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Walker LO, Kang S, Longoria KD. Systematic Review of Health Promotion Frameworks Focused on Health in the Postpartum Period. J Obstet Gynecol Neonatal Nurs 2022; 51:477-490. [PMID: 35753368 DOI: 10.1016/j.jogn.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE To systematically review the scope and development of frameworks to promote health during the postpartum period. DATA SOURCES We searched PubMed, CINAHL, and American Psychological Association PsycInfo during May 2021. STUDY SELECTION We included English-language, peer-reviewed articles focused on frameworks for health promotion in the postpartum period. We placed no time limit on publication date. Our search resulted in 2,355 articles after we removed duplicates. After excluding articles based on titles and abstracts, we conducted full-text reviews of 23 articles. Three articles met inclusion criteria and addressed the following frameworks: Integrated Perinatal Health Framework, Perinatal Maternal Health Promotion Model, and Maternal Self-Care Framework. DATA EXTRACTION We extracted data into analytic tables that included categories for the scope, such as time frame, and criteria for the level of development of the frameworks, including the origins, concept definitions and theoretical linkages among concepts, and evidence of application in research or practice. DATA SYNTHESIS The three frameworks described in the articles included in our review covered various periods, including the reproductive life span, the first year after birth, and the first 6 weeks after birth. Overall, the frameworks were comprehensive. Most key concepts in the frameworks were defined, and some degree of relationships linking concepts was specified. Empirical referents were provided for most but not all concepts in the frameworks. Developers of the three frameworks elaborated on application in practice or health services, but only the developers of the Maternal Self-Care Framework indicated how their framework might be used in research. The Integrated Perinatal Health Framework and Maternal Self-Care Framework were partially derived from existing general theories; the methods used to develop the Perinatal Maternal Health Promotion Model were less clear. CONCLUSION The frameworks met most criteria and together provided a comprehensive strategy for health promotion during the postpartum period. Elaboration of the frameworks for application in research is needed.
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'There's Just Something Really Peaceful About It': a Qualitative Exploration of Mothers with Young Children and Engagement in Group-Based Physical Activity Programs. Int J Behav Med 2022; 29:807-819. [PMID: 35175540 PMCID: PMC8853414 DOI: 10.1007/s12529-022-10062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/15/2022]
Abstract
Background Many mothers with young children often do not achieve recommendations of at least 150-min moderate-to-vigorous physical activity (MVPA) each week. Previous qualitative work has generally focused on getting inactive mothers with young children to be active, so the characteristics of women who are active during early postpartum period are not well understood. This research set out to capture the characteristics of mothers with young children who engage in MVPA and how these women manage barriers and harness enablers to sustain in engagement in physical activity (PA) over an extended period. Method Thirty-two participants ranging in age from 27 to 42 years (35.2 ± 4.8), with age of their youngest child ranging from 6 weeks old to 5 years, participated in semi-structured interviews. Results Inductive thematic analysis revealed three overarching themes and fourteen sub-themes relating to the characteristics of active mothers with young children and the engagement and maintenance factors that recruit and sustain these women in group-based physical activity programs. Specifically, mothers with young children relish a welcoming and supportive environment that accommodates babies and young children, is affordable and convenient, focuses on building strength and functionality, and is non-judgmental. Conclusion These findings advance knowledge by providing considerations and recommendations that support intervention and program designers to be able to develop group-based physical activity programs for mothers with young children.
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Carr RM, Quested E, Stenling A, Thøgersen-Ntoumani C, Prestwich A, Gucciardi DF, McVeigh J, Ntoumanis N. Postnatal Exercise Partners Study (PEEPS): a pilot randomized trial of a dyadic physical activity intervention for postpartum mothers and a significant other. Health Psychol Behav Med 2021; 9:251-284. [PMID: 34104560 PMCID: PMC8158286 DOI: 10.1080/21642850.2021.1902815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: Research suggests dyadic interventions can increase physical activity; such interventions are untested within postpartum parent couples. Methods: A three-armed pilot randomized trial addressed this gap and tested which type of dyadic intervention is most effective. Inactive postpartum mothers and a significant other were recruited in Australia (n = 143 assessed for eligibility) and randomised in a single-blinded fashion (i.e. participants were blinded) to 1 of 3 dyadic conditions involving a single face-to-face session with access to web-based group support: a minimal treatment control (n = 34), collaborative planning group (n = 38), or collaborative planning + need supportive communication group (n = 30). Participants were asked to wear their accelerometers for 8 days and completed self-report measures at baseline, end of intervention (week 4), and follow-up (week 12). We expected dyads in the collaborative planning + need supportive communication group would have the greatest increases in Physical Activity (PA), autonomous motivation, and partners' need supportive behaviours; and decreases in controlled motivation and controlling partner behaviours. Results: Results from 51 dyads using Bayesian actor-partner interdependence models provided some evidence for a small positive effect on total PA at follow-up for postpartum mothers in the collaborative planning group and for partners in the collaborative planning + need supportive communication group. Furthermore, partners in the collaborative planning + need supportive communication group were more likely to engage in some vigorous PA. At follow-up, postpartum mothers in the collaborative planning + need supportive communication group scored lower on personal autonomous reasons. Conclusions: The impact of prior specification mean intervention effects need to be interpreted with caution. Progression to a full trial is warranted.
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Affiliation(s)
- Rachel Margaret Carr
- School of Psychology, Curtin University, Perth, Australia.,Department of Health Sciences, University of York, York, UK.,Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
| | - Eleanor Quested
- School of Psychology, Curtin University, Perth, Australia.,Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
| | | | - Cecilie Thøgersen-Ntoumani
- School of Psychology, Curtin University, Perth, Australia.,Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
| | | | - Daniel Frank Gucciardi
- School of Psychology, Curtin University, Perth, Australia.,Physical Activity and Well-being Research Group, Curtin University, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Joanne McVeigh
- School of Psychology, Curtin University, Perth, Australia.,School of Occupational Therapy, Speech Therapy and Social Work, Curtin University, Perth, Australia
| | - Nikos Ntoumanis
- School of Psychology, Curtin University, Perth, Australia.,Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
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Kogutt BK, Szymanski LM. Diabesity and Pregnancy: How Do We Get Our Patients Moving? Clin Obstet Gynecol 2021; 64:185-195. [PMID: 33284141 DOI: 10.1097/grf.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obesity and diabetes are 2 commonly encountered complications in pregnancy that adversely affect pregnancy outcomes, maternal health, and the health of the offspring, both short-term and long-term. It is well established that physical activity provides numerous health benefits, both during and outside of pregnancy. By participating in physical activity, many of the negative consequences of both obesity and diabetes may be mitigated. Physical activity guidelines recommend that all adults, including pregnant women, perform at least 150 minutes of moderate-intensity exercise weekly in order to obtain health benefits. More physical activity may be needed to achieve weight management goals.
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Affiliation(s)
- Benjamin K Kogutt
- Obstetrix Medical Group of Texas & Baylor Medical Center, Fort Worth, Texas
| | - Linda M Szymanski
- Division of Maternal-Fetal Medicine, Mayo Clinic, Rochester, Minnesota
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McGirr C, Rooney C, Gallagher D, Dombrowski SU, Anderson AS, Cardwell CR, Free C, Hoddinott P, Holmes VA, McIntosh E, Somers C, Woodside JV, Young IS, Kee F, McKinley MC. Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background
There is a need to develop weight management interventions that fit seamlessly into the busy lives of women during the postpartum period.
Objective
The objective was to develop and pilot-test an evidence- and theory-based intervention, delivered by short message service, which supported weight loss and weight loss maintenance in the postpartum period.
Design
Stage 1 involved the development of a library of short message service messages to support weight loss and weight loss maintenance, with personal and public involvement, focusing on diet and physical activity with embedded behaviour change techniques, and the programming of a short message service platform to allow fully automated intervention delivery. Stage 2 comprised a 12-month, single-centre, two-arm, pilot, randomised controlled trial with an active control.
Setting
This study was set in Northern Ireland; women were recruited via community-based approaches.
Participants
A total of 100 women with overweight or obesity who had given birth in the previous 24 months were recruited.
Interventions
The intervention group received an automated short message service intervention about weight loss and weight loss maintenance for 12 months. The active control group received automated short message service messages about child health and development for 12 months.
Main outcome measures
The main outcomes measured were the feasibility of recruitment and retention, acceptability of the intervention and trial procedures, and evidence of positive indicative effects on weight. Weight, waist circumference and blood pressure were measured by the researchers; participants completed a questionnaire booklet and wore a sealed pedometer for 7 days at baseline, 3, 6, 9 and 12 months. Outcome assessments were collected during home visits and women received a voucher on completion of each of the assessments. Qualitative interviews were conducted with women at 3 and 12 months, to gather feedback on the intervention and active control and the study procedures. Quantitative and qualitative data were used to inform the process evaluation and to assess fidelity, acceptability, dose, reach, recruitment, retention, contamination and context.
Results
The recruitment target of 100 participants was achieved (intervention, n = 51; control, n = 49); the mean age was 32.5 years (standard deviation 4.3 years); 28 (28%) participants had a household income of < £29,999 per annum. Fifteen women became pregnant during the follow-up (intervention, n = 9; control, n = 6) and withdrew from the study for this reason. At the end of the 12-month study, the majority of women remained in the study [85.7% (36/42) in the intervention group and 90.7% (39/43) in the active control group]. The research procedures were well accepted by women. Both groups indicated a high level of satisfaction with the short message service intervention that they were receiving. There was evidence to suggest that the intervention may have a positive effect on weight loss and prevention of weight gain during the postpartum period.
Limitations
The interviews at 3 and 12 months were conducted by the same researchers who collected other outcome data.
Conclusions
An evidence- and theory-based intervention delivered by short message service was successfully developed in conjunction with postpartum women with overweight and obesity. The intervention was acceptable to women and was feasible to implement in the 12-month pilot randomised controlled trial. The progression criteria for a full randomised controlled trial to examine effectiveness and cost-effectiveness were met.
Future work
Some minor refinements need to be made to the intervention and trial procedures based on the findings of the pilot trial in preparation for conducting a full randomised controlled trial.
Trial registration
Current Controlled Trial ISRCTN90393571.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information. The intervention costs were provided by the Public Health Agency, Northern Ireland.
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Affiliation(s)
- Caroline McGirr
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ciara Rooney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Dunla Gallagher
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | | | - Annie S Anderson
- Centre for Research into Cancer Prevention and Screening, Cancer Division, Medical Research Institute, Ninewells Medical School, Dundee, UK
| | - Christopher R Cardwell
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Caroline Free
- Clinical Trials Unit, Department for Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Valerie A Holmes
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Camilla Somers
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jayne V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ian S Young
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Michelle C McKinley
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
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Rouhi M, Stirling CM, Crisp EP. Mothers' views of health problems in the 12 months after childbirth: A concept mapping study. J Adv Nurs 2019; 75:3702-3714. [PMID: 31452233 DOI: 10.1111/jan.14187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/22/2019] [Accepted: 08/10/2019] [Indexed: 01/03/2023]
Abstract
AIMS To identify the health problems that women feel require help and subsequent help-seeking behaviour during the 12 months period after childbirth. BACKGROUND Many women experience physical and mental health problems after childbirth, but there is a gap in understanding how they perceive their health after childbirth. Studies suggested they are inhibited in expressing their needs and so seek informal rather than professional help for their health problems. DESIGN A mixed method concept mapping study. METHOD Two groups of Australian women were recruited by an online platform and purposive sampling (N = 81) in 2017-2018, based on an established concept mapping methodology. A first group created 83 brainstorm statements about post-childbirth health problems and help-seeking and a second group sorted and rated the statements based on their perception of the prevalence of the issues and the help-seeking advice they would offer to others. Bradshaw`s Taxonomy of Needs was used to theoretically underpins the explanation of the results of women's felt need after childbirth. RESULTS Multidimensional scaling resulted in six clusters of issues which were categorized into three domains: 'health issues and care', 'support' and 'fitness'. Despite being directly asked, about two-thirds of the women did not report experiencing any health problems. CONCLUSION Our findings showed women had a broader perception of healthcare needs which included support and fitness. There is a potential gap in services for women who do not have good social support. IMPACT Family and friends were a key source of help-seeking. Post-childbirth routine care was focused on infant care and limited to the first 6 weeks after childbirth. The content of current post-childbirth care must be reviewed.
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Affiliation(s)
- Maryam Rouhi
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Christine M Stirling
- School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Elaine P Crisp
- School of Nursing, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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Abstract
It is important to pay attention to weight management before and between pregnancies, as women have an increased risk of weight gain during the reproductive years. Having a baby is a life-changing event for women and the challenge of weight management amidst this period of major physiological, psychological and social change should not be underestimated. However, the postpartum period offers an opportune time for lifestyle interventions, as women may have heightened awareness of their own and their wider families' health. Systematic reviews indicate that interventions including both diet and physical activity along with individualised support and self-monitoring are more likely to be successful in promoting postpartum weight loss. However, high levels of attrition and poor engagement have been an issue in previous trials in this area. Since postpartum women are difficult to reach and retain, future research must consider how to make weight-management interventions an attractive and attainable proposition for women who are juggling multiple, competing demands on their time. Ideally, intervention approaches need to be flexible and allow sustained contact with women, to facilitate a focus on maintenance of weight loss, as well as opportunities for re-engagement after life events that may disrupt weight-management progress. Using technology to deliver or support interventions holds promise but trials are needed to generate a range of appealing, effective and scalable options for postpartum women. What works at other life stages may not necessarily work here owing to specific barriers to weight management encountered in the postpartum period.
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Development and evaluation of a mother-centered toolkit for postpartum behavioral and psychosocial health. J Behav Med 2018; 41:591-599. [DOI: 10.1007/s10865-018-9928-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/24/2018] [Indexed: 11/11/2022]
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Morris J, Nikolopoulos H, Berry T, Jain V, Vallis M, Piccinini-Vallis H, Bell RC. Healthcare providers' gestational weight gain counselling practises and the influence of knowledge and attitudes: a cross-sectional mixed methods study. BMJ Open 2017; 7:e018527. [PMID: 29138209 PMCID: PMC5695303 DOI: 10.1136/bmjopen-2017-018527] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To understand current gestational weight gain (GWG) counselling practices of healthcare providers, and the relationships between practices, knowledge and attitudes. DESIGN Concurrent mixed methods with data integration: cross-sectional survey and semistructured interviews. PARTICIPANTS Prenatal healthcare providers in Canada: general practitioners, obstetricians, midwives, nurse practitioners and registered nurses in primary care settings. RESULTS Typically, GWG information was provided early in pregnancy, but not discussed again unless there was a concern. Few routinely provided women with individualised GWG advice (21%), rate of GWG (16%) or discussed the risks of inappropriate GWG to mother and baby (20% and 19%). More routinely discussed physical activity (46%) and food requirements (28%); midwives did these two activities more frequently than all other disciplines (P<0.001). Midwives interviewed noted a focus on overall wellness instead of weight, and had longer appointment times which allowed them to provide more in-depth counselling. Regression results identified that the higher priority level that healthcare providers place on GWG, the more likely they were to report providing GWG advice and discussing risks of GWG outside recommendations (β=0.71, P<0.001) and discussing physical activity and food requirements (β=0.341, P<0.001). Interview data linked the priority level of GWG to length of appointments, financial compensation methods for healthcare providers and the midwifery versus medical model of care. CONCLUSIONS Interventions for healthcare providers to enhance GWG counselling practices should consider the range of factors that influence the priority level healthcare providers place on GWG counselling.
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Affiliation(s)
- Jill Morris
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Hara Nikolopoulos
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Tanya Berry
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Venu Jain
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Vallis
- Department of Family Medicine, Behaviour Change Institute, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Rhonda C Bell
- Department of Agricultural Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Yang S, Sang W, Feng J, Zhao H, Li X, Li P, Fan H, Tang Z, Gao L. The effect of rehabilitation exercises combined with direct vagina low voltage low frequency electric stimulation on pelvic nerve electrophysiology and tissue function in primiparous women: A randomised controlled trial. J Clin Nurs 2017; 26:4537-4547. [PMID: 28252827 DOI: 10.1111/jocn.13790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE To evaluate the effect of rehabilitation exercises combined with Direct Vagina Low Voltage Low Frequency Electric Stimulation (DES) on pelvic nerve electrophysiology and tissue function after delivery. BACKGROUND Whether and how DES effects pelvic floor dysfunction (PFD) are not known clearly. DESIGN This was a randomised, controlled clinical trial. METHODS The 189 primiparous women 20-35 years old and with an episiotomy or second degree episiotomy tear were divided into three groups: the control group (n = 60) received routine postpartum guidance 2 hr postpartum, the training group (n = 63) performed rehabilitation exercises (Kegel exercises and pelvic movements) from 2 days postpartum until 3 months postpartum, and the combination group (n = 66) received DES 15 times (3 times a week for 30 min at a time) beginning at the sixth week postpartum in addition to performing rehabilitation exercises. Adopt international standard scale and score method to inspect maternal life treatment, such as pelvic organ prolapse situation (POP-Q division), the degree of incontinence score and pelvic floor muscle intensity of muscular contraction. Data were collected during the third month after delivery. RESULTS Three months postpartum, there were differences among the three groups in the POP-Q grade, the degree of incontinence score, the Oxford grade for pelvic floor muscle strength and the pelvic floor muscle electrophysiology condition. Additionally, there were significant differences regarding the pubic symphysis clearance. Rehabilitation exercises can promote healing of the maternal pubic symphysis and recovery of the pelvis. The total electrical value, type I muscle fibre strength and type II muscle fibre strength were significantly increased in the combination group after treatment than before treatment. CONCLUSION Rehabilitation exercises combined with DES were beneficial to the recovery of postpartum pelvic nerve tissue function, and a synergistic effect was observed when the two methods were combined. RELEVANCE TO CLINICAL PRACTICE These conclusions justify that rehabilitation exercise combined with DES can better relieve uncomfortable symptoms postpartum and improve the women's quality of life.
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Affiliation(s)
- Sumian Yang
- Department of Obsterics and Gynecology, Hebei General Hospitaly, Shijiazhuang, China
| | - Wenshu Sang
- Medical Department, Hebei General Hospitaly, Shijiazhuang, China
| | - Jing Feng
- Department of Obsterics and Gynecology, Hebei General Hospitaly, Shijiazhuang, China
| | - Haifeng Zhao
- Department of Anesthesiology, Shijiazhuang Obsterics and Gynecological Hospital, Shijiazhuang, China
| | - Xian Li
- Department of Nursing, Hebei General Hospitaly, Shijiazhuang, China
| | - Ping Li
- Department of Postpartum Rehabilitation, Shijiazhuang Maternal and Child Health Care Hospital, Shijiazhuang, China
| | - Hongfang Fan
- Department of Postpartum Rehabilitation, Shijiazhuang Maternal and Child Health Care Hospital, Shijiazhuang, China
| | - Zengjun Tang
- Department of Obsterics and Gynecology, Hebei General Hospitaly, Shijiazhuang, China
| | - Lina Gao
- Department of Obsterics and Gynecology, Hebei General Hospitaly, Shijiazhuang, China
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Walker LO, Murphey CL, Xie B. Missed Opportunities for Postpartum Behavioral and Psychosocial Health Care and Acceptability of Screening Options. J Obstet Gynecol Neonatal Nurs 2016; 45:614-24. [DOI: 10.1016/j.jogn.2016.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2016] [Indexed: 10/21/2022] Open
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van der Pligt P, Olander EK, Ball K, Crawford D, Hesketh KD, Teychenne M, Campbell K. Maternal dietary intake and physical activity habits during the postpartum period: associations with clinician advice in a sample of Australian first time mothers. BMC Pregnancy Childbirth 2016; 16:27. [PMID: 26831724 PMCID: PMC4736124 DOI: 10.1186/s12884-016-0812-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous health benefits are associated with achieving optimal diet and physical activity behaviours during and after pregnancy. Understanding predictors of these behaviours is an important public health consideration, yet little is known regarding associations between clinician advice and diet and physical activity behaviours in postpartum women. The aims of this study were to compare the frequency of dietary and physical activity advice provided by clinicians during and after pregnancy and assess if this advice is associated with postpartum diet and physical activity behaviours. METHODS First time mothers (n = 448) enrolled in the Melbourne InFANT Extend trial completed the Cancer Council of Australia's Food Frequency Questionnaire when they were three to four months postpartum, which assessed usual fruit and vegetable intake (serves/day). Total physical activity time, time spent walking and time in both moderate and vigorous activity for the previous week (min/week) were assessed using the Active Australia Survey. Advice received during and following pregnancy were assessed by separate survey items, which asked whether a healthcare practitioner had discussed eating a healthy diet and being physically active. Linear and logistic regression assessed associations of advice with dietary intake and physical activity. RESULTS In total, 8.6% of women met guidelines for combined fruit and vegetable intake. Overall, mean total physical activity time was 350.9 ± 281.1 min/week. Time spent walking (251.97 ± 196.78 min/week), was greater than time spent in moderate (36.68 ± 88.58 min/week) or vigorous activity (61.74 ± 109.96 min/week) and 63.2% of women were meeting physical activity recommendations. The majority of women reported they received advice regarding healthy eating (87.1%) and physical activity (82.8%) during pregnancy. Fewer women reported receiving healthy eating (47.5%) and physical activity (51.9%) advice by three months postpartum. There was no significant association found between provision of dietary and/or physical activity advice, and mother's dietary intakes or physical activity levels. CONCLUSIONS Healthy diet and physical activity advice was received less after pregnancy than during pregnancy yet no association between receipt of advice and behaviour was observed. More intensive approaches than provision of advice may be required to promote healthy diet and physical activity behaviours in new mothers. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( ACTRN12611000386932 13/04/2011).
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Affiliation(s)
- Paige van der Pligt
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Ellinor K Olander
- />Centre for Maternal and Child Health Research, City University London, London, UK
| | - Kylie Ball
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - David Crawford
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Kylie D Hesketh
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Megan Teychenne
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Karen Campbell
- />Centre for Physical activity and Nutrition Research (C-PAN), Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC 3125 Australia
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Wang ML, Arroyo J, Druker S, Sankey HZ, Rosal MC. Knowledge, Attitudes and Provider Advice by Pre-Pregnancy Weight Status: A Qualitative Study of Pregnant Latinas With Excessive Gestational Weight Gain. Women Health 2015; 55:805-28. [DOI: 10.1080/03630242.2015.1050542] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Monica L. Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Julie Arroyo
- Massachusetts Rehabilitation Commission, Malden, Massachusetts, USA
| | - Susan Druker
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Jarlenski M, McManus J, Diener-West M, Schwarz EB, Yeung E, Bennett WL. Association between support from a health professional and breastfeeding knowledge and practices among obese women: evidence from the Infant Practices Study II. Womens Health Issues 2014; 24:641-8. [PMID: 25239780 DOI: 10.1016/j.whi.2014.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 08/02/2014] [Accepted: 08/07/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obese women are less likely to initiate and continue breastfeeding. We described barriers to breastfeeding and examined the association between support from a health professional and breastfeeding knowledge and practices, by prepregnancy obesity status. METHODS Using data from the Infant Feeding Practices Study II, a cohort of U.S. women (N = 2,997), we performed descriptive statistics to describe barriers to breastfeeding by prepregnancy obesity status. We conducted multivariable regression to examine the association of breastfeeding support from a physician or nonphysician health professional with knowledge of the recommended duration of breastfeeding, breastfeeding initiation, and breastfeeding duration, and whether breastfeeding support had different associations with outcomes by prepregnancy obesity status. Average marginal effects were calculated from regression models to interpret results as percentage-point changes. FINDINGS Believing that formula was as good as breast milk was the most commonly cited reason for not initiating breastfeeding, and milk supply concerns were cited as reasons for not continuing breastfeeding. Physician breastfeeding support was associated with a 9.4 percentage-point increase (p < .05) in breastfeeding knowledge among obese women, although no increase was observed among nonobese women. Breastfeeding support from a physician or nonphysician health professional was associated with a significantly increased probability of breastfeeding initiation (8.5 and 12.5 percentage points, respectively) and breastfeeding for 6 months (12.5 and 8.4 percentage points, respectively), without differential associations by prepregnancy obesity. CONCLUSIONS Support for exclusive breastfeeding is an important predictor of breastfeeding initiation and duration among obese and nonobese women. Health educational interventions tailored to obese women might improve their breastfeeding initiation and continuation.
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Affiliation(s)
- Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
| | | | - Marie Diener-West
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eleanor Bimla Schwarz
- Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Edwina Yeung
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Wendy L Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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15
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Miller M, Hearn L, van der Pligt P, Wilcox J, Campbell KJ. Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care. Aust J Prim Health 2014; 20:123-7. [PMID: 24176286 DOI: 10.1071/py13080] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/02/2013] [Indexed: 01/15/2023]
Abstract
Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.
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Affiliation(s)
- Margaret Miller
- Child Health Promotion Research Centre, Edith Cowan University, 2 Bradford St, Mount Lawley, WA 6050, Australia
| | - Lydia Hearn
- Child Health Promotion Research Centre, Edith Cowan University, 2 Bradford St, Mount Lawley, WA 6050, Australia
| | - Paige van der Pligt
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Jane Wilcox
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
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16
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van der Pligt P, Willcox J, Hesketh KD, Ball K, Wilkinson S, Crawford D, Campbell K. Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth. Obes Rev 2013; 14:792-805. [PMID: 23773448 DOI: 10.1111/obr.12053] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/06/2013] [Accepted: 05/22/2013] [Indexed: 01/21/2023]
Abstract
Postpartum weight retention can predict future weight gain and long-term obesity. Moreover, failure to lose weight gained during pregnancy can lead to increased body mass index for subsequent pregnancies, increasing the risk of adverse maternal and foetal pregnancy outcomes. This systematic review evaluates the effectiveness of lifestyle interventions aimed at reducing postpartum weight retention. Seven electronic databases were searched for intervention studies and trials enrolling women with singleton pregnancies and published in English from January 1990 to October 2012. Studies were included when postpartum weight was a main outcome and when diet and/or exercise and/or weight monitoring were intervention components. No limitations were placed on age, body mass index or parity. Eleven studies were identified as eligible for inclusion in this review, of which 10 were randomized controlled trials. Seven studies were successful in decreasing postpartum weight retention, six of which included both dietary and physical activity components, incorporated via a range of methods and delivered by a variety of health practitioners. Few studies utilized modern technologies as alternatives to traditional face-to-face support and cost-effectiveness was not assessed in any of the studies. These results suggest that postpartum weight loss is achievable, which may form an important component of obesity prevention in mothers; however, the optimal setting, delivery, intervention length and recruitment approach remains unclear.
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Affiliation(s)
- P van der Pligt
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
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17
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Evenson KR, Brouwer RJN, Østbye T. Changes in physical activity among postpartum overweight and obese women: results from the KAN-DO Study. Women Health 2013; 53:317-34. [PMID: 23705761 DOI: 10.1080/03630242.2013.769482] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Few studies have assessed physical activity at multiple time points in the postpartum period or used both self-reported and objective measures of assessment. The purpose of this study was to describe physical activity and sedentary behavior at two time points in a cohort of overweight or obese postpartum women using both self-reported and objective measures. In total, 132 women completed physical activity assessments at a median of 24 weeks postpartum and again approximately 10 months later. At both time points, women wore an Actical accelerometer for one week and completed the Kaiser Physical Activity Survey. Adjusted Poisson regression models were used to determine whether physical activity changed over time for the cohort. Overall counts per minute and moderate to vigorous physical activity increased from baseline to 10 months later, although the absolute levels were modest (median 6.9 to 8.8 minutes/day). A median of 64%-71% at baseline and 63%-67% at follow-up of their monitored times were sedentary. More intensive interventions are needed to help postpartum women integrate physical activity and reduce sedentary behavior. [Supplementary material is available for this article. Go to the publisher's online edition of Women & Health for the following resource: three figures that show the distribution of physical activity and sedentary behavior by study periods among control participants].
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Affiliation(s)
- Kelly R Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27514, USA.
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18
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Evenson KR, Herring AH, Wen F. Self-Reported and objectively measured physical activity among a cohort of postpartum women: the PIN Postpartum Study. J Phys Act Health 2012; 9:5-20. [PMID: 22232505 PMCID: PMC3257811 DOI: 10.1123/jpah.9.1.5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Few studies measure physical activity objectively or at multiple time points during postpartum. We describe physical activity at 3- and 12-months postpartum among a cohort of women using both self-reported and objective measures. METHODS In total, 181 women completed the 3-month postpartum measures, and 204 women completed the 12-month postpartum measures. Participants wore an ActiGraph accelerometer for 1 week and completed in-home interviews that included questions on physical activity. A cohort of 80 women participated at both time points. Poisson regression models were used to determine whether physical activity differed over time for the cohort. RESULTS For the cohort, average counts/minute were 364 at 3-months postpartum and 394 at 12-months postpartum. At both time periods for the cohort, vigorous activity averaged 1 to 3 minutes/day, and moderate activity averaged 16 minutes/day. Sedentary time averaged 9.3 hours at 3-months postpartum and 8.8 hours at 12-months postpartum, out of a 19-hour day. Average counts/minute increased and sedentary behavior declined from 3- to 12-months postpartum. CONCLUSION Interventions are needed to help women integrate more moderate to vigorous physical activity and to capitalize on the improvements in sedentary behavior that occur during postpartum.
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Affiliation(s)
- Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Amy H. Herring
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Fang Wen
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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Sonneville KR, Rifas-Shiman SL, Oken E, Peterson KE, Gortmaker SL, Gillman MW, Taveras EM. Longitudinal association of maternal attempt to lose weight during the postpartum period and child obesity at age 3 years. Obesity (Silver Spring) 2011; 19:2046-52. [PMID: 21350436 PMCID: PMC3219435 DOI: 10.1038/oby.2011.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The effect of maternal attempt to lose weight during the postpartum period on later child weight has not been explored. Among 1,044 mother-infant pairs in Project Viva, we estimated longitudinal associations of maternal attempt to lose weight during the postpartum period with child weight and adiposity at age 3 years and examined differences in associations by type of weight loss strategy used. Using covariate-adjusted linear and logistic regression models, we estimated associations before and after adjusting for maternal weight-related variables including prepregnancy BMI. At 6 months postpartum, 53% mothers were trying to lose weight. At age 3 years, mean (s.d.) child BMI z-score was 0.44 (1.01) and 8.9% of children were obese. Children whose mothers were trying to lose weight at 6 months postpartum had higher BMI z-scores (0.30 (95% confidence interval (CI) 0.18, 0.42)) and were more likely to be obese (3.0 (95% CI 1.6, 5.8)) at 3 years of age. Addition of maternal prepregnancy BMI to the models attenuated but did not eliminate the associations seen for BMI z-score (0.24 (95% CI 0.12, 0.36) and obesity (2.4 (95% CI 1.2, 4.7)). Attempting to lose weight by exercising alone was the only weight loss strategy that consistently predicted higher child BMI z-score (0.36 (95% CI 0.14, 0.58)) and odds of obesity (6.0 (95% CI 2.2, 16.5)) at age 3 years. In conclusion, we observed an association between maternal attempt to lose weight at 6 months postpartum, particularly through exercise alone, measured using a single item and child adiposity at age 3 years. This association should be thoroughly examined in future studies.
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Affiliation(s)
- Kendrin R Sonneville
- Department of Medicine, Division of Adolescent Medicine, Children's Hospital Boston, Boston, Massachusetts, USA.
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