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Weight-gain and physical inactivity in pregnancy have important implications for First Nations and Métis women, populations that experience a disproportionate burden of poor health outcomes in pregnancy. Utilizing a postcolonial feminist theoretical lens in conjunction with a social determinants of health framework and tenets of cultural safety, the purpose of my doctoral research, which was written in the publishable paper format, was to address four questions: a) Are First Nations women marginalized through current physical activity pregnancy guidelines?; b) How do pregnant First Nations and Métis women understand weight-gain and physical activity during pregnancy?; c) What are the factors that influence excessive weight-gain during pregnancy in urban First Nations and Métis women?; and d) How can obesity prevention programs with pregnant First Nations and Métis women who live in urban centres be reflective of and sensitive to their cultural practices? To answer these questions, I conducted community-based qualitative research, which included 15 semi-structured interviews with key informants who are health/service providers for Aboriginal women in Ottawa and focus groups and semi-structured interviews with 25 pregnant/postpartum First Nations and Métis women. I also conducted two focus groups with both health/service providers and pregnant/postpartum women to determine what type of resource would benefit pregnant, urban First Nations and Métis women. Ultimately, I used this information to develop this resource. My research results revealed a complex interaction between the social determinants of health underlined by current manifestations of colonialism, which impact urban First Nations and Métis women’s physical activity and weight-gain during pregnancy. These findings emphasize the need for culturally safe physical activity and weight-gain resources for First Nations and Métis women during pregnancy. Ultimately, this study identified the importance of community consultation to develop culturally safe, community-driven, and useful health interventions for urban, pregnant First Nations and Métis women.

Excessive weight gain during pregnancy is a risk factor for postpartum weight retention and future weight gain and obesity. Whether a behavioral intervention in pregnancy can reduce long-term weight retention is unknown.This randomized trial tested whether a low-intensity behavioral intervention to prevent excessive gestational weight gain could increase the proportion of women who returned to prepregnancy weight by 12 mo postpartum.Women (n = 401, 13.5 wk of gestation, 50% normal weight, 50% overweight/obese) were randomly assigned into an intervention or control group; 79% completed the 12-mo assessment. The telephone-based intervention targeted gestational weight gain, healthy eating, and exercise and was discontinued at delivery.In modified intent-to-treat analyses that excluded women with miscarriages (n = 6), gestational diabetes (n = 32), or subsequent pregnancies (n = 32), the intervention had no significant effect on the odds of achieving prepregnancy weight at 12 mo postpartum (n = 331; 35.4% compared with 28.1%; P = 0.18). Completer analyses suggested that the intervention tended to increase the percentages of women who reached prepregnancy weight (n = 261; 45.3% compared with 35.3%; P = 0.09) and significantly reduced the magnitude of mean ± SD postpartum weight retained (1.4 ± 6.3 compared with 3.0 ± 5.7 kg; P = 0.046) at 12 mo. Women in the intervention group reported higher dietary restraint through 6 mo postpartum (P = 0.023) and more frequent self-monitoring of body weight (P0.02 for all) throughout the study.A low-intensity behavioral intervention in pregnancy can reduce 12-mo postpartum weight retention and improve dietary restraint and self-weighing in study completers. Future research is needed to test the long-term effects of more intensive behavioral interventions in pregnancy. This trial was registered at clinicaltrials.gov as NCT01117961.