Motivation and emotion/Book/2025/Motivation for healthy change in pregnancy

Motivation for healthy change in pregnancy:
What motivates overweight and obese women to adopt healthier behaviours during pregnancy?

Overview

Figure 1. Pregnancy is often considered to be a "teachable moment" Melissa's story: Motivation to lose weight Melissa had battled with her weight since early childhood and this had always been a source of significant anguish for her. Her diet had always been high in processed food and she was not "keen" on exercise. Eating and watching movies were two of her great pleasures in life. By the time she was in her mid 30s Melissa and her partner decided that it was time to "try" for a baby. Melissa had always dreamed of becoming a mother. Twelve months passed and Melissa had not fallen pregnant so she consulted with a general medical practitioner (GP). Her infertility, they said, was most likely due to her high body weight and that to increase her chances of falling pregnant naturally she should engage in healthier behaviours including eating a nutritious diet and undertaking regular physical activity.

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Definition of overweight and obesity in pregnancy

Pregnancy, a biological state following conception of a fertilised egg within the female uterus, leads to the growth and maturation of a fetus. Lasting on average between 38 to 41 weeks, pregnancy is divided into three stages called trimesters, during which the female body undergoes significant hormonal and physiological changes. Health professionals including dietitians, midwives and obstetricians use body mass index (BMI) to screen for overweight (25-29) and obesity (30+) in pregnancy. It estimates adiposity based on a woman's height in metres squared divided by body weight in kilograms.

Prevalence and complications

The prevalence of obesity has significantly increased over the last fifty years with the World Health Organization (WHO) describing this phenomenon as a “global epidemic". The incidence of maternal obesity has also been increasing, and this has become one of the most important health issues in pregnancy (Kent et al., 2024). Overweight and obesity affects the woman and her offspring and is associated with various complications, including hypertension, gestational diabetes, caesarean section, still birth (Knight-Agarwal et al., 2016), macrosomia (Kumalasari et al., 2023) and postnatal depression (Dachew et al., 2021). Gestational weight gain (GWG) above the recommended values set by the Institute of Medicine, especially for those women who enter pregnancy with a high BMI, increases complication risks even further (Martinez-Hortelano et al., 2020). Additionally, the transgenerational impact of overweight and obesity in pregnancy is a key driver of the global epidemic of chronic morbidities such as type 2 diabetes, and cardiovascular disease for both women and their offspring (Creanga et al., 2022). In Australia, maternal overweight and obesity disproportionately impacts vulnerable groups, including Aboriginal and Torres Strait Islander women (Ferris et al., 2022).

Psychological factors

Figure 2. Motivation is often required to follow healthy lifestyle behaviours

Pre-existing or new onset mood states can negatively influence maternal overweight and obesity by not only impacting GWG and eating habits but increasing risks for poor pregnancy outcomes in both the woman and her offspring (Herzog-Petropaki et al., 2022).

Table 1.

Psychological factors associated with overweight and obesity

Psychological factor	Consequence
Low self-esteem	Societal pressures to be 'thin' can lead to negative self-talk and poor body image
Mental health problems	The emotional burden of living in a larger body in addition to the influence of various biological factors can trigger depression and anxiety
Motivation	Low levels of motivation can lead to poor adherence to healthy lifestyle behaviours
Support	When individuals lack support they may experience increased stress leading to unhealthy eating behaviours
Weight stigma	Discrimination can lead to stress which for some people may perpetuate a cycle of unhealthy eating behaviours
Chronic stress	Increased cortisol levels can trigger weight gain perpetuated by unhealthy behaviours such as emotional eating

Note. Adapted from Rockliffe et al. (2021)

Healthy behaviours

Alfred Adler, the founder of individual psychology, believed that lifestyle encompasses an individual's unique and rational pattern of thinking, feeling, and behaving, developed in early childhood, that forms a personal psychological blueprint. He also posited it remained constant throughout one's lifetime but could be modified through psychotherapy (Adler, 2013). Healthy behaviours are intentional actions individuals take to maintain, improve, and protect their health plus prevent disease. Healthy behaviours that women are encouraged to follow during pregnancy include undertaking recommended amounts of physical activity, consuming a nutrient-dense diet, limiting intake of foods high in fat and sugar in addition to avoiding alcohol and maintaining hydration by consuming adequate amounts of water. Guidelines for managing overweight and obesity in pregnancy have been published, and a comprehensive approach with behavioural lifestyle interventions using diet and exercise is universally recommended (O'Connor et al., 2025).

What motivates overweight and obese women to make healthy behaviour change in pregnancy?

There are several factors that have been shown to motivate women to make healthy behaviour changes during pregnancy. A few of these are presented below.

Baby's health and well-being

It has been well established that maternal lifestyle influences the growth and development of the baby. This is supported by the Developmental Origins of Health and Disease (DOHaD) theory which states that exposure to stress, pollution, or malnutrition during critical periods of human development, such as in-utero, can have both short= and long-term effects on an individuals health and wellbeing. Dencker et al. (2016) undertook a qualitative study to explore the experiences of women with BMI ≥ 30 kg/m² who were actively encouraged by health professionals to minimise their GWG. The unborn baby was the most important motivation for women to change their eating habits and exercise during pregnancy (Dencker et al., 2016). A systematic review of qualitative studies reported that women who attempted to increase levels of physical activity and then received positive feedback on their baby’s health were even more motivated than previously to continue making healthy changes (Rockliffe et al., 2021). Similar findings have been reported elsewhere (Bagherzadeh et al., 2021; Hsiung et al., 2021)

Pregnancy is a teachable moment

The ‘teachable moment’ (TM) is a common term used within mainstream health psychology. It describes naturally occurring life events where individuals become motivated to change lifestyle habits and move from engaging in unhealthy behaviours to ones considered more healthy (Atkinson et al., 2016; Kebbe et al., 2021). Pregnancy is one such life stage in which many of the TM studies have been conducted partly due to the idea that women experience increased motivations to protect their unborn child. In addition, women have more regular contact with health professionals, creating a window of opportunity for advice and support regarding healthy behaviour change (Olander et al., 2016; Rockliffe et al., 2021). Atkins et al. (2016) undertook an interpretative phenomenological analysis of the experiences of women during their first pregnancy. They reported that women implemented immediate changes to their diet and physical activity behaviour in response to discovering their pregnancy. The adoption of healthy lifestyle behaviours such as eating well and exercising regularly were underpinned by the development of their new mother identity which served as an outward demonstration of their commitment to being a good mother and role model (Atkins et al., 2016).

Social and environmental factors

Social support has been reported to be a critical influence for women during pregnancy, especially regarding the adoption of healthy lifestyle behaviours. Previous research has shown that women whose partners continue to drink alcohol throughout pregnancy are significantly less likely to change their own behaviour (Ortega-García et al., 2020). This highlights the importance of engaging both members of the 'couple' in discussions surrounding lifestyle changes during the antenatal period. Likewise, the Ku et al. (2022) qualitative study found that their pregnant participants valued making social connections with many forming a community of peers going through similar experiences. This mutual support provided women with additional motivation to adopt and maintain healthy lifestyle behaviours during pregnancy including regular physical activity (Ku et al., 2022). For other women, changes they made during pregnancy for example decreasing or abstaining from alcohol, were due in part, to societal pressures and expectations. In the same systematic review, women reported feeling constantly under surveillance throughout their pregnancy. The stigma and judgement experienced when making unhealthy lifestyle choices were motivators for some to adjust their behaviour (Rockliffe et al., 2021). Societal expectations to eat more healthily during pregnancy have also been reported elsewhere (Tran et al., 2025).

Melissa's story continued After consulting with the GP the only other medical option at this point was in vitro fertilisation (IVF). Melissa and her partner knew this would be extremely expensive in addition to placing significant strain on Melissa's body both physically and psychologically. Their desire to have a baby was so great that over the next six months Melissa and her partner both lost weight with Melissa shifting almost 20% of her total body weight. Even though Melissa was still classed as overweight it was not long after achieving this weight loss that she discovered she was pregnant. Melissa's joy was like nothing she had felt before but now that she was pregnant would Melissa return to her old lifestyle habits? Could an intervention supported by psychological behaviour change theory help her to stay on track?

Psychological theories of motivation that support healthy behaviour change in pregnancy

A common aspect of ineffective behavioural interventions is that they are not underpinned by theory (Flannery et al., 2019). Using psychological theory when developing and implementing lifestyle interventions is vital if causal factors of behaviour are to be identified in addition to understanding the many pathways via which motivation to change may or may not occur (Bartholomew & Mullen, 2011).

Self-determination theory

According to self-determination theory (SDT), sources of motivation span three basic psychological needs including autonomy (i.e., engaging in a behaviour with free will), competence (i.e., the experience of mastery), and relatedness (i.e., the need to feel meaningfully connected to other people) (Ryan & Deci, 2000). Intrinsic motivation is the most independent form of self-regulation because it is anchored in personal enjoyment or accomplishment. This construct has predicted readiness to change and engagement in healthy lifestyle behaviours outside of pregnancy (Lewis et al., 2016). Nevertheless, there is a paucity of evidence examining women's motivation to engage in these behaviours within pregnancy.

Brown et al. (2023) undertook a cross-sectional study to examine physical activity, healthy eating and self-monitoring of weight during pregnancy. In adjusted bivariate models, 1-unit elevation in intrinsic motivation were significantly (p < 0.0001) associated with increased likelihood of meeting physical activity guidelines, healthy eating recommendations and regular self-weighing to minimise excessive GWG. The authors concluded that intrinsic motivation during pregnancy should be considered for any lifestyle interventions where the goal is to improve maternal and infant health (Brown et al., 2023). SDT has been used to explain pregnancy-related eating habits by highlighting how psychological factors like stress, emotions, and a desire for self-control impact food choices, often leading to restricted eating and subsequent loss of control. Poor mental health and body dissatisfaction can trigger emotional eating, food cravings, and contribute to excessive GWG. Mooney et al. (2022) examined whether stress attenuates motivation for healthy eating in pregnancy. They found a strong, positive association between autonomous motivation and diet quality, but no association of controlled motivation with diet quality. These results indicate that the source of motivation may be an important area of assessment in understanding eating behaviours during pregnancy (Mooney et al., 2022).

The transtheoretical model

The transtheoretical model (TTM), also know as the stages of change theory, describes the process of behaviour change as occurring in well-defined stages. It has been applied effectively across a wide range of situations, including alcohol consumption, weight control and exercise acquisition. Numerous studies have shown that lifestyle interventions tailored to an individual’s stage of change is the most effective way to enhance behaviour modification (Hsiung et al., 2021; Hanson et al., 2017).

Cognitive load theory (CLT) explains how individuals generally learn, store new information in addition to the practices that best support mastery whilst considering both working and long-term memory. A retrospective analysis was performed of pregnant women with GDM. Participants were grouped based on the type of nursing intervention received including a control group that underwent standard care and an observation group that received an additional cognitive load-informed dietary education program based on the TTM. After receiving the dietary education, the intervention group was associated with significantly lower levels of fasting glucose alongside higher scores in self-management and self-efficacy compared to the control group (p < .05) (Cao & Wu, 2025). The efficacy of interventions to reduce alcohol consumption during pregnancy has been well-established, yet some subsets of women remain at risk. One intervention study, underpinned by by TTM, reported that nondepressed women reduced risky drinking behaviours at roughly twice the rate of women with depression (49% vs. 24%). Women with depression should receive treatment before or alongside behaviour change interventions as their mental health state may make behaviour change even more challenging (Floyd et al., 2007).

The Com-B model

The COM-B model posits that for a given behaviour to occur an individual must have the capability and opportunity to engage in the behaviour. In addition, motivation to participate in the behaviour must be greater than for any other competing behaviour. Interventions focusing on healthy lifestyle behaviours in pregnancy are on-going but there appears to be few that pinpoint the underlying mechanisms by which the intervention is expected to work (Flannery et al., 2019).

Flannery et al. (2018) conducted qualitative interviews with overweight and obese pregnant women to explore their perspectives on physical activity within the Com-B model. Women were motivated to exercise following advice received from family and friends. Many women reported enjoying physical activity most when tailored for pregnancy and in the company of other pregnant women. Goal setting enhanced motivation in addition to the use of devices such as pedometers which women claimed were an important adjunct for self-monitoring (Flannery et al., 2018). Nevertheless, Rockliffe et al. (2022) recently conducted a longitudinal cohort study with women to assess the utility of the COM-B model in relation to healthy eating across the entire course of pregnancy. Overall, the COM-B model explained 18.4% of the variance in eating behaviour, with the most variance observed in early and late-pregnancy compared with mid-pregnancy. This suggests that there may be certain antenatal periods that offer more effective teachable moments for women than others (Rockliffe et al., 2022).

A recent systematic review examined the effectiveness of dietary interventions during pregnancy through the lens of the COM-B model. Mixed findings were reported largely due to substantial heterogeneity in intervention designs. The majority of interventions targeted psychological capability and reflective motivation, whilst very few focused on social opportunity and environmental restructuring (Li & Li, 2025).

There are a variety of theories in health psychology that help inform when, why and how women change their lifestyle behaviours during pregnancy. Only a few of these have been explored as part of this chapter. More research is required to further elucidate the importance of behaviour change theories in the context of interventions designed and implemented to help motivate pregnant women who are overweight or obese to make healthy lifestyle changes. The results available to date are largely positive but more research is needed.

How much do you know about motivation and behaviour change?

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Do you need to be motivated to undertake healthy behaviour change?

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Conclusion

Maternal overweight and obesity is a global public health problem increasing the mother and baby's risk of developing various complications, including hypertension, GDM, caesarean section, still birth and postnatal depression. Nevertheless, pregnancy has been identified as a teachable moment where overweight and obese women are more motivated than usual to undertake healthy behaviour changes in order to optimise the well-being of not only themselves but their baby as well. The behaviour change models outlined in this chapter explore the psychological and social factors that drive overweight and obese women to adopt healthy behaviours or modify existing ones during pregnancy in addition to emphasizing the role of motivation in the process. By understanding psychological theories of motivation, healthcare professionals can develop more effective interventions to support overweight and obese women in adopting and maintaining healthy behaviours during and beyond pregnancy. These interventions should be tailored to the specific needs and circumstances of pregnant women, taking into account their unique situations.

See also

• Motivational interviewing (Wikiversity)
• Self-determination theory (Wikipedia)

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External links

• Pregnancy: A Teachable Moment for Weight Control and Obesity
• How to motivate yourself to change your behavior | Tali Sharot | TEDxCambridge
• Do you or someone else you know need help during pregnancy? - Perinatal and Infant Mental Health Services, Canberra.