Healthy Pregnancies Are for Every Body! Understanding Prenatal Care for Plus-Size Women

Background:

According to CDC, approximately 41% of women have obesity, categorized as a body mass index (BMI) of 30 kg/m² and higher. Among pregnant women, evidence shows an association between obesity and increased risk of pregnancy complications, such as gestational diabetes, cesarean delivery, and pregnancy loss. Obese women often report having negative experiences with healthcare providers because of their weight, leading some women to fear medical appointments and interfering with care seeking.

Program background:

The Eunice Kennedy Shriver National Institute of Child and Human Development (NICHD) National Child & Maternal Health Education Program is developing an initiative that educates plus-size (i.e., obese) pregnant women about the need for healthcare providers (e.g., obstetricians, gynecologists) to use BMI and high-risk classifications to develop an individualized plan for a healthy pregnancy. It also educates providers on the importance of having open, nonjudgmental conversations with plus-size patients about their weight and pregnancy risks. The American College of Obstetricians and Gynecologists’ practice guidelines for managing obesity during pregnancy are the evidence base for this initiative. Formative research involving obese pregnant women and consultation with a subject matter expert (SME) in the field of plus-size pregnancy offered insight into reframing the conversation about BMI, weight, and pregnancy risk as part of the overall prenatal care plan. This initiative is intended to empower pregnant women to work collaboratively with their providers to develop a care plan.

Evaluation Methods and Results:

A literature review on patient–provider interactions and conversations with a plus-size pregnancy SME revealed unconscious biases among providers toward obese patients. These biases often led to patients feeling judged or shamed by their providers and in some cases caused them to avoid or delay care. NICHD conducted 16 in-depth interviews and two focus groups with obese pregnant women and women who recently gave birth (n = 9). Although participants reported generally positive interactions with providers, some noted that most appointments were standard and did not address their specific questions about their weight during pregnancy. There also appeared to be some knowledge gaps related to BMI and its role in assessing pregnancy risk. NICHD tested key messages and imagery for the initiative to use in educational materials. Messages with an empowering and inclusive tone were well received, as were images of plus-size women engaging in healthy activities (e.g., taking a walk with a partner) and/or experiencing healthy outcomes (e.g., holding a newborn).

Conclusions:

A mixed-methods approach (e.g., review of the literature, focus groups) was used to ensure a thorough understanding of the public health problem and ways to address it with intended audiences. Additionally, clinical recommendations guided the initiative’s strategy, including development of key messages, creative concepts, and educational materials for each audience.

Implications for research and/or practice:

Effective communication between patients and healthcare providers is vital to ensuring quality healthcare delivery and patient satisfaction. This initiative is designed to bridge both knowledge and communication gaps between patients and providers around the sensitive topic of weight and pregnancy.