Pre- and Post-Migration Influences on Weight Management Behaviours: Perceptions of African Migrant Women in England

The prevalence of overweight/obesity is high among Black women in England, who also face high risks of pregnancy and childbirth complications. This study explored African migrant women’s perceptions of pre- and post-migration influences on their weight-related behaviours and weight management support during pregnancy. Interviews were conducted with women of child-bearing age from Ghana, Nigeria, and Cameroon (n = 23). Data were analysed using thematic analysis. Four themes were identified: changing dietary behaviours after migration, changing physical activity (PA) behaviours after migration, increased discourse on obesity, and weight management advice and support received. Navigating a new food environment, interactions with other populations in England, and the need to socialise influenced changes in dietary behaviours. Participants considered that living in England ‘makes you lazy’ due to its obesogenic environment, while increased discourses on obesity heightened weight awareness. Women struggled to relate to dietary advice from midwives but found PA advice useful. Relatives provided valuable support but could influence unhealthy weight-related practices. There is a need for interventions addressing gaps in weight management support for these women, especially considering their migrant backgrounds and multicultural identities. Further research is needed to understand their unique challenges, and collaborations with relatives could inform the development of effective weight management interventions

Newspaper media framing of obesity during pregnancy in the UK: A review and framework synthesis

Two thirds of women report experiencing weight stigma during pregnancy. Newspaper media is powerful in framing health issues. This review synthesized UK newspaper media portrayal of maternal obesity. NexisUni was searched to identify newspaper articles, published January 2010 to May 2021, reporting content on obesity during pregnancy. Framework synthesis integrated quantitative and qualitative analysis of the content of articles. There were 442 articles included (59% tabloids and 41% broadsheets). Three overarching themes with interacting sub-themes were as follows: (1) Women were blamed for their weight, risks, and NHS impact. (2) Women were solely responsible for solving obesity, gendered from school age. (3) Women with obesity were a burden on individuals (e.g., themselves, their children, and health professionals), to society, and the NHS. Catastrophizing language framed the “problem,” “scale,” and “public health concern” of maternal obesity, emphasizing risk, and danger and was alarmist, aggressive, and violent as to elicit fear or devalue women. Articles platformed ‘expert’ voices rather than women's lived experiences. This review identified that UK newspaper media negatively frames and oversimplifies the topic of maternal obesity. Exposure to blaming and alarmist messaging could increase women's guilt, stigma, and internalized weight bias. The newspaper media should be harnessed to de-stigmatize maternal obesity and promote maternal well-being

The effectiveness of weight management, smoking cessation, and alcohol reduction interventions on changing behaviors during pregnancy: an umbrella review protocol.

REVIEW OBJECTIVE/QUESTION: The objective of this umbrella review is to examine the effectiveness of different types of weight management, smoking cessation and alcohol reduction interventions in producing explicitly measured behavior change or proxy measures of behavior change in pregnant women.Specifically the review question is: are weight management, smoking cessation and alcohol reduction interventions effective in producing behavior change in pregnant women

Lived experiences of routine antenatal dietetic services among women with obesity: A qualitative phenomenological study

Objective: To understand the lived experiences and views of being referred to an antenatal dietetic service from the perspective of pregnant women with obesity.Design: A qualitative, interpretive approach using one-to-one in-depth interviews to explore the lived experience of pregnant women with obesity following referral to an antenatal dietetics service. Thematic content analysis was carried out by two researchers independently to develop data-driven themes.Setting: One NHS Trust maternity and dietetic services, North East England, UKParticipantsFifteen pregnant women with a booking body mass index ≥30 kg/m2 attending an obesity-specific antenatal dietetic service. All women were White, parity between 0–2, and BMI range 30–51 kg/m2.Findings: Four themes were identified within this concept. 1) Women's overall experience of the service: experiences were predominately positive with only two negative cases identified. 2) Process of referral: women placed importance on informative and in-person communication about the service, with health professionals, at the point of referral. 3) Delivery of the service: dietitians were considered to be the experts and women wanted more frequent contact. 4) Content of the service: tailored advice enabled behaviour change, and women desired increased physical activity support and weight monitoring.Key conclusions: Women reported an overall positive experience and thought that dietitians were the expert health professionals to support them. Women in this study felt that tailoring advice specific to their personal circumstances helped them implement changes, and had a strong interest in the nutritional benefits for fetal development. Women considered weight monitoring to be a positive element of the service; however, further research is required given the limited and conflicting evidence-base.Implications for practice: It is important to incorporate women's experiences in the development and delivery of antenatal weight management services to facilitate person-centred care. Communication by health professionals at the point of referral is particularly important to provide accurate expectations of services and to reduce anxieties. Dietitians are considered to be appropriate experts to deliver these services, although they may need additional support to address women's physical activity needs in pregnancy

Food insecurity during pregnancy in high-income countries, and maternal weight and diet: a systematic review and meta-analysis

Food insecurity is a well-established obesity driver. Less is known about food insecurity in pregnancy. This review (PROSPERO:CRD42022311669) aimed to explore associations between food insecurity, maternal obesity, gestational weight gain (GWG) and nutrition. Searches included seven databases, grey literature, references, citations, and contacting authors. Observational studies reporting data from January 1st 2008 to 21 November 2023 in high-income countries were included. Duplicate screening, data extraction and quality assessments were performed. Random effects meta-analysis estimated odds ratios (OR), mean difference (MD) and 95% confidence intervals (CI). Narrative synthesis was conducted when data could not be pooled. Database searches identified 22,272 results; 20 studies were included (n=19 North America, n=1 Europe; n=32,803 women). Food insecurity significantly increased obesity (OR 1.53 95%CI 1.39, 1.66), but not underweight (OR 1.12 95%CI 0.89, 1.34) or overweight (OR 1.18 95%CI 0.90, 1.46). Food insecurity significantly reduced GWG (MD -0.42kg 95%CI -0.62, -0.22) and increased inadequate GWG (OR 1.16 95%CI 1.05, 1.28), but not excessive GWG (OR 1.04 95%CI 0.96, 1.13). Diet outcomes were inconsistent, with some evidence of reduced vitamin E and diet quality and increased red/processed meat consumption. Further studies outside of North America are needed to inform practice and policy to support maternal health

The association between maternal body mass index and child obesity : a systematic review and meta-analysis

Funding: ES is a PhD student funded by the Medical Research Council (reference MR/K501396/1, https://mrc.ukri.org/). AP is a PhD student funded by the Economic and Social Research Council (reference 160149300, https://www.ninedtp.ac.uk/). ZA is a PhD student funded by Newcastle University Research Excellence Academy (https://www.ncl.ac.uk). NH is funded by a National Institute of Health Research Career Development Fellowship (reference CDF-2018-11-ST2-011, https://www.nihr.ac.uk/our-research-community/NIHR-academy). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Acknowledgments The authors would like to acknowledge Shannon Robalino (information scientist) for support in developing search strategies for database searches, and the authors who responded to our correspondence about additional data required for the meta-analysis. Authors who responded to our correspondence and provided the data requested were Dr Aline Andres, Professor Patrick Catalano, Dr Romy Gaillard, Professor Dana Dabelea, Dr Ai Kubo, Professor David Taylor-Robinson, Dr Sophie Wickham, Professor Christine Olson, and Dr Stephen Weng. Authors who responded to our correspondence but were unable to provide data were Zoe Bider-Canfield, Dr Claire Margerison-Zilko, Professor Juliana Kain, Dr Marieke de Hoog, and Professor Aaron Caughey.Peer reviewedPublisher PD

Trends in maternal body mass index, health inequalities, and the impact of maternal obesity on NHS maternity services

The primary objective of the work presented in this thesis was to identify trends in maternal body mass index (BMI) over time, the demographic predictors of those women most at risk of being obese in pregnancy, health inequalities, and the impact of maternal obesity on maternity services. A mixed methodology utilised quantitative and qualitative research to address these objectives. Data were collated from 34 maternity units across England, including 619,323 deliveries between 1989 and 2007 inclusive. Analysis identified an increasing incidence of maternal obesity over time, regional differences in incidence, and significant inequalities with women residing in the highest levels of deprivation, and Black ethnic group. A systematic review was carried out including 49 studies investigating obesity and pregnancy outcomes with acute maternity resource implications. The meta-analysis found significantly increased odds of a number of outcomes, and concluded that maternal obesity had a considerable impact on maternity resources, and contributed towards a poorer prognosis for the mother and the baby during delivery and in the immediate post-partum period. Qualitative interviews and focus groups with 30 HCPs across eight NHS Trusts in the North East of England were carried out to identify barriers in implementing maternal obesity services, and to gain HCPs perspectives on what they felt was required in order to address maternal obesity effectively. The study identified the themes of ‘Service Development’, ‘Psychosocial Issues and Maternal Obesity Services’, ‘Information, Evidence, and Training’, and ‘Where to go From Here?’. Overall this programme of research has identified that maternal obesity is increasing over time and is significantly associated with health inequalities. The increase in maternal obesity has an impact on acute services, and HCPs feel that a holistic approach is required through partnership work in order to address maternal obesity effectively. This programme of research has primarily contributed to the knowledge of maternal obesity with the provision of the first national level statistics for trends in maternal obesity. The research has also provided a holistic view of the impact of obesity in pregnancy on maternity services, including the impact on resources and the issues relating to addressing the maternal obesity in clinical practice. The research has also identified aspects of service that need to be improved, and knowledge gaps in how to move services forward to effective address maternal obesity. The contribution of this research to the knowledge base is emphasised in the journal pre-publications, dissemination through UK and European, and international conference presentations, being an invited speaker at a number of conferences in the UK, and I received the 2007 Association for the Study of Obesity (ASO) Student Researcher Award for producing exemplary work in the study of obesity.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Differential effects of diet and physical activity interventions in pregnancy to prevent gestational diabetes mellitus and reduce gestational weight gain by level of maternal adiposity: a protocol for an individual patient data (IPD) meta-analysis of randomised controlled trials.

INTRODUCTION: Women and their infants are at increased risk of complications if gestational diabetes mellitus (GDM) or excessive gestational weight gain (GWG) occurs in pregnancy. Weight management interventions in pregnancy, consisting of diet and physical activity components are targeted based on maternal body mass index (BMI). However, the relative effectiveness of interventions targeted based on alternative measures of adiposity to BMI is unclear. This individual patient data (IPD) meta-analysis aims to explore whether interventions are more effective at preventing GDM and reducing GWG in women according to their level of adiposity. METHODS: The International Weight Management in Pregnancy Collaborative Network has a living database of IPD from randomised trials of diet and/or physical activity interventions in pregnancy. This IPD meta-analysis will use IPD from trials identified from systematic literature searches up until March 2021, where maternal adiposity measures (eg, waist circumference) were collected prior to 20 weeks' gestation. A two-stage random effects IPD meta-analysis approach will be taken for each outcome (GDM and GWG) to understand the effect of early pregnancy adiposity measures on the effect of weight management interventions for GDM prevention and GWG reduction. Summary intervention effects with 95% CIs) will be derived along with treatment covariate interactions. Between-study heterogeneity will be summarised by I2 and tau2 statistics. Potential sources of bias will be evaluated, and the nature of any missing data will be explored and appropriate imputation methods adopted. ETHICS AND DISSEMINATION: Ethics approval is not required. The study is registered on the International Prospective Register of Systematic Reviews (CRD42021282036). Results will be submitted to peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42021282036