Perceptions of gestational weight gain in Turkish women: a qualitative study guided by a socio-ecological model.

backgroundMaternal body weight, nutrition, and lifestyle are critical indicators of both maternal and fetal health. Gestational weight gain (GWG) that deviates from the Institute of Medicine (IOM) guidelines is associated with adverse pregnancy outcomes. Despite the rising prevalence of overweight and obesity among Turkish women of reproductive age, qualitative evidence regarding their GWG experiences remains limited. Using a qualitative approach guided by the Socio-Ecological Model (SEM), this study aimed to explore women’s perceptions, experiences, and behaviors regarding weight gain during pregnancy, as well as the facilitators and barriers influencing weight management.

methodsA qualitative descriptive study using reflexive thematic analysis was conducted. Semi-structured interviews were conducted with eighteen Turkish pregnant women recruited through purposive sampling with maximum variation from two Family Health Centers in Izmir, Türkiye. Data analysis was performed using MAXQDA software, utilizing both deductive (SEM-guided) and inductive coding strategies. Inductive codes were generated from participant narratives and subsequently organized into themes within the four levels of the SEM framework, adhering to the principles of reflexive thematic analysis.

resultsThe interview data were categorized according to the four SEM levels. At the intrapersonal level, participants demonstrated awareness of healthy GWG but often held inaccurate perceptions of their own Body Mass Index (BMI) status. At the interpersonal level, family pressure around “eating for two” was a prominent barrier, though participants largely rejected this myth. At the community/social level, participants reported inadequate individualized counseling from healthcare providers. At the environmental level, financial constraints and social exclusion were identified as structural barriers.

conclusionThis study demonstrates that GWG behaviors in Turkish pregnant women are shaped by multiple, interacting factors across all SEM levels. The findings underscore the necessity for routine, individualized GWG counseling at every antenatal visit, family-inclusive nutritional guidance, and workplace accommodations for pregnant women. Future interventions should address the multilevel nature of these influences to effectively support healthy weight management during pregnancy.