Background: The number of women considered overweight (OW) and obese (OB) in Canada has steadily increased over the past thirty years. In addition, there has also been a rise in the amount of weight women gain during pregnancy. Many adverse pregnancy outcomes are associated with maternal overweight, obesity and/or excessive gestational weight gain (GWG), which have been widely studied and reported. In 2009, the Institute of Medicine (IOM) developed healthy GWG guidelines, based on trial and observational evidence, that provide BMI-related weight gain targets. This evidence has shown that weight gain within the guidelines results in better health outcomes for the mother and baby, during pregnancy, as well as postpartum. Objectives: (1) To address diet quality and patterns using data collected from the Maternal Obesity Management (MOM) Intervention Trial, and (2) Develop and validate a comprehensive web-based questionnaire that can be used in a future study to examine women’s knowledge of the IOM GWG guidelines, dietary recommendations, physical activity (PA) practices, as well as other lifestyle habits. Methods: (1) Exploratory pooled analysis of dietary data from Maternal Obesity Management (MOM) trial - To identify diet quality of women who exceeded (EX) versus did not exceed (NEX) the 2009 IOM pregnancy weight gain targets. Participants (n=50) completed 7-day food records at 3 points during pregnancy (baseline (V1: 12-20 weeks), between 26-28 weeks (V2) and between, 36-40 weeks (V3). Data were analyzed in ESHA Food Processor Program and SPSS (version 13) to see if there was any difference found in diet between EX and NEX women. (2) Development and validation of a comprehensive maternal health questionnaire aimed to establish gaps in women’s behaviours and perceptions of the IOM GWG guidelines - An expert panel was consulted in the development of questionnaire constructs and items to gain content validity of the questionnaire. After multiple phases of questionnaire development and revisions, a 14-day test re-test validation pilot study was conducted to establish test re-test validity. Results: (1) In the EX and NEX analysis, significant decreases were found in total energy intake, including fat and protein, across pregnancy in the NEX GWG group. Significant group-by-time interaction was also found for energy intake and protein. (2) Most constructs included in the electronic maternal (EMat) Health questionnaire all proved to have sufficient test re-test validity via correlation analysis. Conclusion: In order to address the knowledge gaps regarding excess weight and changes in dietary habits during pregnancy, it is beneficial to explore pregnant women's knowledge and behaviours regarding these issues and collect information on what women report as barriers and facilitators to gestational weight management. The conclusions drawn from both of these studies may inform future interventions, as well as indicate where further education strategies are needed.

abstract: Excessive gestational weight gain (GWG) during pregnancy is a major public health concern. Studies have reported more than 70% of pregnant women gain excessive weight which may pose increased maternal and fetal risks. Little is known about the relationships of GWG to behavioral factors (i.e., physical activity, sleep, social support) and maternal mental health (i.e., stress, anxiety, depression) during pregnancy. This descriptive, cross-sectional study explored the relationships of GWG to behavioral factors and maternal mental health during pregnancy. Secondarily, this study described the preferences, uses of, and interests in alternative approaches as well as the mental health differences between users and non-users of alternative approaches during pregnancy. A national survey was administered to women ≥8 weeks pregnant, ≥18 years old, and residing in the United States (N=968). Bivariate correlations were used to determine relationships between GWG and variables of interest. Independent t-tests were used to observe mental health differences between users and non-users of alternative approaches. Data were analyzed throughout pregnancy and by trimester. Throughout pregnancy, significant relationships were found in GWG to stressful events (r=-.112, p<.01), depression (r=.066, p<.05), mindfulness (r=-.067, p<.05), and sleep (r=.089, p<.01). When GWG was assessed by trimester, stressful events were significant in the second (r=-.216, p<.01) and third trimesters (r=-.085, p<.05). Depression remained positively related to GWG in the first (r=.409, p<.01) and second trimesters (r=.162, p<.01). A positive relationship emerged between GWG and anxiety in the first trimester (r=.340, p<.01) and physical activity became significant in the second (r=-.136; p<.05) and third trimesters (r=-.100; p<.05). Mindfulness was the only variable significantly related to GWG throughout all time points. Mean anxiety (d=.236; p=.001) and depression (d=.265; p<.001) scores were significantly lower in users compared to non-users of alternative approaches throughout pregnancy and when assessed by trimester anxiety (d=.424; p=.001) and depression (d=.526; p<.001) were significant in the second trimester. This study provides a framework for future analyses in GWG and maternal mental health. The information presented here may inform future interventions to test the effectiveness of alternative approaches to simultaneously manage maternal mental health and GWG due to the integrative nature of alternative approaches. / Dissertation/Thesis / Masters Thesis Exercise and Wellness 2015