ORCID

Abstract

University Of Plymouth, Plymouth, UKPeople living with obesity have a greater chance of developingcomplications during pregnancy and are over-represented inmaternal mortality data relating to both direct and indirect causesduring pregnancy and up to a year after the birth of their child. Inaddition, epigenetic influences result in metabolic changes inoffspring of people living with obesity leading to a greater chanceof them experiencing long-term health consequences. In view ofthese health concerns, people living with obesity are advised to loseweight in the preconception period, before becoming pregnant.Sustained weight loss, however, can be difficult to achieve, andpeople do not always seek preconception advice. The aim of thisstudy was to explore what form of preconception care for peoplewith health conditions, including those living with obesity, works, forwhom, how, and in what circumstances. Realist methodology wasused to identify causal explanations, involving consideration ofunobservable processes or powers. A realist evaluation involved 31qualitative interviews with relevant stakeholders: women living withhealth conditions (n = 20), including those living with obesity (n = 3),their partners or supporting family members (n = 2), and healthcareprofessionals involved in providing preconception care (n = 9). Themulti-stage realist evaluation generated 13 refined middle-rangetheories, providing causal explanations of what works for whom, andhow. Of these, one specifically relates to achieving support toimprove preconception health for people living with obesity. Themechanisms identified involve resources that include monitoring andtreatment, and reasoning that reduces feelings of guilt or blame,facilitating effective communication between the person living withobesity and their healthcare professional. This is the first study ofpreconception care for people with health conditions, includingpeople living with obesity, using a realist approach. The findingsidentified obesity as an outlier, when compared with healthconditions such as diabetes or epilepsy, which are monitored, treated, and for which preconception care is offered by healthcareprofessionals. It provides a causal explanation of how preconceptionhealth could be improved by including obesity as a health conditionand emphasises the importance of treating people with kindnessand respect.Disclosures: None

Publication Date

2025-09-02

Deposit Date

2026-01-05

First Page

10

Last Page

10

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