INTERNATIONAL JOURNAL OF CHILDBIRTH Volume 5, Issue 3, 2015 © 2015 Springer Publishing Company, LLC www.springerpub.com http://dx.doi.org/10.1891/2156-5287.5.3.1 1 Dutch Midwives’ Behavior and Determinants in Promoting Healthy Gestational Weight Gain, Phase 1: A Qualitative Approach Astrid Merkx, Marlein Ausems, Luc Budé, Raymond de Vries, and Marianne J. Nieuwenhuijze BACKGROUND: A significant contributor to the global threat of obesity is excessive gestational weight gain (GWG). The aim of this article is to explore Dutch primary care midwives’ behaviors in promoting healthy GWG. METHODS: We used the attitude–social influence–self-efficacy (ASE) model to guide interviews with a purposive sample of 6 midwives working in primary care. RESULTS: Midwives reported activities in 3 areas related to GWG: GWG monitoring (weighing and discussing GWG), diet education, and to a lesser degree physical activity education. The determinants from the ASE model were confirmed and other relevant determinants, including midwives’ perception of their role in health promotion, were added. PRACTICE IMPLICATIONS: The identified determinants can be used for quantitative research. Quantitative research is necessary to identify the magnitude of the determinants associated with mid- wives’ behavior in promoting healthy GWG. KEYWORDS: prevention obesity; prenatal care; education; behavioral theory; qualitative AQ2 Yaktine, 2009). The percentage of women in high-income countries who gain weight within these recommenda- tions varies from 21.6% to 48.7% (Daemers, Wijnen, van Limbeek, Budé, & de Vries, 2013; Hunt, Alanis, Johnson, Mayorga, & Korte, 2013; Rauh et al., 2013). The inci- dence of pregnant woman who gain weight below (19%), within (44%), and above the guidelines (38%) in the Netherlands (Althuizen, van Poppel, Seidell, & van Mechelen, 2009) also demonstrates a clear need to focus on healthy GWG to improve the health prospects of mothers and their offspring. It is as yet unclear how midwives anticipate and adapt to the growing incidence of unhealthy GWG (Fieldwick et al., 2014; Furness et al., 2011; Willcox et al., 2012). A review of the literature on GWG reveals that we do not yet know what the best intervention is for promoting healthy GWG (Adamo, Ferraro, & Brett, 2012; Muktabhant, Lumbiganon, INTRODUCTION High gestational weight gain (GWG) is associated with later overweight and obesity among women and their offspring (Koletzko, Brands, Poston, Godfrey, & Demmelmair, 2012; McClure, Catov, Ness, & Bodnar, 2013; Rode, Kjaergaard, Ottesen, Damm, & Hegaard, 2012). Obesity is seen as a global threat to public health because it is related to major health problems, includ- ing diabetes and coronary heart disease (World Health Organization, 2012). Several studies have found that both high and low GWG are positively associated with problems during pregnancy and birth (Rasmussen & Yaktine, 2009; Viswanathan et al., 2008; Yu et al., 2013). The Institute of Medicine (IOM) guidelines recommend minimum and maximum GWG for women based on prepregnancy body mass index (BMI; Rasmussen & 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 IJC5-3_R1_A3_001-013.indd 1 IJC5-3_R1_A3_001-013.indd 1 7/17/15 5:03 AM 7/17/15 5:03 AM