Supporting pregnant women to improve their diet and physical activity behaviours

Abstract

A woman’s diet quality and level of physical activity during pregnancy will influence both her own health and the lifelong health of her offspring. From the earliest stages of development, a baby’s health and long-term risk of disease are programmed according to its mother’s nutritional status and body composition, among other factors. One way of improving the health of the next generation is therefore to intervene during pregnancy, supporting women to improve their health behaviours, and give their offspring the best possible start.

Pregnancy is often viewed as a teachable moment when women are more motivated to improve their health for their babies’ benefit. However, many pregnant women gain weight that exceeds guidelines and do not meet recommendations for physical activity, showing that more needs to be done to support women to make a change during pregnancy. It is clear from the literature that the factors that influence diet and physical activity in pregnancy are complex and wide-ranging, and many of these factors influence one another. For this reason, a complex adaptive system framework underpins this thesis with a particular focus on individual-level factors as these have not previously been conceptualised as a complex system. This work was undertaken to inform the development of future interventions to support women to improve their diet and physical activity behaviours in pregnancy.

First, questionnaire data were analysed to identify key factors associated with diet and physical activity in mothers of childbearing age. This analysis identified that social support, self-efficacy for healthy eating, perceived control, food involvement and positive outcome expectancies were associated with diet quality and that self-efficacy for physical activity was associated with women’s level of physical activity.

The second study comprised a systematic review of behaviour change interventions in pregnancy that aimed to increase physical activity or improve diet quality, and that also aimed to improve at least one individual-level factor that may mediate or moderate intervention effectiveness. Nine studies were identified. Narrative synthesis of these studies showed that knowledge and planning were both amenable to change and associated with changes in behaviour.

Finally, a qualitative study that included interviews with recently pregnant women, and focus groups with pregnant women, was undertaken to gain a richer understanding of women’s experiences in pregnancy and their engagement with available behaviour change support. Women’s interest in improving their health behaviours, and their engagement with available sources of support, appeared to be closely linked to the extent to which they identified as healthy people. Thus, ‘health identity’ is a key concept that emerged from this research. Data from the qualitative work also showed that pregnancy-specific symptoms such as nausea make it difficult for some women to make a change, even if they intend to do so, and that women’s interest in their own health is an important factor that affects their motivation to change.

The findings from these three studies have been incorporated into a complex adaptive systems model, which may be used to inform the development of future interventions to support pregnant women to improve their diet quality or increase their levels of physical activity.

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Identifiers

ORCID for Mary Barker: orcid.org/0000-0003-2976-0217

ORCID for Wendy Lawrence: orcid.org/0000-0003-1264-0438

ORCID for Janis Baird: orcid.org/0000-0002-4039-4361

ORCID for Kathryn Woods-Townsend: orcid.org/0000-0003-3376-6988

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