September 2013 Article Summary

A Qualitative Study of Motivators an Barriers to Healthy Eating in Pregnancy for Low-Income, Overweight, African-American Mothers

            Research has shown that excessive weight gain during pregnancy can have serious consequences. Gaining more than the recommended 15-24 pounds during pregnancy increases the risk of preeclampsia (pregnancy induced hypertension), eclampsia (convulsions and coma related to preeclampsia), cesarien sections births, macrosomia (excessive birth weight), and perinatal deaths (deaths before 28 days of life). It is important that child bearing women are aware of these risks in order to have a healthier pregnancy and healthy newborn.

           

            Other studies have found that excessive weight gain during pregnancy occurs most often in women who have a BMI classified as overweight before their pregnancy and are of low income. Those who consumed a large daily intake of energy, ate greater amounts of dairy, ate fried foods, and did not do much physically activity tended to gain more than the recommended amount of weight during pregnancy.

            Unfortunately, many women find it difficult to manage their diets during pregnancy. They may intend to eat healthy, but have limited access to healthy foods, be pressured from family to eat larger quantities of foods, or be unaware that their food choices are unhealthy. This qualitative study interviewed expectant, low-income, African American women in order to find what motivates or prevents healthy eating. The focus was on African American women because they have the highest rates of obesity than any other group. Finding an intervention for these women is important to reduce complications and promote healthy pregnancies for this group.

            Twenty-one participants who self identified themselves as African American, were between the ages of 18 and 37, were pregnant, and had a body mass index greater than 25 were interviewed. It was determined that 16% of participants that already had children, 33% had not completed high school, and 48% were unemployed. Of the 21 participants, 33% were food insecure and 52% were enrolled in WIC. Participants were recruited from an outpatient prenatal care clinic in Philadelphia Pennsylvania. Each participant signed a written consent form and was compensated for their time with $50 cash.

            Participants were interviewed one-on-one with semi-structured questions. Sample questions regarding consistent habits included the following, “How has your eating changed now that you’re pregnant?” “Do you prepare your meals or eat out?” “Do you do the food shopping for you and your family? How do you decide what to buy?” Questions based on healthy eating beliefs included: “Do you think your diet is healthy now?” “What might get in the way of eating healthier?”; “Do you feel like you have control over what you eat and the amount you eat?”

            All interviews were then transcribed to determine any trends and develop common themes. Out of all 21 interviews, ten themes were identified and categorized into either “motivators for healthy eating” or “barriers to healthy eating.”

            Two motivators for healthy eating were identified. They were to have a healthier baby and reduced physical symptoms of pregnancy (morning sickness, heartburn). These findings show that these women know that a healthy diet is better for the baby and themselves. They, therefore, may be eating with healthy intentions.

            Unfortunately, more barriers to healthy eating were found than motivators from these interviews. These barriers were: taste and cost of healthy foods, limited access to healthy foods, plentiful access to unhealthy foods, no steady supply of healthy foods month-to-month, lack of meal schedule, pregnancy induced fatigue prevents cooking, misconception of what healthy food is, overeating so as not to deprive baby, and pressure to eat from others.

            While many women feel motivated to eat healthy for their children, there are many more barriers that prevent them from doing so. This unhealthy eating leads to unhealthy weight gain and other potential problems. By focusing on what prevents these women from eating healthy, many lifestyle interventions can be created to help them make better choices.

            Barriers to this study are the small sample size and its low ability to generalize to a larger population. Any interventions created from information found in this study need to be aimed at pregnant, low-income, urban, overweight, African American women.

Reyes, N. R., Klotz, A. A., Herring, S. J. (2013). Healthy eating in pregnancy for low-income overweight, african-american mothers. Journal of the Academy of Nutrition and Dietetics, 113 (9), 1175-1181.

Supplemental Articles:

1. Stuebe, A. M., Oken, E., Gillman, M. W., (2009) Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain. Am J Obstet Gynecol, 201(58), e1-8.

2. Langford, A., Joshu, C., Chang, J. J., Myles, T., Leet, T. (2011). Does gestational weight gain affect the risk of adverse maternal and infant outcomes in overweight women? Maternal Child Health Journal, 15, 860-865.