Prospective Relationships between Health Cognitions and Excess Gestational Weight Gain in a Cohort of Healthy and Overweight Pregnant Women

Published:February 09, 2017DOI:



      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.


      To examine the relationship between health cognitions and excess GWG for women who enter pregnancy at a healthy weight (body mass index <25) or overweight (body mass index ≥25). 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.


      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 prepregnancy 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 preexisting 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 prepregnancy weight status.


      For healthy-weight women, higher weight locus of control scores were protective against excess GWG (odds ratio 0.6, 95% CI 0.4 to 0.8), whereas higher perceived risk scores (personal risk and risk arising from prepregnancy weight) (odds ratio 1.3, 95% CI 1.1 to 1.7) were associated with excess GWG. For overweight women higher negative outcome expectation scores were associated with an increased risk of excess GWG (odds ratio 1.4, 95% CI 1.1 to 2.0).


      Lifestyle-related health cognitions are associated with excess GWG and differed by prepregnancy weight status, suggesting the need to tailor behavior change interventions accordingly.


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        • World Health Organization
        Obesity: Preventing and managing the global epidemic. Report of a WHO consultation.
        World Health Organ Tech Rep Ser. 2000; 894 (i-xii, 1-253)
        • Institute of Medicine, National Research Council
        Weight Gain During Pregnancy: Reexamining the Guidelines.
        The National Academies Press, Washington, DC2009
        • de Jersey S.J.
        • Nicholson J.M.
        • Callaway L.K.
        • Daniels L.A.
        A prospective study of pregnancy weight gain in Australian women.
        Aust N Z J Obstet Gynaecol. 2012; 52: 545-551
        • Nehring I.
        • Schmoll S.
        • Beyerlein A.
        • Hauner H.
        • von Kries R.
        Gestational weight gain and long-term postpartum weight retention: A meta-analysis.
        Am J Clin Nutr. 2011; 94: 1225-1231
        • de Jersey S.J.
        • Ross L.J.
        • Himstedt K.
        • McIntyre H.D.
        • Callaway L.K.
        • for the Bambino Study Group
        Weight gain and nutritional intake in obese pregnant women: Some clues for intervention.
        Nutr Diet. 2011; 68: 53-59
        • Tanentsapf I.
        • Heitmann B.L.
        • Adegboye A.R.A.
        Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women.
        BMC Pregnancy Childbirth. 2011; 11 (81-81)
        • Thangaratinam S.
        • Rogozińska E.
        • Jolly K.
        • et al.
        Effects of interventions in pregnancy on maternal weight and obstetric outcomes: Meta-analysis of randomised evidence.
        BMJ. 2012; 344: e2088
        • Muktabhant B.
        • Lawrie T.A.
        • Lumbiganon P.
        • Laopaiboon M.
        Diet or exercise, or both, for preventing excessive weight gain in pregnancy.
        Cochrane Database Syst Rev. 2015; : 6
        • Aboud F.E.
        Virtual special issue introduction: Health behaviour change.
        Soc Sci Med. 2010; 71: 1897-1900
        • Bettinghaus E.P.
        Health promotion and the knowledge-attitude-behavior continuum.
        Prev Med. 1986; 15: 475-491
        • Fishbein M.
        • Yzer M.C.
        Using theory to design effective health behavior interventions.
        Comm Theory. 2003; 13: 164-183
        • Poston L.
        • Bell R.
        • Croker H.
        • et al.
        Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): A multicentre, randomised controlled trial.
        Lancet Diabetes Endocrinol. 2015; 3: 767-777
        • Dodd J.M.
        • Turnbull D.
        • McPhee A.J.
        • et al.
        Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial.
        BMJ. 2014; 348: g1285
        • Dodd J.M.
        • Cramp C.
        • Sui Z.
        • et al.
        The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: The LIMIT randomised trial.
        BMC Med. 2014; 12: 161
        • Polley B.A.
        • Wing R.R.
        • Sims C.J.
        Randomized controlled trial to prevent excessive weight gain in pregnant women.
        Int J Obes Relat Metab Disord. 2002; 26: 1494-1502
        • Phelan S.
        • Phipps M.G.
        • Abrams B.
        • Darroch F.
        • Schaffner A.
        • Wing R.R.
        Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: The Fit for Delivery Study.
        Am J Clin Nutr. 2011; 93: 772-779
        • Green L.W.
        • Kreuter M.W.
        Health Program Planning: An Educational and Ecological Approach.
        4th ed. McGraw Hill, New York, NY2005
        • Noar S.M.
        • Zimmerman R.S.
        Health Behavior Theory and cumulative knowledge regarding health behaviors: Are we moving in the right direction?.
        Health Educ Res. 2005; 20: 275-290
      1. de Jersey SJ, Mallan K, Callaway LK, Daniels LA, Nicholson JM. A cross-sectional comparison of predisposing, reinforcing and enabling factors for lifestyle health behaviours and weight gain in healthy and overweight pregnant women [published online ahead of print July 22, 2016]. Matern Child Health J.

        • de Jersey S.J.
        • Nicholson J.M.
        • Callaway L.K.
        • Daniels L.A.
        An observational study of nutrition and physical activity behaviors, knowledge, and advice in pregnancy.
        BMC Pregnancy Childbirth. 2013; : 13
      2. Statistical Services Branch Queensland Health. 2012 Queensland Perinatal Statistics, September 2010-February 2011. Brisbane, Australia: Queensland Health. Accessed October 6, 2011.

        • de Jersey S.J.
        • Callaway L.K.
        • Daniels L.A.
        • Nicholson J.M.
        Weight-related risk perception among healthy and overweight pregnant women: A cross-sectional study.
        J Perinatol. 2015; 35: 683-688
        • Streiner D.L.
        Being inconsistent about consistency: When coefficient alpha does and doesn't matter.
        J Pers Assess. 2003; 80: 217-222
        • Cortina J.M.
        What is coefficient alpha? An examination of theory and applications.
        J Appl Psychol. 1993; 78: 98
        • Streiner D.L.
        Starting at the beginning: An introduction to coefficient alpha and internal consistency.
        J Pers Assess. 2003; 80: 99-103
        • Saltzer E.B.
        The Weight Locus of Control (WLOC) scale: A specific measure for obesity research.
        J Pers Assess. 1982; 46: 620
        • Campbell M.W.
        • Williams J.
        • Hampton A.
        • Wake M.
        Maternal concern and perceptions of overweight in Australian preschool-aged children.
        Med J Aust. 2006; 184: 274-277
        • Olson C.M.
        • Strawderman M.S.
        • Dennison B.A.
        Maternal weight gain during pregnancy and child weight at age 3 years.
        Matern Child Health J. 2009; 13: 839-846
        • Oken E.
        • Taveras E.M.
        • Kleinman K.P.
        • Rich-Edwards J.W.
        • Gillman M.W.
        Gestational weight gain and child adiposity at age 3 years.
        Am J Obstet Gynecol. 2007; 196: 322.e321-322.e328
        • Stotland N.E.
        • Haas J.S.
        • Brawarsky P.
        • Jackson R.A.
        • Fuentes-Afflick E.
        • Escobar G.J.
        Body mass index, provider advice, and target gestational weight gain.
        Obstet Gynecol. 2005; 105: 633-638
        • Cogswell M.E.
        • Scanlon K.S.
        • Fein S.B.
        • Schieve L.A.
        Medically advised, mother's personal target, and actual weight gain during pregnancy.
        Obstet Gynecol. 1999; 94: 616-622
      3. Statistical Package for Social Sciences. Version 20. Armonk, NY: IBM-SPSS Inc; 2012.

        • Kendall A.
        • Olson C.M.
        • Frongillo Jr., E.A.
        Evaluation of psychosocial measures for understanding weight-related behaviors in pregnant women.
        Ann Behav Med. 2001; 23: 50-58
        • Devine C.M.
        • Bove C.F.
        • Olson C.M.
        Continuity and change in women's weight orientations and lifestyle practices through pregnancy and the postpartum period: The influence of life course trajectories and transitional events.
        Soc Sci Med. 2000; 50: 567-582
        • Michie S.
        • Ashford S.
        • Sniehotta F.F.
        • Dombrowski S.U.
        • Bishop A.
        • French D.P.
        A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy.
        Psychol Health. 2011; 26: 1479-1498
        • Bandura A.
        Health promotion by social cognitive means.
        Health Educ Behav. 2004; 31: 143-164
        • Williams D.M.
        • Anderson E.S.
        • Winett R.A.
        A review of the outcome expectancy construct in physical activity research.
        Ann Behav Med. 2005; 29: 70-79
        • Anderson-Bill E.S.
        • Winett R.A.
        • Wojcik J.R.
        • Winett S.G.
        Web-based guide to health: Relationship of theoretical variables to change in physical activity, nutrition and weight at 16-months.
        J Med Internet Res. 2011; 13: e27
        • Kapadia M.Z.
        • Gaston A.
        • Van Blyderveen S.
        • et al.
        Psychological antecedents of excess gestational weight gain: A systematic review.
        BMC Pregnancy Childbirth. 2015; 15: 107
        • Laraia B.A.
        • Siega-Riz A.M.
        • Dole N.
        • London E.
        Pregravid weight is associated with prior dietary restraint and psychosocial factors during pregnancy.
        Obesity. 2009; 17: 550-558
        • Abrams B.
        • Hoggatt K.
        • Kang M.
        • Selvin S.
        History of weight cycling and weight changes during and after pregnancy.
        Paediatr Perinat Epidemiol. 2001; 15 (A1-A1)
        • Conway R.
        • Reddy S.
        • Davies J.
        Dietary restraint and weight gain during pregnancy.
        Eur J Clin Nutr. 1999; 53: 849-853
        • Mumford S.L.
        • Siega-Riz A.M.
        • Herring A.
        • Evenson K.R.
        Dietary restraint and gestational weight gain.
        J Am Diet Assoc. 2008; 108: 1646-1653
        • Sheeran P.
        Intention—behavior relations: A conceptual and empirical review.
        Eur Rev Soc Psychol. 2002; 12: 1-36
        • Kremers S.P.J.
        Theory and practice in the study of influences on energy balance-related behaviors.
        Patient Educ Couns. 2010; 79: 291-298
        • Chang M.-W.
        • Brown R.L.
        • Baumann L.J.
        • Nitzke S.A.
        Self-efficacy and dietary fat reduction behaviors in obese African-American and white mothers.
        Obesity. 2008; 16: 992-1001
        • Anderson E.S.
        • Winett R.A.
        • Wojcik J.R.
        Self-regulation, self-efficacy, outcome expectations, and social support: Social cognitive theory and nutrition behavior.
        Ann Behav Med. 2007; 34: 304-312
        • Richman R.
        • Loughnan G.
        • Droulers A.
        • Steinbeck K.
        • Caterson I.
        Self-efficacy in relation to eating behaviour among obese and non-obese women.
        Int J Obes. 2001; 25: 907-913
        • Byrd-Bredbenner C.
        • Abbot J.M.
        • Cussler E.
        Relationship of social cognitive theory concepts to mothers' dietary intake and BMI.
        Matern Child Nutr. 2011; 7: 241-252
        • Lawrence W.
        • Schlotz W.
        • Crozier S.
        • et al.
        Specific psychological variables predict quality of diet in women of lower, but not higher, educational attainment.
        Appetite. 2011; 56: 46-52
        • Anderson E.S.
        • Wojcik J.R.
        • Winett R.A.
        • Williams D.M.
        Social-cognitive determinants of physical activity: The influence of social support, self-efficacy, outcome expectations, and self-regulation among participants in a church-based health promotion study.
        Health Psychol. 2006; 25: 510
        • Kim C.
        • McEwen L.N.
        • Kieffer E.C.
        • Herman W.H.
        • Piette J.D.
        Self-efficacy, social support, and associations with physical activity and body mass index among women with histories of gestational diabetes mellitus.
        Diabet Educ. 2008; 34: 719-728
        • Linde J.A.
        • Rothman A.J.
        • Baldwin A.S.
        • Jeffery R.W.
        The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial.
        Health Psychol. 2006; 25: 282
        • Nothwehr F.
        Self-efficacy and its association with use of diet-related behavioral strategies and reported dietary intake.
        Health Educ Behav. 2008; 35: 698
        • Gardner B.
        • Wardle J.
        • Poston L.
        • Croker H.
        Changing diet and physical activity to reduce gestational weight gain: A meta-analysis.
        Obes Rev. 2011; 12: e602-e620
      4. Schwarzer R, Sniehotta FF, Lippke S, et al. On the assessment and analysis of variables in the health action process approach: Conducting an investigation. 2003. Accessed November 10, 2009.

      5. Schwarzer R. The Health Action Process Approach. 2009. Accessed December 10, 2009.

        • Sallis J.F.
        • Pinski R.B.
        • Grossman R.M.
        • Patterson T.L.
        • Nader P.R.
        The development of self-efficacy scales for healthrelated diet and exercise behaviors.
        Health Educ Res. 1988; 3: 283-292
        • Ling A.M.C.
        • Horwath C.
        Self-efficacy and consumption of fruit and vegetables: Validation of a summated scale.
        Am J Health Promot. 1999; 13: 290-298
        • Marcus B.H.
        • Owen N.
        Motivational readiness, self-efficacy and decision-making for exercise.
        J Appl Soc Psychol. 1992; 22: 3-16


      S. J. de Jersey is an advanced accredited practicing dietitian, Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia, and a visiting research fellow, School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.


      K. M. Mallan is a visiting research fellow, School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia, and a lecturer, School of Psychology (Brisbane Campus), Australian Catholic University, Banyo, Queensland, Australia.


      L. K. Callaway is a professor of medicine, University of Queensland, Herston, Queensland, Australia, and an obstetric physician, Department of Internal Medicine, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia.


      L. A. Daniels is head of the school, a professor, and a fellow of the Dietitians Association of Australia, School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.


      J. M. Nicholson is the inaugural Roberta Holmes Professor, Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia, and with the Centre for Learning Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.