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Yang N, Guo R, Guo Y, Wei Y, An N. Effects of dietary intervention combined with insulin aspart on serum nesfatin-1 and CTRP12 levels and pregnancy outcomes in pregnant women with gestational diabetes mellitus. Medicine (Baltimore) 2023; 102:e35498. [PMID: 37861506 PMCID: PMC10589536 DOI: 10.1097/md.0000000000035498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
To analyze the effects of dietary intervention combined with insulin aspart on the serum levels of nesfatin-1, C1q/TNF related protein-12 (CTRP12), and pregnancy outcomes in pregnant women with gestational diabetes mellitus (GDM). In this retrospective cohort study, 513 women with GDM admitted to Tangshan Central Hospital (Tangshan, China) between January 2019 and December 2022 were selected and divided into an observation group (dietary intervention combined with insulin aspart therapy; n = 284) and a control group (insulin aspart therapy, n = 229). The general characteristics, clinical outcomes, serum nesfatin-1 and CTRP12 levels, 2-hour postprandial blood glucose levels, pregnancy outcomes, and perinatal outcomes of the 2 groups were compared. After treatment, the total effective rate in the observation group was significantly higher than that of the control group (97.54% vs 86.03%, respectively; P < .001). Compared with the pretreatment levels, nesfatin-1 and CTRP12 levels were decreased in both groups; nesfatin-1 and CTRP12 levels in the observation group were significantly higher than those in the control group. After treatment, the preprandial and 2-hour postprandial blood glucose levels in the observation group were significantly lower than those in the control group. Compared with the control group, the observation group had significantly fewer cesarean sections, and a significantly lower incidence of postpartum hemorrhage, premature rupture of membranes, and other adverse pregnancy outcomes. After treatment, the risks of preterm birth, macrosomia, fetal distress, neonatal asphyxia, neonatal hypoglycemia, and other adverse perinatal outcomes were significantly lower in the observation group than in the control group. In pregnant women with GDM, dietary intervention combined with insulin aspart can improve clinical outcomes; reduce nesfatin-1, CTRP12, and blood glucose levels; and reduce the incidence of adverse pregnancy outcomes.
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Affiliation(s)
- Na Yang
- Department of Obstetrics, Tangshan Central Hospital, Tangshan, Hebei, China
| | - Runli Guo
- Department of Obstetrics and Gynaecology, Jingxing County Hospital, Shijiazhuang, Hebei, China
| | - Yan Guo
- Department of Obstetrics, Xingtai Third Hospital, Xingtai, Hebei, China
| | - Yongmei Wei
- Department of Obstetrics, Fourth People’s Hospital of Langfang, Langfang, Hebei, China
| | - Nan An
- Department of Obstetrics and Gynaecology, Zhengding County People’s Hospital, Shijiazhuang, Hebei, China
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Raju S, Cowdell PF, Dyson PJ. Midwives' experiences of supporting healthy gestational weight management: A mixed methods systematic literature review. Midwifery 2023; 124:103750. [PMID: 37285752 DOI: 10.1016/j.midw.2023.103750] [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: 05/20/2022] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Excessive levels of gestational weight gain (GWG) are linked with poorer health outcomes for mother and baby, including an increased risk of pregnancy-related hypertension, labour induction, caesarean delivery and increased birth weight. OBJECTIVE To explore literature relating to midwives' experiences and challenges and identify interventions relating to GWG. DESIGN This review was conducted in accordance with the Joanna Briggs Institute methodology for mixed methods systematic reviews. CINAHL complete, APA PsycArticles, APA PsycInfo, the Cochrane Library and MEDLINE were systematically searched in May 2022. Search terms related to midwives, advice, weight management and experiences were used. A PRISMA approach was taken to identify data, and thematic analysis combined with descriptive statistics allowed synthesis and integration. FINDINGS Fifty-seven papers were included and three overarching themes were generated; i) emotion and weight, ii) ability to influence and iii) practical challenges and strategies for success. Weight was consistently described as a sensitive topic. Challenges included level of expertise and comfort, perceptions of ability to influence and an awareness of incongruence of midwives' own weight and the advice they are delivering. Interventions evaluated well with some self-reports of improved knowledge and confidence. There was no evidence of impact on practice or GWG. KEY CONCLUSIONS Although addressing maternal weight gain is an international priority due to the significant risks incurred, in this review we have identified multiple challenges for midwives to support women in healthy weight management. Identified interventions targeting midwives do not directly address the challenges identified and are therefore likely to be insufficient to improve existing practice. IMPLICATIONS FOR PRACTICE Partnership working and co-creation with women and midwives is essential to ensure knowledge about maternal weight gain is effectively shared across communities to catalyse change.
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Affiliation(s)
- Sereena Raju
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
| | - Professor Fiona Cowdell
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
| | - Professor Judith Dyson
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham, B15 3TN, England.
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Dempsey K, Mottola MF, Atkinson SA. Comparative Assessment of Diet Quality and Adherence to a Structured Nutrition and Exercise Intervention Compared with Usual Care in Pregnancy in a Randomized Trial. Curr Dev Nutr 2023; 7:100097. [PMID: 37441683 PMCID: PMC10334218 DOI: 10.1016/j.cdnut.2023.100097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 07/15/2023] Open
Abstract
Background In trials testing the efficacy of diet and exercise modifications during pregnancy on health outcomes, assessment of participant adherence to interventions of diet and exercise is rarely reported, with few standard methods existing to measure adherence. Objective We aimed to assess the maternal diet quality and create an algorithm to evaluate adherence to an intervention of high protein/dairy nutrition and walking exercise from early pregnancy to birth. Methods In Be Healthy in Pregnancy randomized trial (NCT01693510), diet quality was measured using scores from an adapted PrimeScreen food frequency questionnaire, nutrient intake assessed by 3-day diet records, and physical activity using accelerometry at 14-17 (early), 26-28 (middle), and 36-38 (late) weeks' gestation. A novel adherence score was derived by combining data for compliance with prescribed protein and energy intakes and daily step counts in the intervention group. Between-group diet quality scores and changes in adherence scores in the intervention group across pregnancy were analyzed using generalized estimating equations adjusted for prepregnancy body mass index and study site. Results Diet scores were similar for intervention (n = 55) and control (n = 56) groups at baseline but only the intervention group significantly improved and maintained their scores from early to middle (18.7 ± 7.6 vs. 22.9 ± 6.1; P < 0.001) and late (22.5 ± 6.9; P < 0.008) pregnancy. Protein intake was significantly (P < 0.001) higher but energy intakes were similar in the intervention group compared with those in the control group. Adherence scores for the intervention increased significantly (P < 0.01) from early (1.52 ± 0.70) to midpregnancy (1.89 ± 0.82) but declined from midpregnancy to late (1.55 ± 0.78; P < 0.0005) pregnancy primarily owing to lower step counts. Conclusions Adherence to an intervention may decline toward the end of pregnancy, particularly in maintaining physical activity. Creation of adherence scores is a feasible approach to measure combined intervention compliance for diet and physical activity and may increase transparency in interpreting results of randomized trials in pregnancy.This trial was registered at clinicaltrials.gov as NCT01689961 (https://clinicaltrials.gov/ct2/show/NCT01689961?cond=NCT01689961&rank=1; registered on 21 September 2012).
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Affiliation(s)
- Kendra Dempsey
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Michelle F. Mottola
- School of Kinesiology, The University of Western Ontario, London, Ontario, Canada
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Langley-Evans SC, Pearce J, Ellis S. Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: a narrative review. J Hum Nutr Diet 2022; 35:250-264. [PMID: 35239212 PMCID: PMC9311414 DOI: 10.1111/jhn.12999] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Abstract
The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre‐pregnancy body mass index greater than 25 kg m–2 are more likely than those with a body mass index in the ideal range (20–24.99 kg m–2) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care. Overweight and obesity before pregnancy and excessive gestational weight gain are major determinants of risk for pregnancy loss, gestational diabetes, hypertensive conditions, labour complications and maternal death. Pregnancy is regarded as a teachable moment when women are at their most receptive to messages about their health. However, unclear guidance on diet and physical activity, weight stigma from health professionals, inexperience and reluctance among professionals about raising issues about weight, and stretched resources put the health of women and babies at risk. Excessive weight gain in pregnancy and post‐partum weight retention compromise future fertility and increase risk for future pregnancies. Large randomised controlled trials have had little success in addressing excessive gestational weight gain or antenatal complications. Individualised, culturally sensitive and responsive interventions appear to have greater success.
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Affiliation(s)
- Simon C Langley-Evans
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, LE12 5RD, UK
| | - Jo Pearce
- Food & Nutrition Subject Group, Sheffield Hallam University, Sheffield, UK
| | - Sarah Ellis
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, LE12 5RD, UK
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Melwani S, Cleland V, Patterson K, Nash R. A scoping review: global health literacy interventions for pregnant women and mothers with young children. Health Promot Int 2021; 37:6322401. [PMID: 34269394 DOI: 10.1093/heapro/daab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The World Health Organization is focused on enhancing health literacy (HL) throughout the life-course to address the growing burden of non-communicable diseases (NCDs) globally. Pregnancy and early motherhood offer a window of opportunity to address NCDs risk earlier in the life-course. Empowering women through HL may help to reduce the intergenerational impact of NCDs. A scoping review of the international literature was conducted to identify HL interventions that focused on improving NCD-related health outcomes or health behaviors of pregnant women and/or mothers with young children. The search was conducted on 4 databases and identified 5019 articles. After full text screening, 25 studies met the inclusion criteria. No study acknowledged their intervention as an HL intervention, even though they were assessed as targeting various HL dimensions. Only one study measured the HL of mothers. The review suggests that HL interventions are being underutilized and highlight the need to create awareness about the importance of addressing HL of pregnant women and mothers using appropriate tools to understand HL strengths and challenges in achieving healthy lifestyle practices. This can help to co-design locally responsive solutions that may enable women to make informed healthier lifestyle choices for themselves and for their children and thus may accelerate prevention of NCDs globally.
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Affiliation(s)
- Satish Melwani
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
| | - Verity Cleland
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
| | - Kira Patterson
- School of Education, College of Arts, Law and Education, University of Tasmania, Launceston, TAS 7250, Australia
| | - Rosie Nash
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7001, Australia
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Cantor AG, Jungbauer RM, McDonagh M, Blazina I, Marshall NE, Weeks C, Fu R, LeBlanc ES, Chou R. Counseling and Behavioral Interventions for Healthy Weight and Weight Gain in Pregnancy: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:2094-2109. [PMID: 34032824 DOI: 10.1001/jama.2021.4230] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Counseling and active behavioral interventions to limit excess gestational weight gain (GWG) during pregnancy may improve health outcomes for women and infants. The 2009 National Academy of Medicine (NAM; formerly the Institute of Medicine) recommendations for healthy GWG vary according to prepregnancy weight category. OBJECTIVE To review and synthesize the evidence on benefits and harms of behavioral interventions to promote healthy weight gain during pregnancy to inform the US Preventive Services Task Force recommendation. DATA SOURCES Ovid MEDLINE and the Cochrane Library to March 2020, with surveillance through February 2021. STUDY SELECTION Randomized clinical trials and nonrandomized controlled intervention studies focused on diet, exercise, and/or behavioral counseling interventions on GWG. DATA EXTRACTION AND SYNTHESIS Independent data abstraction and study quality rating with dual review. MAIN OUTCOMES AND MEASURES Gestational weight-related outcomes; maternal and infant morbidity and mortality; harms. RESULTS Sixty-eight studies (N = 25 789) were included. Sixty-seven studies evaluated interventions during pregnancy, and 1 evaluated an intervention prior to pregnancy. GWG interventions were associated with reductions in risk of gestational diabetes (43 trials, n = 19 752; relative risk [RR], 0.87 [95% CI, 0.79 to 0.95]; absolute risk difference [ARD], -1.6%) and emergency cesarean delivery (14 trials, n = 7520; RR, 0.85 [95% CI, 0.74 to 0.96]; ARD, -2.4%). There was no significant association between GWG interventions and risk of gestational hypertension, cesarean delivery, or preeclampsia. GWG interventions were associated with decreased risk of macrosomia (25 trials, n = 13 990; RR, 0.77 [95% CI, 0.65 to 0.92]; ARD, -1.9%) and large for gestational age (26 trials, n = 13 000; RR, 0.89 [95% CI, 0.80 to 0.99]; ARD, -1.3%) but were not associated with preterm birth. Intervention participants experienced reduced weight gain across all prepregnancy weight categories (55 trials, n = 20 090; pooled mean difference, -1.02 kg [95% CI, -1.30 to -0.75]) and demonstrated lower likelihood of GWG in excess of NAM recommendations (39 trials, n = 14 271; RR, 0.83 [95% CI, 0.77 to 0.89]; ARD, -7.6%). GWG interventions were associated with reduced postpartum weight retention at 12 months (10 trials, n = 3957; mean difference, -0.63 kg [95% CI, -1.44 to -0.01]). Data on harms were limited. CONCLUSIONS AND RELEVANCE Counseling and active behavioral interventions to limit GWG were associated with decreased risk of gestational diabetes, emergency cesarean delivery, macrosomia, and large for gestational age. GWG interventions were also associated with modest reductions in mean GWG and decreased likelihood of exceeding NAM recommendations for GWG.
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Affiliation(s)
- Amy G Cantor
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- Department of Family Medicine, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Ian Blazina
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Nicole E Marshall
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Chandler Weeks
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University-Portland State University
| | - Erin S LeBlanc
- Kaiser Permanente, Center for Health Research, Portland, Oregon
| | - Roger Chou
- Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Aung W, Saw L, Sweet L. An integrative review of interventions for limiting gestational weight gain in pregnant women who are overweight or obese. Women Birth 2021; 35:108-126. [PMID: 33958291 DOI: 10.1016/j.wombi.2021.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
PROBLEM Excessive gestational weight gain in women who are overweight or obese puts them at risk of poor short- and long-term outcomes for maternal and neonatal health. Several interventions have been trialled to encourage women who are overweight or obese to limit gestational weight gain during pregnancy. AIM The aim of this review was to analyse the evidence on interventions to limit gestational weight gain in pregnant women who are overweight or obese. METHOD An integrative review guided by the Joanna Briggs Institute approach was conducted. An unlabeled search query of pregnancy, weight, and obesity was conducted in Medline, Scopus and CINAHL, limited to English language, 2010-2020 publications, and primary research on humans. Unlabeled search query of "((pregnancy outcome) OR (prenatal care) OR (pregnancy complications)) AND ((weight loss) OR (weight gain) OR (weight management)) AND (obesity) was used. Additional 9 records were identified through reference lists. Following a critical appraisal, 21 primary research articles were included in this review. A thematic synthesis was undertaken. FINDINGS Four major themes were identified. These are (1) mixed findings of lifestyle interventions for weight management, (2) ineffectiveness of probiotics or metformin for weight management, (3) psycho-behavioural interventions for weight management, and (4) midwifery role as an integral component in multidisciplinary intervention for weight management. CONCLUSION The literature suggests a need for longer duration of behavioural lifestyle intervention sessions led by the same midwife trained in motivational interviewing to limit weight gain in pregnant women who are overweight or obese.
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Affiliation(s)
- Wintnie Aung
- College of Medicine and Public Health, Flinders University, Australia
| | - Lauren Saw
- College of Medicine and Public Health, Flinders University, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Australia.
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MacAulay S, Lagan BM, Casson K. Planning, implementation and evaluation of antenatal weight management programmes: What are the key components? A mixed methods study. Midwifery 2019; 79:102545. [PMID: 31627087 DOI: 10.1016/j.midw.2019.102545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/01/2019] [Accepted: 09/29/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide an understanding of the influential components required for the planning, delivery and evaluation of antenatal weight management programmes for women who are overweight or obese. DESIGN Two phase sequential explanatory mixed methods design comprising of an online survey and one-to-one telephone interviews. SETTING AND PARTICIPANTS All UK maternity services (n = 168) and local government councils (n = 417). FINDINGS From the 378 responses, 49 maternity services and 28 local government councils reported having an antenatal weight management programme. Of the 62 responses that specified BMI as an inclusion criterion only two-fifths (40.3% n = 25) adhered to the recommended threshold to include women with a BMI ≥30 kg/m2. Although having a multi-disciplinary team was identified as fundamental when planning a programme, only 20.6% (n = 14/68) of the programmes involved service users during the planning phase. How the programme was communicated to a woman was a key factor which determined whether she partook in the programme or not. Having administrative support and staff with expertise in data collection were essential when evaluating a programme. Staff having protected time was identified as important when planning, delivering and evaluating a programme. Three overarching themes were identified from the individual interviews (n = 14) 'choices and decisions', 'demands and resources' and 'engagement and disengagement'. KEY CONCLUSIONS National guidelines recommendations regarding service user involvement when planning programmes and the BMI threshold used for inclusion are not being met. In addition to having adequate time, personnel and finances, successful programmes are dependent on the confidence and communication skills of midwives to raise the issue of obesity with these women at the booking appointment. Without staff having the time and necessary knowledge and skills, evaluation, and hence demonstrating programme impact, will likely remain difficult. Organisational support is needed to release resources to plan, deliver and evaluate these programmes. Strategic communication strategies are needed to promote the programme to both women and staff within organisations. Future programmes need to ensure there is engagement with service users from the planning of the programme through to evaluation.
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Affiliation(s)
- Sarah MacAulay
- School of Nursing/Institute of Nursing & Health Research, Ulster University, Belfast, County Antrim, Northern Ireland BT37 0QB, United Kingdom; Wales Cancer Network, 1st Floor, River House, Bridge Court, Cardiff, Wales CF15 9SS, United Kingdom.
| | - Briege M Lagan
- School of Nursing/Institute of Nursing & Health Research, Ulster University, Belfast, County Antrim, Northern Ireland BT37 0QB, United Kingdom.
| | - Karen Casson
- School of Nursing/Institute of Nursing & Health Research, Ulster University, Belfast, County Antrim, Northern Ireland BT37 0QB, United Kingdom.
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Olander EK, Berg F, Berg M, Dencker A. Offering weight management support to pregnant women with high body mass index: A qualitative study with midwives. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 20:81-86. [PMID: 31084825 DOI: 10.1016/j.srhc.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/10/2019] [Accepted: 04/01/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The prevalence of pregnant women with high body mass index is increasing worldwide. High body mass index is associated with health risks for mother and baby and supporting healthy gestational weight gain is important. Midwives play an important role in supporting women to engage in behaviours such as healthy eating and physical activity. The aim of this study was to explore how midwives' support pregnant women with high body mass index to establish a healthy lifestyle with emphasis on nutrition and physical activity in order to minimise gestational weight gain. METHODS Semi-structured interviews were conducted with 16 midwives working in antenatal health care in Sweden. Interviews were conducted shortly after new guidelines on care for pregnant women with high body mass index had been introduced. The interviews were recorded, transcribed and analysed by thematic analysis. RESULTS Three main themes were identified; use a conscious approach, invite to participate and have a long-term health perspective. Midwives built a relationship with a woman through identifying her concerns and circumstances, before sensitively discussing weight. Some midwives used Motivational Interviewing to help women identify their own resources. To reach long-term health benefits, midwives set achievable goals with the women. CONCLUSION These study findings provide practical examples of how midwives can support women with weight management during pregnancy. Through being sensitive when developing a relationship, midwives enabled the women to identify their own resources and achievable goals. Support after the baby is born is needed subsequently to help women maintain their healthy behaviour changes.
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Affiliation(s)
- Ellinor K Olander
- Centre for Maternal and Child Health Research, City, University of London, United Kingdom.
| | - Frida Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Maternity Ward, NU Hospital Group, Trollhattan, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, University of Gothenburg, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), Institute of Health and Care Sciences, University of Gothenburg, Sweden
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10
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DeJonckheere M, Nichols LP, Vydiswaran VGV, Zhao X, Collins-Thompson K, Resnicow K, Chang T. Using Text Messaging, Social Media, and Interviews to Understand What Pregnant Youth Think About Weight Gain During Pregnancy. JMIR Form Res 2019; 3:e11397. [PMID: 30932869 PMCID: PMC6462892 DOI: 10.2196/11397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/30/2018] [Accepted: 01/27/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The majority of pregnant youth gain more weight than recommended by the National Academy of Medicine guidelines. Excess weight gain during pregnancy increases the risk of dangerous complications during delivery, including operative delivery and stillbirth, and contributes to the risk of long-term obesity in both mother and child. Little is known regarding youth's perceptions of and knowledge about weight gain during pregnancy. OBJECTIVE The aim of this study was to describe the feasibility and acceptability of 3 novel data collection and analysis strategies for use with youth (social media posts, text message surveys, and semistructured interviews) to explore their experiences during pregnancy. The mixed-methods analysis included natural language processing and thematic analysis. METHODS To demonstrate the feasibility and acceptability of this novel approach, we used descriptive statistics and thematic qualitative analysis to characterize participation and engagement in the study. RESULTS Recruitment of 54 pregnant women aged between 16 and 24 years occurred from April 2016 to September 2016. All participants completed at least 1 phase of the study. Semistructured interviews had the highest rate of completion, yet all 3 strategies were feasible and acceptable to pregnant youth. CONCLUSIONS This study has described a novel youth-centered strategy of triangulating 3 sources of mixed-methods data to gain a deeper understanding of a health behavior phenomenon among an at-risk population of youth.
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Affiliation(s)
- Melissa DeJonckheere
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lauren P Nichols
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - V G Vinod Vydiswaran
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, United States.,School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Xinyan Zhao
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Kenneth Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States
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11
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Cho J, Su X, Holditch-Davis D. Associations of Hormonal Biomarkers With Mental Health and Healthy Behaviors Among Mothers of Very-Low-Birthweight Infants. Biol Res Nurs 2019; 21:253-263. [PMID: 30764642 DOI: 10.1177/1099800419829592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the concurrent use of self-report questionnaires and hormonal biomarkers, specifically levels of testosterone and cortisol, along with demographic variables and corrected age (CA) in the assessment of mental health and healthy behaviors among mothers of very-low-birthweight (VLBW, BW < 1,500 g) infants at five time points over 2 years post birth. METHOD Data on 40 mothers from a neonatal intensive care unit of a tertiary medical center in the southeast United States were collected from the medical record, standard questionnaires for the mother (depressive symptoms, perceived stress, anxiety, mental health status, parenting stress, and healthy lifestyle behaviors), and biochemical measurement of maternal testosterone and cortisol using enzyme immunoassay at birth, 40 weeks' postmenstrual age, and 6, 12, and 24 months CA. RESULTS Maternal self-report of mental health improved from birth to 6 or 12 months then worsened at 24 months. Mixed linear models showed that mothers with higher testosterone levels had more depressive symptoms and smoked more, whereas mothers with higher cortisol levels had healthier behaviors and exercised more. Testosterone levels were negatively correlated with cortisol levels. Marital status, education, and health insurance were the most predictive demographic variables for the levels of hormonal biomarkers, mental health, and healthy behaviors. CONCLUSIONS The use of self-report and biochemical measurement was effective in assessing maternal mental health and healthy behaviors over 2 years post birth, when mothers of VLBW infants tend to experience more mental health problems and parenting difficulties than mothers of normal-BW full-term infants.
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Affiliation(s)
- June Cho
- 1 School of Nursing, University of Nevada, Las Vegas, NV, USA
| | - Xiaogang Su
- 2 Department of Mathematical Sciences, University of Texas at El Paso, El Paso, TX, USA
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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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Kothe E, Lamb M, Bruce L, McPhie S, Klas A, Hill B, Skouteris H. Student midwives' intention to deliver weight management interventions: A theory of planned behaviour & self-determination theory approach. NURSE EDUCATION TODAY 2018; 71:10-16. [PMID: 30212705 DOI: 10.1016/j.nedt.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/23/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Overweight and obesity during pregnancy is a risk to the health of mother and child. Midwives can modify this key risk factor by providing weight management interventions to women before and during pregnancy. This study investigated social cognitive determinants of pre-clinical student midwives' intention to provide weight management intervention in preconception and antenatal clinical contexts. Social cognitive determinants from the theory of planned behaviour (attitudes, subjective norms, perceived behavioural control) and self-determination theory (autonomous motivation) were used to predict pre-clinical students' intentions once they enter practice. METHOD The sample was 183 female pre-clinical student midwives from 17 Australian universities (age range = 18-54 years). Participants received a cross-sectional questionnaire that measured demographic items, attitudes, subjective norms, perceived behavioural control and autonomous motivation towards providing weight management intervention at two different stages of pregnancy - preconception and antenatal. RESULTS Attitudes, subjective norms, and perceived behavioural control accounted for 56% of intention to provide weight management interventions to women planning pregnancy; however, the addition of autonomous motivation was non-significant. In contrast, attitudes and subjective norms (but not perceived behavioural control) accounted for 39% of intention to provide weight management interventions to women during pregnancy. Furthermore, the addition of autonomous motivation to the model was significant and accounted for an additional 3.1% of variance being explained. IMPLICATIONS AND CONCLUSIONS Curriculum changes that support and increase pre-clinical student midwives' intention should focus on these specific correlates of intention in order to foster long term changes in clinical practice. Changes to the education and training of midwives should be carefully considered to understand their impact on these important determinants of intention to engage in this critical clinical skill.
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Affiliation(s)
- Emily Kothe
- Deakin University, School of Psychology, Geelong, Australia.
| | - Michelle Lamb
- Deakin University, School of Psychology, Geelong, Australia
| | - Lauren Bruce
- Monash Centre for Health Research & Implementation, Monash University, Australia
| | - Skye McPhie
- Deakin University, School of Psychology, Geelong, Australia
| | - Anna Klas
- Deakin University, School of Psychology, Geelong, Australia
| | - Briony Hill
- Monash Centre for Health Research & Implementation, Monash University, Australia
| | - Helen Skouteris
- Deakin University, School of Psychology, Geelong, Australia; Monash Centre for Health Research & Implementation, Monash University, Australia
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Davenport MH, Ruchat SM, Poitras VJ, Jaramillo Garcia A, Gray CE, Barrowman N, Skow RJ, Meah VL, Riske L, Sobierajski F, James M, Kathol AJ, Nuspl M, Marchand AA, Nagpal TS, Slater LG, Weeks A, Adamo KB, Davies GA, Barakat R, Mottola MF. Prenatal exercise for the prevention of gestational diabetes mellitus and hypertensive disorders of pregnancy: a systematic review and meta-analysis. Br J Sports Med 2018; 52:1367-1375. [DOI: 10.1136/bjsports-2018-099355] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2018] [Indexed: 12/11/2022]
Abstract
ObjectiveGestational diabetes mellitus (GDM), gestational hypertension (GH) and pre-eclampsia (PE) are associated with short and long-term health issues for mother and child; prevention of these complications is critically important. This study aimed to perform a systematic review and meta-analysis of the relationships between prenatal exercise and GDM, GH and PE.DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were included (except case studies) if published in English, Spanish or French, and contained information on the Population (pregnant women without contraindication to exercise), Intervention (subjective or objective measures of frequency, intensity, duration, volume or type of exercise, alone [“exercise-only”] or in combination with other intervention components [e.g., dietary; “exercise + co-intervention”]), Comparator (no exercise or different frequency, intensity, duration, volume and type of exercise) and Outcomes (GDM, GH, PE).ResultsA total of 106 studies (n=273 182) were included. ‘Moderate’ to ‘high’-quality evidence from randomised controlled trials revealed that exercise-only interventions, but not exercise+cointerventions, reduced odds of GDM (n=6934; OR 0.62, 95% CI 0.52 to 0.75), GH (n=5316; OR 0.61, 95% CI 0.43 to 0.85) and PE (n=3322; OR 0.59, 95% CI 0.37 to 0.9) compared with no exercise. To achieve at least a 25% reduction in the odds of developing GDM, PE and GH, pregnant women need to accumulate at least 600 MET-min/week of moderate-intensity exercise (eg, 140 min of brisk walking, water aerobics, stationary cycling or resistance training).Summary/conclusionsIn conclusion, exercise-only interventions were effective at lowering the odds of developing GDM, GH and PE.
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Lamminpää R, Vehviläinen-Julkunen K, Schwab U. A systematic review of dietary interventions for gestational weight gain and gestational diabetes in overweight and obese pregnant women. Eur J Nutr 2018; 57:1721-1736. [PMID: 29128995 PMCID: PMC6060815 DOI: 10.1007/s00394-017-1567-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/13/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE The number of overweight and obese women is increasing in the obstetric population. The aim of this study was to review studies that reported results related to the efficacy of dietary interventions on gestational weight gain (GWG) or the prevention of gestational diabetes (GDM) in overweight and obese women. METHODS The search was performed using the CINAHL, PubMed, Scopus and Medic electronic databases and limited to the years between 2000 and March 2016. This systematic review includes 15 research articles of which 12 were randomized controlled trials, and three were controlled trials. Three main categories emerged as follows: (1) the types of interventions, (2) the contents of the interventions and (3) the efficacy of the intervention on GWG and the prevention of GDM. The quality of the selected studies was evaluated using the AHRQ Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews. RESULTS Of the selected 15 studies, eight included a specified diet with limited amounts of nutrients or energy, and the others included a dietary component along with other components. Ten studies reported significant differences in the measured outcomes regarding GWG or the prevention of GDM between the intervention and the control groups. CONCLUSIONS This review confirms the variability in the strategies used to deliver dietary interventions in studies aiming to limit GWG and prevent GDM in overweight and obese women. Inconsistency in the provider as well as the content of the dietary interventions leaves the difficulty of summarizing the components of effective dietary interventions.
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Affiliation(s)
- Reeta Lamminpää
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, P.O. BOX 1627, 70211, Kuopio, Finland.
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland and Kuopio University Hospital, 70029, Kuopio, Finland
| | - Ursula Schwab
- Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, 70211, Kuopio, Finland
- Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital, 70029, Kuopio, Finland
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Chang CW, Hsu YY, Kuo SE, Hou TW. Maternal body weight and diet management system. Contemp Clin Trials Commun 2018; 11:63-68. [PMID: 30023459 PMCID: PMC6024153 DOI: 10.1016/j.conctc.2018.06.001] [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] [Received: 01/24/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 11/13/2022] Open
Abstract
Background Body weight control is a significant issue to pregnant women. Overweight or underweight not only affects the normal growth of the fetus but also results in health impacts for pregnant women. Currently, some mobile applications which have released to stress how to achieve the purpose of weight control are not suitable for pregnant women. To design an appropriate mobile application of body weight control for pregnant women, a multidiscipline team collaborated. Objective This study proposed a mobile application approach to assist women to maintain an ideal weight control during their pregnancy. In addition, the usefulness of the application was evaluated among pregnancy women. Methods Firstly, the guidance of weight and diet management for pregnant women were obtained from textbooks and professional healthcare providers including nurses and nutritionists. Secondly, the researcher considered aspects of Human-Computer Interaction and theories of information technology behavior to design the mobile application. Finally, 52 pregnant women were recruited to test the prototype, which is a mobile application available on different devices with browsers. Conclusions Compared with other similar types of body weight and diet management mobile applications, the proposed application offers several characteristics to increase pregnant women's willingness to use it.
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Affiliation(s)
- Chung-Wei Chang
- Department of Engineering Science, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Yun Hsu
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Su-E Kuo
- Department of Nutritional Services, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ting-Wei Hou
- Department of Engineering Science, National Cheng Kung University, Tainan, Taiwan
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17
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Maternal obesity: a serious pediatric health crisis. Pediatr Res 2018; 83:1087-1089. [PMID: 29584713 DOI: 10.1038/pr.2018.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 03/04/2018] [Indexed: 11/08/2022]
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Elliott-Sale KJ, Graham A, Hanley SJ, Blumenthal S, Sale C. Modern dietary guidelines for healthy pregnancy; maximising maternal and foetal outcomes and limiting excessive gestational weight gain. Eur J Sport Sci 2018; 19:62-70. [PMID: 29842836 DOI: 10.1080/17461391.2018.1476591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Maternal dietary habits influence maternal and foetal health, representing a pathway for intervention to maximise pregnancy outcomes. Advice on energy intake is provided on a trimester basis, with no additional calories required in the first trimester and an additional 340 kcal d-1 and 452 kcal d-1 needed for the second and third trimesters. Energy intake depends on pre-gravid body mass index (BMI); underweight women are recommended an increase of 150, 200 and 300 kcal d-1 during the first, second and third trimester, normal weight women an increase of 0, 350 and 500 kcal d-1 and obese women an increase of 0, 450 and 350 kcal day-1. The recommendations for carbohydrate and protein intake are 175 g d-1 and 0.88-1.1 g kgBM d-1, with no change to fat intake. The number of pre-gravid obese women is rising; therefore, we need to regulate weight in women of childbearing age and limit gestational weight gain to within the recommended ranges [overweight women 6.8-11.3 kg and obese women 5.0-9.1 kg]. This can be achieved using nutritional interventions, as dietary changes have been shown to help with gestational weight management. As pregnancy has been identified as a risk factor for the development of obesity, normal weight women should gain 11.5-16.0 kg during pregnancy. While some research has shown that dietary interventions help to regulate gestational weight gain and promote postpartum weight loss to some extent, future research is needed to provide safe and effective guidelines to maximise these effects, while benefitting maternal and foetal health.
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Affiliation(s)
- Kirsty Jayne Elliott-Sale
- a Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology , Nottingham Trent University , Nottingham , UK
| | - Ashley Graham
- a Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology , Nottingham Trent University , Nottingham , UK
| | - Stephanie Jane Hanley
- a Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology , Nottingham Trent University , Nottingham , UK
| | | | - Craig Sale
- a Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement (SHAPE) Research Centre, School of Science and Technology , Nottingham Trent University , Nottingham , UK
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19
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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.
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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
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20
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van der Pligt P, Ball K, Hesketh KD, Teychenne M, Crawford D, Morgan PJ, Collins CE, Campbell KJ. A pilot intervention to reduce postpartum weight retention and central adiposity in first-time mothers: results from the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) study. J Hum Nutr Diet 2017; 31:314-328. [PMID: 29034545 DOI: 10.1111/jhn.12521] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND Postpartum weight retention (PPWR) increases the risk for obesity and complications during subsequent pregnancies. Few interventions have been successful in limiting PPWR in mothers. The present study assessed the effectiveness of the mums OnLiNE (Online, Lifestyle, Nutrition & Exercise) intervention with respect to reducing PPWR and improving diet, physical activity and sedentary behaviour. METHODS A subsample of first-time mothers enrolled in the Extended Melbourne Infant Feeding Activity and Nutrition Trial (InFANT Extend) completed the nonrandomised mums OnLiNE intervention. Women in the intervention (I) group (n = 28) received access to an online calorie tracking program, smartphone app, three telephone counselling calls with a dietitian and written material. Women in two comparison groups (CI and C2) (n = 48; n = 43) were from the control (C1) and intervention (C2) arms of InFANT Extend and received no additional support. Weight and waist circumference were measured objectively. Written surveys assessed diet and physical activity. Sedentary behaviour was self-reported. Linear and logistic regression assessed changes in outcomes between groups from 9 to 18 months postpartum. RESULTS Mean PPWR decreased in the (I) group (-1.2 kg) and the C2 group (-1.2 kg), although the changes were not significant. Mean waist circumference for all groups exceeded recommendations at baseline but decreased to below recommendations for women in the (I) group (78.3 cm) and significantly for the (I) group (-6.4 cm) compared to C1 (-1.1 cm; P = 0.002) and C2 (-3.3 cm; P = 0.001). Changes in diet, physical activity or sedentary behaviour were not significant. CONCLUSIONS The online intervention reported in the present study shows promise with respect to reducing waist circumference in postpartum women. Further evidence of strategies that may improve weight and related behaviours in this target group is needed.
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Affiliation(s)
- P van der Pligt
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - K Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - K D Hesketh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - M Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - D Crawford
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - P J Morgan
- Priority Research Centre for Physical Activity and Nutrition, School of Education, The University of Newcastle, NSW, Australia
| | - C E Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, NSW, Australia
| | - K J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Swift JA, Langley-Evans SC, Pearce J, Jethwa PH, Taylor MA, Avery A, Ellis S, McMullen S, Elliott-Sale KJ. Antenatal weight management: Diet, physical activity, and gestational weight gain in early pregnancy. Midwifery 2017; 49:40-46. [DOI: 10.1016/j.midw.2017.01.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 01/13/2017] [Accepted: 01/30/2017] [Indexed: 01/10/2023]
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22
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Han Y, Zheng YL, Wu AM, Liu HB, Su JB, Lu XY, Han YW, Ji JL, Ji JH, Shi Y. Effects of management in gestational diabetes mellitus with normal prepregnancy body mass index on pregnancy outcomes and placental ultrastructures: a prospective cohort study. Endocrine 2016; 54:691-699. [PMID: 27481362 DOI: 10.1007/s12020-016-1064-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 07/12/2016] [Indexed: 02/02/2023]
Abstract
A great quantity of gestational diabetes mellitus with normal prepregnancy body mass index have emerged with the new criteria of gestational diabetes mellitus in China based on the International Diabetes in Pregnancy Consensus group criteria, and understanding placental changes and how they affect outcomes are necessary in order to develop effective management approach. The aim of this study was to prospectively explore the effect of active management starting from the late second trimester in gestational diabetes mellitus women with normal prepregnancy body mass index on pregnancy outcomes and placental ultrastructures, and to provide scientific evidences for optimizing the management of gestational diabetes mellitus in China. Gestational diabetes mellitus women with normal prepregnancy body mass index in the same period of this prospective cohort study were divided into intervention group (n = 51) and control group (n = 55). The intervention group was managed rigorously, while the control group received conventional prenatal cares. The glucose profile, gestational weight gain and pregnancy outcomes were followed up and placental ultrastructures were observed and recorded by transmission electron microscopy. The blood glucose level and gestational weight gain in intervention group were significantly better controlled than those in control group (P < 0.01). The incidences of fetal distress, cesarean section and large for gestational age were significantly lower in intervention group than in control group (P < 0.05). There was a significant reduction in the incidence of abnormal placental ultrastructure in the intervention group (P < 0.01). After adjustment for confounding factors, the undesirable glycemic control and conventional management were related to abnormal placental ultrastructure (P < 0.05). Meanwhile, the undesirable glycemic control, abnormal placental ultrastructure and conventional management made sense in the incidence of fetal distress (P < 0.05), and the target glycemic control, recommend weight gain and active management were associated with reductions in the prevalence of cesarean delivery and large for gestational age (P < 0.05). The active management of gestational diabetes mellitus women with normal prepregnancy body mass index can improve pregnancy outcomes and placental ultrastructures, and the abnormal placental ultrastructure might be closely associated with the undesirable glycemic control and adverse pregnancy outcomes.
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Affiliation(s)
- Yun Han
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nantong University, NO. 6 North Hai-er-xiang Road, Nantong, 226001, China
| | - Yan-Li Zheng
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nantong University, NO. 6 North Hai-er-xiang Road, Nantong, 226001, China.
| | - Ai-Min Wu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nantong University, NO. 6 North Hai-er-xiang Road, Nantong, 226001, China
| | - Hong-Bin Liu
- Department of Pathology, The Second Affiliated Hospital of Nantong University, NO. 6 North Hai-er-xiang Road, Nantong, 226001, China
| | - Jian-Bin Su
- Department of Endocrinology, The Second Affiliated Hospital of Nantong University, NO. 6 North Hai-er-xiang Road, Nantong, 226001, China
| | - Xiao-Yan Lu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nantong University, NO. 6 North Hai-er-xiang Road, Nantong, 226001, China
| | - Yu-Wen Han
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nantong University, NO. 6 North Hai-er-xiang Road, Nantong, 226001, China
| | - Jin-Long Ji
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Nantong University, NO. 6 North Hai-er-xiang Road, Nantong, 226001, China
| | - Ju-Hua Ji
- Department of Pediatrics, The Second Affiliated Hospital of Nantong University, NO. 6 North Hai-er-xiang Road, Nantong, 226001, China
| | - Yue Shi
- Johns Hopkins Medicine, 1013 N Wolfe Street, Baltimore, MD, 21205, USA
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Horie S, Nomura K, Nakagawa J, Kido M, Sugimoto M. Factors Associated with Blood Loss after Delivery in 1,294 Mothers with Full-Term Singleton Baby. Nihon Eiseigaku Zasshi 2016; 71:208-215. [PMID: 27725424 DOI: 10.1265/jjh.71.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To clarify the predisposing factors associated with blood loss after delivery in mothers with full-term singleton babies. METHODS In this retrospective cohort study, we investigated 1,294 women who delivered singleton babies vaginally in 2011 at a medical center in Tokyo. We determined the amount of blood loss after delivery and covariates of age, parity, pre pregnancy body mass index (BMI), gestational weight gain (GWG), gestational week, pregnancy complications, lifestyles of smoking and drinking, placental weight, and infant weight and sex. RESULTS The majority of participants had lost less than 500 ml of blood (n=868, 67%), 21% lost between 500-799 ml of blood (n=273), 12% lost 800 ml or more of blood (n=153). The amount of blood loss statistically increased (p<0.001) as pre pregnancy BMI category level increased from underweight (<18.5 kg/m2), normal (18.5-22.9 kg/m2), to overweight/obesity (≥23 kg/m2). Compared with the least category of GWG <8.2 kg, ≥8.2 kg GWG was statistically associated with a larger amount of blood loss category (p=0.032). Multinomial logistic regression analyses demonstrated that with the reference pre pregnancy BMI 18.5-22.9 kg/m2, obese and obesity mothers with pre pregnancy BMI ≥23 kg/m2 were at an increased risk of blood loss [OR 2.28, 95%confidence interval (95%CI): 1.48-3.50 for the category of 500-799 ml and OR 2.15, 95%CI: 1.29-3.59 for a category of 800 ml≤)]. In addition, pregnancy induced hypertension (PIH) (p=0.010) and infant weight (p<0.0001) significantly increased the risk of blood loss. CONCLUSIONS In mothers with full-term singleton babies, increased pre pregnancy BMI overweight/obesity, PIH, and infant weight, were suggested to be risk factors for increased amount of blood loss.
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Affiliation(s)
- Saki Horie
- Teikyo University, Support Center for Women Physicians and Researchers
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Agha-Jaffar R, Oliver N, Johnston D, Robinson S. Gestational diabetes mellitus: does an effective prevention strategy exist? Nat Rev Endocrinol 2016; 12:533-46. [PMID: 27339886 DOI: 10.1038/nrendo.2016.88] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The overall incidence of gestational diabetes mellitus (GDM) is increasing worldwide. Preventing pathological hyperglycaemia during pregnancy could have several benefits: a reduction in the immediate adverse outcomes during pregnancy, a reduced risk of long-term sequelae and a decrease in the economic burden to healthcare systems. In this Review we examine the evidence supporting lifestyle modification strategies in women with and without risk factors for GDM, and the efficacy of dietary supplementation and pharmacological approaches to prevent this disease. A high degree of heterogeneity exists between trials so a generalised recommendation is problematic. In population studies of dietary or combined lifestyle measures, risk of developing GDM is not improved and those involving a physical activity intervention have yielded conflicting results. In pregnant women with obesity, dietary modification might reduce fetal macrosomia but in these patients, low compliance and no significant reduction in the incidence of GDM has been observed in trials investigating physical activity. Supplementation with probiotics or myoinositol have reduced the incidence of GDM but confirmatory studies are still needed. In randomized controlled trials, metformin does not prevent GDM in certain at-risk groups. Given the considerable potential for reducing disease burden, further research is needed to identify strategies that can be easily and effectively implemented on a population level.
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Affiliation(s)
- Rochan Agha-Jaffar
- Division of Diabetes, Endocrinology and Metabolism, G3 Medical School Building, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Nick Oliver
- Division of Diabetes, Endocrinology and Metabolism, G3 Medical School Building, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Desmond Johnston
- Division of Diabetes, Endocrinology and Metabolism, G3 Medical School Building, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Stephen Robinson
- Department of Metabolic Medicine, Mint Wing, St Mary's Hospital, Imperial College NHS Trust, Praed Street, London, W2 1NY, UK
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Lavender T, Smith DM. Seeing it through their eyes: a qualitative study of the pregnancy experiences of women with a body mass index of 30 or more. Health Expect 2016; 19:222-33. [PMID: 25601510 PMCID: PMC5055269 DOI: 10.1111/hex.12339] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Maternal obesity [body mass index (BMI) ≥ 30 kg/m(2)] is associated with numerous complications, but currently, little is known about the pregnancy experiences of these women. OBJECTIVE To gain insight into the experience of pregnant women with BMI ≥ 30 kg/m(2), when accessing maternity services and attending a community lifestyle programme. DESIGN Qualitative methodology, utilizing focus groups and semi-structured interviews with post-natal women who had an antenatal BMI ≥ 30 kg/m(2). The sample was obtained from a larger study. RESULTS Thirty-four women participated. Three main themes were identified using thematic analysis. Women described disappointment with their pregnancy. In particular, their informational expectations were not met; some health professionals appeared uninterested, insensitive or unconfident. Women described readiness to make a lifestyle change, but this was not encouraged during routine care. Attending the programme began the process of behavioural change. Women's beliefs that small changes make a big difference led to them being spurred on by success; driven by a desire to improve the health of their family. DISCUSSION AND CONCLUSION Pregnant women who are obese know this is the case and expect to be provided with information to assist them in making lifestyle changes. Health professionals should be aware of women's readiness for change and view pregnancy as an ideal time to communicate. Pregnant women with a BMI ≥ 30 kg/m(2) should contribute to health professional training, to highlight the reality of the maternity system journey; first-hand accounts may improve the way health professionals' approach these women. Lifestyle interventions should be developed with input from the intended target group.
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Affiliation(s)
- Tina Lavender
- The School of Nursing, Midwifery and Social WorkManchester Academic Health Science Centre'The University of ManchesterManchesterUK
| | - Debbie M. Smith
- The School of Psychological SciencesManchester Academic Health Science CentreThe University of ManchesterManchesterUK
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Hutcheon JA, Oken E. Towards Defining Optimal Gestational Weight Gain. CURR EPIDEMIOL REP 2016. [DOI: 10.1007/s40471-016-0062-z] [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]
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