December 2, 2016

New research examines health advice given by friends and family to pregnant women

A new mixed methods study used text message surveys to tap into community conversations about pregnancy health norms and health literacy.


Research trailer for new research in BMC Pregnancy and Childbirth, senior author Tammy Chang, M.D., M.P.H., M.S. 

When it comes to their health, pregnant women juggle many sources of information, from their clinicians and the Internet to family and friends. Advice from a loved one may play a key role in the choices women make about their health and how they view their pregnancy. 

A new mixed methods study in BMC Pregnancy and Childbirth, led by former University of Michigan medical student Bianca A. Verma, M.D., and senior author Tammy Chang, M.D., M.P.H., M.S., compared advice given to pregnant women on two health behaviors that have a critical impact on health outcomes for the mother and child: smoking and dietary habits/physical activity. According to the authors "The objective of this study was to determine retrospectively whether community members give advice to pregnant women, what advice they give about smoking versus weight gain during pregnancy, and to assess their comfort in speaking about these topics."

The researchers used text message polling to ask community members present in the waiting room of a diverse, low-income primary care setting. Participants (n=370, 77 % female, 40 % non-Hispanic Black, 25 % education of high school or less) were asked if they had ever spoken to a pregnant woman about weight gain during pregnancy and about smoking during pregnancy. For those who had, they were then asked to share what they had said. For those who hadn't shared, they were then asked if they would feel comfortable talking about the two health topics with pregnant women they knew.

The researchers found that over half of community members had talked to pregnant women about one or more of the health behaviors. Female respondents and those with higher education were more likely to have spoken about both health topics. They found that among those who had never shared their advice, more were uncomfortable discussing weight gain (65%) compared to smoking (34%) (p<0.001). Additionally, 80% of respondents had never talked to a pregnant woman about weight gain, compared to 60% who had never talked about smoking.

In addition to being less comfortable addressing weight gain compared to smoking, there was also a distinction between the advice they gave on the two topics. Respondents had a deeper understanding of the negative health effects of smoking and advice was more strongly negative, e.g. encouraging women to quit smoking and consider specific health risks for their baby. Advice about weight gain and dietary habits was more often reassuring, normalizing, or posed general warnings against gaining excess weight.

The research points to both social stigma regarding conversations about weight and a knowledge gap in the health risks of excessive weight gain during pregnancy. According to the authors, "Respondents showed greater understanding of the poor health effects of smoking, had more accurate knowledge about the dangers of smoking...and addressed the issue more directly with pregnant women." 

The study suggests framing excessive gestational weight gain not only as a clinical issue, but as a public health educational initiative, targeting community members who are more likely to share their advice with pregnant women.

Their conclusion for fellow clinicians is to "acknowledge that friends and family might give inaccurate information about healthy weight gain during pregnancy. As a trusted source of health information, clinicians, nurses, and public health workers should anticipate a knowledge gap about this topic and strive to discuss healthy weight gain with every pregnant woman at every visit."
The study was published in BMC Pregnancy and Childbirth in November 2016.

For more Department of Family Medicine research on health literacy during pregnancy, download Crowdsourcing and the Accuracy of Online Information Regarding Weight Gain in Pregnancy: A Descriptive Study or browse our Reproductive and Women's Health research page.