Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
Division of clinical epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
BMC Pregnancy Childbirth. 2020 Dec 3;20(1):755. doi: 10.1186/s12884-020-03438-1.
Gestational weight interventions are important in maternity care to counteract adverse pregnancy events. However, qualitative findings indicate potential obstacles in the implementation of interventions due to the sensitivity of the subject and existing obesity stigma. Pregnant women have reported disrespectful or unhelpful communication, while some midwives seem to avoid the topic, as not to upset women. This descriptive study aimed to provide knowledge about maternity care providers' beliefs about obesity, and their attitudes towards gestational weight management.
A web survey was emailed to Swedish maternity care clinics. Existing questionnaires, "Beliefs About Obese People" (BAOP), "Perceived weight bias in health care" and "Attitudes toward obese patients" was used, supplemented with questions formulated for this study. An open free-text question allowed participants to provide a deeper and more nuanced picture of the topic.
274 respondents (75% midwives and 25% obstetricians) participated. One third of respondents found obesity to be a more sensitive topic than smoking or alcohol habits, and 17% of midwives agreed to the statement: "I sometimes avoid talking about weight so as not to make the pregnant woman worried or ashamed". Having had training in motivational interviewing seemed positively associated with midwives' inclination to talk about body weight, especially with women with obesity (p = .001), whereas years of working experience were not associated. Having received obesity education increased confidence in providing adequate information, but still only 46% felt they had enough knowledge to provide diet and exercise advice to pregnant women with obesity. Qualitative data revealed great empathy for women with obesity, and a wish to have more obesity education and access to other professionals.
Swedish maternity care staff displayed empathy for women with obesity and found gestational weight interventions important, but almost one fifth of midwives sometimes avoid the subject of body weight for fear of upsetting women. Education about obesity facts, training in person-centered communication, i.e. motivational interviewing, and access to dieticians may facilitate gestational weight management implementation.
妊娠体重干预在产妇保健中很重要，可以抵消不良妊娠事件。然而，定性研究结果表明，由于该主题的敏感性和现有的肥胖污名，干预措施的实施存在潜在障碍。孕妇报告说她们受到了不尊重或无益的沟通，而一些助产士似乎避免讨论这个话题，以免让妇女感到不安。本描述性研究旨在提供关于产妇保健提供者对肥胖的信念，以及他们对妊娠体重管理的态度的知识。
向瑞典产妇保健诊所发送了网络调查。使用了现有的问卷“肥胖者信念”（BAOP）、“医疗保健中感知到的体重偏见”和“对肥胖患者的态度”，并补充了为此研究制定的问题。一个开放的自由文本问题允许参与者更深入和更细致地描述这个主题。
274 名受访者（75%的助产士和 25%的产科医生）参与了调查。三分之一的受访者认为肥胖比吸烟或饮酒习惯更敏感，17%的助产士同意这样的说法：“我有时避免谈论体重，以免让孕妇感到担忧或羞耻”。接受过动机访谈培训与助产士倾向于谈论体重的意愿呈正相关，尤其是对肥胖的妇女（p=0.001），而工作年限则没有关联。接受过肥胖教育增加了提供充分信息的信心，但只有 46%的人认为他们有足够的知识为肥胖孕妇提供饮食和运动建议。定性数据显示，对肥胖妇女有很大的同情心，希望有更多的肥胖教育和获得其他专业人士的帮助。
瑞典产妇保健工作人员对肥胖妇女表示同情，并认为妊娠体重干预很重要，但近五分之一的助产士有时会因为担心让妇女不安而回避体重问题。关于肥胖事实的教育、以人为主导的沟通培训，即动机访谈，以及获得营养师的帮助，可能会促进妊娠体重管理的实施。
