Sep 28.
women with a raised BMI are more likely to gain excessive weight in pregnancy compared to women with a BMI in the normal range. Recent behaviour change interventions have had moderate to no influence on GWG, and no effect on other perinatal outcomes. Evidence is required regarding the social and cultural contexts of weight and pregnancy. No studies to date have included the views of partners.
to explore the experiences, attitudes and health-related behaviours of pregnant women with a BMI >40kg/m; and to identify the factors and considerations which shape their beliefs, experiences and behaviours, and how these may change during and after pregnancy. 2. To determine the impact, if any, of the beliefs and attitudes of significant members of the women's families and social networks upon the women's experiences, attitudes and health-related behaviours in relation to weight and pregnancy METHODS: this was a prospective serial interview study. Semi-structured interviews were conducted with 11 pregnant women with a BMI >40kg/m, during pregnancy and after birth, and once with 7 partners (all male) of women. Interview questions were designed to be appropriately but flexibly framed, in order to explore and gather data on participants' everyday life, lifestyles, views, experiences, relationships and behaviours, focussing more specifically on beliefs about health, pregnancy, weight and diet. Thematic content analysis was used to formally analyse and unearth patterns in the data.
the findings can be grouped into six interrelated themes: the complexities of weight histories and relationships with food; resisting risk together; resisting stigma together; pregnancy as a 'pause';receiving dietary advice; postnatal intentions. These themes are interrelated due to the 'spoiled identity' (Goffman, 1963) that the large body represents in western culture and related stigma.
this study provides evidence that there exist deeply ingrained social and cultural beliefs among women and in particular their partners, regarding pregnancy diet and weight gain. Further, this study provides evidence that male partners may resist stigmatised risk on behalf of a pregnant partner. All women (and several men) expressed an intention to adopt healthy behaviours and lose weight once their baby was born. Further evidence is required regarding the means by which women who experience stigmatised risk during pregnancy, and their partners, might be engaged and receptive to health advice. Models which draw on ideals of relationship-centred care, and selfefficacy via open discussion with women and families, engaging women and partners by providing them with an opportunity to talk about their beliefs and concerns, could be explored to inform future research and practice.
与体重指数（BMI）处于正常范围的女性相比，BMI升高的女性在孕期更有可能体重增加过多。近期的行为改变干预措施对孕期体重增加（GWG）的影响不大甚至没有影响，对其他围产期结局也没有作用。需要有关于体重和怀孕的社会文化背景的证据。迄今为止，尚无研究纳入伴侣的观点。
这是一项前瞻性系列访谈研究。对11名BMI>40kg/m²的孕妇在孕期和产后进行了半结构化访谈，并对7名女性的伴侣（均为男性）进行了一次访谈。访谈问题的设计既恰当又灵活，旨在探索并收集关于参与者日常生活、生活方式、观点、经历、人际关系和行为的数据，更具体地关注关于健康、怀孕、体重和饮食的信念。采用主题内容分析法对数据进行正式分析并挖掘其中的模式。
研究结果可归纳为六个相互关联的主题：体重史的复杂性以及与食物的关系；共同抵御风险；共同抵制污名；怀孕是一种“暂停”；接受饮食建议；产后打算。由于西方文化中大体型所代表的“受损身份”（戈夫曼，1963）以及相关污名，这些主题相互关联。
本研究提供了证据，表明女性尤其是其伴侣中存在关于孕期饮食和体重增加的根深蒂固的社会文化信念。此外，本研究提供了证据，表明男性伴侣可能会代表怀孕伴侣抵制污名化风险。所有女性（以及几名男性）都表示打算在宝宝出生后采取健康行为并减肥。关于孕期经历污名化风险的女性及其伴侣可能参与并接受健康建议的方式，还需要更多证据。可以探索借鉴以关系为中心的护理理念以及通过与女性和家庭进行开放讨论来提高自我效能的模式，通过为女性和伴侣提供谈论其信念和担忧的机会来促使他们参与其中，从而为未来的研究和实践提供参考。
