Are we missing opportunities understanding health behaviours associated with overweight in pregnancy

ARE WE MISSING OPPORTUNITIES? UNDERSTANDING HEALTH BEHAVIOURS ASSOCIATED WITH OVERWEIGHT IN PREGNANCY Susan Jane de Jersey MPH, BHlthSci (Nut&Diet) (Hons), BAppSci (HMS) (Hons) This thesis is submitted for the degree of Doctor of Philosophy in the School of Nutrition and Exercise Science, Queensland University of Technology April, 2013 Keywords Pregnancy, weight gain, overweight, nutrition, physical activity, knowledge attitudes practice, behaviour change, maternal health, obesity prevention, PRECEDE-PROCEED model Are we missing opportunities? Understanding health behaviours associated with overweight in pregnancy i Abstract While maternal obesity, excess pregnancy weight gain and lifestyle behaviours are associated with future overweight for both mothers and babies, there is limited research on how best to intervene An evidence base that identifies behavioural influences is crucial to the development of effective interventions This thesis aims to gain an understanding of maternal behavioural outcomes of healthy eating, physical activity and gestational weight gain (GWG), the psychosocial influences on these and to examine differences according to pre-pregnancy weight status The New Beginnings Healthy Mothers and Babies Study was a prospective observational study using the PRECEDE-PROCEED model of health promotion planning as a framework A consecutive sample of 715 women was recruited Height and weight were measured and women completed questionnaires at approximately 16 and 36 weeks gestation This thesis presents three chapters of original research across four study domains While healthy eating was widely regarded as important during pregnancy and had become more so, there was more variability in attitudes towards physical activity Ninety-two percent of participants achieved the maximum knowledge score relating to the influence of nutrition on pregnancy However, 8% and 36% respectively knew how many serves of fruit and vegetables should be consumed daily Six percent of participants met the recommendations for fruit consumption, 4% achieved the recommended vegetable intake and 44% achieved sufficient physical activity There were few differences between healthy and overweight women for measures of physical activity and healthy eating Many predisposing, reinforcing and enabling factors with a positive influence on health behaviours were lower in women commencing pregnancy overweight and those factors with a negative influence on health behaviours were higher when compared to healthy weight women Some of these antecedents to health behaviours that were different according to prepregnancy weight status were associated with diet quality and physical activity While self efficacy was consistently associated with diet quality and Are we missing opportunities? Understanding health behaviours associated with overweight in pregnancy ii physical activity for both weight groups, other associations between specific predisposing, reinforcing and enabling factors differed with behaviour and weight status group These results highlight the complexity of supporting behaviour change in a one-size-fits-all approach Sixty-four percent of participants gained weight outside of recommendations Compared to healthy weight women, those women who were already overweight at the beginning of pregnancy were more likely to gain too much weight (30% vs 56%, p