There is a growing focus on the impact of maternal nutrition on pregnancy and birth outcomes. Diet can directly influence pre-gravid BMI and gestational weight gain, both of which are implicated in poor pregnancy outcomes and the later development of metabolic diseases in the offspring ⁽Reference Barker^1, Reference Gluckman, Cutfield, Hofman and Hanson²⁾. Fit for Birth was a longitudinal cohort study looking at aspects of lifestyle that contributed to overweight in pregnant women with a BMI ⩾35 kg/m² in Liverpool. Quantitative data suggested deterioration in the quality of dietary intake during pregnancy with increasing intakes of energy dense, nutrient poor foods in the latter stages⁽Reference Charnley, Weeks and Abayomi³⁾. The aim of this qualitative study was to explore the historical and current experiences of these pregnant women with respect to dietary intake, weight change and perceptions of health. Women were invited to participate in semi-structured interviews using an interview guided approach. Interviews were transcribed verbatim and thematically analysed.

Emerging themes are indicated in the above table. Over-arching themes relate to the contribution of childhood and adolescent eating behaviours to pre-gravid obesity; the external influences that lead to weight gain and obesity; and the emotional issues affecting current eating behaviours.

Dietary intakes changed between childhood and adulthood with traditional home-cooked meals being replaced by irregular eating practices and increased intakes of convenience and takeaway foods. All the women had engaged with commercial slimming clubs and had tried other weight loss methods but many still perceived pregnancy as an opportunity to relax eating behaviours. Overall health was generally percieved as good but a lack of energy and above normal tiredness persisted throughout. Many experienced mobility difficulties as pregnancy progressed and pre-exisiting conditions, such as asthma, were exacerbated. Most of the women expressed a strong desire that their children should not have the same negative experience with weight with one women saying

The qualitative data supports the quantitative findings and it is suggested that any future interventions focus on overall health and quality of diet rather than just weight.