Understanding women’s weight-related health behaviours across pregnancy: A qualitative longitudinal study

Background: Women’s weight-related health behaviours (WRHBs) during pregnancy can contribute to excessive gestational weight gain, which can be retained throughout life. In this study, WRHBs are health behaviours which have the potential to impact on women’s gestational weight gain, but are not necessarily engaged in with the intention of weight change. Lacking from the evidence is an understanding of women’s WRHBs and their determinants across pregnancy and utilising psychological theory when designing antenatal behaviour change interventions. Aim: To understand women’s experiences of WRHBs across pregnancy, with a view to explore if this varies throughout the journey of pregnancy. Methods: Pregnant women were recruited at their antenatal appointment in two areas of a Northern UK city and interviewed at three timepoints (two antenatal, one postnatal), two of which are presented here: approximately 10-16 weeks and 28-32 weeks gestation. Interview data were first inductively analysed to generate a thematic framework. WRHBs were identified from the thematic framework and subsequently mapped to existing psychological theory. Findings: Eighteen women with differing demographic and obstetric characteristics (e.g., area of deprivation, body mass index and parity) participated in the study. Four themes with sub-themes were identified across both timepoints; which reflected similarities and nuanced differences in women’s WRHBs across pregnancy. Twenty-five WRHBs were identified; 8 of which were the same across both timepoints. Women’s WRHBs were disrupted in early pregnancy due to physiological and psychological factors, with women motivated to engage in WRHBs by changes in beliefs towards ‘health’. In later pregnancy women indicated passivity towards their WRHBs. Motivation primarily drove women’s WRHBs, whilst also interacting with other behavioural determinants. Conclusions: Engagement in pre-pregnancy WRHBs, changing physiological and psychological factors all interact with each other to impact on women’s WRHBs across pregnancy. This interaction is not the same for every WRHB, and each WRHB should be considered individually in future research.