Pregnant Women with Obesity Have Unique Perceptions About Gestational Weight Gain, Exercise, and Support for Behavior Change.

INTRODUCTION Prepregnancy obesity and excessive gestational weight gain (GWG) pose health risks to woman and fetus, yet gestational weight management interventions are largely unsuccessful. Little research examines the perceptions of women with obesity about weight gain and exercise. Although women with obesity have different body habitus and life experiences, most studies combine overweight and obese women into one group. METHODS We conducted 3 focus groups with pregnant women with obesity to determine perceptions of GWG, exercise, and a proposed behavioral intervention. RESULTS Seventeen women participated in the focus groups including 6 at a birth center and 11 at a federally qualified health center. A key finding was that women with obesity felt stigmatized and perceived pregnancy as a refuge from fat shaming. Participants viewed risks associated with excessive GWG as exaggerated and instead deemed self-assessments of how they feel and look as more reliable measures of maternal and fetal health. Participants reported that quality rather than quantity of food promotes pregnancy health and that restrained eaters put their fetuses at risk. Knowledge gaps emerged related to dissatisfaction with counseling about weight gain guidelines. Although physical activity was endorsed, participants voiced safety concerns about exercise during pregnancy and instead favored walking and routine daily activity. Goal setting, positive messaging, and positive reinforcement were identified as favorable aspects of the proposed behavioral intervention. DISCUSSION Pregnant women with obesity share other pregnant women's perceptions about weight gain and exercise in pregnancy but also have unique perceptions. Pregnant women with obesity in this study reported feeling stigmatized and fearful of being shamed by their health care providers but paradoxically eager for guidance. The findings offer implications for health care counseling and GWG interventions for this population.