Introduction: Introduction: Weight stigma in healthcare settings is a barrier to equitable treatment and open patient-healthcare provider communication. Pregnant women who have a body mass index (BMI) ≥30.0 kg/m^2 are at risk of experiencing weight stigma during prenatal care. This scoping review aims to summarize causes of weight stigma in prenatal care settings and recommendations for healthcare providers (HCPs) to improve the delivery of care during pregnancy.
Methods: Using Tricco et al. scoping review methodology, studies of any design that reported on weight stigma specifically during prenatal care among women who have a BMI ≥30.0 kg/m^2 were included. Two investigators screened and extracted themes from papers with findings summarized as: 1. Sources of weight stigma and; 2. Recommendations for HCPs to eliminate weight stigma.
Results: A total of 421 articles were screened, and twenty-four studies were included. The majority of the included studies were qualitative in design (n=18; interviews and focus groups with patients and/or HCPs). The main source of stigma in prenatal healthcare was avoidance from HCPs when discussing weight and weight-related health risks. In response, patients report feeling guilty when wanting to discuss health behaviours (e.g., nutrition). Recommendations to eliminate weight stigma in prenatal care are: 1. Sensitivity training for HCPs and; 2. Promotion of a patient-centred approach when caring for pregnant women who have obesity.
Conclusion: Previous studies have consistently reported that pregnant women who have obesity are aware that their weight may increase their risk for complications. HCPs avoiding weight-related discussions and poor communication about potential risks increases patient-perceived stigma. To eliminate weight stigma during prenatal care, HCPs should receive sensitivity training to increase their comfort when discussing weight gain and obesity-associated risks during pregnancy. Additionally, both shared-decision making between patients and their HCPs and non-judgmental patient-centered approaches should be promoted and implemented.
Rebecca Liu– Post-Doctoral Fellow, University of Ottawa
Laura Gaudet– Doctor of Medicine, Maternal Fetal Medicine. Associate Scientist and Professor., Queen's University
Jocelynn Cook– Scientific Director, Society of Obstetricians and Gynecologists of Canada
Kristi Adamo– Associate Professor, University of Ottawa