Perceptions of Low-Income African-American Mothers About Excessive Gestational Weight Gain

A rising number of low-income African-American mothers gain more weight in pregnancy than is recommended, placing them at
risk for poor maternal and fetal health outcomes. Little is known about the perceptions of mothers in this population that
may influence excessive gestational weight gain. In 2010–2011, we conducted 4 focus groups with 31 low-income, pregnant African-Americans
in Philadelphia. Two readers independently coded the focus group transcripts to identify recurrent themes. We identified 9
themes around perceptions that encouraged or discouraged high gestational weight gain. Mothers attributed high weight gain
to eating more in pregnancy, which was the result of being hungrier and the belief that consuming more calories while pregnant
was essential for babies’ health. Family members, especially participants own mothers, strongly reinforced the need to “eat
for two” to make a healthy baby. Mothers and their families recognized the link between poor fetal outcomes and low weight
gains but not higher gains, and thus, most had a greater pre-occupation with too little food intake and weight gain rather
than too much. Having physical symptoms from overeating and weight retention after previous pregnancies were factors that
discouraged higher gains. Overall, low-income African-American mothers had more perceptions encouraging high gestational weight
gain than discouraging it. Interventions to prevent excessive weight gain need to be sensitive to these perceptions. Messages
that link guideline recommended weight gain to optimal infant outcomes and mothers’ physical symptoms may be most effective
for weight control.