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Flor-Alemany M, Acosta-Manzano P, Migueles JH, Henriksson P, Löf M, Aparicio VA. Impact of Exercise Intervention Combined with Optimal Mediterranean Diet Adherence during Pregnancy on Postpartum Body Composition: A Quasi-Experimental Study-The GESTAFIT Project. Nutrients 2023; 15:4413. [PMID: 37892487 PMCID: PMC10609918 DOI: 10.3390/nu15204413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/08/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
This study aimed to investigate whether the effects of an exercise program during pregnancy on postpartum body composition are moderated by following a healthy dietary pattern (i.e., Mediterranean diet (MD)). Eighty-three pregnant women (control n = 40, exercise n = 43) were included in the present quasi-experimental study. The exercise intervention consisted of a 60 min, 3 day/week throughout pregnancy from gestational week 17, supervised concurrent (aerobic + resistance) exercise program. A food frequency questionnaire and the MD Score (min-max: 0-50) were employed to assess dietary habits and the MD adherence during pregnancy, respectively. Postpartum body composition was measured with dual-energy X-ray absorptiometry, 6 weeks postpartum. The body mass index and the gynecoid fat mass at postpartum were lower in the exercise compared to the control group (p = 0.018 and p = 0.047, respectively). There was an interaction showing that the MD adherence during pregnancy positively moderated the effects of the exercise intervention on postpartum lean mass (p = 0.024), fat mass percentage (p = 0.092), android fat mass (p = 0.076), and android-to-gynecoid fat mass (p = 0.019). The Johnson-Neyman technique revealed that the effects of exercise were enhanced at a MD score of ~31 for lean mass, ~25 for fat mass, ~23 for android fat mass and ~29 for android-to-gynecoid fat mass. Our results suggest that a concurrent-exercise training plus an optimal MD adherence during pregnancy might be a useful strategy to promote a healthier body composition at the postpartum period.
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Affiliation(s)
- Marta Flor-Alemany
- Department of Physiology, University of Granada, 18071 Granada, Spain; (M.F.-A.); (V.A.A.)
- Biomedical Research Centre (CIBM), Institute of Nutrition and Food Technology (INYTA), University of Granada, 18016 Granada, Spain
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain;
| | - Pedro Acosta-Manzano
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain;
- Institute of Human Movement Science, Sport and Health, University of Graz, 8010 Graz, Austria
| | - Jairo H. Migueles
- PROFITH “Promoting FITness and Health through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden;
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, 14152 Huddinge, Sweden;
| | - Virginia A. Aparicio
- Department of Physiology, University of Granada, 18071 Granada, Spain; (M.F.-A.); (V.A.A.)
- Biomedical Research Centre (CIBM), Institute of Nutrition and Food Technology (INYTA), University of Granada, 18016 Granada, Spain
- Sport and Health University Research Institute (IMUDS), 18007 Granada, Spain;
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2
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Kumari A, Ranjan P, Vikram NK, Kaur D, Balsarkar G, Malhotra A, Puri M, Batra A, Madan J, Tyagi S, Guleria K, Dabral A, Sarkar S, Nigam A, Anwar W, Kamath S, Bhatla N, Kumari SS, Kumar R, Choranur A, Venkataraman S, Kaur T, Rathore AM, Kaloiya GS, Prakash A, Tiwaskar M, Verma A, Singh R, Sharma KA, Baitha U, Tewary K, Misra A, Guleria R. Evidence and consensus-based clinical practice guideline for the management of obesity and overweight in postpartum women: An AIIMS-DST initiative. J Family Med Prim Care 2023; 12:812-855. [PMID: 37448937 PMCID: PMC10336934 DOI: 10.4103/jfmpc.jfmpc_45_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/23/2022] [Accepted: 01/31/2022] [Indexed: 07/18/2023] Open
Affiliation(s)
- Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naval K. Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Divjyot Kaur
- Department of Home Science, University of Delhi, Delhi, India
| | - Geetha Balsarkar
- Department of Obstetrics and Gynaecology, Seth G. S. Medical College, Mumbai, Maharashtra, India
| | - Anita Malhotra
- Department of Home Science, University of Delhi, Delhi, India
| | - Manju Puri
- Director Professor and Head, Department of Obstetrics and Gynaecology, LHMC and SSK Hospital, New Delhi, India
| | - Achla Batra
- President, Association of Obstetricians and Gynaecologists of Delhi (AOGD), New Delhi, India
- Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Jagmeet Madan
- National President, Indian Dietetic Association, New Delhi, India
| | - Shakun Tyagi
- Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynaecology, University College of Medical Sciences, New Delhi, India
| | - Anjali Dabral
- Professor and Head, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Aruna Nigam
- Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - Wareesha Anwar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandhya Kamath
- Former Dean, LT Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
- Former Dean, Seth G. S. Medical College, and KEM Hospital, Mumbai, Maharashtra, India
| | - Neerja Bhatla
- Professor and Head, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S. Shantha Kumari
- President, The Federation of Obstetric and Gynaecological Societies of India, India
| | - Raman Kumar
- President, Academy of Family Physicians of India, India
- President, World Organization of Family Doctors (WONCA), New Delhi, India
| | | | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Tanveer Kaur
- Department of Psychology, University of Delhi, Delhi, India
| | - Asmita Muthal Rathore
- Director Professor and Head, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Gauri Shankar Kaloiya
- Department of Clinical Psychology and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Prakash
- Department of Medicine, LHMC and SSK Hospital, New Delhi, India
| | | | - Archana Verma
- Vice President, The Federation of Obstetric and Gynaecological Societies of India, India
| | - Rakhi Singh
- The Federation of Obstetric and Gynaecological Societies of India, India
| | - K Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kamlesh Tewary
- President, Association of the Physicians of India, India
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India
- Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC), New Delhi, India
- President, Diabetes Foundation (India) (DFI), New Delhi, India
| | - Randeep Guleria
- Director, All India Institute of Medical Sciences, New Delhi, India
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3
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Adams AM, Wu H, Zhang FR, Wajsberg JR, Bruney TL. Postpartum Care in the Time of COVID-19: The Use of Telemedicine for Postpartum Care. Telemed J E Health 2023; 29:235-241. [PMID: 35727135 DOI: 10.1089/tmj.2022.0065] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Telemedicine was implemented at our institution in response to the COVID-19 pandemic. Data do not currently exist about the use of telemedicine in providing comprehensive postpartum care. Objective: This project aimed to evaluate the impact of telemedicine on postpartum care at an urban Federally Qualified Health Center (FQHC). Study Design: This was a retrospective cohort study of patients who delivered at an urban hospital in New York between September and November 2019 (pre-COVID), February through April 2020 (peak-COVID) and June through August 2020 (ongoing-COVID). The primary outcome was postpartum visit attendance. Secondary outcomes included contraception use, breastfeeding, depression screening, hospital readmission, and emergency department visit rates. Log-binomial regression models were used to estimate relative risk. Results: Telemedicine accounted for 1% of postpartum visits in the pre-COVID cohort, 60% in the peak-COVID cohort, and 48% in the ongoing-COVID cohort. Postpartum visit attendance rates were 52% in the pre-COVID cohort, 43% in the peak-COVID cohort, and 56% in the ongoing-COVID cohort (p > 0.05). There was a nonsignificant increase in postpartum visit show rate for telemedicine visits compared to in-person visits in the peak-COVID cohort (76% vs. 65%; relative risk [RR] 1.17 [0.87-1.57]) and ongoing-COVID cohort (85% vs. 74%; RR 1.16 [0.90-1.50]). Patients were significantly less likely to have a Patient Health Questionnaire-2 Depression screen in the peak-COVID and ongoing-COVID cohorts (22% and 33%) than in the pre-COVID cohort (74%) (p < 0.01). There were no significant differences in hospital readmissions, contraceptive use or breastfeeding rates across cohorts (p > 0.05). Conclusions: At our urban FQHC, telemedicine was comparable to in-person postpartum care in terms of attendance rates during the COVID-19 pandemic, without an increase in rates of hospital visits or readmissions. However, postpartum depression screening needs to be better integrated into the telemedicine visit type.
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Affiliation(s)
- Ayoka M Adams
- Department of Obstetrics and Gynecology & Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
| | - Haotian Wu
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Faye R Zhang
- Medical Program, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Julia R Wajsberg
- Medical Program, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York, USA
| | - Talitha L Bruney
- Department of Obstetrics and Gynecology & Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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Turner J, Clanchy K, Vincze L. Telehealth interventions for physical activity and exercise participation in postpartum women: A quantitative systematic review. Prev Med 2023; 167:107413. [PMID: 36603606 DOI: 10.1016/j.ypmed.2022.107413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/14/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
Postpartum women are one of the least physically active vulnerable populations globally and telehealth has been proposed as a potential method of delivering effective exercise interventions for this population. However, clinical practice guidelines are based upon the recommendations for the general population and therefore, the most efficacious exercise dose and the delivery method for this population is unclear. This quantitative systematic review will examine the implementation and outcomes of telehealth exercise interventions in the postpartum population to synthesise the degree to which these outcomes have been assessed and evaluated. Five databases were searched from January 2001 to March 2022. Studies implementing synchronous telehealth exercise interventions for postpartum women were included. Interventions were examined against the Template for Intervention Description and Replication (TIDieR) checklist that assesses intervention reporting completeness and replicability. Of the 1036 records identified, 16 studies progressed to data extraction. Six interventions provided individualised exercise prescription, and only four were delivered by university-level exercise practitioners. Physical activity participation was well reported, however health-related outcomes (i.e., muscular strength and aerobic capacity) were very minimally assessed. Only one intervention utilised modern video conferencing as the primary telehealth communication method. With the minimal assessment of health-related outcomes, there is limited scope to assess the effectiveness of these interventions for postpartum women. Future research interventions need to be reported according to a validated trial reporting system and focus on relevant health related outcomes including postpartum depressive symptoms, quality of life, cardiovascular fitness, muscular strength and body composition.
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Affiliation(s)
- Jemma Turner
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Kelly Clanchy
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
| | - Lisa Vincze
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
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5
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Salas-Groves E, Galyean S, Alcorn M, Childress A. Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e41235. [PMID: 36637888 PMCID: PMC9883741 DOI: 10.2196/41235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited. OBJECTIVE The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any. METHODS A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records. RESULTS In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24%) measured maintenance of health behavior change, of which 7 (64%) sustained behavior change for approximately 6 to 12 months and 4 (36%) showed a decline in behavior change or discontinued app use. CONCLUSIONS The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15%) showed sustained health behavior change, and some (4/46, 9%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps.
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Affiliation(s)
- Emily Salas-Groves
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Shannon Galyean
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Michelle Alcorn
- Department of Hospitality & Retail Management, Texas Tech University, Lubbock, TX, United States
| | - Allison Childress
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
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6
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Dias Duarte de Carvalho Souza M, Mary Ribeiro M, Bueno Ferreira L, Silva do Carmo A, Dos Santos LC. Weight Reduction and Changes in Body Circumferences in Lactating Women as a Function of Differences in Dietary Macronutrient Content. Breastfeed Med 2022; 17:511-518. [PMID: 35353584 DOI: 10.1089/bfm.2021.0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives: Investigating waist circumference (WC) and abdominal circumference (AC) evolution in lactating women, based on macronutrient intake adequacy up to 6 months after childbirth. Materials and Methods: Prospective cohort comprising lactating women recruited at a maternity hospital in Minas Gerais State, Brazil, from June 2018 to June 2019. Selected individuals were healthy adult women who had given birth 72 hours before data collection. Sociodemographic, breastfeeding, and anthropometric data were collected. Food intake was determined through 24 hours dietary recalls. Adequate carbohydrate, protein, and lipid intake was herein defined as 45-65%, 10-35%, and 20-35% of the caloric value consumed by participants, respectively. Wilcoxon test and generalized estimating equations were carried out. This research was approved by the Research Ethics Committee, as well as by the National Research Ethics Committee. Results: There was decrease in weight (-4.45 kg), body mass index (-4.43 kg/m2), WC (-4.70 cm), and AC (-4.70 cm) values from the baseline (n = 260) up to 6 months after childbirth (p < 0.001). The evolution of these measurements has indicated that high carbohydrate and low protein intake were associated with the highest AC values. Low protein and high lipid intake have led to lower WC values (p < 0.05). Conclusions: Macronutrient intake adequacy by the investigated lactating women has influenced their WC and AC evolution. This outcome has evidenced the important role played by nutritional monitoring in puerperium to prevent abdominal fat retention after pregnancy.
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Affiliation(s)
| | - Marinara Mary Ribeiro
- Department of Nutrition, Nursing School, Federal University of Minas Gerais, Belo Horizonte, Brazil
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7
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Timm A, Kragelund Nielsen K, Joenck L, Husted Jensen N, Jensen DM, Norgaard O, Terkildsen Maindal H. Strategies to promote health behaviors in parents with small children-A systematic review and realist synthesis of behavioral interventions. Obes Rev 2022; 23:e13359. [PMID: 34734473 DOI: 10.1111/obr.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/12/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022]
Abstract
In this systematic review and realist synthesis, we aimed to identify strategies to improve dietary and physical activity behaviors for parents with small children. A systematic literature search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO in July 2021. Included studies had to: (i) target one or both parents with at least one child (0-3 years), (ii) aim to improve diet and physical activity, and (iii) report on diet and physical activity outcomes. Intervention context, delivery, and outcomes were extracted, and behavior change techniques were coded. A program theory was developed, and context-mechanism-outcome configurations were identified. In total, 17 interventions reported in 28 studies (19 effectiveness studies; nine protocols) were included. Nine interventions showed small improvements: in diet (n = 5), physical activity (n = 2), or both (n = 2) in mothers. The realist synthesis revealed three strategies to improve health behaviors: (1) using knowledge and role modelling to improve family dynamics, (2) providing various home-based activities to change home environment, and (3) offering flexible delivery, for example, phone or website-based to increase social support. Future interventions for parents with small children should consider involving the whole family, focusing on home-based and practical components, and offering various delivery modes. The protocol for the systematic review and realist synthesis was registered in Research Registry (registration ID: reviewregistry860) March 30th, 2020.
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Affiliation(s)
- Anne Timm
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Larke Joenck
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | | | - Dorte Moeller Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Norgaard
- Department of Education, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
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8
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Lim K, Chan SY, Lim SL, Tai BC, Tsai C, Wong SR, Ang SM, Yew TW, Tai ES, Yong EL. A Smartphone App to Restore Optimal Weight (SPAROW) in Women With Recent Gestational Diabetes Mellitus: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e22147. [PMID: 33724204 PMCID: PMC8088857 DOI: 10.2196/22147] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 12/14/2020] [Accepted: 01/09/2021] [Indexed: 12/23/2022] Open
Abstract
Background Women with a history of gestational diabetes mellitus (GDM) are at an increased risk of developing type 2 diabetes mellitus (T2DM). Lifestyle interventions aimed at postpartum weight loss to reduce T2DM risk have been reported, but poor compliance remains a barrier. Smartphone-based interventions may improve compliance, but data on its use in women with recent GDM are limited. Objective This trial aimed to investigate the efficacy of a smartphone app in restoring optimal weight following delivery in women with GDM, in the setting of a population with high rates of GDM and type 2 diabetes. Methods In this unblinded randomized controlled trial, 200 women with GDM were randomized to receive the intervention or standard care following delivery. The intervention enabled logging of weight, meals, and activity, with web-based interaction with a team comprising dieticians, a physiotherapist, and an occupational therapist. The primary outcome was an achievement of optimal weight (defined as the restoration of first trimester weight if first trimester BMI≤23 kg/m2 or weight loss of at least 5% from first trimester weight if first trimester BMI>23 kg/m2) at 4 months post partum. Secondary outcome measures included absolute weight loss, serum metabolic markers, self-reported nutritional intake, health education, and quality of life via questionnaires and user engagement in the intervention group. Results In total, 40% (38/96) of women in the intervention group achieved optimal weight at 4 months post delivery compared with 32% (28/93) in the control group (P=.27). Compared with the control group, women in the intervention group reported significantly reduced caloric intake at 4 months after delivery (P<.001) and higher health-directed behavior scores (P=.045). The intervention group also reported increased emotional distress scores (P=.01). At 4 months, participant engagement with the intervention was maintained at 60.8% (SD 33.9%). Conclusions Although a statistically significant increase in women achieving healthy weight was not observed, this app remains promising, as women in the intervention group reported improved health behaviors and lower caloric intake. Importantly, the high retention rates suggest that a larger study with a longer follow-up period might confirm the effectiveness of this app for weight management. Trial Registration ClinicalTrials.gov NCT03324737; https://clinicaltrials.gov/ct2/show/NCT03324737 International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-7691-3
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Affiliation(s)
- Karen Lim
- Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Cammy Tsai
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | - Su Ren Wong
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | - Siew Min Ang
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Tong Wei Yew
- Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - E Shyong Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Eu Leong Yong
- Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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9
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Feasibility of a Digital Intervention to Promote Healthy Weight Management among Postpartum African American/Black Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042178. [PMID: 33672229 PMCID: PMC7927035 DOI: 10.3390/ijerph18042178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022]
Abstract
The study aim was to implement and evaluate the feasibility of a culturally informed (“BeFAB”) app for African American/Black women to address postpartum weight. Women (n = 136; mean age = 27.8 ± 5.4; mean BMI = 32.5 ± 4.3) were recruited from postpartum units, and randomly assigned to receive BeFAB (n = 65) or usual care (n = 71) for 12 weeks. App content included didactic lessons delivered via a virtual coach, app-based messages, goal setting and tracking, and edutainment videos. Feasibility outcomes included recruitment, retention and engagement, and self-reported acceptability. Behavioral (i.e., diet, physical activity), psychosocial (i.e., stress, coping, support, self-efficacy) and weight outcomes were also examined. Recruitment goals were met, but attrition was high, with 56% retention at 12 weeks. Approximately half of participants accessed the app and set a goal ≥one time, but <10% reported achieving a nutrition or activity goal. Among study completers, ≥60% found the app content at least somewhat helpful. Within-group changes for BeFAB among completers were found for increased moderate-to-vigorous physical activity and decreased fruit/vegetable intake and weight. Findings indicate initial feasibility of recruiting postpartum women to participate in a digital healthy body weight program but limited use, reflecting low acceptability and challenges in engagement and retention. Future research is needed on strategies to engage and retain participants in postpartum interventions.
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10
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Hadgraft NT, Winkler E, Climie RE, Grace MS, Romero L, Owen N, Dunstan D, Healy G, Dempsey PC. Effects of sedentary behaviour interventions on biomarkers of cardiometabolic risk in adults: systematic review with meta-analyses. Br J Sports Med 2021; 55:144-154. [PMID: 32269058 PMCID: PMC7841485 DOI: 10.1136/bjsports-2019-101154] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 01/28/2023]
Abstract
CONTEXT/PURPOSE Observational and acute laboratory intervention research has shown that excessive sedentary time is associated adversely with cardiometabolic biomarkers. This systematic review with meta-analyses synthesises results from free living interventions targeting reductions in sedentary behaviour alone or combined with increases in physical activity. METHODS Six electronic databases were searched up to August 2019 for sedentary behaviour interventions in adults lasting for ≥7 days publishing cardiometabolic biomarker outcomes covering body anthropometry, blood pressure, glucose and lipid metabolism, and inflammation (54 studies). The pooled effectiveness of intervention net of control on 15 biomarker outcomes was evaluated using random effects meta-analyses in the studies with control groups not providing other relevant interventions (33 studies; 6-25 interventions analysed). RESULTS Interventions between 2 weeks and <6 months in non-clinical populations from North America, Europe and Australia comprised much of the evidence base. Pooled effects revealed small, significant (p<0.05) beneficial effects on weight (≈ -0.6 kg), waist circumference (≈ -0.7 cm), percentage body fat (≈ -0.3 %), systolic blood pressure (≈ -1.1 mm Hg), insulin (≈ -1.4 pM) and high-density lipoprotein cholesterol (≈ 0.04 mM). Pooled effects on the other biomarkers (p>0.05) were also small, and beneficial in direction except for fat-free mass (≈ 0.0 kg). Heterogeneity ranged widely (I2=0.0-72.9). CONCLUSIONS Our review of interventions targeting sedentary behaviour reductions alone, or combined with increases in physical activity, found evidence of effectiveness for improving some cardiometabolic risk biomarkers to a small degree. There was insufficient evidence to evaluate inflammation or vascular function. Key limitations to the underlying evidence base include a paucity of high-quality studies, interventions lasting for ≥12 months, sensitive biomarkers and clinical study populations (eg, type 2 diabetes). PROSPERO TRIAL REGISTRATION NUMBER CRD42016041742.
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Affiliation(s)
- Nyssa T Hadgraft
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Elisabeth Winkler
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Rachel E Climie
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Megan S Grace
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Neville Owen
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - David Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Central Clinical School/Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Institute of Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, VIC, Australia
- School of Sport Science, Exercise and Health, The University of Western Australia, Perth, WA, Australia
| | - Genevieve Healy
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
| | - Paddy C Dempsey
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
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11
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Rahmawati W, van der Pligt P, Worsley A, Willcox JC. Indonesian antenatal nutrition education: A qualitative study of healthcare professional views. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211066077. [PMID: 34892998 PMCID: PMC8669879 DOI: 10.1177/17455065211066077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early lifestyle intervention, including antenatal nutrition education, is required to reduce the triple burden of malnutrition. Understanding healthcare professionals' views and experiences is essential for improving future nutrition education programmes for Indonesian pregnant women. This study aimed to investigate the views of Indonesian antenatal healthcare professionals regarding nutrition education for pregnant women and the improvements required to provide more effective antenatal nutrition education. METHODS A descriptive qualitative study involved semi-structured interviews was conducted with 24 healthcare professionals, including nutritionists (n = 10), midwives (n = 9) and obstetricians (n = 5) in Malang, Indonesia, between December 2018 and January 2019. Data were analysed using thematic analysis. RESULTS The study identified four main themes. First, healthcare professionals were aware of the importance of providing antenatal nutrition education, which included supporting its targeted delivery. Second, there were differing views on who should provide nutrition education. Most midwives and obstetricians viewed nutritionists as the prime nutrition education provider. Nutritionists were confident in their capability to provide nutrition education. However, some nutritionists reported that only a few women visited primary health centres and received nutrition counselling via this pathway. Third, healthcare professionals revealed some barriers in providing education for women. These barriers included a limited number of nutritionists, lack of consistent guidelines, lack of healthcare professionals' nutrition knowledge and lack of time during antenatal care services. Fourth, participants expressed the need to strengthen some system elements, including reinforcing collaboration, developing guidelines, and enhancing capacity building to improve future antenatal nutrition education. CONCLUSIONS Healthcare professionals play a central role in the provision of antenatal nutrition education. This study highlighted the importance of educational models that incorporate various antenatal nutrition education delivery strategies. These methods include maximizing referral systems and optimizing education through multiple delivery methods, from digital modes to traditional face-to-face nutrition education in pregnancy classes and community-based health services.
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Affiliation(s)
- Widya Rahmawati
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
- Department of Nutrition Science, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Anthony Worsley
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Jane C Willcox
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
- Centre for Quality and Patient Safety Research–Epworth HealthCare Partnership, Institute of Health Transformation, School of Nursing & Midwifery, Deakin University, Burwood, VIC, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
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12
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Weight Management Interventions for Adults With Overweight or Obesity: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2020; 121:1855-1865. [PMID: 33069660 DOI: 10.1016/j.jand.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022]
Abstract
The objectives of this evidence scoping review were to identify and characterize studies investigating weight management interventions provided by a registered dietitian nutritionist or international equivalent (RDN) among adults with overweight or obesity. A medical librarian conducted an electronic literature search in 6 databases-MEDLINE (Ovid), Embase (Ovid), PyscINFO (Ovid), Cochrane CENTRAL (Ovid), Cochrane Database of Systematic Reviews (Ovid), and CINAHL (Ebsco). Except for narrative review, gray literature, and case study or report, all types of peer-reviewed articles published between January 2008 and April 26, 2019 were eligible. Two content advisors, who are experts in adult weight management, guided the process and reviewed the search plan and findings. The literature search resulted in 30,551 records with 16 additional records identified through other sources. A total of 29,756 records were excluded during the first round of screening due to duplication or irrelevancy. Of the 811 full-text articles that were screened, 139 met the criteria and were included. Approximately 51% and 43% of the studies were conducted in the community setting and in the United States or Canada, respectively. Over 97% of the studies were clinical or quasi-experimental trials. A total of 6 different intervention delivery modes were reported, which resulted in 22 combinations of the modes of delivery. RDNs delivered the weight management intervention (especially the nutrition component) in all studies, but some (61%) also involved an interdisciplinary team to deliver other components of the intervention. The average length of the intervention was about 10 months with a follow-up that ranged from 0 to 9 years. The commonly reported outcomes were anthropometrics, endocrine, and cardiovascular measures; dietary intake; and physical activity. Based on the scoping review, there were systematic reviews and evidence-based practice guidelines on weight management interventions but none of them met the a priori inclusion or exclusion criteria. Therefore, it would be beneficial to conduct a systematic review and develop an evidence-based practice guideline on adult weight management interventions provided by an RDN to guide practitioners and to evaluate their effects on health and nutrition-related outcomes.
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Abstract
Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. OBJECTIVE: To systematically review the effectiveness of telehealth interventions for improving obstetric and gynecologic health outcomes. DATA SOURCES: We conducted a comprehensive search for primary literature in ClinicalTrials.gov, Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. METHODS OF STUDY SELECTION: Qualifying primary studies had a comparison group, were conducted in countries ranked very high on the United Nations Human Development Index, published in English, and evaluated obstetric and gynecologic health outcomes. Cochrane Collaboration's tool and ROBINS-I tool were used for assessing risk of bias. Summary of evidence tables were created using the United States Preventive Services Task Force Summary of Evidence Table for Evidence Reviews. TABULATION, INTEGRATION, RESULTS: Of the 3,926 published abstracts identified, 47 met criteria for inclusion and included 31,967 participants. Telehealth interventions overall improved obstetric outcomes related to smoking cessation and breastfeeding. Telehealth interventions decreased the need for high-risk obstetric monitoring office visits while maintaining maternal and fetal outcomes. One study found reductions in diagnosed preeclampsia among women with gestational hypertension. Telehealth interventions were effective for continuation of oral and injectable contraception; one text-based study found increased oral contraception rates at 6 months. Telehealth provision of medication abortion services had similar clinical outcomes compared with in-person care and improved access to early abortion. Few studies suggested utility for telehealth to improve notification of sexually transmitted infection test results and app-based intervention to improve urinary incontinence symptoms. CONCLUSION: Telehealth interventions were associated with improvements in obstetric outcomes, perinatal smoking cessation, breastfeeding, early access to medical abortion services, and schedule optimization for high-risk obstetrics. Further well-designed studies are needed to examine these interventions and others to generate evidence that can inform decisions about implementation of newer telehealth technologies into obstetrics and gynecology practice.
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A pilot intervention to reduce postpartum weight retention at primary health care in Brazil. NUTR HOSP 2019; 36:854-861. [PMID: 31232585 DOI: 10.20960/nh.02508] [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: 11/02/2022] Open
Abstract
Introduction Background: postpartum weight retention (PWR) strongly predicts obesity, the major nutritional concern of this century; however, there is a gap in nutritional care for postpartum women in Brazil. Objective: to evaluate the effect of nutritional counselling provided at primary health care on the reduction of PWR. Method: pilot study carried out in a low-income community in southeastern Brazil, involving postpartum women with PWR, who were provided with individual monthly appointments with a nutritionist over three months of follow-up. Nutritional counselling was based on the Dietary Approach to Stop Hypertension (DASH diet) aiming at healthy and gradual weight loss. Anthropometric evaluation included measurement of weight, height, waist circumference and percentage of body fat. Dietary intake was assessed using a food frequency questionnaire and adherence to diet was evaluated using a DASH score. Results: women who participated in the study (n = 26) showed a reduction in PWR (median -1.80 kg, p = 0.004), body mass index (-0.57 kg/m², p = 0.004), and waist circumference (-2.50 cm, p = 0.024), as well as 91.67% of them presented good adherence to diet. Conclusion: nutritional counselling provided to low-income postpartum women at primary health care contributed to the reduction of PWR, body mass index and waist circumference, as the study participants presented good adherence to a healthy dietary pattern.
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Pollak MJ, Milte CM, van der Pligt P, Teychenne M. Total physical activity but not diet quality associated with postnatal depressive symptoms amongst women living in socioeconomically disadvantaged neighborhoods. Nutr Res 2019; 68:54-61. [PMID: 31421393 DOI: 10.1016/j.nutres.2019.05.009] [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: 12/20/2018] [Revised: 05/02/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
Lifestyle behaviors such as healthy diet and some forms of physical activity have been linked to lower risk of depressive symptoms in the general population. However, little is known regarding their associations with postnatal depressive symptoms. Given that postnatal women (particularly those living in socioeconomically disadvantaged neighborhoods) are more likely to have poorer diet quality, lower physical activity levels and greater risk of depressive symptoms, this study sought to determine the associations between diet quality, total and domain specific physical activity and depressive symptoms amongst postnatal women from socioeconomically disadvantaged neighborhoods. It was hypothesized that higher diet quality and levels of leisure-time physical activity would be associated with lower depressive symptoms. In 2007-2008, cross-sectional data were collected from 246 women living in socioeconomically disadvantaged neighborhoods in Victoria, Australia. Participants completed self-report measures of diet (using a 17 item dietary questionnaire), domain specific physical activity (International Physical Activity Questionnaire), and depressive symptoms (Centre for Epidemiologic Studies Depression Scale). Linear regression analyses were used to determine the associations between diet quality, physical activity and postnatal depressive symptoms. There was a significant inverse association between total physical activity (B, -0.009; 95% CI, -0.016 to -0.001; P = .023) and postnatal depressive symptoms. No association was found between other domain-specific physical activity (i.e. leisure-time, domestic or transport-related physical activity), or diet quality and postnatal depressive symptoms. Acknowledging the cross-sectional nature of this study, these findings suggest that total physical activity may play a more important role than diet quality in the relationship with postnatal depressive symptoms.
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Affiliation(s)
- Miriam J Pollak
- School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.
| | - Catherine M Milte
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences.
| | - Paige van der Pligt
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences.
| | - Megan Teychenne
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences.
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Thomaschewski M, Beyer F, Thomaschewski M, Ellebrecht D, Jonczyk M, Schneider M, Keck T, Mentler T, Hummel R. Application-based management of perioperative anticoagulant therapy: description of POPACTApp. Langenbecks Arch Surg 2019; 404:633-645. [PMID: 31209561 DOI: 10.1007/s00423-019-01796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Perioperative management of oral anticoagulation (OAC) is a constant challenge in interventional and surgical procedures. When deciding to discontinue OAC, the risk of thromboembolic events must be balanced against the risk of bleeding during and after the planned procedure. These risks differ across patients and must be considered individually. METHODS POPACTApp, an application for the perioperative or peri-interventional management of oral anticoagulants, was developed using a human-centered design process (ISO 9241-210:2010). The treatment concept developed here can be adapted to a patient's individual risk profile. POPACTApp provides recommendations based on guidelines, consensus statements, and study data. After entering patient-specific risk factors, the attending physician using POPACTApp receives a clear and direct presentation of a periprocedural treatment concept, which should enable the efficient use of the program in everyday clinical practice. The perioperative treatment concept is presented via a timeline, including (1) the decision on whether to interrupt OAC, (2) the timing of the last preoperative administration of OAC in cases of interruption, (3) the decision on whether and how to bridge with heparins, and (4) the decision about when to reinitiate anticoagulation. RESULTS A task-based survey to evaluate POPACTApp's usability conducted with 20 surgeons showed that all clinicians correctly interpreted the recommendations provided by the app. Further, a questionnaire using a 7-point Likert scale from - 3 (negative) to + 3 (positive) revealed the following results to three specific questions: (1) satisfaction with the current standard procedure in the respective unit of the participant (0.15; SD = 1.57), (2) individual satisfaction with the POPACTApp application (2.7; SD = 0.47), and (3) estimation of the usefulness of POPACTApp for clinical practice (2.7; SD = 0.47). CONCLUSIONS POPACTApp provides clinicians with an individual risk-optimized treatment concept for the perioperative or peri-interventional management of OAC based on current guidelines, consensus statements, and study data, enabling the standardized perioperative handling of OAC in daily clinical practice.
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Affiliation(s)
- Michael Thomaschewski
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Florens Beyer
- Institute for Multimedia and Interactive Systems, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Martin Thomaschewski
- Center for Nano Optics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - David Ellebrecht
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Markus Jonczyk
- Department of Vascular Surgery, Academic Teaching Hospital St. Adolf-Stift, University of Hamburg, Hamburger Straße 41, 21465, Reinbek, Germany
| | - Matthias Schneider
- Department of Vascular Surgery, Academic Teaching Hospital St. Adolf-Stift, University of Hamburg, Hamburger Straße 41, 21465, Reinbek, Germany
| | - Tobias Keck
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Tilo Mentler
- Institute for Multimedia and Interactive Systems, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Richard Hummel
- Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
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Wright C, Mogul M, Acevedo G, Aysola J, Momplaisir F, Schwartz S, Shea J. Preparing for a trial to test a postpartum weight retention intervention among low income women: feasibility of a protocol in a community-based organization. BMC WOMENS HEALTH 2018; 18:27. [PMID: 29370795 PMCID: PMC5785896 DOI: 10.1186/s12905-018-0517-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/14/2018] [Indexed: 11/29/2022]
Abstract
Background Postpartum weight retention (PPWR) causes intergenerational harm, negatively affecting a mother’s cardiovascular health and ability to have future healthy pregnancies. Low-income minority women are at highest risk for PPWR with little guidance concerning timeline or strategy to lose weight after delivery. An academic-community partnership conducted observational and focus group work to develop an intervention for PPWR among low-income mothers. This study’s objective is to determine the feasibility of implementing a PPWR intervention trial in partnership with a community-based organization (CBO) serving low-income families with social service support. Methods We analyzed five implementation outcomes in this feasibility study: acceptability, adoption, appropriateness, penetration, and sustainability. Other secondary outcomes were the change in psychosocial and clinical outcomes from baseline to one year following the intervention delivery. Results An academic-community partnership developed and piloted a postpartum weight retention intervention among 17 participants that included 1) six weeks of interactive daily health texting, 2) exercise assistance with baby carrier, home exercise program, and pedometer provision, 3) two live healthy eating and baby feeding workshops, and 4) two 45-min home visits over one year to provide social support and acquire followup data. Implementation outcomes demonstrate an intervention supported by the organization and accepted by end-users, with increased capacity of the CBO to test and deliver an effective intervention. Weight loss was achieved by the majority of participants at one year (Md − 5 pounds (IQR = − 14.5 - 0.3). Conclusion We made protocol enhancements to the developed intervention based on the analysis of this study, and now prepare for a funded randomized controlled trial (RCT) in a community-based setting. Our central hypothesis is that low-income women who participate in a multi-component, low cost-intervention delivered by a CBO will have less postpartum weight retention than those women who do not participate in the program. Trial registration The trial was retrospectively registered, ID NCT02867631, 8/11/16.
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Affiliation(s)
- Charmaine Wright
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA.
| | - Marjie Mogul
- Maternity Care Coalition, 2000 Hamilton Avenue, Suite 205, Philadelphia, PA, 19130, USA
| | - Glamarys Acevedo
- Maternity Care Coalition, 2000 Hamilton Avenue, Suite 205, Philadelphia, PA, 19130, USA
| | - Jaya Aysola
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Florence Momplaisir
- Drexel School of Medicine, Department of Medicine, Infectious Diseases, Partnership Comprehensive Care Practice, 1427 Vine Street, 2nd Floor, Philadelphia, PA, 19102, USA
| | - Sandy Schwartz
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Judy Shea
- Division of General Internal Medicine, Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
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