The present study aimed to explore mothers’ perceptions and experiences regarding the lifestyle patterns during and after pregnancy and the reasons for adopting this lifestyle. The results of the study showed that motivation is fundamental for lifestyle modifications during pregnancy. Pregnant women decide to modify their lifestyle because of feeling a sense of motherhood and and having a healthy baby. Access to information and supports from various sources promotes the mother’s inner decision to change, which ultimately leads to modifying different aspects of the mother’s life. However, despite reminding the advantages of a healthy lifestyle, these changes often shift to a pre-pregnancy lifestyle, especially in playing an optimal maternal role in the future, due to cessation of support and care provided during pregnancy.
Exploring the participants’ experiences showed that the sense of motherhood makes an individual change her lifestyle and battle for that change. The sense of motherhood means that the mother considers herself responsible for ending the pregnancy in the best possible way. The fetus overshadows the harmful interests of the mother, and the mother decides to replace healthy behaviors with unhealthy ones.
According to Dencker et al. (2016), the baby was the most important motivation for participants to change their eating habits and exercise during pregnancy. Although addressing only two aspects of lifestyle, the results of their study were consistent with those of the present study in terms of motivation for change [23].
Ayyala et al. (2020) on USA women showed that motivation to have a healthy baby during pregnancy and back to work after delivery were reinforcing factors for sustainable health behavior [29]. Which is inconsistent with the results of the present study. For Iranian women, the child is important than anything else. They care less about their health than the health of their children [30]. This attitude can be the reason for not referring to one’s health as a motivation to change lifestyle during pregnancy.
According to Edvardsson et al. (2011), Swedish mothers were not such motivated to shift to a healthy lifestyle because they considered themselves healthy and robust, despite considering weight loss, physical activity, and healthy eating useful [31]. This finding was inconsistent with that of the present study, showing that most women needed lifestyle modifications during pregnancy. The reason for this contradiction may be different attitudes of the studied populations. Bassett-Gunter et al. (2013) concluded that attitude is the most important predictor of behavior intention [32]. Pregnant women are more motivated to change their habits and lifestyles than non-pregnant ones. However, the ability to make changes depends on the individual’s motivation [9]. In the study of Edvardsson et al. (2011), the most important motivation for changing the lifestyle was , fetus health which is consistent with the results of the present study [31]. mothers who consider themselves healthy and the ones who find themselves in need to change their lifestyle have the motivation to adopt the correct behavior and distance themselves from harmful habits because of baby’s health.Pregnancy can be a good time to educate and develop health-promoting behaviors and quit harmful habits.
Staneva et al. (2016) showed that there is no correlation between maternal orientation and pregnancy distress [33]; these results are inconsistent with those of the present study, and the reason for this contradiction may be due to the study types, and different definitions of motherhood in the two studies. In the present study, however, maternity is a trigger for change that other factors (e.g. support) facilitate this change. They are not addressed in Staneva’s study.
Moreover, access to information and supports from various sources facilitated lifestyle modifications during pregnancy. Access to information was noted as an influential factor in decision-making about lifestyle change and makes mothers put into practice the optimal information gained about lifestyle change during pregnancy. The source of information may include physicians, midwives, health care providers, digital databases and mass media. Lagan et al. (2010) showed that 94% of pregnant women get information surfing on the internet and from the physician, and 83% of them made decisions accordingly [34]. Poels et al. (2017) reported that two-thirds of women seek preconception health information to prepare for pregnancy, and information they seek is related to positive changes in preconception lifestyle [35].
Considering the importance of digital databases and media as a means of accessing information, social media can provide users with false information as well.
Health care providers should identify reliable websites and introduce them to pregnant women. In addition to routine care, health care providers should allocate time to recommend a healthy lifestyle. Dencker et al. (2016) showed that a midwife, as a healthcare provider, should adhere to several principles for lifestyle change; first, give consultation without judgment and solely based on the individual’s conditions, and second, lifestyle change should be considered as a collaborative task; i e, both the midwife and the pregnant woman should participate [23].
Experiences of women indicated that changing lifestyle andreturning to a healthy lifestyle during pregnancy require the support by mothers, partners, other family members, as well as friends. Of course, the share of the future mother or grandmother was beyond just support. In addition to all-around support, participants considered the mother as a source of the sense of motherhood. In Widarsson et al.’s study (2012), the supportive role of partner, mother, and other relatives was highlighted [36] that is consistent with present study results. The absence of the mother was considered as a gap in the life of pregnant women. In Iranian culture, women often spend most of their time in their parents’ home in their first pregnancy and even after childbirth to receive care for a while. Pregnant women who have lost their mothers or cannot receive maternal support should be consulted to find alternative support.
Most participants mentioned the supportive role of the partner. The results showed that women with unwanted pregnancies have little or no support from a husband. A review study found that the husband’s participation and assistance during pregnancy and childbirth were useful for the husband himself and the mother and baby [37]. Lack of ‘ ‘ husband’s cooperation and commitment during pregnancy was associated with maternal and neonatal outcomes [15]. Studies showed that intimate partner violence during pregnancy could have serious health consequences for mothers and newborns, such as unwanted pregnancy, abortion, preterm labor, low birth weight, intrauterine fetal death, and like these [8, 38, 39]. Women experiencing intimate partner violence are more likely to get prenatal care late. Prenatal care visits contribute to reducing maternal and child mortality [40]. Ilska and Przybyła-Basista (2017) found that partners receiving support mediated the relationship between the prenatal concerns of women and some areas of their psychological health. Due to the support received by pregnant women from their partners, prenatal concerns stop affecting their attitude about the meaning of life, feeling of fulfillment of essential roles, and beliefs about their ability to cope with the world [41].
It seems that informing husbands about supporting their wives and their participation in prenatal care should be included in the health care plan. Likewise, setting up comprehensive care where the health care team and the pregnant woman’s family are involved and trained to provide the best possible support can lead to a good pregnancy for the mother and her relatives. Studies showed that prenatal care should include both parents, but husbands are neglected in many prenatal care plans. If partners are considered in such plans and committed during pregnancy, they will be committed to childcare [36, 42]. Another important point is that the decision to change lifestyle and adopt a healthy lifestyle is made after learning about pregnancy. At the same time, the mother’s health is critical before fertilization and the early stages of fertilization and pregnancy. Unfortunately, in Iran, pre-pregnancy care is still not very important. Prenatal care and informing women and their husbands about the importance of a healthy lifestyle in preconception care should be on the agenda of health care providers.
The results showed modification in physical and psychological aspects of lifestyle and even interaction with the partner. Religious changes were also important. Most pregnant women stated that they strived to get adequate nutrition and sleep, stop harmful habits, and provide a peaceful and restful living environment during pregnancy. They stated that they tried to act in marital relations and sex to be not harmful to the fetus. This lifestyle change was more prevalent in the first pregnancy than in subsequent pregnancies, and according to some participants, these changes were subject to the support of the partner and appropriate family interactions. The study by O’Keeffe et al. (2016) on Irish women found that driving the correct behaviors during pregnancy, such as reducing or eliminating alcohol consumption and stopping smoking had increased, but a few women changed their behaviors [19]. One study found that 61% of women were satisfied with lifestyle changes in pregnancy [31]. However, the result was not comparable with those studies above due to the research method, which showed that womenwere concerned about a change in pregnancy, which should be implemented and enhanced with appropriate stimuli. Health educators can take a practical step on this path by showing the advantages of a lifestyle change for the mother and the growing fetus to the pregnant woman and the husband.
Participants stated that they felt closer to God during pregnancy and tried to follow more religious orders and avoid whatever forbidden in Islam. A study by Cyphers et al., (2017) in Eastern Pennsylvania showed that being religious is directly related to adopting health-promoting behaviors in pregnancy [43]. Iranian Muslim women believe that adhering to religious orders in pregnancy will give birth to a righteous and religious child in the future. Perhaps this is the driving factor for adopting the right lifestyle. Religious-based interventions and beliefs can promote some of the religious aspects [44].
It is worth noting that women have piritual needs besides the health-related needs.
Some reliable experts should be introduced to mothers to help them change their behavior during pregnancy.
The experiences of multiparous women indicated that they could not keep up with the changes because of reduced support and lack of time, fatigue, and stress, despite trying to maintain the new lifestyle after giving birth by remembering the advantages of lifestyle change. Dencker et al., concluded that healthy diet and exercise during pregnancy did not persist after childbirth andprenatal care provided by midwives shifts to infant care after birth; so they are primary factors for discontinuity of changes [23]; in conclusion, pregnancy requires the support of the partner and then the relatives. However, the partner and relatives should keep in mind that the postpartum period is very important, both for the baby’s health and the woman’s health. Therefore, the partner and relatives should continue to provide support after delivery.
On the other hand, health care providers should be aware that lifestyle changes in pregnancy, if not motivated to continue, return to pre-pregnancy status. Thus, by educating and counseling about the impact of maternal health on the present and future health of the family and children, the motivation for sustaining health-promoting behaviors should be strengthened for a long time or forever. Training partners to support women should always be on the agenda of health care providers.
Implications for health policy and practice
Pregnant women are generally open to health-promoting changes in their lifestyle. Health care providers, including doctors, midwives, and other health care professionals, should utilize this opportunity to inform and motivate pregnant women on health-promoting lifestyle choices, including proper nutrition and sleep, activity during and after pregnancy, marital relationship, and reducing stress.
On the other hand, since pregnant mothers view social media as a main source of information, maternal health care providers should identify reputable websites to access accurate information and introduce them to mothers. Another important point is that partners should support their pregnant wives and be educated about the importance of support during pregnancy. Close relatives should be educated on the assistance they can provide for a pregnant woman to have a better pregnancy. Most importantly, pregnancy is seen an opportunity to change behaviors and adopt a healthy lifestyle. If lifestyle does not sustain after delivery, they may return to the pre-pregnancy period. The role of health care providers at this stage is very important. Women need to be aware that their health is significant to themselves and their families. Pregnancy care should continue in the postpartum period. Community-based care that is lacking in Iran can help continue care. Policy-making for community-based care is necessary. Husbands should receive routine care consultation, physical health tips on interpersonal interactions with the partner, and on how to provide mutual support.
Iranian women mentioned returning to work as an opportunity to care about themselves; organizational measures and policies should be designed to address maternal health and policies for more childcare, such as breastfeeding hours.
In the end, the results of the present study may be helpful for researchers for designing interventions that aim to sustain positive changes during and beyond pregnancy through family-centered approach empowerment, motivation, and behavioral goals.
Limitations
The study faced some limitations. First, all participants received prenatal care. Therefore, present study results are limited to women who have already overcome the barrier of access to care, and our sample is less representative of women who are not in or delay their care. Moreover, information about lifestyle provided by health professionals may have changed ‘participants’ approach to how they answered interview questions, which may result in selection bias.
Another limitation is that multiparous women who talked about lifestyle changes during pregnancy and the unsustainability of the changes after delivery backed to 3-7 years ago, which may be a recall bias. Of course, clearly described experiences reduced the likelihood of bias.
All women in the study had a low-risk pregnancy. Repeating study on women with high-risk pregnancies can help expand the results.
Another limitation of the study was interviewing only pregnant and employed women. Interviewing the partners and relatives of the participants prand maternal health care providers can help clarify the issue from different aspects.
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