Optimising gestational weight gain and improving maternal and infant health outcomes through antenatal dietary, lifestyle and physical activity advice: the OPTIMISE randomised controlled trial protocol

Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study

BACKGROUND

Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention.

OBJECTIVES

The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention.

DESIGN

This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data.

PARTICIPANTS

The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception.

SETTING

UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media.

DATA SOURCES

Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders.

RESULTS

The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined.

LIMITATIONS

There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative.

CONCLUSIONS

An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners.

FUTURE WORK

Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority.

TRIAL REGISTRATION

This trial is registered as ISRCTN14733020.

FUNDING

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.

Reduced n-3 and n-6 PUFA (DHA and AA) Concentrations in Breast Milk and Erythrocytes Phospholipids during Pregnancy and Lactation in Women with Obesity

Obesity during pregnancy is a worrying public health problem worldwide. Maternal diet is critical for fatty acid (FA) placental transport and FA content in breast milk (BM). We evaluated FA composition in erythrocytes phospholipids (EP) and BM in pregnant women with (OBE, n = 30) and without (non-OBE, n = 31) obesity. Sixty-one healthy women were evaluated at their 20-24th gestational week and followed until 6th month of lactation. Diet was evaluated through a food frequency questionnaire. FA composition of EP and BM was assessed by gas-liquid chromatography. The OBE group showed lower diet quality, but total n-6 and n-3 polyunsaturated FA (PUFA), ALA, EPA, and DHA dietary intake was similar between groups. N-3 PUFA, ALA, DHA, and the n-6/n-3 PUFA ratio in EP were lower at the 6th lactation month in the OBE group. In BM, the arachidonic acid (AA) concentration was lower at the end of the lactation, and DHA content showed an earlier and constant decline in the OBE group compared to the non-OBE group. In conclusion, n-3 PUFA and AA and DHA levels were reduced in EP and BM in pregnant women with obesity. Strategies to increase n-3 PUFA are urgently needed during pregnancy and lactation, particularly in women with obesity.

Impact of prepregnancy body mass index on pregnancy outcomes, incidence of urinary incontinence and quality of life during pregnancy - An observational cohort study

Background

To evaluate the effects of prepregnancy body mass index (BMI) on pregnancy outcomes, prevalence of urinary incontinence, and quality of life.

Methods

The observational cohort included 2210 pregnant women who were divided into 4 groups according to their prepregnancy BMI: underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), and obese (≥30). Data were analyzed for pregnancy outcomes, prevalence of urinary incontinence during pregnancy, scores of the Short Form 12 health survey (SF-12) and changes in sexual function.

Results

Compared with normal weight, overweight and obesity were associated with advanced maternal age, low education level, multiparity, preterm delivery, cesarean section, gestational weight gain above the Institute of Medicine (IOM) guidelines, preeclampsia, gestational diabetes, macrosomia and large fetal head circumference. After adjusting for confounding factors, women with overweight and obesity were more likely to have adverse maternal outcomes (gestational weight gain above the IOM guidelines, preeclampsia and gestational diabetes) and fetal outcomes (large fetal head circumference and macrosomia) compared to normal weight women. Overweight and obese women (BMI ≥ 25) were more likely to have urinary incontinence than normal weight and underweight women. There were no significant differences in SF-12 scores among the 4 BMI groups, but more than 90% of pregnant women had reduced or no sexual activities regardless of BMI.

Conclusions

Maternal prepregnancy overweight and obesity are associated with greater risks of preeclampsia, gestational diabetes, macrosomia and urinary incontinence. Health care providers should inform women to start their pregnancy at a BMI in the normal weight category.

A Randomised Trial to Optimise Gestational Weight Gain and Improve Maternal and Infant Health Outcomes through Antenatal Dietary, Lifestyle and Exercise Advice: The OPTIMISE Randomised Trial

There are well-recognised associations between excessive gestational weight gain (GWG) and adverse pregnancy outcomes, including an increased risk of pre-eclampsia, gestational diabetes and caesarean birth. The aim of the OPTIMISE randomised trial was to evaluate the effect of dietary and exercise advice among pregnant women of normal body mass index (BMI), on pregnancy and birth outcomes. The trial was conducted in Adelaide, South Australia. Pregnant women with a body mass index in the healthy weight range (18.5–24.9 kg/m²) were enrolled in a randomised controlled trial of a dietary and lifestyle intervention versus standard antenatal care. The dietitian-led dietary and lifestyle intervention over the course of pregnancy was based on the Australian Guide to Healthy Eating. Baseline characteristics of women in the two treatment groups were similar. There was no statistically significant difference in the proportion of infants with birth weight above 4.0 kg between the Lifestyle Advice and Standard Care groups (24/316 (7.59%) Lifestyle Advice versus 26/313 (8.31%) Standard Care; adjusted risk ratio (aRR) 0.91; 95% confidence interval (CI) 0.54 to 1.55; p = 0.732). Despite improvements in maternal diet quality, no significant differences between the treatment groups were observed for total GWG, or other pregnancy and birth outcomes.

Comparison of linear periodized and non-periodized combined training in health markers and physical fitness of adults with obesity: Clinical trial protocol

The literature discusses that combined training, aerobic more resistance exercises in the same session, is a suitable strategy for people with obesity and that exercise periodization leads to positive health outcomes; however, the implication of different periodizations of combined training for health outcomes in obese adults requires further investigation. The aim of the study will be to describe the methodology used to compare the effect of linear periodized and non-periodized combined training on health markers and health-related physical fitness in adults with obesity. This is a blinded randomized controlled clinical trial investigating adults with obesity in the age group 20-50 years. The sample will be non-probabilistic, and participants will be allocated randomly into one of three groups: control group (CG), non-periodized group (NG), and periodized group (PG). The intervention will occur in 60-min sessions, 3 days a week for 16 weeks, with 1 week dedicated to familiarization with the training and 15 weeks of combined training (aerobic followed by resistance in the same session). The PG group will perform three mesocycles of 5 weeks each, progressing in intensity throughout the intervention [aerobic: from 40-49% to 60-69% of heart rate reserve (HRR); strength: from 12 to 14 maximum repetitions (MR) to 8 to 10MR]; the NG group will maintain the same relative intensity throughout the study (aerobic: 50-59% of HRR; strength: 2 sets of 10-12 MR). Participants in the CG group will maintain their usual activities without the proposed intervention. Pre- and post-intervention assessments will be performed for biochemical markers, body composition, cardiovascular parameters, cardiorespiratory fitness, maximum upper and lower limb strength, flexibility, and subjective health-related parameters. This project was approved by the Committee of Ethics and Research with Human Beings of the institution of origin (protocol 2,448,674) and registered in the Brazilian Registry of Clinical Trials (RBR-3c7rt3).

In overweight and obese women, fetal ultrasound biometry accurately predicts newborn measures

INTRODUCTION

The aim of this study was to evaluate the association between fetal ultrasound and newborn biometry and adiposity measures in the setting of maternal obesity.

MATERIAL AND METHODS

The study population involved 845 overweight or obese pregnant women, who participated in the Standard Care Group of the LIMIT randomised trial (ACTRN12607000161426, 9/03/2007). At 36 weeks gestation, fetal biometry, estimated fetal weight (EFW) and adiposity measures including mid-thigh fat mass (MTFM), subscapular fat mass (SSFM), and abdominal fat mass (AFM) were undertaken using ultrasound. Neonatal anthropometric measurements obtained after birth included birthweight, head circumference (HC), abdominal circumference (AC) and skinfold thickness measurements (SFTM) of the subscapular region and abdomen.

RESULTS

At 36 weeks gestation, every 1 g increase in EFW was associated with a 0.94 g increase in birthweight (95% CI 0.88-0.99; P < 0.001). For every 1 mm increase in the fetal ultrasound measure, there was a 0.69 mm increase in birth HC (95% CI 0.63-0.75, P < 0.001) and 0.69 mm increase in birth AC (95% CI 0.60-0.79, P < 0.001). Subscapular fat mass in the fetus and the newborn (0.29 mm, 95% CI 0.20-0.39, P < 0.001) were moderately associated, but AFM measurements were not (0.06 mm, -0.03 to 0.15, P = 0.203). There is no evidence that these relationships differed by maternal body mass index.

CONCLUSION

In women who are overweight or obese, fetal ultrasound accurately predicts neonatal HC and AC along with birthweight.

Evaluation of a smartphone nutrition and physical activity application to provide lifestyle advice to pregnant women: The SNAPP randomised trial

Our objective was to evaluate the impact of a smartphone application as an adjunct to face-to-face consultations in facilitating dietary and physical activity change among pregnant women. This multicentre, nested randomised trial involved pregnant women with a body mass index ≥18.5 kg/m2 , with a singleton pregnancy between 10 and 20 weeks' gestation, and participating in 2 pregnancy nutrition-based randomised trials across metropolitan Adelaide, South Australia. All women participating in the SNAPP trial received a comprehensive dietary, physical activity, and behavioural intervention, as part of the GRoW or OPTIMISE randomised trials. Women were subsequently randomised to either the "Lifestyle Advice Only Group," where women received the above intervention, or the "Lifestyle Advice plus Smartphone Application Group," where women were additionally provided access to the smartphone application. The primary outcome was healthy eating index (HEI) assessed by maternal food frequency questionnaire completed at trial entry, and 28 and 36 weeks' gestation. Analyses were performed using intention-to-treat principles, with statistical significance at p = .05. One hundred sixty-two women participated: 77 allocated to the Lifestyle Advice plus Smartphone Application Group and 85 to the Lifestyle Advice Only Group. Mean difference in HEI score at 28 weeks of pregnancy was 0.01 (CI [-2.29, 2.62]) and at 36 weeks of pregnancy -1.16 (CI [-4.60, 2.28]). There was no significant additional benefit from the provision of the smartphone application in improving HEI score (p = .452). Although all women improved dietary quality across pregnancy, use of the smartphone application was poor. Our findings do not support addition of the smartphone application.