A mixed-methods exploration of attitudes towards pregnant Facebook fitness influencers

**Background:** Exercise during pregnancy provides health benefits for mother and child, yet most pregnant women do not meet physical activity recommendations. A key barrier is lack of knowledge about safe exercise. Pregnant women increasingly turn to social media for guidance, including content from social media influencers. Little is known about attitudes toward pregnancy exercise information provided by influencers. This study aimed to explore attitudes toward exercise during pregnancy depicted by Facebook fitness influencers and user engagement with posted content.

**Methods:** A mixed-methods approach was used. Ten Facebook video posts from five female influencers (meeting criteria: public figure page, ≥10,000 followers, pregnant within 5 years, ≥2 videos exercising while pregnant) were selected. Influencers had follower counts ranging from 38,800 to 28,000,000. Videos were ranked by engagement; the two highest-engagement videos per influencer were selected. Quantitative descriptive analysis captured views, shares, comments, and emotive reactions. Qualitative thematic analysis of 706 user comments (after screening) followed Braun & Clarke's six-step inductive approach. Two reviewers independently coded the first 100 comments; coding was completed by one reviewer with consultation from a second until consensus.

**Key Results:** The 10 videos were viewed 12,117,200 times total, shared 11,181 times, received 13,455 comments (before screening), and generated 128,804 emotive reactions. The most frequent reaction was 'like' (81.48%, n=104,951), followed by 'love' (13.1%, n=16,905). Four themes emerged: (1) attitudes toward exercise during pregnancy (mostly positive—users acknowledged health benefits for mother and baby, but some perceived exercises as unachievable); (2) attitudes toward influencers (mostly positive—viewed as motivational, inspiring, relatable, and credible; evidence of parasocial relationships); (3) attitudes toward types of exercise (mixed—aerobic and bodyweight exercises were viewed positively; resistance-based exercise with weights was viewed negatively, with users questioning safety and influencer credibility); and (4) community (users provided social support and guidance to each other independently of the influencer). All negative comments about exercise type were associated with posts involving resistance-based exercises using weights.

**Clinical Implications:** User comments revealed a perception that resistance-based exercise with weights is unsafe during pregnancy, which contradicts current best-practice guidelines recommending muscle-strengthening exercises at moderate intensity. This misconception may contribute to low exercise participation among pregnant women. The study suggests that healthcare providers need better education to give accurate exercise advice, and that social media influencers—who are trusted and perceived as experts by their audiences—could be valuable partners for disseminating evidence-based pregnancy exercise information. Limitations include lack of demographic data, restriction to one platform (Facebook), potential sampling bias, and inability to control for trolls or purchased comments.