title: Excess Gestational Weight Gain in Low-Income Overweight and Obese Women: A Qualitative Study.
abstract: OBJECTIVE
  Examine factors implicated in gestational weight gain (GWG) in low-income overweight and obese women.
  
  
  METHODS
  Qualitative study.
  
  
  METHODS
  Community-based perinatal center.
  
  
  METHODS
  Eight focus groups with women (black = 48%, white non-Hispanic = 41%, and Hispanic = 10%) in the first half (n = 12) and last half of pregnancy (n = 10) or postpartum (n = 7), 2 with obstetrician-gynecologists (n = 9).
  
  
  METHODS
  Barriers and facilitators to healthy eating and GWG within different levels of the Social Ecological Model: for example, intrapersonal, interpersonal, and organizational.
  
  
  METHODS
  Coding guide was based on the Social Ecological Model. Transcripts were coded by 3 researchers for common themes. Thematic saturation was reached.
  
  
  RESULTS
  At an intrapersonal level, knowledge/skills and cravings were the most common barriers. At an interpersonal level, family and friends were most influential. At an organizational level, the Special Supplemental Nutrition Program for Women, Infants, and Children and clinics were influential. At the community level, lack of transportation was most frequently discussed. At a policy level, complex policies and social stigma surrounding the Special Supplemental Nutrition Program for Women, Infants, and Children were barriers. There was consensus that ideal intervention approaches would include peer-facilitated support groups with information from experts. Obstetrician-gynecologists felt uncomfortable counseling patients about GWG because of time constraints, other priorities, and lack of training.
  
  
  CONCLUSIONS
  There are multilevel public health opportunities to promote healthy GWG. Better communication between nutrition specialists and obstetrician-gynecologists is needed.
authors.affiliation: Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI.
authors.forename: Cynthie K
authors.initials: CK
authors.lastname: Anderson
authors.affiliation: Department of Kinesiology and Public Health Education, University of North Dakota, Grand Forks, ND.
authors.forename: Tanis J
authors.initials: TJ
authors.lastname: Walch
authors.affiliation: Center for Women's Health and Health Disparities Research, University of Wisconsin, Madison, WI.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Lindberg
authors.affiliation: Prevea Health, Sheboygan, WI.
authors.forename: Aubrey M
authors.initials: AM
authors.lastname: Smith
authors.affiliation: Department of Obstetrics and Gynecology, Reproductive Endocrine Infertility, Boonshoft School of Medicine, Wright State University, Dayton, OH.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Lindheim
authors.affiliation: Paso del Norte Institute for Healthy Living, El Paso, TX. Electronic address: ldwhigham@utep.edu.
authors.forename: Leah D
authors.initials: LD
authors.lastname: Whigham
mesh_terms: D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D009765:Obesity / Q000453:epidemiology*; D050177:Overweight / Q000453:epidemiology*; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care; D036301:Qualitative Research; D015430:Weight Gain; D014922:Wisconsin / Q000453:epidemiology
keywords: WIC; gestational weight gain; obesity; overweight