The maternity experience for women with a body mass index ≥ 30 kg/m2: a meta-synthesis

Background Maternal obesity (body mass index, BMI >= 30 kg/m2) is a global public health issue. There is a dearth of evidence regarding an effective maternal care pathway for pregnant women with a BMI >= 30 kg/m2. Objectives This meta-synthesis aims to increase our understanding of the maternity experience for pregnant women with a BMI >= 30 kg/m2. Search strategy Six electronic databases were searched using predefined search terms. Selection criteria English-language studies using qualitative data to explore the maternity experience for women with a BMI >= 30 kg/m2 were included (defined by a quality appraisal framework). Data collection and analysis An interpretative approach was taken and the constructivist framework was central to the synthesis. Searches were conducted in September 2010, and resulted in six papers being synthesised. Main results Three cluster themes (eight initial themes) were highlighted: acceptance and inevitability of weight gain in pregnancy; depersonalisation of care as a result of medicalisation; and healthy lifestyle benefits for self and baby. Author's conclusions Pregnancy is an ideal period for health professionals to intervene, as women with a BMI >= 30 kg/m2 perceive their weight as more acceptable than when they were not pregnant, and are aware of the benefits of having a healthy lifestyle. Antenatal care should include postnatal weight management advice, as this is the period when women with a BMI >= 30 kg/m2 want to lose weight; this may enable subsequent pregnancies to start with a lower BMI. Such advice should be sensitive and tailored to the individual. Social representations theory provides a framework for understanding maternal obesity.