Department of Pediatrics, Maastricht University Medical Centre (MUMC+), P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, the Netherlands.
BMC Pregnancy Childbirth. 2020 Feb 12;20(1):105. doi: 10.1186/s12884-020-2786-5.
Maternal overweight and obesity are related to several health risks in the periods before, during and after pregnancy including a higher risk of gestational diabetes mellitus, preeclampsia and preterm birth. At the same time, women's daily life quickly changes in these periods. Therefore, we hypothesize that the value of determinants of lifestyle behavior within different levels of the socio-ecological model differ accordingly and influence lifestyle behavior. These dynamics of determinants of lifestyle behavior in the periods before, during and after pregnancy are unexplored and therefore evaluated in this study. These insights are needed to offer appropriate guidance to improve lifestyle in women of childbearing age.
Individual semi-structured interviews were conducted before, during or after pregnancy in 26 women with overweight or obesity living in the Netherlands. Questions covered all levels of the socio-ecological model, i.e. intrapersonal, interpersonal, institutional and environmental/societal. All interviews were transcribed and coded.
Determinants at all levels of the socio-ecological model were perceived as relevant by women of childbearing age. Various determinants were mentioned including knowledge of a healthy lifestyle, social support, access to customized lifestyle guidance, and distance to healthy lifestyle supporting activities. The importance women attributed to determinants differed between the periods before, during and after pregnancy. Before pregnancy, child's wellbeing as motivator for adopting a healthy lifestyle was mentioned less frequently than during and after pregnancy. Women described that the interplay and balance between determinants varied on a daily basis, and not merely per period. This was often expressed as fluctuation in energy level per day which influences their willingness to put effort in making healthy choices.
Findings of this study confirm the importance of determinants at multiple socio-ecological levels for shaping lifestyle behavior in women of childbearing age. The findings add to current insights that the perceived importance of determinants and their interplay differ before, during and after pregnancy. They influence lifestyle behavior decisions, not only per period but even on a daily basis, in particular in this phase of life. This perspective can be helpful in optimizing lifestyle guidance for women of childbearing age in order to prevent perinatal complications.
孕妇超重和肥胖与妊娠前、妊娠中和妊娠后期间的多种健康风险相关，包括妊娠糖尿病、先兆子痫和早产的风险增加。与此同时，女性在这些时期的日常生活会迅速改变。因此，我们假设生活方式行为决定因素在社会生态模型不同层次的价值也会相应不同，并影响生活方式行为。这些妊娠前、妊娠中和妊娠后期间生活方式行为决定因素的动态尚未得到探索，因此在本研究中进行了评估。这些见解对于为育龄妇女提供改善生活方式的适当指导是必要的。
在荷兰，对 26 名超重或肥胖的孕妇或哺乳期妇女进行了个体半结构式访谈，访谈在妊娠前、妊娠中和妊娠后进行。问题涵盖了社会生态模型的所有层次，即个体内部、人际间、机构和环境/社会。所有访谈均进行了转录和编码。
育龄妇女认为社会生态模型各个层次的决定因素都很重要。提到了各种决定因素，包括健康生活方式的知识、社会支持、获得定制的生活方式指导的机会以及距离健康生活方式支持活动的远近。女性在妊娠前、妊娠中和妊娠后期间对决定因素的重视程度不同。在妊娠前，作为采取健康生活方式的动机，孩子的健康被提及的频率低于妊娠中和妊娠后。女性描述说，决定因素之间的相互作用和平衡每天都在变化，而不仅仅是每个阶段。这通常表现为每天的能量水平波动，这会影响她们做出健康选择的意愿。
本研究的结果证实了在育龄妇女中，多个社会生态层次的决定因素对于塑造生活方式行为的重要性。这些发现增加了当前的认识，即决定因素的感知重要性及其相互作用在妊娠前、妊娠中和妊娠后期间不同。它们不仅影响每个阶段的生活方式行为决策，甚至在日常生活中也会影响，特别是在这个生命阶段。这种观点有助于优化育龄妇女的生活方式指导，以预防围产期并发症。
