Key prenatal care topics : perspectives of pregnant individuals and prenatal care providers in a qualitative study

Background: Pregnancy is a critical window of opportunity for health behavior interventions that can impact both maternal and fetal health. Evidence highlights low adherence to key health behaviors during pregnancy (e.g., physical activity and nutrition), along with a high prevalence of gestational weight gain above the recommendations. Although guidance from healthcare providers is crucial, barriers like time, knowledge gaps, and sensitive topics, along with communication gaps between pregnant individuals and prenatal care providers, often hinder patient-centered care and its effectiveness in discussing health behaviours during pregnancy. Dialogue tools like conversation cards are often used in other fields of clinical practice to improve communication, yet none exist for pregnancy. Objective: To explore key discussion topics from pregnant individuals’ and prenatal care providers’ perspectives that will be used to inform the development of PregnancyCards, a dialogue tool to improve communication on health behaviours. Methods: Using a qualitative study design, semi-structured virtual interviews were conducted with pregnant individuals (n= 21) and prenatal care providers (n= 14) across five Canadian provinces. Interview questions were grounded in the COM-B framework, and transcripts were analyzed thematically to identify topics relevant to prenatal care. Results: Analyses generated six themes, including (1) lifestyle and health behaviors, (2) mental health, (3) education and expectation-setting, (4) medical decision-making, (5) birth preparation and postpartum care, and (6) sociocultural and economic influences. Both pregnant individuals and prenatal care providers emphasized communication challenges around nutrition, substance use, mental health, and physical activity. Both groups highlighted the need for open dialogue, cultural sensitivity, and shared decision-making. Conclusions: Health-related topics can be challenging to discuss for both PIs and PCPs. This study identified the key discussion topics during prenatal care. Data from this study will be used to create and further evaluate the feasibility of using PregnancyCards as a conversation tool in clinical practice, their efficacy in enhancing communication on these topics, and their impact on health behaviours that influence maternal and fetal health outcomes.