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Mohammadian F, Delavar MA, Behmanesh F, Azizi A, Esmaeilzadeh S. The impact of health coaching on the prevention of gestational diabetes in overweight/obese pregnant women: a quasi-experimental study. BMC Womens Health 2023; 23:619. [PMID: 37990232 PMCID: PMC10664614 DOI: 10.1186/s12905-023-02750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated that excessive gestational weight gain (GWG) increases the risk of gestational diabetes mellitus (GDM). This study aimed to determine the effect of using health coaching on the prevention of GDM in overweight pregnant women. METHODS In this quasi-experimental study, 64 eligible overweight women at 12-14 gestational weeks were randomly divided into 2 groups: the coaching group and the control group (usual care group). The intervention group received 8 weeks of the phone coaching program, which integrated GWG and physical activity to reduce the incidence of GDM. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess physical activity during pregnancy. The occurrence of gestational diabetes was determined based on the 75-g 2-hour oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. The primary outcome was the incidence of GDM, and the secondary outcomes included physical activity, GWG, and neonatal and maternal birth outcomes. RESULTS The incidence of GDM in the control and intervention groups was 24.1% and 22.6%, respectively. The relative risk (RR) was 0.93 (95% CI, 0.37-2.34; P = 0.887). The post survey results indicated that GWG decreased more considerably in the coaching than in the control group between pre-trial (T0) and post-trial (T1), (MD; -2.49 with 95% CI, -4.38 to -0.60; P < 0.011). Moreover, the total GWG (between pre-pregnancy and birth) diminished more remarkably in the coaching than in the control group, (MD; -2.83 with 95% CI, -5.08 to -0.58; P < 0.014). However, the score of self-efficacy and concern about PPAQ Metabolic Equivalent of Task (METs) did not differ between the coaching and control groups. CONCLUSIONS The findings and implications of this research could significantly contribute to maternal health and gestational diabetes prevention. Additional support from a midwife coach resulted in better GWG. More studies are needed to assess the impact of health coaching as a component of usual care and its long-term effect on maternal and neonatal outcomes.
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Affiliation(s)
- Fateme Mohammadian
- Department of Midwifery Counseling, School of Nursing and Midwifery, Fateme Mohammadian, Babol University of Medical Sciences, Babol, Iran
| | - Mouloud Agajani Delavar
- Department of Midwifery, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran.
- Infertility and Reproductive Health, Research Center of Babol, University of Medical Sciences, Babol-Amol old highway, after Mohammad hasan Khan bridge, Po. Box: 47135-547, Babol, Mazandaran, Iran.
| | - Fereshteh Behmanesh
- Department of Midwifery, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran
| | - Alireza Azizi
- Department of Psychiatry, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Sedighe Esmaeilzadeh
- Department of Obstetrics and Gynecologist, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Science, Babol, Iran
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Sato Y, Yoshioka E, Saijo Y, Miyamoto T, Sengoku K, Azuma H, Tanahashi Y, Ito Y, Kobayashi S, Minatoya M, Bamai YA, Yamazaki K, Itoh S, Miyashita C, Araki A, Kishi R. Population Attributable Fractions of Modifiable Risk Factors for Nonsyndromic Orofacial Clefts: A Prospective Cohort Study From the Japan Environment and Children's Study. J Epidemiol 2020; 31:272-279. [PMID: 32336698 PMCID: PMC7940975 DOI: 10.2188/jea.je20190347] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Population impact of modifiable risk factors on orofacial clefts is still unknown. This study aimed to estimate population attributable fractions (PAFs) of modifiable risk factors for nonsyndromic cleft lip with or without cleft palate (CL±P) and cleft palate only (CP) in Japan. Methods We conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant women from 2011 to 2014. We estimated the PAFs of maternal alcohol consumption, psychological distress, maternal active and passive smoking, abnormal body mass index (BMI) (<18.5 and ≥25 kg/m2), and non-use of a folic acid supplement during pregnancy for nonsyndromic CL±P and CP in babies. Results A total of 94,174 pairs of pregnant women and their single babies were included. Among them, there were 146 nonsyndromic CL±P cases and 41 nonsyndromic CP cases. The combined adjusted PAF for CL±P of the modifiable risk factors excluding maternal alcohol consumption was 34.3%. Only maternal alcohol consumption was not associated with CL±P risk. The adjusted PAFs for CL±P of psychological distress, maternal active and passive smoking, abnormal BMI, and non-use of a folic acid supplement were 1.4% (95% confidence interval [CI], −10.7 to 15.1%), 9.9% (95% CI, −7.0 to 26.9%), 10.8% (95% CI, −9.9 to 30.3%), 2.4% (95% CI, −7.5 to 14.0%), and 15.1% (95% CI, −17.8 to 41.0%), respectively. We could not obtain PAFs for CP due to the small sample size. Conclusions We reported the population impact of the modifiable risk factors on CL±P, but not CP. This study might be useful in planning the primary prevention of CL±P.
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Affiliation(s)
- Yukihiro Sato
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | - Eiji Yoshioka
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | - Yasuaki Saijo
- Division of Public Health and Epidemiology, Department of Social Medicine, Asahikawa Medical University
| | | | - Kazuo Sengoku
- Department of Obstetrics and Gynecology, Asahikawa Medical University
| | - Hiroshi Azuma
- Department of Pediatrics, Asahikawa Medical University
| | | | - Yoshiya Ito
- Faculty of Nursing, Japanese Red Cross Hokkaido College of Nursing
| | | | | | - Yu Ait Bamai
- Center for Environmental and Health Sciences, Hokkaido University
| | - Keiko Yamazaki
- Center for Environmental and Health Sciences, Hokkaido University
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University
| | | | - Atsuko Araki
- Center for Environmental and Health Sciences, Hokkaido University
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University
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Zinsser LA, Stoll K, Wieber F, Pehlke-Milde J, Gross MM. Changing behaviour in pregnant women: A scoping review. Midwifery 2020; 85:102680. [PMID: 32151875 DOI: 10.1016/j.midw.2020.102680] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Behaviour change programmes (BCPs) for pregnant women are frequently implemented as part of health promotion initiatives. At present, little is known about the types of behaviour change programmes that are being implemented and whether these programmes are designed and delivered in accordance with the principles of high quality maternity care. In this scoping review, we provide an overview of existing interventions related to behaviour change in pregnancy with a particular emphasis on programmes that include empowerment components to promote autonomy and woman-led decision-making. METHODS A systematic search strategy was applied to check for relevant papers in August 2017 and again in October 2018. RESULTS Thirty studies met the criteria for inclusion. These studies addressed weight management, smoking cessation, general health education, nutrition, physical activity, alcohol consumption and dental health. The main approach was knowledge gain through education. More than half of the studies (n = 17) included three or more aspects of empowerment as part of the intervention. The main aspect used to foster women`s empowerment was skills and competencies. In nine studies midwives were involved, but not as programme leaders. CONCLUSIONS Education for knowledge gain was found to be the prevailing approach in behaviour change programmes. Empowerment aspects were not a specific focus of the behaviour change programmes. This review draws attention to the need to design interventions that empower women, which may be beneficial through their live. As midwives provide maternal healthcare worldwide, they are well-suited to develop, manage, implement or assist in BCPs.
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Affiliation(s)
- Laura A Zinsser
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
| | - Kathrin Stoll
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover 30625, Germany; University of British Columbia, Division of Midwifery, Faculty of Medicine, 5950 University Boulevard, Vancouver BC V6T 1Z3, Canada.
| | - Frank Wieber
- Zurich University of Applied Sciences, School of Health Professions, Technikumstrasse 81, Winterthur 8400, Switzerland; University of Konstanz, Department of Psychology, Universitätsstr. 10, Konstanz 78457, Germany.
| | - Jessica Pehlke-Milde
- Zurich University of Applied Sciences, School of Health Professions, Technikumstrasse 81, Winterthur 8400, Switzerland.
| | - Mechthild M Gross
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
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Eichler J, Schmidt R, Hiemisch A, Kiess W, Hilbert A. Gestational weight gain, physical activity, sleep problems, substance use, and food intake as proximal risk factors of stress and depressive symptoms during pregnancy. BMC Pregnancy Childbirth 2019; 19:175. [PMID: 31101019 PMCID: PMC6525385 DOI: 10.1186/s12884-019-2328-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 05/03/2019] [Indexed: 12/23/2022] Open
Abstract
Background Because maternal depressive symptoms and stress during pregnancy are strongly associated with poor health of the mother and the developing child, understanding the predictors of women’s mental health problems is important to prevent complications in the perinatal period. Therefore, this study sought to examine the association between six risk factors – gestational weight gain (GWG), low physical activity, sleep problems, alcohol use, cigarette smoking and snack food intake – and mental health problems during pregnancy. We hypothesized that risk factors would predict mental health problems while adjusting for socio-demographic characteristics and pregnancy intention, both cross-sectionally and longitudinally. Methods Hierarchical linear regression analyses were conducted in a population-based sample of N = 463 pregnant women during their 2nd trimester (gestational age: 23 to 28 weeks) of whom n = 349 were reassessed during their 3rd trimester (gestational age: 33 to 38 weeks). Women had a mean age of 29.8 ± 4.2 years and a mean pregravid body mass index of 23.5 ± 4.3 kg/m2. Data were collected by the ‘Leipzig Research Center for Civilization Diseases’ via the Patient Health Questionnaire, Pittsburgh Sleep Quality Index, Food Frequency Questionnaire, self-report items on physical activity and substance use, and objectively measured anthropometrics. Results Cross-sectionally, while a higher snack food intake and sleep problems predicted depressive symptoms and stress during the 2nd trimester, gestational weight gain predicted stress only. Longitudinally, sleep problems positively predicted depressive symptoms during the 3rd trimester. All results remained significant after controlling for age, pregravid body mass index, and pregnancy intention. GWG and significant longitudinal effects became insignificant when controlling for gestational age or baseline depressive symptoms and stress, respectively. Conclusions The results showed that sleep problems were associated with maternal mental health problems during pregnancy. Longitudinal studies using standardized measures, particularly diagnostic interviews and physiological or biochemical markers, are warranted to confirm patterns of risk factors, their association with depressive symptoms and stress during the course of pregnancy, and their effects on mother’s and child’s health. Electronic supplementary material The online version of this article (10.1186/s12884-019-2328-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janina Eichler
- Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.
| | - Ricarda Schmidt
- Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE Child Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research (CPL), University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Wieland Kiess
- LIFE Child Leipzig Research Center for Civilization Diseases, University of Leipzig, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany.,Department of Women and Child Health, Hospital for Children and Adolescents and Centre for Paediatric Research (CPL), University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Medical Psychology and Medical Sociology, Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Philipp-Rosenthal-Strasse 27, 04103, Leipzig, Germany
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Blau LE, Orloff NC, Flammer A, Slatch C, Hormes JM. Food craving frequency mediates the relationship between emotional eating and excess weight gain in pregnancy. Eat Behav 2018; 31:120-124. [PMID: 30253292 DOI: 10.1016/j.eatbeh.2018.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 08/20/2018] [Accepted: 09/14/2018] [Indexed: 11/28/2022]
Abstract
An estimated 50% of pregnancies in the U.S. are associated with maternal weight gain that exceeds Institute of Medicine recommendations. The numerous adverse consequences of obesity in gestation, delivery and the postpartum have been widely documented. The role of excess gestational weight gain (GWG) as a predictor of lifetime obesity risk in mothers and their children is also increasingly recognized. Cravings and negative affect are commonly cited triggers of overconsumption in pregnant women. We sought to examine the role of food craving frequency as a mediator in the relation between emotional eating and excess GWG. In this cross-sectional study, pregnant women (n = 113) completed the Dutch Eating Behavior Questionnaire, a measure of "restrained," "emotional," and "external" eating styles, along with the Food Craving Inventory, which quantifies cravings for "high fat foods," "fast food fats," "carbohydrates/starches," and "sweets." Participants also reported on pre-pregnancy weight and height, and GWG at the time of survey completion. Data supported the hypothesized mediation model, with frequency of "high fat foods" cravings fully mediating the relationship between "emotional" eating and excess GWG (Sobel test z = 2.40, p = .016). This study addresses the striking dearth of research examining potentially modifiable psychosocial predictors of excess GWG. Future longitudinal research should examine if salient affective states trigger food cravings, thus placing pregnant women at increased risk of excess weight gain. Findings have implications for treatment interventions targeting excess GWG, suggesting a need to teach skills to help patients better manage low moods and cravings.
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Affiliation(s)
- Lauren E Blau
- University at Albany, State University of New York, United States of America.
| | - Natalia C Orloff
- University at Albany, State University of New York, United States of America
| | - Amy Flammer
- Albany Medical College, United States of America
| | | | - Julia M Hormes
- University at Albany, State University of New York, United States of America; Albany Medical College, United States of America
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The Associations of Weight Status and Body Attitudes with Depressive and Anxiety Symptoms Across the First Year Postpartum. Womens Health Issues 2018; 28:530-538. [DOI: 10.1016/j.whi.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 06/29/2018] [Accepted: 07/11/2018] [Indexed: 11/18/2022]
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Lau Y, Klainin-Yobas P, Htun TP, Wong SN, Tan KL, Ho-Lim ST, Chi C, Tsai C, Ong KW, Shorey S, Tam WSW. Electronic-based lifestyle interventions in overweight or obese perinatal women: a systematic review and meta-analysis. Obes Rev 2017; 18:1071-1087. [PMID: 28544551 DOI: 10.1111/obr.12557] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 12/30/2022]
Abstract
Electronic-based (e-based) lifestyle interventions provide potential and cost-effective delivery of remote interventions for overweight and obese perinatal women. To date, no meta-analysis has reported the efficacy of maternal and neonatal outcomes. Seven electronic databases were searched from inception up to July 13, 2016, including the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EMBASE, ProQuest Dissertations and Theses, PsycINFO, PubMed and Scopus. Among the 1,145 studies retrieved, 14 randomized controlled trials were selected among 17 publications. The Cochrane risk of bias tool was used to appraise the quality assessment. The meta-analyses demonstrated a significant result for limiting gestational weight gain, losing postnatal weight in 1-2 months, increasing self-reported moderate and vigorous physical activity and reducing caloric intake using diet-related software. Our review shows that an e-based lifestyle intervention is an acceptable approach. The findings reveal the variability in intervention methods and provide limited conclusive evidence. Thus, future studies should examine the efficacy and essential components as well as the various approaches using optimal portions of in-person and phone sessions. Further evaluations comparing the effectiveness of different e-based lifestyle intervention approaches toward activity-related and diet-related outcomes are necessary.
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Affiliation(s)
- Y Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P Klainin-Yobas
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - T P Htun
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S N Wong
- Medical Resource Team, National University of Singapore Libraries, National University of Singapore, Singapore
| | - K L Tan
- Department of Computer Science, National University of Singapore, Singapore
| | - S T Ho-Lim
- Department of Nursing, National University Hospital, Singapore
| | - C Chi
- Department of Obstetrics and Gynecology, National University Hospital, Singapore
| | - C Tsai
- Department of Rehabilitation, National University Hospital, Singapore
| | - K W Ong
- Dietetics, National University Hospital, Singapore
| | - S Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - W S W Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Liu YQ, Liu Y, Hua Y, Chen XL. Effect of diet and exercise intervention in Chinese pregnant women on gestational weight gain and perinatal outcomes: A quasi-experimental study. Appl Nurs Res 2017; 36:50-56. [PMID: 28720239 DOI: 10.1016/j.apnr.2017.05.001] [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] [Received: 11/20/2016] [Revised: 03/21/2017] [Accepted: 05/20/2017] [Indexed: 01/23/2023]
Abstract
Aim To determine the effect of a diet and exercise intervention in pregnant women on total gestational weight gain, weekly weight gain, 42-days postpartum weight retention, mode of delivery, and infant birth weight. METHODS One hundred and one eligible Chinese pregnant women whose pre-pregnancy body mass index ranged from 18.5 to 24.9 were recruited between June 2013 and June 2014 from a tertiary hospital. Ninety participants, 45 in each group, completed the study. Intervention women received three face-to-face interventions and three follow-up phone calls which were developed based on the Transtheoretical Model. Gestational weight was measured at each prenatal check. Mode of delivery and infant birth weight were collected from the medical record. The 42-days postpartum weight was measured during the postpartum visits. RESULTS (1) The total gestational weight gain and mean weight gain per week in the intervention group were significantly less than the control group (P=0.045 and P=0.008 respectively). (2) Infant birth weight was significantly lower in the intervention group (P=0.012). (3) Postpartum weight retention was significantly less in the intervention group (P=0.001). 4) There were not significant differences in mode of delivery. 5) Infant birth weight was significantly less than the control group (P=0.012). CONCLUSIONS The lifestyle intervention significantly reduced gestational weight gain, optimized infant weight and lowered postpartum weight retention. Promotion of gestational weight management is needed and cultural health beliefs about pregnancy and postpartum practices should be considered when developing the intervention plan.
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Affiliation(s)
- Yan Qun Liu
- Wuhan University School of Health Sciences, Wuhan University HOPE School of Nursing, 115 Donghu Road, Wuchang, Wuhan, Hubei Province, China.
| | - Yun Liu
- Wuhan University School of Health Sciences, Wuhan University HOPE School of Nursing, 115 Donghu Road, Wuchang, Wuhan, Hubei Province, China.
| | - Yun Hua
- Wuhan Women and Children Medical Care Center, 100 Xianggang Road, Hankou, Wuhan, Hubei Province, China.
| | - Xiao Li Chen
- Wuhan University School of Health Sciences, Wuhan University HOPE School of Nursing, 115 Donghu Road, Wuchang, Wuhan, Hubei Province, China.
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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.
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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.
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