51
|
Fahey MC, Wayne Talcott G, Cox Bauer CM, Bursac Z, Gladney L, Hare ME, Harvey J, Little M, McCullough D, Hryshko-Mullen AS, Klesges RC, Kocak M, Waters TM, Krukowski RA. Moms fit 2 fight: Rationale, design, and analysis plan of a behavioral weight management intervention for pregnant and postpartum women in the U.S. military. Contemp Clin Trials 2018; 74:46-54. [PMID: 30291998 PMCID: PMC6289301 DOI: 10.1016/j.cct.2018.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Margaret C Fahey
- Department of Psychology, The University of Memphis, Memphis, TN, USA.
| | - G Wayne Talcott
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Callie M Cox Bauer
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Leslie Gladney
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jean Harvey
- Department of Nutrition and Food Sciences, The University of Vermont, Burlington, VT, USA
| | - Melissa Little
- Center for Addition and Prevention Research, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Deirdre McCullough
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ann S Hryshko-Mullen
- Defense Institute for Medical Operations, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Teresa M Waters
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
52
|
Dalrymple KV, Martyni‐Orenowicz J, Flynn AC, Poston L, O'Keeffe M. Can antenatal diet and lifestyle interventions influence childhood obesity? A systematic review. MATERNAL & CHILD NUTRITION 2018; 14:e12628. [PMID: 29962095 PMCID: PMC6866012 DOI: 10.1111/mcn.12628] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 12/12/2022]
Abstract
Evidence suggests that adverse nutritional exposures during in utero development may contribute to heightened risk of obesity in childhood. Pregnancy offers the opportunity to modify the intrauterine environment by manipulation of diet and/or physical activity, which may result in favourable health benefits for the child. The objective of this systematic review was to determine whether antenatal lifestyle interventions in pregnant women, aimed at modifying diet and/or physical activity, and lead to a reduction in measures of offspring obesity in early childhood. Three electronic databases were searched from January 1990 to July 2017 for antenatal interventions with subsequent offspring follow-up publications. Eight trials were identified. Five trials included women from all body mass index categories, and 3 trials included obese women only. Children in the offspring follow-up studies were aged 6 months to 7 years. Measures of adiposity in the offspring (n = 1989) included weight, body mass index, z-scores, circumferences, and skinfold thicknesses. Two studies, focusing on obese women only, reported reduced measures of adiposity (subscapular skinfold thickness and weight-for-age z-score) at 6 and 12 months, respectively. The remaining 6 studies, two from infancy and 4 in early childhood found no effect on measures of adiposity. Measures of obesity up to 12 months of age have been shown to be reduced by antenatal lifestyle interventions during pregnancy in obese women. Due to the heterogeneity of the methodology of the antenatal interventions and the reported offspring outcomes we were unable to draw any conclusion on the influence of antenatal interventions on measures of obesity in early childhood.
Collapse
Affiliation(s)
- Kathryn V. Dalrymple
- Department of Women and Children's HealthSchool of Life Course Sciences, King's College LondonLondonUK
| | - Julia Martyni‐Orenowicz
- Department of Women and Children's HealthSchool of Life Course Sciences, King's College LondonLondonUK
| | - Angela C. Flynn
- Department of Women and Children's HealthSchool of Life Course Sciences, King's College LondonLondonUK
| | - Lucilla Poston
- Department of Women and Children's HealthSchool of Life Course Sciences, King's College LondonLondonUK
| | - Majella O'Keeffe
- Department of Nutritional Sciences, King's College LondonSchool of Life Course SciencesLondonUK
| |
Collapse
|
53
|
Seward MW, Simon D, Richardson M, Oken E, Gillman MW, Hivert MF. Supporting healthful lifestyles during pregnancy: a health coach intervention pilot study. BMC Pregnancy Childbirth 2018; 18:375. [PMID: 30223779 PMCID: PMC6142676 DOI: 10.1186/s12884-018-2010-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/06/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) is associated with adverse health outcomes in both the mother and child. Many previous lifestyle interventions in women with excess weight during pregnancy encouraging appropriate GWG have been unsuccessful, and there remains no consensus about the content, format, or theoretical framework of GWG interventions. We assessed the feasibility and acceptability of a remote health coach intervention to promote healthful lifestyle behaviors and appropriate GWG among overweight pregnant women. METHODS At one northeastern US clinic, we enrolled 30 overweight (pre-pregnancy BMI ≥ 25 kg/m2) pregnant women at a median gestation of 12.5 weeks (IQR: 11-15) into a one-arm trial. We connected participants with a health coach to provide behavioral support to help participants adopt healthful lifestyles during pregnancy. Health coaches contacted participants by phone every 2-3 weeks to monitor goals, and sent emails and text messages between calls. Participants completed baseline (N = 30) and follow-up (N = 26) surveys at the end of the intervention (36 weeks gestation), as well as follow-up phone interviews (N = 18). RESULTS Among 30 participants, median age was 32 years (IQR: 28-33), median self-reported pre-pregnancy BMI was 27.3 kg/m2 (IQR: 25.7-31.1), and 17/30 were white, 9/30 African-American, and 3/30 Asian. Three-quarters (22/29) of participants completed at least a college degree. Although 25/30 participants reported in baseline surveys that they worried about being able to lose the weight postpartum that they expected to gain during pregnancy, just 12/26 participants reported the same at follow-up (P < 0.001). In follow-up surveys, 21/26 participants reported that health coaches were helpful in keeping them motivated, and 22/26 thought the phone conversations helped them face problems and find solutions. Based on qualitative assessment, several themes emerged in follow-up interviews about the quality of the intervention including accountability and support from health coaches. Participants also expressed desire for more visual resources and integration with standard clinical care to improve the intervention. CONCLUSIONS We demonstrated feasibility and high participant satisfaction with our remote health coach intervention during pregnancy. We identified areas in which we could refine the intervention for inclusion in a full-scale RCT, such as integration with clinical care and additional visual resources. TRIAL REGISTRATION Retrospectively registered at ClinicalTrials.gov ( NCT03080064 , 3/14/2017).
Collapse
Affiliation(s)
- Michael W Seward
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Denise Simon
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Martha Richardson
- Obstetrics & Gynecology, Harvard Vanguard Medical Associates, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Matthew W Gillman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Environmental Influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA. .,Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
54
|
Tabak RG, Schwarz CD, Carter E, Haire-Joshu D. Context for implementing a gestational weight gain program nationally. HEALTH BEHAVIOR AND POLICY REVIEW 2018; 5:77-89. [PMID: 30775399 PMCID: PMC6374035 DOI: 10.14485/hbpr.5.5.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Use the Consolidated Framework for Implementation Research to describe the context in which a gestational weight gain (GWG) intervention, embedded within Parents as Teachers (PAT), will be implemented at PAT sites nationwide. METHODS Ten site leaders and six parent educators from ten PAT sites in eight states participated in semi-structured interviews and a survey. Audio-recordings and systematic notes were used in a deductive analysis. Scales were descriptively analyzed. RESULTS Surveys demonstrated positive perspectives of PAT+GWG. In interviews, participants described PAT+GWG filling a need for prenatal health education and confidence delivering this content, valued integration of PAT+GWG within the PAT curriculum, and recommended materials to meet their clients' needs. CONCLUSIONS Contextual information can help maximize PAT+GWG's impact.
Collapse
Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA, phone: 314-935-0153, ,
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA, phone: 314-935-3063, ,
| | - Ebony Carter
- Washington University School of Medicine in St. Louis, Washington University in St. Louis, 660 S. Euclid Ave., CB8064, St. Louis, MO, 63110, USA, phone: 314-362-8280, ,
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA, phone: 314-935-3963, ,
| |
Collapse
|
55
|
Shieh C, Cullen DL, Pike C, Pressler SJ. Intervention strategies for preventing excessive gestational weight gain: systematic review and meta-analysis. Obes Rev 2018; 19:1093-1109. [PMID: 29806187 DOI: 10.1111/obr.12691] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Interventions relevant to energy intake to prevent excessive gestational weight gain in pregnant overweight and obese women are important but scarce. This review synthesized healthy eating and physical activity strategies and their effects on excessive gestational weight gain prevention. METHODS Twenty-three randomized controlled trials that included healthy eating and/or physical activity as an intervention in healthy pregnant overweight or obese adult women and gestational weight gain as a primary or secondary outcome were reviewed. FINDINGS Heathy eating and/or physical activity (21 studies, n = 6,920 subjects) demonstrated 1.81 kg (95% CI: -3.47, -0.16) of gestational weight gain reduction favouring intervention. Healthy eating (-5.77 kg, 95% CI: -9.34, -2.21, p = 0.02) had a larger effect size than combined healthy eating/physical activity (-0.82 kg, 95% CI: -1.28, -0.36, p = 0.0005) in limiting gestational weight gain. Physical activity did not show a significant pooled effect. Healthy eating with prescribed daily calorie and macronutrient goals significantly limited gestational weight gain by 4.28 kg and 4.23 kg, respectively. CONCLUSION Healthy eating and/or physical activity are effective in gestational weight gain control. Healthy eating with calorie and macronutrient goals are especially effective in limiting excessive gestational weight gain among pregnant overweight and obese women.
Collapse
Affiliation(s)
- C Shieh
- Department of Community and Health Systems, Indiana University School of Nursing, Indianapolis, IN, USA
| | - D L Cullen
- Department of Science for Nursing Care, Indiana University School of Nursing, Indianapolis, IN, USA
| | - C Pike
- Indiana University and Purdue University in Indianapolis University Library, Indianapolis, IN, USA
| | - S J Pressler
- Center for Enhancing Quality of Life in Chronic Illness, Indiana University School of Nursing, Indianapolis, IN, USA
| |
Collapse
|
56
|
Porter H, West DS, Cleves MA, Saylors ME, Andres A, Krukowski RA. Association Between Household Food Environment and Excessive Gestational Weight Gain. J Womens Health (Larchmt) 2018; 27:1064-1070. [DOI: 10.1089/jwh.2017.6552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Delia S. West
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Mario A. Cleves
- Pediatrics Biostatistics, Arkansas Children's Nutrition Center, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
| | - Marie E. Saylors
- Pediatrics Biostatistics, Arkansas Children's Nutrition Center, University of Arkansas for Medical Sciences, College of Medicine, Little Rock, Arkansas
| | - Aline Andres
- Arkansas Children's Nutrition Center, Little Rock, Arkansas
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Rebecca A. Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| |
Collapse
|
57
|
Bennett CJ, Walker RE, Blumfield ML, Gwini SM, Ma J, Wang F, Wan Y, Dickinson H, Truby H. Interventions designed to reduce excessive gestational weight gain can reduce the incidence of gestational diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials. Diabetes Res Clin Pract 2018; 141:69-79. [PMID: 29698713 DOI: 10.1016/j.diabres.2018.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/12/2018] [Accepted: 04/04/2018] [Indexed: 01/18/2023]
Abstract
AIMS To (i) evaluate the global impact of interventions designed to prevent excessive gestational weight gain (eGWG) on the incidence of gestational diabetes (GDM), and (ii) examine whether the effects differ by pre-conception body mass index (BMI) or ethnicity. METHODS A systematic search of randomised controlled trials (RCTs) with a primary or secondary aim to reduce eGWG was conducted in seven international and three Chinese databases without date limits. Meta-analysis data are reported as relative risk (RR) for GDM incidence for interventions including: diet, physical activity (PA), and lifestyle (diet and PA). RESULTS Forty-five studies were included, 37 in the meta-analyses. Diet and PA interventions reduced GDM risk by 44% (RR: 0.56, 95% CI: 0.36-0.87) and 38% (RR: 0.62, 95% CI: 0.50-0.78), respectively. Lifestyle interventions and BMI didn't significantly alter GDM risk. PA interventions from Southern-Europe reduced GDM risk by 37% (RR: 0.63, 95% CI: 0.50-0.80). Whereas, diet and lifestyle interventions conducted in Asia reduced GDM risk by 62% (RR: 0.38, 95% CI: 0.24-0.59) and 32% (RR: 0.68, 95% CI: 0.54-0.86), respectively. CONCLUSION Diet and PA interventions designed to reduce GWG are more effective than standard care in reducing the incidence of GDM, although the effect varies by region and BMI. The 'one size fits all' approach is not supported.
Collapse
Affiliation(s)
- Christie Jane Bennett
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Ruth Elizabeth Walker
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michelle Louise Blumfield
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Stella-May Gwini
- Biostatistics Platform, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jianhua Ma
- Institute of Nutrition and Food Hygiene, School of Public Health, Lanzhou University, China
| | - Fenglei Wang
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou, China
| | - Yi Wan
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou, China
| | - Hayley Dickinson
- The Richie Centre, Translational Research Facility, Hudson Institute of Medical Research, Clayton, Vic., Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Vic., Australia
| | - Helen Truby
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
| |
Collapse
|
58
|
Saxbe D, Corner GW, Khaled M, Horton K, Wu B, Khoddam HL. The weight of fatherhood: identifying mechanisms to explain paternal perinatal weight gain. Health Psychol Rev 2018; 12:294-311. [PMID: 29712505 DOI: 10.1080/17437199.2018.1463166] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Men appear to gain weight during the transition to parenthood, and fathers are heavier than non-fathers. Paternal perinatal weight gain may set weight trajectories in midlife and have long-term health implications. Since men do not undergo the physical demands of pregnancy and breastfeeding, the specific mechanisms underlying weight gain in new fathers warrant investigation. This review aims to stimulate research on paternal perinatal weight gain by suggesting testable potential mechanisms that (1) show change across the transition to parenthood and (2) play a role in weight and body composition. We identify seven mechanisms, within three categories: behavioural mechanisms (sleep, physical activity, and diet), hormonal mechanisms (testosterone and cortisol), and psychological mechanisms (depression and stress). We also discuss direct effects of partner pregnancy influences (e.g., 'couvade syndrome') on men's body weight. In presenting each mechanism, we discuss how it may be affected by the transition to parenthood, and then review its role in body composition and weight. Next, we describe bidirectional and interactive effects, discuss timing, and present three broad research questions to propel theoretical development.
Collapse
Affiliation(s)
- Darby Saxbe
- a Department of Psychology , University of Southern California , Los Angeles , CA , USA
| | - Geoffrey W Corner
- a Department of Psychology , University of Southern California , Los Angeles , CA , USA
| | - Mona Khaled
- a Department of Psychology , University of Southern California , Los Angeles , CA , USA
| | - Katelyn Horton
- a Department of Psychology , University of Southern California , Los Angeles , CA , USA
| | - Brian Wu
- b Keck School of Medicine , University of Southern California , Los Angeles , CA , USA
| | - Hannah Lyden Khoddam
- a Department of Psychology , University of Southern California , Los Angeles , CA , USA
| |
Collapse
|
59
|
Haby K, Berg M, Gyllensten H, Hanas R, Premberg Å. Mighty Mums - a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity. BMC OBESITY 2018; 5:16. [PMID: 29881627 PMCID: PMC5985595 DOI: 10.1186/s40608-018-0194-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 04/26/2018] [Indexed: 11/10/2022]
Abstract
Background Obesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes. Methods The intervention was performed in a city in Sweden 2011–2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790). Results In the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG < 7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (− 0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population. Conclusion Pregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting. Trial registration The study has been registered at ClinicalTrials.gov, Identifier: NCT03147079. May 10 2017, retrospectively registered.
Collapse
Affiliation(s)
- Karin Haby
- Primary Health Care, Research and Development Unit, Närhälsan, Region Västra Götaland, Gothenburg, Sweden.,2Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- 2Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,3GPCC - University of Gothenburg Centre for Person-centred Care, Gothenburg, Sweden
| | - Hanna Gyllensten
- 2Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,3GPCC - University of Gothenburg Centre for Person-centred Care, Gothenburg, Sweden
| | - Ragnar Hanas
- 4Department of Pediatrics, NU Hospital Group, Region Västra Götaland, Uddevalla, Sweden.,5Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Åsa Premberg
- Primary Health Care, Research and Development Unit, Närhälsan, Region Västra Götaland, Gothenburg, Sweden.,2Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
60
|
Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet 2018; 391:1830-1841. [PMID: 29673873 PMCID: PMC6075697 DOI: 10.1016/s0140-6736(18)30311-8] [Citation(s) in RCA: 620] [Impact Index Per Article: 103.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/03/2017] [Accepted: 01/31/2018] [Indexed: 12/15/2022]
Abstract
A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.
Collapse
Affiliation(s)
- Judith Stephenson
- Institute for Women's Health, University College London, London, UK.
| | - Nicola Heslehurst
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer Hall
- Institute for Women's Health, University College London, London, UK
| | | | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, UK
| | | | - Sarah R Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Kalyanaraman Kumaran
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - Chittaranjan S Yajnik
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, Maharashtra, India
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Gita D Mishra
- School of Public Health, University of Queensland, Herston, QLD, Australia
| |
Collapse
|
61
|
Barker M, Dombrowski SU, Colbourn T, Fall CHD, Kriznik NM, Lawrence WT, Norris SA, Ngaiza G, Patel D, Skordis-Worrall J, Sniehotta FF, Steegers-Theunissen R, Vogel C, Woods-Townsend K, Stephenson J. Intervention strategies to improve nutrition and health behaviours before conception. Lancet 2018; 391:1853-1864. [PMID: 29673875 PMCID: PMC6075694 DOI: 10.1016/s0140-6736(18)30313-1] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/03/2017] [Accepted: 01/31/2018] [Indexed: 12/11/2022]
Abstract
The nutritional status of both women and men before conception has profound implications for the growth, development, and long-term health of their offspring. Evidence of the effectiveness of preconception interventions for improving outcomes for mothers and babies is scarce. However, given the large potential health return, and relatively low costs and risk of harm, research into potential interventions is warranted. We identified three promising strategies for intervention that are likely to be scalable and have positive effects on a range of health outcomes: supplementation and fortification; cash transfers and incentives; and behaviour change interventions. On the basis of these strategies, we suggest a model specifying pathways to effect. Pathways are incorporated into a life-course framework using individual motivation and receptiveness at different preconception action phases, to guide design and targeting of preconception interventions. Interventions for individuals not planning immediate pregnancy take advantage of settings and implementation platforms outside the maternal and child health arena, since this group is unlikely to be engaged with maternal health services. Interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population. We propose a dual strategy that targets specific groups actively planning a pregnancy, while improving the health of the population more broadly. Modern marketing techniques could be used to promote a social movement based on an emotional and symbolic connection between improved preconception maternal health and nutrition, and offspring health. We suggest that speedy and scalable benefits to public health might be achieved through strategic engagement with the private sector. Political theory supports the development of an advocacy coalition of groups interested in preconception health, to harness the political will and leadership necessary to turn high-level policy into effective coordinated action.
Collapse
Affiliation(s)
- Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Stephan U Dombrowski
- Faculty of Natural Sciences, Division of Psychology, University of Stirling, Stirling, UK
| | - Tim Colbourn
- UCL Institute for Global Health, University College London, London, UK
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Natasha M Kriznik
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Wendy T Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Shane A Norris
- MRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gloria Ngaiza
- UCL Institute for Global Health, University College London, London, UK
| | - Dilisha Patel
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | | | - Falko F Sniehotta
- Institute of Health and Society, Newcastle University and Fuse, the UK Clinical Research Collaboration Centre of Excellence for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Régine Steegers-Theunissen
- Department of Obstetrics and Gynaecology, and Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK; Southampton Education School, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Judith Stephenson
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.
| |
Collapse
|
62
|
de Jersey SJ, Mallan K, Callaway L, Daniels LA, Nicholson JM. A Cross Sectional Comparison of Predisposing, Reinforcing and Enabling Factors for Lifestyle Health Behaviours and Weight Gain in Healthy and Overweight Pregnant Women. Matern Child Health J 2018; 21:626-635. [PMID: 27447795 DOI: 10.1007/s10995-016-2148-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives Little is known about the antecedents to dietary and physical activity behaviours that can support healthy gestational weight gain (GWG) across different weight status groups in pregnancy. The aim of this study was to use constructs common to dominant health behaviour theories to determine if predisposing, reinforcing and enabling factors for healthy eating, physical activity and weight gain differed between healthy and overweight pregnant women. Methods Pregnant women (n = 664) aged 29 ± 5 (mean ± SD) years were recruited at 16 ± 2 weeks gestation. Measures were self-reported pre-pregnancy weight, psychosocial constructs for healthy eating, physical activity and GWG and demographic data. Height was measured at 16 weeks. Psychosocial constructs were compared between women with pre-pregnancy weight status of healthy (BMI < 25 kg/m2) and overweight (BMI ≥ 25 kg/m2). Results Health behaviour intentions, positive outcome expectations and social support for healthy eating and physical activity were not different between healthy (66 %) and overweight (34 %) women. Overweight women had lower self-efficacy for healthy eating, physical activity and GWG (p < 0.001), higher negative outcome expectations for GWG (p = 0.004), and higher barriers to healthy eating (p = 0.002), and physical activity (p = 0.006). Conclusions for practice Both healthy and overweight women appear motivated to follow a healthy diet, exercise and avoid excess gestational weight during pregnancy. However many psychosocial factors associated with achieving these goals were different between healthy and overweight women. Health behaviour interventions tailored to overweight pregnant women should consider improving self-efficacy, providing support to overcome perceived barriers, validate positive changes made, and assist in managing negative expectations.
Collapse
Affiliation(s)
- Susan J de Jersey
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2 James Mayne Building, Butterfield Street, Herston, QLD, 4029, Australia. .,School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.
| | - Kimberley Mallan
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia.,School of Psychology (Brisbane Campus), Australian Catholic University, 1100 Nudgee Road, Banyo, QLD, 4014, Australia
| | - Leonie Callaway
- Royal Brisbane and Women's Hospital Clinical School, School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.,Department of Internal Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Lynne A Daniels
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Jan M Nicholson
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, 3000, Australia.,Centre for Learning Innovation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| |
Collapse
|
63
|
Garnett C, Crane D, Brown J, Kaner E, Beyer F, Muirhead C, Hickman M, Redmore J, de Vocht F, Beard E, Michie S. Reported Theory Use by Digital Interventions for Hazardous and Harmful Alcohol Consumption, and Association With Effectiveness: Meta-Regression. J Med Internet Res 2018; 20:e69. [PMID: 29490895 PMCID: PMC5856921 DOI: 10.2196/jmir.8807] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Applying theory to the design and evaluation of interventions is likely to increase effectiveness and improve the evidence base from which future interventions are developed, though few interventions report this. OBJECTIVE The aim of this paper was to assess how digital interventions to reduce hazardous and harmful alcohol consumption report the use of theory in their development and evaluation, and whether reporting of theory use is associated with intervention effectiveness. METHODS Randomized controlled trials were extracted from a Cochrane review on digital interventions for reducing hazardous and harmful alcohol consumption. Reporting of theory use within these digital interventions was investigated using the theory coding scheme (TCS). Reported theory use was analyzed by frequency counts and descriptive statistics. Associations were analyzed with meta-regression models. RESULTS Of 41 trials involving 42 comparisons, half did not mention theory (50% [21/42]), and only 38% (16/42) used theory to select or develop the intervention techniques. Significant heterogeneity existed between studies in the effect of interventions on alcohol reduction (I2=77.6%, P<.001). No significant associations were detected between reporting of theory use and intervention effectiveness in unadjusted models, though the meta-regression was underpowered to detect modest associations. CONCLUSIONS Digital interventions offer a unique opportunity to refine and develop new dynamic, temporally sensitive theories, yet none of the studies reported refining or developing theory. Clearer selection, application, and reporting of theory use is needed to accurately assess how useful theory is in this field and to advance the field of behavior change theories.
Collapse
Affiliation(s)
- Claire Garnett
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - David Crane
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Colin Muirhead
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - James Redmore
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Frank de Vocht
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| |
Collapse
|
64
|
Schumacher TL, Weatherall L, Keogh L, Sutherland K, Collins CE, Pringle KG, Rae KM. Characterizing gestational weight gain in a cohort of Indigenous Australian women. Midwifery 2018; 60:13-19. [PMID: 29471174 DOI: 10.1016/j.midw.2018.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/26/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE to determine the adequacy of gestational weight gain for a cohort of Indigenous Australian women and investigate whether it is associated with pre-pregnancy body mass index. DESIGN analysis of observational data collected from a longitudinal cohort study that follows Indigenous Australian women through pregnancy. SETTING women recruited through antenatal clinics in regional and remote towns in NSW, Australia to the Gomeroi gaaynggal program. PARTICIPANTS 110 pregnant women who either identified as being an Indigenous Australian or as carrying an Indigenous child. MEASUREMENTS AND FINDINGS measurements included weight and height, self-reported pre-pregnancy weight and smoking status, parity and health conditions that may contribute to gestational weight gain, such as hypertensive or diabetic disorders. Compared to the 2009 Institute of Medicine recommendations for gestational weight gain and based on prepregnancy body mass index, the rate of adequate gestational weight gain in this cohort was very low (15%). 32% of women had inadequate weight gain and 54% had excessive weight gain. The highest rate of excessive gestational weight gain was found in overweight women (74%), with rates of 48% and 50% found in healthy and obese (all classes) categories, respectively. Parity (coefficient 4.5, p<0.01) and hypertension (coefficient 4.8, p = 0.04) were found to be significantly associated with gestational weight gain in mixed model linear regression. CONCLUSIONS few women gained adequate gestational weight gain in this study. Culturally acceptable ways of addressing this issue are needed for this group of women, as inadequate and excessive rates of gestational weight gain have health implications for women and their offspring. IMPLICATIONS FOR PRACTICE a systematic approach to addressing gestational weight gain within antenatal care is required, including asking about diet and exercise, for all women identifying as Indigenous Australian.
Collapse
Affiliation(s)
- Tracy L Schumacher
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ring Rd, Callaghan, NSW 2308, Australia.
| | - Loretta Weatherall
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Lyniece Keogh
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Kathryn Sutherland
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Ring Rd, Callaghan, NSW 2308, Australia; School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Kirsty G Pringle
- School of Biomedical Sciences and Pharmacy, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre of Reproductive Sciences, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
| | - Kym M Rae
- Gomeroi gaayngal Centre, Faculty of Health and Medicine, University of Newcastle, 2/1 Hinkler Rd, Tamworth, NSW 2340, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre of Reproductive Sciences, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre of Generational Health and Ageing, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Department of Rural Health, University of Newcastle, Tamworth, NSW 2340, Australia.
| |
Collapse
|
65
|
Effectiveness of brief nutrition interventions on dietary behaviours in adults: A systematic review. Appetite 2018; 120:335-347. [DOI: 10.1016/j.appet.2017.09.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022]
|
66
|
Farpour-Lambert NJ, Ells LJ, Martinez de Tejada B, Scott C. Obesity and Weight Gain in Pregnancy and Postpartum: an Evidence Review of Lifestyle Interventions to Inform Maternal and Child Health Policies. Front Endocrinol (Lausanne) 2018; 9:546. [PMID: 30319539 PMCID: PMC6168639 DOI: 10.3389/fendo.2018.00546] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Maternal obesity, excessive gestational weight gain (GWG) and post-partum weight retention (PPWR) constitute new public health challenges, due to the association with negative short- and long-term maternal and neonatal outcomes. The aim of this evidence review was to identify effective lifestyle interventions to manage weight and improve maternal and infant outcomes during pregnancy and postpartum. Methods: A review of systematic reviews and meta-analyses investigating the effects of lifestyle interventions on GWG or PPWR was conducted (Jan 2009-2018) via electronic searches in the databases Medline, Pubmed, Web of Science and Cochrane Library using all keywords related to obesity/weight gain/loss, pregnancy or postpartum and lifestyle interventions;15 relevant reviews were selected. Results: In healthy women from all BMI classes, diet and physical activity interventions can decrease: GWG (mean difference -1.8 to -0.7 kg, high to moderate-quality evidence); the risks of GWG above the IOM guidelines (risk ratio [RR] 0.72 to 0.80, high to low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low to very low-quality evidence); cesarean section (RR 0.91 to 0.95; high to moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.56, high-quality evidence); without any maternal/fetal/neonatal adverse effects. In women with overweight/obesity, multi-component interventions can decrease: GWG (-0.91 to -0.63 kg, moderate to very low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low-quality evidence); macrosomia (RR 0.85, 0.73 to 1.0, moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.47, 0.26 to 0.85, moderate-quality evidence). Diet is associated with greater reduction of the risks of GDM, pregnancy-induced hypertension and preterm birth, compared with any other intervention. After delivery, combined diet and physical activity interventions reduce PPWR in women of any BMI (-2.57 to -2.3 kg, very low quality evidence) or with overweight/obesity (-3.6 to -1.22, moderate to very low-quality-evidence), but no other effects were reported. Conclusions: Multi-component approaches including a balanced diet with low glycaemic load and light to moderate intensity physical activity, 30-60 min per day 3-5 days per week, should be recommended from the first trimester of pregnancy and maintained during the postpartum period. This evidence review should help inform recommendations for health care professionals and women of child-bearing age.
Collapse
Affiliation(s)
- Nathalie J. Farpour-Lambert
- Obesity Prevention and Care Program “Contrepoids,” Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Pediatric Sports Medicine Consultation, Service of General Pediatrics, Department of Child and Adolescent, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- *Correspondence: Nathalie J. Farpour-Lambert
| | - Louisa J. Ells
- School of Health and Social Care, Teesside University, Middlesbrough, United Kingdom
| | - Begoña Martinez de Tejada
- Service of Obstetrics, Department of Gynaecology and Obstetrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Courtney Scott
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| |
Collapse
|
67
|
Mahmudiono T. Bagaimana Gizi Sejak Massa Konsepsi Dapat Mempengaruhi Kesehatan Biologis Anak? AMERTA NUTRITION 2017. [DOI: 10.20473/amnt.v1i4.2017.261-265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: good nutrition for mothers since pre-conception and conception is an important preparation for the health of the fetus and the child in the future.Objective: The purpose in writing this literature review is to explain argumentatively how nutrition from the time of conception can affect the child's biological health.Discussion: The results of the literature review show evidence that nutrition from the time of conception can affect the child's biological health. Several articles show a mechanism that explains the possible mechanisms of nutritional influence as conception on the child's biological health as in the future as Barker Hyphothesis or fetal programming. However, the data obtained to date is still not fully convincing. It is necessary to develop a long or longitudinal and experimental research that can guarantee the truth of the theory. Conclusion: the argument that nutrition from the time of conception is believed to affect the biological health of children in the future is increasingly stronger in the current literature although evidence of experimental research results still need to be accumulated to ensure the truth.ABSTRAK Latar Belakang: gizi yang baik bagi ibu sejak masa pra konsepsi dan konsepsi merupakan persiapan yang penting untuk kesehatan janin dan anak dimasa dating. Tujuan: tujuan dalam penulisan literature review ini adalah untuk menjelaskan secara argumentative bagaimana gizi sejak masa konsepsi dapat mempengaruhi kesehatan biologis anak. Pembahasan: hasil literature review menunjukkan bukti bahwa gizi sejak masa konsepsi dapat mempengaruhi kesehatan biologis anak. Beberapa artikel menunjukkan mekanisme yang menjelaskan kemungkinan mekanisme pengaruh gizi saat konsepsi terhadap kesehatan biologis anak dimasa datang seperti halnya Barker Hyphothesis atau fetal programming. Namun begitu, data yang diperoleh hingga saat ini masih belum meyakinkan sepenuhnya. Untuk itu perlu dikembangkan penelitian yang panjang atau longitudinal dan eksperimental yang dapat menggaransi kebenaran teori tersebut.Kesimpulan: argumentasi bahwa gizi sejak masa konsepsi diyakini berpengaruh terhadap kesehatan biologis anak dimasa depan semakin menguat dalam literature terkini walaupun bukti hasil penelitian eksperimental masih perlu banyak diakumulasikan untuk memastikan kebenarannya. ABSTRAKLatar Belakang: gizi yang baik bagi ibu sejak masa pra konsepsi dan konsepsi merupakan persiapan yang penting untuk kesehatan janin dan anak dimasa dating. Tujuan: tujuan dalam penulisan literature review ini adalah untuk menjelaskan secara argumentative bagaimana gizi sejak masa konsepsi dapat mempengaruhi kesehatan biologis anak. Pembahasan: hasil literature review menunjukkan bukti bahwa gizi sejak masa konsepsi dapat mempengaruhi kesehatan biologis anak. Beberapa artikel menunjukkan mekanisme yang menjelaskan kemungkinan mekanisme pengaruh gizi saat konsepsi terhadap kesehatan biologis anak dimasa datang seperti halnya Barker Hyphothesis atau fetal programming. Namun begitu, data yang diperoleh hingga saat ini masih belum meyakinkan sepenuhnya. Untuk itu perlu dikembangkan penelitian yang panjang atau longitudinal dan eksperimental yang dapat menggaransi kebenaran teori tersebut. Kesimpulan: argumentasi bahwa gizi sejak masa konsepsi diyakini berpengaruh terhadap kesehatan biologis anak dimasa depan semakin menguat dalam literature terkini walaupun bukti hasil penelitian eksperimental masih perlu banyak diakumulasikan untuk memastikan kebenarannya.
Collapse
|
68
|
Rohatgi KW, Tinius RA, Cade WT, Steele EM, Cahill AG, Parra DC. Relationships between consumption of ultra-processed foods, gestational weight gain and neonatal outcomes in a sample of US pregnant women. PeerJ 2017; 5:e4091. [PMID: 29230355 PMCID: PMC5723430 DOI: 10.7717/peerj.4091] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/03/2017] [Indexed: 01/22/2023] Open
Abstract
Background An increasingly large share of diet comes from ultra-processed foods (UPFs), which are assemblages of food substances designed to create durable, convenient and palatable ready-to-eat products. There is increasing evidence that high UPF consumption is indicative of poor diet and is associated with obesity and metabolic disorders. This study sought to examine the relationship between percent of energy intake from ultra-processed foods (PEI-UPF) during pregnancy and maternal gestational weight gain, maternal lipids and glycemia, and neonatal body composition. We also compared the PEI-UPF indicator against the US government’s Healthy Eating Index-2010 (HEI-2010). Methods Data were used from a longitudinal study performed in 2013–2014 at the Women’s Health Center and Obstetrics & Gynecology Clinic in St. Louis, MO, USA. Subjects were pregnant women in the normal and obese weight ranges, as well as their newborns (n = 45). PEI-UPF and the Healthy Eating Index-2010 (HEI-2010) were calculated for each subject from a one-month food frequency questionnaire (FFQ). Multiple regression (ANCOVA-like) analysis was used to analyze the relationship between PEI-UPF or HEI-2010 and various clinical outcomes. The ability of these dietary indices to predict clinical outcomes was also compared with the predictive abilities of total energy intake and total fat intake. Results An average of 54.4 ± 13.2% of energy intake was derived from UPFs. A 1%-point increase in PEI-UPF was associated with a 1.33 kg increase in gestational weight gain (p = 0.016). Similarly, a 1%-point increase in PEI-UPF was associated with a 0.22 mm increase in thigh skinfold (p = 0.045), 0.14 mm in subscapular skinfold (p = 0.026), and 0.62 percentage points of total body adiposity (p = 0.037) in the neonate. Discussion PEI-UPF (percent of energy intake from ultra-processed foods) was associated with and may be a useful predictor of increased gestational weight gain and neonatal body fat. PEI-UPF was a better predictor of all tested outcomes than either total energy or fat intake, and a better predictor of the three infant body fat measures than HEI-2010. UPF consumption should be limited during pregnancy and diet quality should be maximized in order to improve maternal and neonatal health.
Collapse
Affiliation(s)
- Karthik W Rohatgi
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Rachel A Tinius
- School of Kinesiology, Recreation, and Sport, Western Kentucky University, Bowling Green, KY, United States of America
| | - W Todd Cade
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States of America
| | | | - Alison G Cahill
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Diana C Parra
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States of America
| |
Collapse
|
69
|
Skouteris H, Bailey C, Nagle C, Hauck Y, Bruce L, Morris H. Interventions Designed to Promote Exclusive Breastfeeding in High-Income Countries: A Systematic Review Update. Breastfeed Med 2017; 12:604-614. [PMID: 28885859 DOI: 10.1089/bfm.2017.0065] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Worldwide, women seldom reach the recommended target of exclusive breastfeeding up to 6 months postpartum. The aim of the current study was to update a previously published review that presented a conceptual and methodological synthesis of interventions designed to promote exclusive breastfeeding up to 6 months in high-income countries. MATERIALS AND METHODS A systematic search of leading databases was conducted for scholarly, peer-reviewed, randomized controlled trials published from June 2013 to December 2016. Twelve new articles were identified as relevant; all were published in English and assessed exclusive breastfeeding with a follow-up period extending beyond 4 months postpartum. Articles were analyzed for overall quality of evidence in regard to duration of exclusive breastfeeding, using the Grading and Recommendations Assessment, Development, and Evaluation approach. RESULTS A significant increase in the duration of exclusive breastfeeding was found in 4 of the 12 studies. All four successful interventions had long-duration postpartum programs, implemented by telephone, text message, or through a website. Some of the successful interventions also included prenatal education or in-hospital breastfeeding support. CONCLUSIONS Results from this review update correspond closely with previous findings, in that all of the successful interventions had lengthy postnatal support or an education component. More studies assessed intervention fidelity than in the previous review; however, there was little discussion of maternal body-mass index. While a pattern of successful interventions is beginning to emerge, further research is needed to provide a robust evidence base to inform future interventions, particularly with overweight and obese women.
Collapse
Affiliation(s)
- Helen Skouteris
- 1 School of Psychology, Deakin University , Geelong, Australia .,2 Center for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Cate Bailey
- 1 School of Psychology, Deakin University , Geelong, Australia .,2 Center for Social and Early Emotional Development (SEED), Deakin University, Geelong, Australia
| | - Cate Nagle
- 1 School of Psychology, Deakin University , Geelong, Australia .,3 Centre for Nursing and Midwifery Research , James Cook University, Geelong, Australia
| | - Yvonne Hauck
- 4 Australia School of Nursing , Midwifery and Paramedicine and King Edward Memorial Hospital, Curtin University, Perth, Australia
| | - Lauren Bruce
- 1 School of Psychology, Deakin University , Geelong, Australia
| | - Heather Morris
- 1 School of Psychology, Deakin University , Geelong, Australia
| |
Collapse
|
70
|
Phillips JK, Higgins ST. Applying behavior change techniques to weight management during pregnancy: Impact on perinatal outcomes. Prev Med 2017; 104:133-136. [PMID: 28757450 PMCID: PMC5735012 DOI: 10.1016/j.ypmed.2017.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 12/19/2022]
Abstract
Unhealthy behaviors and lifestyle choices are contributing to the obesity epidemic and associated morbidities. Among reproductive aged women, obesity adversely affects perinatal outcomes and longer term maternal and child health. Interventions utilizing strategies of behavior change have the potential to improve outcomes, especially during pregnancy. Antenatal interventions to improve adherence to gestational weight gain guidelines are one such example. Although behaviorally-based intervention trials have been associated with modest decreases in gestational weight gain, the effect on short term perinatal outcomes has thus far been minimal. This commentary aims to discuss possible reasons behind the failure to improve perinatal outcomes as well as to encourage future areas of study.
Collapse
Affiliation(s)
- Julie K Phillips
- Vermont Center on Behavior and Health, University of Vermont, United States; Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, United States.
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, United States; Psychiatry, University of Vermont, United States; Psychological Science, University of Vermont, United States
| |
Collapse
|
71
|
Sherifali D, Nerenberg KA, Wilson S, Semeniuk K, Ali MU, Redman LM, Adamo KB. The Effectiveness of eHealth Technologies on Weight Management in Pregnant and Postpartum Women: Systematic Review and Meta-Analysis. J Med Internet Res 2017; 19:e337. [PMID: 29030327 PMCID: PMC5660296 DOI: 10.2196/jmir.8006] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The emergence and utilization of electronic health (eHealth) technologies has increased in a variety of health interventions. Exploiting the real-time advantages offered by mobile technologies during and after pregnancy has the potential to empower women and encourage behaviors that may improve maternal and child health. OBJECTIVE The objective of this study was to assess the effectiveness of eHealth technologies for weight management during pregnancy and the postpartum period and to review the efficacy of eHealth technologies on health behaviors, specifically nutrition and physical activity. METHODS A systematic search was conducted of the following databases: MEDLINE, EMBASE, Cochrane database of systematic reviews (CDSR), Cochrane central register of controlled trials (CENTRAL), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO. The search included studies published from 1990 to July 5, 2016. All relevant primary studies that involved randomized controlled trials (RCTs), non-RCTs, before-and-after studies, historically controlled studies, and pilot studies were included. The study population was adult women of childbearing age either during pregnancy or the postpartum period. eHealth weight management intervention studies targeting physical activity, nutrition, or both, over a minimum 3-month period were included. Titles and abstracts, as well as full-text screening were conducted. Study quality was assessed using Cochrane's risk of bias tool. Data extraction was completed by a single reviewer, which was then verified by a second independent reviewer. Results were meta-analyzed to calculate pooled estimates of the effect, wherever possible. RESULTS Overall, 1787 and 176 citations were reviewed at the abstract and full-text screening stages, respectively. A total of 10 studies met the inclusion criteria ranging from high to low risk of bias. Pooled estimates from studies of the effect for postpartum women resulted in a significant reduction in weight (-2.55 kg, 95% CI -3.81 to -1.28) after 3 to 12 months and six studies found a nonsignificant reduction in weight gain for pregnant women (-1.62 kg, 95% CI -3.57 to 0.33) at approximately 40 weeks. CONCLUSIONS This review found evidence for benefits of eHealth technologies on weight management in postpartum women only. Further research is still needed regarding the use of these technologies during and after pregnancy.
Collapse
Affiliation(s)
- Diana Sherifali
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Clinical Nurse Specialist, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Kara A Nerenberg
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shanna Wilson
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kevin Semeniuk
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Muhammad Usman Ali
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Leanne M Redman
- Reproductive Endocrinology and Women's Health Lab, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, United States
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
72
|
Duncan M, Murawski B, Short CE, Rebar AL, Schoeppe S, Alley S, Vandelanotte C, Kirwan M. Activity Trackers Implement Different Behavior Change Techniques for Activity, Sleep, and Sedentary Behaviors. Interact J Med Res 2017; 6:e13. [PMID: 28807889 PMCID: PMC5575434 DOI: 10.2196/ijmr.6685] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 06/06/2017] [Accepted: 06/23/2017] [Indexed: 12/28/2022] Open
Abstract
Background Several studies have examined how the implementation of behavior change techniques (BCTs) varies between different activity trackers. However, activity trackers frequently allow tracking of activity, sleep, and sedentary behaviors; yet, it is unknown how the implementation of BCTs differs between these behaviors. Objective The aim of this study was to assess the number and type of BCTs that are implemented by wearable activity trackers (self-monitoring systems) in relation to activity, sleep, and sedentary behaviors and to determine whether the number and type of BCTs differ between behaviors. Methods Three self-monitoring systems (Fitbit [Charge HR], Garmin [Vivosmart], and Jawbone [UP3]) were each used for a 1-week period in August 2015. Each self-monitoring system was used by two of the authors (MJD and BM) concurrently. The Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy was used to assess the implementation of 40 BCTs in relation to activity, sleep, and sedentary behaviors. Discrepancies in ratings were resolved by discussion, and interrater agreement in the number of BCTs implemented was assessed using kappa statistics. Results Interrater agreement ranged from 0.64 to 1.00. From a possible range of 40 BCTs, the number of BCTs present for activity ranged from 19 (Garmin) to 33 (Jawbone), from 4 (Garmin) to 29 (Jawbone) for sleep, and 0 (Fitbit) to 10 (Garmin) for sedentary behavior. The average number of BCTs implemented was greatest for activity (n=26) and smaller for sleep (n=14) and sedentary behavior (n=6). Conclusions The number and type of BCTs implemented varied between each of the systems and between activity, sleep, and sedentary behaviors. This provides an indication of the potential of these systems to change these behaviors, but the long-term effectiveness of these systems to change activity, sleep, and sedentary behaviors remains unknown.
Collapse
Affiliation(s)
- Mitch Duncan
- School of Medicine & Public Health, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Beatrice Murawski
- School of Medicine & Public Health, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Camille E Short
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Amanda L Rebar
- Physical Activity Research Group, School of Medical, Health and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Stephanie Schoeppe
- Physical Activity Research Group, School of Medical, Health and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Stephanie Alley
- Physical Activity Research Group, School of Medical, Health and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, School of Medical, Health and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Morwenna Kirwan
- School of Science and Health, Western Sydney University, Campbelltown, Australia
| |
Collapse
|
73
|
Moss EL, Tobin LN, Campbell TS, von Ranson KM. Behavioral weight-loss treatment plus motivational interviewing versus attention control: lessons learned from a randomized controlled trial. Trials 2017; 18:351. [PMID: 28743313 PMCID: PMC5526285 DOI: 10.1186/s13063-017-2094-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 07/11/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies evaluating the benefit of adding motivational interviewing (MI) to behavioral weight-loss programs (BWLPs) have yielded mixed findings. METHODS The aims of this randomized controlled trial were to: (1) assess the efficacy of adding MI to a BWLP on weight loss and adherence among 135 individuals with overweight and obesity (77.8% female; mean BMI = 33.6 kg/m2) enrolled in a 12-week BWLP and (2) explore levels of importance, confidence, and readiness for change ratings. RESULTS Participants, who were randomized to receive two MI sessions or two attention control sessions, were assessed at baseline, the end of the BWLP, and 6 months post BWLP. Both groups decreased their weight from baseline to the end of the BWLP; however, there was no weight change in either group when measured between baseline and 6 months post BWLP. We observed no group differences in importance, confidence, and readiness for change after each session. CONCLUSIONS We highlight some important lessons learned from the present trial that can be applied to MI + BWLP research. Participants may not have benefited from MI because they were already highly motivated to change, which highlights the importance of pretreatment assessment. Findings also suggest that treatment monitoring may help to enhance MI + BWLP efficacy by guiding a stepped-care approach that identifies individuals for whom additional MI sessions are needed, and when. A focus on refining elements of treatment remains an important direction. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT02649634 . Retrospectively registered on 5 January 2016.
Collapse
Affiliation(s)
- Erin L. Moss
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | - Leah N. Tobin
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | - Tavis S. Campbell
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | - Kristin M. von Ranson
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| |
Collapse
|
74
|
Behaviour change in overweight and obese pregnancy: a decision tree to support the development of antenatal lifestyle interventions. Public Health Nutr 2017; 20:2642-2648. [PMID: 28691650 DOI: 10.1017/s136898001700129x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Antenatal healthy lifestyle interventions are frequently implemented in overweight and obese pregnancy, yet there is inconsistent reporting of the behaviour-change methods and behavioural outcomes. This limits our understanding of how and why such interventions were successful or not. DESIGN The current paper discusses the application of behaviour-change theories and techniques within complex lifestyle interventions in overweight and obese pregnancy. The authors propose a decision tree to help guide researchers through intervention design, implementation and evaluation. The implications for adopting behaviour-change theories and techniques, and using appropriate guidance when constructing and evaluating interventions in research and clinical practice are also discussed. CONCLUSIONS To enhance the evidence base for successful behaviour-change interventions during pregnancy, adoption of behaviour-change theories and techniques, and use of published guidelines when designing lifestyle interventions are necessary. The proposed decision tree may be a useful guide for researchers working to develop effective behaviour-change interventions in clinical settings. This guide directs researchers towards key literature sources that will be important in each stage of study development.
Collapse
|
75
|
Bull ER, Clayton H, Hendry T. Bump Start: developing and piloting a healthy living group intervention for obese pregnant women. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjom.2017.25.6.386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
76
|
Dodd JM, Briley AL. Managing obesity in pregnancy – An obstetric and midwifery perspective. Midwifery 2017; 49:7-12. [DOI: 10.1016/j.midw.2017.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/03/2017] [Indexed: 11/15/2022]
|
77
|
Thompson EL, Vamos CA, Daley EM. Physical activity during pregnancy and the role of theory in promoting positive behavior change: A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2017; 6:198-206. [PMID: 30356571 PMCID: PMC6189011 DOI: 10.1016/j.jshs.2015.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/16/2015] [Accepted: 07/10/2015] [Indexed: 05/28/2023]
Abstract
BACKGROUND Physical activity (PA) during pregnancy provides physical and psychological benefits for mother and child. U.S. guidelines recommend ≥30 min of moderate exercise for healthy pregnant women most days of the week; however, most women do not meet these recommendations. Theory assists in identifying salient determinants of health behavior to guide health promotion interventions; however, the application of theory to examine PA among pregnant women has not been examined cohesively among multiple levels of influence (e.g., intrapersonal, interpersonal, neighborhood/environmental, and organizational/political). Subsequently, this systematic review aims to identify and evaluate the use of health behavior theory in studies that examine PA during pregnancy. METHODS Articles published before July 2014 were obtained from PubMed and Web of Science. Inclusion criteria applied were: (1) empirically-based; (2) peer-reviewed; (3) measured factors related to PA; (4) comprised a pregnant sample; and (5) applied theory. Fourteen studies were included. Each study's application of theory and theoretical constructs were evaluated. RESULTS Various theories were utilized to explain and predict PA during pregnancy; yet, the majority of these studies only focused on intrapersonal level determinants. Five theoretical frameworks were applied across the studies-all but one at the intrapersonal level. Few determinants identified were from the interpersonal, neighborhood/environmental, or organizational/political levels. CONCLUSION This systematic review synthesized the literature on theoretical constructs related to PA during pregnancy. Interpersonal, community, and societal levels remain understudied. Future research should employ theory-driven multi-level determinants of PA to reflect the interacting factors influencing PA during this critical period in the life course.
Collapse
|
78
|
Yeo S, Walker JS, Caughey MC, Ferraro AM, Asafu-Adjei JK. What characteristics of nutrition and physical activity interventions are key to effectively reducing weight gain in obese or overweight pregnant women? A systematic review and meta-analysis. Obes Rev 2017; 18:385-399. [PMID: 28177566 DOI: 10.1111/obr.12511] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/11/2016] [Accepted: 12/12/2016] [Indexed: 12/29/2022]
Abstract
UNLABELLED Lifestyle interventions targeting gestational weight gain (GWG) report varying degrees of success. To better understand factors influencing efficacy, we reviewed randomized trials specifically among obese and overweight pregnant women. METHODS We conducted a systematic review and a meta-analysis of 32 studies with a pooled population of 5,869 overweight or obese pregnant women. Random effects models were fit to compute the weighted mean difference (WMD) in GWG between groups across studies. Subgroup analyses were conducted to compare intervention efficacy in overweight vs. obese pregnant women, and interventions delivered by prenatal care providers (PCPs) vs. non-PCPs during pregnancy. Moderator analyses ensured. RESULTS Nine (28%) of 32 studies reported significant reductions in GWG in response to intervention. Of these, six (66%) of nine were delivered by PCPs. Overall, the WMD in GWG was -1.71 (95% confidence interval [CI]: -2.55, -0.86) kg. However, interventions delivered by PCPs yielded a significantly greater reduction in GWG compared to interventions delivered by non-PCPs (WMD = -3.88 kg; 95% CI: -7.01, -0.75 vs. -0.80 kg; 95% CI: -1.32, -0.28; p for difference = 0.005). CONCLUSION When PCPs counsel nutrition and physical activity, obese and overweight pregnant women have greater success meeting GWG targets and may be more motivated to modify their behaviour than with other modes of intervention deliveries.
Collapse
Affiliation(s)
- SeonAe Yeo
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S Walker
- Health Science Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa C Caughey
- School of Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda M Ferraro
- Undergraduate Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Josephine K Asafu-Adjei
- School of Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
79
|
O’Brien OA, Lindsay KL, McCarthy M, McGloin AF, Kennelly M, Scully HA, McAuliffe FM. Influences on the food choices and physical activity behaviours of overweight and obese pregnant women: A qualitative study. Midwifery 2017; 47:28-35. [DOI: 10.1016/j.midw.2017.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 11/16/2022]
|
80
|
Poston L, Bell R, Briley AL, Godfrey KM, Nelson SM, Oteng-Ntim E, Sandall J, Sanders TAB, Sattar N, Seed PT, Robson SC, Trépel D, Wardle J. Improving pregnancy outcome in obese women: the UK Pregnancies Better Eating and Activity randomised controlled Trial. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05100] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BackgroundObesity in pregnancy is associated with insulin resistance, which underpins many common complications including gestational diabetes mellitus (GDM) and fetal macrosomia.ObjectivesTo assess the effect of a complex behavioural intervention based on diet and physical activity (PA) on the risk of GDM and delivery of a large-for-gestational age (LGA) infant.DesignThree phases: (1) the development phase, (2) the pilot study and (3) a multicentre randomised controlled trial (RCT) comparing a behavioural intervention to improve glycaemic control with standard antenatal care in obese pregnant women. A cost–utility analysis was undertaken to estimate the cost-effectiveness of the health training (intervention) over and above standard care (control).SettingPilot study: antenatal clinics in four inner-city UK hospitals. RCT: eight antenatal clinics in eight UK inner-city hospitals.ParticipantsWomen were eligible for inclusion if they had a body mass index of ≥ 30 kg/m2, were pregnant with a single fetus and at 15+0to 18+6weeks’ gestation, were able to give written informed consent and were without predefined disorders.InterventionThe intervention comprised an initial session with a health trainer, followed by eight weekly sessions. Dietary advice recommended foods with a low dietary glycaemic index, avoidance of sugar-sweetened beverages and reduced saturated fats. Women were encouraged to increase daily PA.Main outcome measuresDevelopment phase: intervention development, acceptability and optimal approach for delivery. Pilot study: change in dietary and PA behaviours at 28 weeks’ gestation. RCT: the primary outcome of the RCT was, for the mother, GDM [as measured by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG)’s diagnostic criteria] and, for the infant, LGA delivery (i.e. customised birthweight ≥ 90th centile for gestational age).ResultsDevelopment phase: following a literature meta-analysis, a study of dietary intention questionnaires and semistructured interviews, an intervention based on behavioural science was developed that incorporated optimal and acceptable methods for delivery. Pilot study: the pilot study demonstrated improvement in dietary behaviours in the intervention compared with the standard care arm but no increase in objectively measured PA. Process evaluation demonstrated feasibility and general acceptability. RCT: the RCT showed no effect of the intervention on GDM in obese pregnant women or the number of deliveries of LGA infants. There was a reduction in dietary glycaemic load (GL) and reduced saturated fat intake, an increase in PA and a modest reduction in gestational weight gain, all secondary outcomes. Lower than expected was the number of LGA infant deliveries in all women, which suggested that universal screening for GDM with IADPSG’s diagnostic criteria, and subsequent treatment, may reduce the number of deliveries of LGA infants. According to the cost–utility analysis, the estimated probability that the UK Pregnancies Better Eating and Activity Trial (UPBEAT) behavioural intervention is cost-effective at the £30,000/quality-adjusted life-year willingness-to-pay threshold was 1%.LimitationsIncluded the high refusal rate for participation and self-reported assessment of diet and PA.ConclusionsThe UPBEAT intervention, an intense theoretically based intervention in obese pregnant women, did not reduce the risk of GDM in women or the number of LGA infant deliveries, despite successfully reducing the dietary GL. Based on total cost to the NHS provider and health gains, the UPBEAT intervention provided no supporting evidence to suggest that the intervention represents value for money based on the National Institute for Health and Care Excellence benchmarks for cost-effectiveness.Future workAlternative strategies for reducing the risk of GDM in obese pregnant women and the number of LGA infant deliveries should be considered, including development of clinically effective interventions to prevent obesity in women of reproductive age, of clinically effective interventions to reduce weight retention following pregnancy and of risk stratification tools in early pregnancy.Trial registrationCurrent Controlled Trials ISRCTN89971375 and UK Clinical Research Network Portfolio 5035.FundingThis project was funded by the NIHR Programme Grant for Applied Research programme and will be published in full inProgramme Grants for Applied Research, Vol. 5, No. 10. See the NIHR journals library website for further project information. Contributions to funding were also provided by the Chief Scientist Office CZB/4/680, Scottish Government Health Directorates, Edinburgh; Guys and St Thomas’ Charity, Tommy’s Charity (Lucilla Poston, Annette L Briley, Paul T Seed) and the NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, UK and the Academy of Finland, Finland. Keith M Godfrey was supported by the National Institute for Health Research through the NIHR Southampton Biomedical Research Centre. Lucilla Poston and Keith M Godfrey were supported by the European Union’s Seventh Framework Programme (FP7/2007-2013), project EarlyNutrition under grant agreement number 289346.
Collapse
Affiliation(s)
- Lucilla Poston
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Ruth Bell
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Annette L Briley
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Keith M Godfrey
- Lifecourse Epidemiology Unit and NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Scott M Nelson
- School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Jane Sandall
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Thomas AB Sanders
- Division of Diabetes and Nutritional Sciences, King’s College London, London, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Paul T Seed
- Division of Women’s Health, King’s College London, King’s Health Partners, London, UK
| | - Stephen C Robson
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Institute of Epidemiology and Health, University College London, London, UK
| |
Collapse
|
81
|
Come On! Using intervention mapping to help healthy pregnant women achieve healthy weight gain. Public Health Nutr 2017; 20:1666-1680. [PMID: 28294098 DOI: 10.1017/s1368980017000271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Gaining too much or too little weight in pregnancy (according to Institute of Medicine (IOM) guidelines) negatively affects both mother and child, but many women find it difficult to manage their gestational weight gain (GWG). Here we describe the use of the intervention mapping protocol to design 'Come On!', an intervention to promote adequate GWG among healthy pregnant women. DESIGN We used the six steps of intervention mapping: (i) needs assessment; (ii) formulation of change objectives; (iii) selection of theory-based methods and practical strategies; (iv) development of the intervention programme; (v) development of an adoption and implementation plan; and (vi) development of an evaluation plan. A consortium of users and related professionals guided the process of development. RESULTS As a result of the needs assessment, two goals for the intervention were formulated: (i) helping healthy pregnant women to stay within the IOM guidelines for GWG; and (ii) getting midwives to adequately support the efforts of healthy pregnant women to gain weight within the IOM guidelines. To reach these goals, change objectives and determinants influencing the change objectives were formulated. Theories used were the Transtheoretical Model, Social Cognitive Theory and the Elaboration Likelihood Model. Practical strategies to use the theories were the foundation for the development of 'Come On!', a comprehensive programme that included a tailored Internet programme for pregnant women, training for midwives, an information card for midwives, and a scheduled discussion between the midwife and the pregnant woman during pregnancy. The programme was pre-tested and evaluated in an effect study.
Collapse
|
82
|
Guo W, Zhang B, Wang X. Lifestyle interventions for gestational diabetes mellitus to control blood glucose: a meta-analysis of randomized studies. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0553-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
|
83
|
Prospective Relationships between Health Cognitions and Excess Gestational Weight Gain in a Cohort of Healthy and Overweight Pregnant Women. J Acad Nutr Diet 2017; 117:1198-1209. [PMID: 28189424 DOI: 10.1016/j.jand.2016.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 12/14/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Excess gestational weight gain (GWG) contributes to long-term obesity in mothers and children. To guide the tailoring of interventions to prevent excess GWG, a better understanding is needed of the lifestyle-related health cognitions that influence women's attempts to manage GWG. OBJECTIVE To examine the relationship between health cognitions and excess GWG for women who enter pregnancy at a healthy weight (body mass index <25) or overweight (body mass index ≥25). It was hypothesized that health cognitions with a positive (negative) influence on health behavior would be associated with lower (higher) likelihood of excess GWG and that specific associations would differ between weight status groups. DESIGN This prospective, observational study commenced when participants were <20 weeks' gestation, continuing until the end of their pregnancy. A self-administered quantitative survey at recruitment assessed prepregnancy weight and lifestyle-related health cognitions. Height was measured at 16 weeks and weight at 36 weeks using standard procedures. PARTICIPANTS AND SETTING A consecutive sample of pregnant women (n=715) were recruited from an Australian metropolitan hospital between August 2010 and January 2011. All women <20 weeks' gestation were eligible unless they had preexisting type 1 or 2 diabetes or insufficient English language skills to complete questionnaires. MAIN OUTCOME MEASURES Excess GWG defined according to Institute of Medicine 2009 recommendations and predisposing, reinforcing, and enabling cognitions for lifestyle health behaviors. STATISTICAL ANALYSES PERFORMED Logistic regression analyses examined associations between health cognitions and excess GWG stratified for prepregnancy weight status. RESULTS For healthy-weight women, higher weight locus of control scores were protective against excess GWG (odds ratio 0.6, 95% CI 0.4 to 0.8), whereas higher perceived risk scores (personal risk and risk arising from prepregnancy weight) (odds ratio 1.3, 95% CI 1.1 to 1.7) were associated with excess GWG. For overweight women higher negative outcome expectation scores were associated with an increased risk of excess GWG (odds ratio 1.4, 95% CI 1.1 to 2.0). CONCLUSIONS Lifestyle-related health cognitions are associated with excess GWG and differed by prepregnancy weight status, suggesting the need to tailor behavior change interventions accordingly.
Collapse
|
84
|
Shieh C, Yang Z, Haas DM, Carpenter JS. Feasibility and Potential Benefits of a Self-Monitoring Enhanced Lifestyle Intervention to Prevent Excessive Gestational Weight Gain in Women Who Are Overweight or Obese. J Obstet Gynecol Neonatal Nurs 2017; 46:182-196. [PMID: 28063804 DOI: 10.1016/j.jogn.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and potential benefits of a self-monitoring enhanced lifestyle intervention to prevent excessive gestational weight gain in women who are overweight and obese. DESIGN A one-group, prospective design involving 8 weeks of healthy eating and physical activity and self-monitoring of weight, nutrition, and walking. SETTING Recruitment and enrollment in prenatal clinics and self-monitoring at home. PARTICIPANTS Women (N = 22) at 14 to 24 gestational weeks, with body mass indexes of 25 to 40 kg/m2, without medical and psychiatric diseases that affected cognition or walking. METHODS Participants self-monitored weight and nutrition intake for the first 4 weeks and weight, nutrition intake, and walking in the second 4 weeks. Feasibility data were collected weekly (attrition, self-monitoring adherence, program safety, participant feedback) or at the end of Week 8 (satisfaction ratings). Potential benefits included weight, nutrition, and physical activity, measured at baseline (T1), the end of Week 4 (T2), or the end of Week 8 (T3). RESULTS Attrition rates were 27.3% by T2 and 40.9% by T3. Adherence to log return was 100%. No adverse effects were noted, but food craving was persistent, and stress levels were high. Program satisfaction was high. Trends for improved activity and reduced trans fat consumption were seen. CONCLUSION Our findings indicate that the intervention is worthy of further development and testing with a randomized controlled trial.
Collapse
|
85
|
Okesene-Gafa K, Li M, Taylor RS, Thompson JMD, Crowther CA, McKinlay CJD, McCowan LME. A randomised controlled demonstration trial of multifaceted nutritional intervention and or probiotics: the healthy mums and babies (HUMBA) trial. BMC Pregnancy Childbirth 2016; 16:373. [PMID: 27884128 PMCID: PMC5123375 DOI: 10.1186/s12884-016-1149-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 11/08/2016] [Indexed: 01/28/2023] Open
Abstract
Background Maternal obesity is associated with adverse pregnancy outcomes and has lifelong negative implications for offspring health. The Institute of Medicine recommends limited gestational weight gain (GWG) in obese women for optimal maternal and infant outcomes. However, there is a gap regarding an effective and sustainable intervention strategy to achieve this goal. The aim of the healthy mums and babies (HUMBA) demonstration trial is to assess whether a multifaceted nutritional intervention and/or an oral probiotic treatment in obese pregnant women can reduce excessive GWG and optimise pregnancy outcomes. Methods and design The study is a two by two factorial randomised controlled demonstration trial conducted in Counties Manukau health region, New Zealand, a multi-ethnic region with a high prevalence of obesity. A total of 220 non-diabetic obese women with a singleton pregnancy will be recruited between 120 and 176 weeks. At recruitment, women are randomised to receive either a culturally tailored multifaceted dietary intervention or routine dietary advice, and either an oral probiotic or placebo capsule. Randomisation is undertaken via a web-based protocol, randomize.net, with a 1:1 ratio using stratification by body mass index (BMI) category (BMI of 30–34.9 or BMI ≥35 kg/m2). The dietary intervention includes 4 customised nutrition education visits by a trained community health worker combined with motivational text messaging. Probiotic capsules consist of Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12 at a dose of 7 × 109 colony-forming units one per day until birth. Probiotic and placebo capsules are identically pre-packed and labelled by a third party, and are prescribed in a double blinded fashion. Research assessments are conducted at enrolment, 28 weeks, 36 weeks, at birth and at 5 months post-delivery. The primary outcomes for the study are proportion of women with excessive GWG and infant birthweight. Discussion The HUMBA demonstration trial will assess the efficacy of a culturally tailored multifaceted dietary intervention and probiotic treatment in limiting excessive GWG and optimising birthweight in a multiethnic sample of obese pregnant women. If successful, either one or both of the interventions may be incorporated into future studies powered to investigate important pregnancy outcomes. Trial registration Australian New Zealand Clinical Trials Registry registration number: ACTRN12615000400561, Universal Trial Number: U1111-1155-0409. Date registered: 29th April 2015.
Collapse
Affiliation(s)
- Karaponi Okesene-Gafa
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland, New Zealand.,South Auckland Clinical School, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Minglan Li
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Rennae S Taylor
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - John M D Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | | | - Christopher J D McKinlay
- The Liggins Institute, The University of Auckland, Auckland, New Zealand.,Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Private Bag 92019, Auckland, New Zealand. .,South Auckland Clinical School, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.
| |
Collapse
|
86
|
Graham ML, Uesugi KH, Niederdeppe J, Gay GK, Olson CM. The theory, development, and implementation of an e-intervention to prevent excessive gestational weight gain: e-Moms Roc. Telemed J E Health 2016; 20:1135-42. [PMID: 25354350 DOI: 10.1089/tmj.2013.0354] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Gaining more weight during pregnancy than is recommended by the Institute of Medicine is prevalent and contributes to the development of obesity in women. This article describes the development and use of e-Moms of Rochester (e-Moms Roc), an electronic intervention (e-intervention), to address this health issue in a socioeconomically diverse sample of pregnant women. MATERIALS AND METHODS Formative research in the form of intercept interviews, in-depth interviews, and focus groups was conducted to inform the design of the e-intervention. The Web site continuously tracked each participant's use of e-intervention features. RESULTS An e-intervention, including Web site and mobile phone components, was developed and implemented in a randomized control trial. Formative research informed the design. Participants in all arms accessed blogs, local resources, articles, frequently asked questions, and events. Participants in the intervention arms also accessed the weight gain tracker and diet and physical activity goal-setting tools. Overall, 80% of women logged into the Web site and used a tool or feature at least twice. Among those in the intervention arm, 70% used the weight gain tracker, but only 40% used the diet and physical activity goal-setting tools. CONCLUSIONS To maximize and sustain potential usage of e-Moms Roc over time, the e-intervention included customized reminders, tailored content, and community features such as blogs and resources. Usage was comparable to those in other weight studies with young adults and higher than reported in a published study with pregnant women. This e-intervention specifically designed for pregnant women was used by the majority of women.
Collapse
Affiliation(s)
- Meredith L Graham
- 1 Division of Nutritional Sciences, Cornell University , Ithaca, New York
| | | | | | | | | |
Collapse
|
87
|
Hill B, McPhie S, Moran LJ, Harrison P, Huang TTK, Teede H, Skouteris H. Lifestyle intervention to prevent obesity during pregnancy: Implications and recommendations for research and implementation. Midwifery 2016; 49:13-18. [PMID: 27756642 DOI: 10.1016/j.midw.2016.09.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/12/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
Maternal obesity and excessive gestational weight gain (GWG) are significant contributors to the global obesity epidemic. However, isolated lifestyle interventions to address this in pregnancy appear to have only modest benefit and responses can be variable. This paper aims to address the question of why the success of lifestyle interventions to prevent excessive GWG is suboptimal and variable. We suggest that there are inherent barriers to lifestyle change within pregnancy as a life stage, including the short window available for habit formation; the choice for women not to prioritise their weight; competing demands including physiological, financial, relationship, and social situations; and lack of self-efficacy among healthcare professionals on this topic. In order to address this problem, we propose that just like all successful public health approaches seeking to change behaviour, individual lifestyle interventions must be provided in the context of a supportive environment that enables, incentivises and rewards healthy changes. Future research should focus on a systems approach that integrates the needs of individuals with the context within which they exist. Borrowing from the social marketing principle of 'audience segmentation', we also need to truly understand the needs of individuals to design appropriately tailored interventions. This approach should also be applied to the preconception period for comprehensive prevention approaches. Additionally, relevant policy needs to reflect the changing evidence-based climate. Interventions in the clinical setting need to be integrally linked to multipronged obesity prevention efforts in the community, so that healthy weight goals are reinforced throughout the system.
Collapse
Affiliation(s)
- Briony Hill
- Deakin University, GEELONG, Australia, School of Psychology, Locked Bag 20000, Geelong, VIC 3220, Australia.
| | - Skye McPhie
- Deakin University, GEELONG, Australia, School of Psychology, Locked Bag 20000, Geelong, VIC 3220, Australia.
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Locked bag 29, Clayton 3168, Australia.
| | - Paul Harrison
- Deakin University, GEELONG, Australia, Deakin Business School, Locked Bag 20000, Geelong, VIC 3220, Australia.
| | - Terry T-K Huang
- Graduate School of Public Health and Health Policy, City University of New York, 55W. 125th Street, New York, NY 10027, United States.
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Locked bag 29, Clayton 3168, Australia.
| | - Helen Skouteris
- Deakin University, GEELONG, Australia, School of Psychology, Locked Bag 20000, Geelong, VIC 3220, Australia.
| |
Collapse
|
88
|
Craike M, Hill B, Gaskin CJ, Skouteris H. Interventions to improve physical activity during pregnancy: a systematic review on issues of internal and external validity using the RE-AIM framework. BJOG 2016; 124:573-583. [PMID: 27571933 DOI: 10.1111/1471-0528.14276] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Physical activity (PA) during pregnancy has significant health benefits for the mother and her child; however, many women reduce their activity levels during pregnancy and most are not sufficiently active. Given the important health benefits of PA during pregnancy, evidence that supports research translation is vital. OBJECTIVES To determine the extent to which physical activity interventions for pregnant women report on internal and external validity factors using the RE-AIM framework (reach, efficacy/effectiveness, adoption, implementation, and maintenance). SEARCH STRATEGY Ten databases were searched up to 1 June 2015. Eligible published papers and unpublished/grey literature were identified using relevant search terms. SELECTION CRITERIA Studies had to report on physical activity interventions during pregnancy, including measures of physical activity during pregnancy at baseline and at least one point post-intervention. Randomised controlled trials and quasi-experimental studies that had a comparator group were included. DATA COLLECTION AND ANALYSIS Reporting of RE-AIM dimensions were summarised and synthesised across studies. MAIN RESULTS The reach (72.1%) and efficacy/effectiveness (71.8%) dimensions were commonly reported; however, the implementation (28.9%) and adoption (23.2%) dimensions were less commonly reported and no studies reported on maintenance. CONCLUSIONS This review highlights the under-reporting of issues of contextual factors in studies of physical activity during pregnancy. The translation of physical activity interventions during pregnancy could be improved through reporting of representativeness of participants, clearer reporting of outcomes, more detail on the setting and staff who deliver interventions, costing of interventions and the inclusion of process evaluations and qualitative data. TWEETABLE ABSTRACT The systematic review highlights the under-reporting of contextual factors in studies of physical activity during pregnancy.
Collapse
Affiliation(s)
- M Craike
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Vic., Australia.,Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Geelong, Australia
| | - B Hill
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Geelong, Australia
| | - C J Gaskin
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Geelong, Australia
| | - H Skouteris
- Centre for Social and Early Emotional Development (SEED), School of Psychology, Deakin University, Geelong, Australia
| |
Collapse
|
89
|
Krukowski RA, West D, DiCarlo M, Shankar K, Cleves MA, Tedford E, Andres A. A Behavioral Intervention to Reduce Excessive Gestational Weight Gain. Matern Child Health J 2016; 21:485-491. [DOI: 10.1007/s10995-016-2127-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
90
|
Gainforth HL, West R, Michie S. Assessing Connections Between Behavior Change Theories Using Network Analysis. Ann Behav Med 2016; 49:754-61. [PMID: 26002108 DOI: 10.1007/s12160-015-9710-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A cross-disciplinary scoping review identified 83 of behavior change theories, with many similarities and overlapping constructs. Investigating the derivation of these theories may provide further understanding of their contribution and intended application. PURPOSE To develop and apply a method to describe the explicit derivation of theories of behavior change. METHODS A network analysis of the explicit "contributing to" relations between the 83 theories was conducted. Identification of relations involved textual analysis of primary theory sources. FINDINGS One hundred and twenty-two connections between the theories were identified amounting to 1.8% of the number possible. On average, theories contributed to one or two theories (mean = 1.47 ± 3.69 contributions) and were informed by one or two theories (mean = 1.47 ± 1.61 contributing theories). DISCUSSION Most behavior change theories appear to be explicitly informed by few prior theories. If confirmed, this suggests a considerable dislocation between generations of theories which would be expected to undermine scientific progress.
Collapse
Affiliation(s)
- Heather L Gainforth
- Research Department of Clinical, Educational and Health Psychology, Centre for Outcomes Research and Effectiveness (CORE), University College London, London, UK,
| | | | | |
Collapse
|
91
|
Can a health coaching intervention delivered during pregnancy help prevent excessive gestational weight gain? J Behav Med 2016; 39:793-803. [DOI: 10.1007/s10865-016-9743-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
|
92
|
Ranchod YK, Headen IE, Petito LC, Deardorff JK, Rehkopf DH, Abrams BF. Maternal Childhood Adversity, Prepregnancy Obesity, and Gestational Weight Gain. Am J Prev Med 2016; 50:463-469. [PMID: 26558699 PMCID: PMC4801674 DOI: 10.1016/j.amepre.2015.08.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/04/2015] [Accepted: 08/21/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Growing evidence suggests that exposure to childhood adversity may influence obesity across the life course. High maternal weight complicates pregnancy and increases the risk of child obesity. This study examined the association between maternal childhood adversity and pregnancy-related weight in a large U.S. METHODS Data on 6,199 pregnancies from 2,873 women followed from 1979 to 2012 by the National Longitudinal Survey of Youth 1979 were analyzed in 2014. Associations between three adversity exposures before age 18 years (history of physical abuse, alcohol problems, or mental illness in the household) and two maternal weight outcomes (prepregnancy obesity and excessive gestational weight gain) were modeled separately using survey-adjusted log-binomial models. RESULTS After adjusting for race/ethnicity and early-life socioeconomic factors, childhood physical abuse was associated with a 60% increase in the risk of prepregnancy obesity (adjusted risk ratio=1.6, 95% CI=1.1, 2.2). Household alcohol abuse was associated with a 30% increase in prepregnancy obesity (adjusted risk ratio=1.3, 95% CI=1.0, 1.7), as was household mental illness (adjusted risk ratio=1.3, 95% CI=0.8, 1.9), but the mental illness exposure was not significant. Physical abuse and household alcohol abuse were associated with a significant 20% increase in the risk of excessive gestational weight gain; mental illness was not. CONCLUSIONS Adversity in early life may affect maternal weight before and during pregnancy. Screening and treating women of reproductive age for childhood adversity and its negative effects could significantly reduce obesity-related health outcomes for women and their children.
Collapse
Affiliation(s)
- Yamini K Ranchod
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California; Center for Weight and Health, University of California, Berkeley, Berkeley, California
| | - Irene E Headen
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Lucia C Petito
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Julianna K Deardorff
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, Berkeley, California
| | - David H Rehkopf
- School of Medicine, Stanford University, Stanford, California
| | - Barbara F Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California; Center for Weight and Health, University of California, Berkeley, Berkeley, California.
| |
Collapse
|
93
|
McDonald SM, Liu J, Wilcox S, Lau EY, Archer E. Does dose matter in reducing gestational weight gain in exercise interventions? A systematic review of literature. J Sci Med Sport 2016; 19:323-35. [PMID: 25846125 PMCID: PMC4583795 DOI: 10.1016/j.jsams.2015.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 02/20/2015] [Accepted: 03/05/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The purpose of this review was to examine the relationship between exercise dose and reductions in weight gain during pregnancy in exercise interventions. DESIGN Systematic literature review. METHODS Four electronic research databases (PubMed, Web of Science, CINAHL, and Academic Search Premiere) were used to identify exercise interventions conducted with pregnant women. Eligible articles must have satisfied the following criteria: inclusion of a control condition, exercise as a major intervention component, weight gain measured and reported for each experimental condition, description of exercise dose (frequency, intensity and duration), and utilized an adequate number of control conditions to assess independent effects of exercise on weight gain. RESULTS The literature search identified 4837 articles. Of these, 174 abstracts were screened and 21 intervention studies (18 exercise-only, 3 exercise/diet) were eligible for review. Only 38% of the interventions achieved statistically significant reductions in gestational weight gain. Successful interventions possessed higher adherence and lower attrition rates and were predominantly conducted among normal weight populations. No clear patterns or consistencies of exercise dose and reductions in weight gain were evident. CONCLUSIONS An exercise dose associated with reductions in weight gain was unquantifiable among these interventions. Adherence and retention rates were strong contributors to the success of exercise interventions on gestational weight gain. It is strongly suggested that future researchers investigate methods to increase adherence and compliance, especially among overweight and obese women, and utilize objective measurement tools to accurately evaluate exercise dose performed by the participants and the impact on body composition and weight gain.
Collapse
Affiliation(s)
- Samantha M McDonald
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, United States.
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, University of South Carolina, United States
| | - Sara Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, United States
| | - Erica Y Lau
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, United States
| | - Edward Archer
- Office of Energetics, Nutrition Obesity Research Center, University of Alabama, United States
| |
Collapse
|
94
|
Food intake and gestational weight gain in Swedish women. SPRINGERPLUS 2016; 5:377. [PMID: 27066384 PMCID: PMC4811841 DOI: 10.1186/s40064-016-2015-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/16/2016] [Indexed: 12/02/2022]
Abstract
Background The objective of this study was to investigate if food intake (dairy, snacks, caloric beverages, bread, cheese, margarine/butter, potato/rice/pasta/grains, red meat, fish and fruit/berries/vegetables) is associated with gestational weight gain (GWG) in Swedish women. Methods Four day food records from 95 pregnant Swedish women were collected in the last trimester. GWG was calculated as weighed body weight in the last trimester (median gestational week 36) minus self-reported pre-pregnancy body weight. Excessive GWG was defined according to the guidelines by the Institute of Medicine. Food groups tested for association with GWG were dairy (milk, yoghurt and sour milk), snacks (sweets, crisps, popcorn, ice cream and cookies, but not nuts and seeds), caloric beverages (soft drinks, juice, lemonade and non-alcoholic beer), bread, cheese, margarine/butter, potato/rice/pasta/grains, red meat, fish and fruit/berries/vegetables. Results Median (lower–upper quartiles) GWG was 12.1 kg (10.0–15.3). In total, 28 % had an excessive GWG. Excessive GWG was most common among pre-pregnancy overweight and obese women, where 69 % had an excessive GWG. Median daily intake of fruits and vegetables was 352 g (212–453), caloric beverages was 238 g (100–420) and snacks was 111 g (69–115). Multivariable linear regression analysis showed that intake of caloric beverages, snacks, fish, bread and dairy in the last trimester of pregnancy were positively related to GWG (R2 = 0.32). Multivariable logistic regression analysis showed that intake of caloric beverages, snacks, fish, and bread was associated with higher odds ratios for excessive GWG. Conclusion Intake of caloric beverages, snacks, fish and bread were positively related to excessive GWG. Thus, these results indicate that maternal dietary intake should be given higher attention in the antenatal care.
Collapse
|
95
|
Lacroix M, Battista MC, Doyon M, Moreau J, Patenaude J, Guillemette L, Ménard J, Ardilouze JL, Perron P, Hivert MF. Higher maternal leptin levels at second trimester are associated with subsequent greater gestational weight gain in late pregnancy. BMC Pregnancy Childbirth 2016; 16:62. [PMID: 27004421 PMCID: PMC4802837 DOI: 10.1186/s12884-016-0842-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 03/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) is associated with adverse pregnancy outcomes. In non-pregnant populations, low leptin levels stimulate positive energy balance. In pregnancy, both the placenta and adipose tissue contribute to circulating leptin levels. We tested whether maternal leptin levels are associated with subsequent GWG and whether this association varies depending on stage of pregnancy and on maternal body mass index (BMI). METHODS This prospective cohort study included 675 pregnant women followed from 1(st) trimester until delivery. We collected anthropometric measurements, blood samples at 1(st) and 2(nd) trimester, and clinical data until delivery. Maternal leptin was measured by ELISA (Luminex technology). We classified women by BMI measured at 1(st) trimester: BMI < 25 kg/m(2) = normal weight; 25 ≤ BMI < 30 kg/m(2) = overweight; and BMI ≥ 30 kg/m(2) = obese. RESULTS Women gained a mean of 6.7 ± 3.0 kg between 1(st) and 2(nd) trimester (mid pregnancy GWG) and 5.6 ± 2.5 kg between 2(nd) and the end of 3(rd) trimester (late pregnancy GWG). Higher 1(st) trimester leptin levels were associated with lower mid pregnancy GWG, but the association was no longer significant after adjusting for % body fat (%BF; β = 0.38 kg per log-leptin; SE = 0.52; P = 0.46). Higher 2(nd) trimester leptin levels were associated with greater late pregnancy GWG and this association remained significant after adjustment for BMI (β = 2.35; SE = 0.41; P < 0.0001) or %BF (β = 2.01; SE = 0.42; P < 0.0001). In BMI stratified analyses, higher 2(nd) trimester leptin levels were associated with greater late pregnancy GWG in normal weight women (β = 1.33; SE = 0.42; P =0.002), and this association was stronger in overweight women (β = 2.85; SE = 0.94; P = 0.003--P for interaction = 0.05). CONCLUSIONS Our results suggest that leptin may regulate weight gain differentially at 1(st) versus 2(nd) trimester of pregnancy: at 2(nd) trimester, higher leptin levels were associated with greater subsequent weight gain--the opposite of its physiologic regulation in non-pregnancy--and this association was stronger in overweight women. We suspect the existence of a feed-forward signal from leptin in second half of pregnancy, stimulating a positive energy balance and leading to greater weight gain.
Collapse
Affiliation(s)
- Marilyn Lacroix
- Department of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada
| | - Marie-Claude Battista
- Department of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada
| | - Myriam Doyon
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12th Avenue North, wing 9, door 6, Sherbrooke, Québec, Canada
| | - Julie Moreau
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12th Avenue North, wing 9, door 6, Sherbrooke, Québec, Canada
| | - Julie Patenaude
- Department of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada
| | - Laetitia Guillemette
- Department of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada
| | - Julie Ménard
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12th Avenue North, wing 9, door 6, Sherbrooke, Québec, Canada
| | - Jean-Luc Ardilouze
- Department of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada.,Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12th Avenue North, wing 9, door 6, Sherbrooke, Québec, Canada
| | - Patrice Perron
- Department of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada.,Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12th Avenue North, wing 9, door 6, Sherbrooke, Québec, Canada
| | - Marie-France Hivert
- Department of Medicine, Université de Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada. .,Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12th Avenue North, wing 9, door 6, Sherbrooke, Québec, Canada. .,Diabetes Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA, USA. .,Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, suite 401, Boston, MA, USA.
| |
Collapse
|
96
|
Soltani H, Arden MA, Duxbury AMS, Fair FJ. An Analysis of Behaviour Change Techniques Used in a Sample of Gestational Weight Management Trials. J Pregnancy 2016; 2016:1085916. [PMID: 27034836 PMCID: PMC4789468 DOI: 10.1155/2016/1085916] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/03/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Maternal obesity and excessive gestational weight gain are associated with multiple adverse outcomes. There is a lack of clarity on the specific components of effective interventions to support pregnant women with gestational weight management. METHOD All 44 studies within a preexisting review of lifestyle interventions, with a potential to impact on maternal weight outcomes, were considered for content analysis. Interventions were classified using Behaviour Change Technique (BCT) taxonomy clusters to explore which categories of BCT were used in interventions and their effectiveness in managing gestational weight gain. RESULTS The most commonly used BCTs were within the categories of "feedback and monitoring," "shaping knowledge," "goals and planning," "repetition and substitution," "antecedents," and "comparison of behaviours." For diet and mixed interventions "feedback and monitoring," "shaping knowledge," and "goals and planning" appeared the most successful BCT categories. CONCLUSIONS Poor reporting within studies in defining the BCTs used, in clarifying the differences in processes between intervention and control groups, and in differentiating between the intervention and research processes made BCT classification difficult. Future studies should elaborate more clearly on the behaviour change techniques used and report them accurately to allow a better understanding of the effective ingredients for lifestyle interventions during pregnancy.
Collapse
Affiliation(s)
- H. Soltani
- Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent, Sheffield S10 2BP, UK
| | - M. A. Arden
- Department of Psychology, Sociology & Politics, Sheffield Hallam University, Heart of the Campus, Collegiate Crescent, Sheffield S10 2BQ, UK
| | - A. M. S. Duxbury
- Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent, Sheffield S10 2BP, UK
| | - F. J. Fair
- Centre for Health and Social Care Research, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent, Sheffield S10 2BP, UK
| |
Collapse
|
97
|
Daley AJ, Jolly K, Jebb SA, Roalfe AK, Mackillop L, Lewis AL, Clifford S, Kenyon S, MacArthur C, Aveyard P. Effectiveness of regular weighing, weight target setting and feedback by community midwives within routine antenatal care in preventing excessive gestational weight gain: randomised controlled trial. BMC OBESITY 2016; 3:7. [PMID: 26885375 PMCID: PMC4743115 DOI: 10.1186/s40608-016-0086-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
Background Many pregnant women gain excess weight during pregnancy which increases the health risks to the mother and her baby. Interventions to prevent excess weight gain need to be given to the whole population to prevent excess weight gain. The aim of this study was to assess the effectiveness of a simple and brief intervention embedded withinroutine antenatal care to prevent excessive gestation weight gain. Methods Six hundred and ten pregnant women (between 10-14 weeks gestation), aged ≥18 years with a body mass index (BMI) ≥18.5 kg/m2, planned to receive community midwife led care or shared care at the time of recruitment are eligible to take part in the study. Women will be recruited from four maternity centres in England. Community midwives complete a short training module before delivering the intervention. In the intervention, midwives weigh women, set maximum weight limits for weight gain at each antenatal appointment and ask women to monitor their weight at home. Themaximum weight limit is adjusted by the midwife at each antenatal appointment if women have exceeded their maximum weight gain limit set at their previous appointment. The intervention will be compared with usual antenatal care. The primary outcome is the proportion of women per group who exceed the Institute of Medicine guidelines for gestational weight gain at 38 weeks of pregnancy according to their early pregnancy BMI category. Discussion The proposed trial will test a brief intervention comprising regular weighing, target setting and monitoring ofweight during pregnancy that can be delivered at scale as part of routine antenatal care. Using the professional expertise of community midwives, but without specialist training in weight management, the intervention will incur minimal additionalhealthcare costs, and if effective at reducing excess weight gain, is likely to be very cost effective. Trial registration Current controlled trials ISRCTN67427351. Date assigned 29/10/2014.
Collapse
Affiliation(s)
- Amanda J Daley
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - K Jolly
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - A K Roalfe
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - L Mackillop
- Women's Centre, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
| | - A L Lewis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - S Clifford
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - S Kenyon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - C MacArthur
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| |
Collapse
|
98
|
Boghossian NS, Orekoya O, Liu J, Liu J. Pregnancy Interventions or Behaviors and Cardiometabolic Biomarkers: a Systematic Review. CURR EPIDEMIOL REP 2016. [DOI: 10.1007/s40471-016-0061-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
99
|
O'Brien CM, Grivell RM, Dodd JM. Systematic review of antenatal dietary and lifestyle interventions in women with a normal body mass index. Acta Obstet Gynecol Scand 2016; 95:259-69. [PMID: 26610169 DOI: 10.1111/aogs.12829] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/11/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Women who commence pregnancy with a normal body mass index (BMI) are at the greatest risk of excessive gestational weight gain, impacting on infant birthweight, pregnancy-related complications and postpartum weight retention. Our aim was to review systematically the effect of antenatal dietary and lifestyle interventions in pregnant women with a normal BMI on maternal and infant outcomes. MATERIAL AND METHODS We searched the Cochrane Controlled Trials Register, PubMed, Medline, and the Australian and International Clinical Trials Registry with the date of the last search in July 2015. We included all published, unpublished and ongoing randomized trials recruiting women of a normal BMI, comparing dietary and/or lifestyle interventions with standard antenatal care. RESULTS Twelve randomized controlled trials were identified, involving a total of 2713 pregnant women, with five studies reporting clinical data for 714 women with a normal BMI. Women who received a dietary and lifestyle intervention were less likely to experience gestational weight gain [four studies, 446 women; mean difference -1.25 kg; 95% confidence interval (CI) -2.39 to -0.11], weight gain above the Institute of Medicine guidelines (four studies, 446 women; risk ratio 0.66; 95% CI 0.53-0.83) and hypertension (two studies; 243 women; risk ratio 0.34; 95% CI 0.13-0.91). There were no statistically significant differences in the occurrence of gestational diabetes, cesarean section or birthweight greater than 4 kg. CONCLUSIONS While providing an antenatal dietary and lifestyle intervention for pregnant women of normal BMI appears to reduce gestational weight gain, the review was limited by the relatively small available sample size. Further well-designed randomized controlled trials are required.
Collapse
Affiliation(s)
- Cecelia M O'Brien
- School of Paediatrics and Reproductive Health, and Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Department of Perinatal Medicine, Women's and Babies' Division, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Rosalie M Grivell
- School of Paediatrics and Reproductive Health, and Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Department of Perinatal Medicine, Women's and Babies' Division, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Jodie M Dodd
- School of Paediatrics and Reproductive Health, and Robinson Research Institute, University of Adelaide, North Adelaide, South Australia, Australia.,Department of Perinatal Medicine, Women's and Babies' Division, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| |
Collapse
|
100
|
Samura T, Steer J, Michelis LD, Carroll L, Holland E, Perkins R. Factors Associated With Excessive Gestational Weight Gain: Review of Current Literature. Glob Adv Health Med 2016; 5:87-93. [PMID: 26937318 PMCID: PMC4756783 DOI: 10.7453/gahmj.2015.094] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Excessive gestational weight gain (EGWG) places women at increased risk for complications during pregnancy and also increases the likelihood that they will remain overweight after pregnancy. The Institute of Medicine (IOM) has recommended weight gain guidelines based on pre-pregnancy body mass index (BMI), but evidence-based strategies to achieve these goals are limited. Objective: This review discusses factors associated with EGWG with the goal of identifying targets for future intervention. Methods: A search was performed using the PubMed database to identify all English-language papers published between 1995 and 2014 related to excessive weight gain in pregnancy. Papers were grouped by theme: preconception BMI, sociodemographics, diet and exercise, psychosocial characteristics, and type of prenatal care. Results: Studies found that women who were overweight or obese at the time of conception were at higher risk of EGWG and that increased physical activity protected against EGWG. Studies on diet and sociodemographic characteristics were inconclusive. Psychological factors, specifically accurate perceptions of BMI, also appear to play a role in EGWG. Limited studies on methods of prenatal care delivery did not show improvement of weight parameters with group compared to one-on-one visits. Conclusion: Pre-pregnancy BMI is most strongly associated with EGWG, indicating that healthy weight habits throughout adult life may be especially important in periods of expected weight change, such as pregnancy. To decrease EGWG, providers should focus on improving pre-conception BMI through appropriate counseling on healthy eating and increased physical activity as well as encouraging pregnant women to continue moderate exercise during pregnancy when appropriate.
Collapse
Affiliation(s)
- Tirah Samura
- Department of Obstetrics and Gynecology, Boston Medical Center, Massachusetts, United States
| | - Jonathan Steer
- Department of Obstetrics and Gynecology, Boston Medical Center, Massachusetts, United States
| | - L Daniela Michelis
- Department of Obstetrics and Gynecology, Boston Medical Center, Massachusetts, United States
| | - Lisa Carroll
- Department of Obstetrics and Gynecology, Boston Medical Center, Massachusetts, United States
| | - Erica Holland
- Department of Obstetrics and Gynecology, Boston Medical Center, Massachusetts, United States
| | - Rebecca Perkins
- Department of Obstetrics and Gynecology, Boston Medical Center, Massachusetts, United States
| |
Collapse
|