Abstract
Poor diet quality is common among low-income, overweight, African-American mothers,
placing them at high risk for adverse pregnancy outcomes. We sought to better understand
the contextual factors that may influence low-income African-American mothers’ diet
quality during pregnancy. In 2011, we conducted semi-structured interviews with 21
overweight/obese, pregnant African Americans in Philadelphia, PA, all of whom received
Medicaid and were eligible for the Special Supplemental Nutrition Program for Women,
Infants, and Children. Two readers independently coded the interview transcripts to
identify recurrent themes. We identified 10 themes around motivators and barriers
to healthy eating in pregnancy. Mothers believed that consuming healthy foods, like
fruits and vegetables, would lead to healthy babies and limit the physical discomforts
of pregnancy. However, more often than not, mothers chose foods that were high in
fats and sugars because of taste, cost, and convenience. In addition, mothers had
several misconceptions about the definition of healthy (eg, “juice is good for baby”),
which led to overconsumption. Many mothers feared they might “starve” their babies
if they did not get enough to eat, promoting persistent snacking and larger portions.
Living in multigenerational households and sharing resources also limited the mothers’
control over food choices and made consuming healthy foods especially difficult. Despite
the good intentions of low-income African-American mothers to improve diet quality
during pregnancy, multiple factors worked together as barriers to healthy eating.
Interventions that emphasize tasty and affordable healthy food substitutes, address
misconceptions, and counsel mothers about true energy needs in pregnancy may improve
low-income, African-American, overweight/obese mothers’ diet quality.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Academy of Nutrition and DieteticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- What's a pregnant woman to eat? A review of current USDA Dietary Guidelines and MyPyramid.J Perinat Educ. 2006; 15: 28-33
- Second trimester folate status and preterm birth.Am J Obstet Gynecol. 2004; 191: 1851-1857
- Diet quality and risk of neural tube defects.Med Hypotheses. 2003; 60: 351-355
- Associations of diet and physical activity during pregnancy with risk for excessive gestational weight gain.Am J Obstet Gynecol. 2009; 201: 58.e1-58.e8
- Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain.J Am Diet Assoc. 2003; 103: 48-54
- Perceptions of low-income African-American mothers about excessive gestational weight gain.Matern Child Health J. 2012; 16: 1837-1843
- Weight gain in pregnancy: Implications for maternal and child health.Ann Nestle. 2010; 68: 17-28
- Pregravid body mass index is negatively associated with diet quality during pregnancy.Public Health Nutr. 2007; 10: 920-926
- A decrease in diet quality occurs during pregnancy in overweight and obese women which is maintained post-partum.Int J Obes. 2013; 37: 704-711
- Healthy Eating Index during pregnancy according to pre-gravid and gravid weight status.Public Health Nutr. 2011; 14: 290-296
- Food choices of low-income women during pregnancy and postpartum.J Am Diet Assoc. 2005; 105: 899-907
- First trimester predictors of diet and birth outcomes in low-income pregnant women.J Community Health Nurs. 2005; 22: 117-130
- Tracking of food choices across the transition to motherhood.J Nutr Educ Behav. 2005; 37: 129-136
- The web of risk factors for excessive gestational weight gain in low income women.Matern Child Health J. 2013; 17: 344-351
- Weight, diet, and physical activity-related beliefs and practices among pregnant and postpartum Latino women: The role of social support.Matern Child Health J. 2006; 10: 95-104
- A qualitative study of factors affecting pregnancy weight gain in African American women.Matern Child Health J. 2013; 17: 432-440
- Identifying healthy eating strategies in low-income pregnant women: Applying a positive deviance model.Health Care Women Int. 2005; 26: 807-820
- Gestational weight and dietary intake during pregnancy: Perspectives of African American women.Matern Child Health J. 2008; 12: 718-724
- Prevalence of obesity in the United States, 2009-2010. NCHS data brief, no. 82.National Center for Health Statistics, Hyattsville, MD2012: 1-8
- How to conduct the study. Designing Qualitative Research.SAGE Publications, London, UK2006: 45-120
- Promoters and barriers to fruit, vegetable, and fast-food consumption among urban, low-income African Americans—A qualitative approach.Am J Public Health. 2010; 100: 631-635
- Contextual factors influencing the eating behaviours of African American women: A focus group investigation.Ethn Health. 2002; 7: 133-147
US Household Food Security Survey Module: Six-Item Short Form. Economic Research Service, US Department of Agriculture. http://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/survey-tools.aspx#six. Updated July 2008. Accessed November 10, 2010.
- Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory.SAGE Publications, Thousand Oaks, CA1998
- Predictors of dietary quality in low-income pregnant women: A path analysis.Nurs Res. 2011; 60: 286-294
- The National WIC Evaluation: Evaluation of the Special Supplemental Food Program for Women, Infants, and Children. V. Longitudinal study of pregnant women.Am J Clin Nutr. 1988; 48: 439-483
- Users’ guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? Evidence-Based Medicine Working Group.JAMA. 2000; 284: 478-482
Biography
N. R. Reyes is a research dietitian, Department of Medicine, Center for Obesity Research and Education, Temple University, Philadelphia, PA.
Biography
A. A. Klotz is a research analyst, Department of Medicine, Center for Obesity Research and Education, Temple University, Philadelphia, PA.
Biography
S. J. Herring is an assistant professor, Department of Medicine, Center for Obesity Research and Education, Temple University, Philadelphia, PA.
Article info
Publication history
Published online: July 16, 2013
Accepted:
April 18,
2013
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This study was supported by a grant from the US National Institutes of Health (K23 HL106231).
Identification
Copyright
© 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
