# From “Eating for Two” to Food Insecurity: Understanding Weight Gain Perspective During Pregnancy Among Malaysian Women

## TL;DR

This study explores why Malaysian women experience unhealthy weight gain during pregnancy, highlighting issues like poor health before pregnancy, diabetes management, and financial struggles.

## Contribution

The study identifies unique factors in Malaysia influencing suboptimal gestational weight gain, including diabetes management and food insecurity.

## Key findings

- Pre-pregnancy overweight and obesity are influenced by unhealthy lifestyles and limited access to nutritious food.
- Diabetes management during pregnancy leads to inadequate weight gain due to restrictive behaviors and lack of dietary guidance.
- Financial constraints in low-income households contribute to food insecurity and suboptimal GWG.

## Abstract

Background/Objectives: Gestational weight gain (GWG) is a critical determinant of pregnancy outcomes; however, studies on factors contributing to suboptimal GWG in developing countries, including Malaysia, remain limited. Methods: This study employed an explanatory sequential mixed-methods design, with the quantitative phase conducted between January and March 2020, followed by the qualitative phase from July 2020 to March 2021 in Selangor. The qualitative phase aimed to explain the factors influencing suboptimal (inadequate and excessive) GWG identified in the quantitative phase. Inclusion criteria included Malaysian women aged 18 and above who had suboptimal GWG (either inadequate or excessive) from the quantitative phase. Exclusion criteria included women who refused participation. Of the 475 participants from the quantitative phase, 20 with suboptimal GWG were purposively selected for in-depth telephone interviews using a semi-structured interview protocol. Data were analysed using thematic analysis. Results: Three key themes emerged: (1) the impact of pre-pregnancy overweight and obesity, shaped by unhealthy lifestyles, social influences, and limited access to nutritious food and physical activity; (2) the management of diabetes during pregnancy, contributing to inadequate GWG due to psychological responses, restrictive behaviours, and barriers to dietary guidance; and (3) financial constraints in middle- and low-income households, leading to income vulnerability, financial crises, and food insecurity. Conclusions: This finding highlights the urgent need for targeted interventions to optimize GWG, emphasizing pre-pregnancy health optimization, enhanced diabetes management, and strategies to mitigate financial constraints and food insecurity among pregnant women.