Department of Family Medicine, McMaster University, 1280 Main Street W, Hamilton, Ontario, L8S 4L8, Canada.
Department of Family Medicine, DBHSC 5003E, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada.
BMC Pregnancy Childbirth. 2020 Sep 3;20(1):507. doi: 10.1186/s12884-020-03210-5.
Despite ample clinical evidence that gaining excess weight in pregnancy results in negative health outcomes for women and infants, more than half of women in Western industrialized nations gain in excess of national guidelines. The influence of socio-demographic factors and weight gain is well-established but not causal; the influence of psychological factors may explain some of this variation.
This is the qualitative portion of an explanatory sequential mixed-methods study designed to identify predictive psychological factors of excess gestational weight gain (QUAN) and then explain the relevance of those factors (qual). For this portion of the study, we used a qualitative descriptive approach to elicit 39 pregnant women's perspectives of gestational weight gain, specifically inquiring about factors determined as relevant to excess gestational weight gain by our previous predictive study. Women were interviewed in the latter half of their third trimester. Data were analyzed using a combination of unconstrained deductive content analysis to describe the findings relevant to the predictive factors and a staged inductive content analytic approach to examine the data without a focus on the predictive factors.
Very few participants consistently made deliberate choices relevant to weight gain; most behaviour relevant to weight gain happened with in-the-moment decisions. These in-the-moment decisions were influenced by priorities, hunger, a consideration of the consequence of the decision, and accommodation of pregnancy-related discomfort. They were informed by the foundational information a woman had available to her, including previous experience and interactions with health care providers. The foundational information women used to make these decisions was often incomplete. While women were aware of the guidelines related to gestational weight gain, they consistently mis-applied them due to incorrect understanding of their own BMI. Only one woman was aware that weight gain was linked to maternal and infant health outcomes.
There is an important role for prenatal providers to provide the foundational information to positively influence in-the-moment decisions. Understanding how weight gain guidelines apply to one's own pre-pregnancy BMI and comprehending the well-established link between gestational weight gain and health outcomes may help women prioritize healthy weight gain amongst many competing factors.
尽管有大量临床证据表明，孕妇体重过度增加会对妇女和婴儿的健康产生负面影响，但在西方工业化国家，超过一半的妇女体重增加超过了国家指南。社会人口因素和体重增加的影响已经得到充分证实，但不是因果关系；心理因素的影响可能可以解释这种变化的一部分。
这是一项解释性序贯混合方法研究的定性部分，旨在确定过度妊娠体重增加的预测心理因素，然后解释这些因素的相关性（quan）。在本研究的这一部分，我们采用了定性描述方法来引出 39 名孕妇对妊娠体重增加的看法，特别是询问了我们之前的预测研究中确定与过度妊娠体重增加相关的因素。在妊娠晚期后半段对这些妇女进行了访谈。使用非约束性演绎内容分析法对数据进行了分析，以描述与预测因素相关的发现，并采用分阶段归纳内容分析方法来检查数据，而不关注预测因素。
很少有参与者始终做出与体重增加相关的深思熟虑的选择；大多数与体重增加相关的行为都是在当下的决定中发生的。这些当下的决定受到优先事项、饥饿、对决策后果的考虑以及对与怀孕相关的不适的适应的影响。这些决定是基于女性可用的基本信息，包括以前的经验和与医疗保健提供者的互动。女性用来做出这些决定的基本信息往往是不完整的。尽管女性知道与妊娠体重增加相关的指南，但由于对自己 BMI 的误解，她们经常错误地应用这些指南。只有一名女性意识到体重增加与母婴健康结果有关。
产前提供者在提供基本信息以积极影响当下的决策方面发挥着重要作用。了解体重增加指南如何适用于自己的孕前 BMI，并理解体重增加与健康结果之间已确立的联系，可能有助于女性在许多相互竞争的因素中优先考虑健康的体重增加。
