Originally published in the June issue of JNEB.

Pregnancy is an exciting, stressful, challenging time for most women. We try to be perfect so that the little one develops into a healthy, happy baby. However, trying to be perfect can be so stressful! In terms of food and weight gain, the challenges are there every day.

Kroeger et al¹ reported on the reasons for late-night eating within a sample of 18 low-income black, pregnant women since this type of eating could lead to impaired glucose tolerance in overweight women late in pregnancy. Hunger, altered sleep pat- terns and the influence of others  were the prominent reasons for late- night eating. If other people in the household were snacking, they were there with them. Some even shared that they had a secret stash of snacks so they didn’t have to share. Graham et al² found that  pregnant  women (n = 15) who were in the third trimester of their first pregnancy often made food choices because of cravings, hunger, nausea, and fatigue. Avoiding caffeine and alcohol, along with these physical reasons, often led to increased sugar intake, which may contribute to increased weight gain.

Certainly the frequency and intensity of these physical or psycho- logical reasons for increased snacking and increased sugar intake might be related to the trimester of the pregnancy. Plante et al³ examined the associations between intuitive eating and trimester-specific weight gain as well as the associations with diet quality in 79 pregnant women. Intuitive eating and subscale scores were stable across trimesters. Not surprisingly, intuitive eating scores were higher for women within the gestational weight gain guidelines for the first and third trimesters versus those who weighed above those guidelines. Eating for physical rather than emotional reasons was also associated with more appropriate weight gain. The authors suggest that intuitive or mindful eating be incorporated into nutritional programs for pregnant women.

However, several studies with pregnant women related to weight management have not had the most positive outcomes. A 9-week, promo-tora-led program that included 1-hour educational sessions and 2 walking groups per week only had 7 in the participant group and 5 in the non-participant group complete the program of a total recruitment pool of 525 women.⁴ This program was conducted in partnership with a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic, and recruitment was face-to- face. The setting and approach were based on formative work to further enhance acceptability. However, the authors conclude that demand and acceptability would need to improve before this program could be considered feasible. Another study also examined the feasibility and accept- ability of a program, this one targeting postpartum women for a 12-week Facebook-based weight loss intervention.⁵ While weight loss was realized, and 58% lost ≥5% of their body weight, only 19 participated after 134 were approached to assess eligibility. Nevertheless, most remained engaged throughout the program. A significant limitation was that the sample was highly educated, partnered, and non-Hispanic white, and therefore the findings may not be applicable to other audiences. A self-guided approach to weight management for postpartnum women was compared to a group discussion approach. Attrition was fairly large, with no significant outcomes at 1 year. Although there was a demonstrated need for such a program, non-attendance was high. Authors suggested that the stress of the postpartum period may be a detriment to class attendance and offered some steps to minimize attrition.

Not specific to pregnant women, managing attrition and poor recruitment appears to be an obstacle across many age ranges nutrition education program topics. How to tip the decisional balance in our favor for both signing up for a program and to continue attending may require substantial formative work in order to build trust, provide benefits that outweigh perceived barriers such as time and cost, and to tailor the program to the overall needs and desires of the targeted audience.⁶ It may be that pregnant and postpartum women’s top concerns are not weight-related. If professional development topics were more desirable, perhaps those are the topics we should be offering, and “tucking in” some weight management tips, similar to “tucking in” vegetables to a much-loved lasagna dish.

Karen Chapman-Novakofski, PhD, RDN
Editor-in-Chief

REFERENCES

1. Kroeger EN, Carson TL, Baskin ML et al. Reasons for late-night eating and willingness to change: A qualitative study in pregnant black women. J Nutr Educ Behav. https://doi.org/10.1016/j. jneb.2018.11.003.
2. Graham JE, Mayan M, McCargar LJ, Bell Making compromises: A quali- tative study of sugar consumption behav- iors during pregnancy. J Nutr Educ Behav. 2013;45:578–585.
3. Plante A-S, Savard C, Lemieuz S, et Trimester-specific intuitive eating in association with gestational weight gain and diet quality. J Nutr Educ Behav. 2019;51:677–683.