Prospective relationships between health cognitions and excess gestational weight gain in a cohort of healthy and overweight pregnant women

Background - Excess gestational weight gain (GWG) contributes to long term obesity in mothers and children. To guide the tailoring of interventions to prevent excess GWG, a better understanding is needed of the lifestyle-related health cognitions that influence women’s attempts to manage GWG. Objective - To examine the relationship between health cognitions and excess GWG for women who enter pregnancy at a healthy weight (BMI<25kgm/m 2 ) or overweight (BMI>25kg/m 2 ). It was hypothesized that health cognitions with a positive [negative] influence on health behavior would be associated with lower [higher] likelihood of excess GWG and that specific associations would differ between weight status groups. Design - This prospective, observational study commenced when participants were <20 weeks gestation, continuing until the end of their pregnancy. A self-administered quantitative survey at recruitment assessed pre-pregnancy weight and lifestyle-related health cognitions. Height was measured at 16 weeks and weight at 36 weeks using standard procedures. Participants and setting - A consecutive sample of pregnant women (n=715) were recruited from an Australian metropolitan hospital between August 2010 and January 2011. All women <20 weeks gestation were eligible unless they had pre-existing Type 1 or 2 diabetes or insufficient English language skills to complete questionnaires. Main outcome measures - Excess GWG defined according to Institute of Medicine 2009 recommendations and predisposing, reinforcing and enabling cognitions for lifestyle health behaviors. Statistical analyses performed - Logistic regression analyses examined associations between health cognitions and excess GWG stratified for pre-pregnancy weight status. Results - For healthy weight women higher weight locus of control scores were protective against excess GWG (OR [95%CI]) (0.6 [0.4-0.8]), whereas higher perceived risk scores (personal risk and risk arising from pre-pregnancy weight) (1.3[1.1-1.7]) were associated with excess GWG. For ...