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Saidi L, Godbout PD, Morais-Savoie C, Registe PPW, Bélanger M. Association between physical activity education and prescription during prenatal care and maternal and fetal health outcomes: a quasi-experimental study. BMC Pregnancy Childbirth 2023; 23:496. [PMID: 37407926 DOI: 10.1186/s12884-023-05808-x] [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: 11/21/2021] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Physical activity (PA) during pregnancy is associated with healthy gestational weight gain (GWG) and a reduced risk of developing gestational diabetes (GD), gestational hypertension (GHT) and fetal macrosomia. However, in Canada, less than 20% of pregnant women meet PA recommendations. This study assessed associations between an intervention including PA education by prenatal nurses and a PA prescription delivered by physicians and fetal and maternal outcomes. METHODS This is a quasi-experimental study. Two groups of women who received their prenatal care at the obstetrics clinic of a university hospital were created. In the first group, 394 pregnant women followed at the clinic received standard care. In the second group, 422 women followed at the clinic received standard care supplemented with education on the relevance of PA during pregnancy and a prescription for PA. Data for both study groups were obtained from the medical records of the mothers and their newborns. Logistic regressions were used to compare the odds of developing excessive GWG, GD, GHT, and fetal macrosomia between the two study groups. RESULTS The addition of PA education and PA prescription to prenatal care was associated with 29% lower odds of developing excessive GWG (adjusted odds ratios (OR) 0.71, 95% confidence intervals (CI) 0.51-0.99), 73% lower odds of developing GHT (0.27, 0.14-0.53), 44% lower odds of fetal macrosomia (> 4 kg) (0.56, 0.34-0.93), and 40% lower odds of being large for gestational age (0.60, 0.36-0.99). The intervention was not associated with a difference in odds of developing GD (0.48, 0.12-1.94). CONCLUSIONS The inclusion of education and prescription of PA as part of routine prenatal care was associated with improvements in maternal and fetal health outcomes, including significantly lower odds of GWG, GHT and macrosomia.
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Affiliation(s)
- Latifa Saidi
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500, boul. de l 'Université, Sherbrooke, Québec, J1K 2R1, Canada.
| | - Pierre D Godbout
- School of Nursing, Université de Moncton, Campus de Shippagan, 725, Rue du Collège, Bathurst, NB, E2A 3Z2, Canada
| | - Camille Morais-Savoie
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, Pavillon J-Raymond-Frenette, 50 Rue de La Francophonie St, Moncton, NB, E1A 7R1, Canada
| | - Pierre Philippe Wilson Registe
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500, boul. de l 'Université, Sherbrooke, Québec, J1K 2R1, Canada
| | - Mathieu Bélanger
- Department of Family and Emergency Medicine, Université de Sherbrooke, Centre de Formation Médicale du Nouveau-Brunswick, Vitalité Health Network, Pavillon J-Raymond-Frenette, 18, Avenue Antonine-Maillet, Moncton, NB, E1A 3E9, Canada
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2
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Pauley AM, Moore GA, Mama SK, Molenaar P, Downs DS. Systematic review of the associations between prenatal sleep behaviours and components of energy balance for regulating weight gain. J Sleep Res 2023; 32:e13619. [PMID: 35510276 DOI: 10.1111/jsr.13619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/02/2022] [Accepted: 04/06/2022] [Indexed: 12/13/2022]
Abstract
This systematic review aimed to examine the magnitude and direction of the associations between prenatal sleep behaviours (i.e. nighttime sleep duration, sleep quality, night awakenings and daytime nap duration) and eating behaviours, physical activity and gestational weight gain. A systematic search was conducted using Medline/PubMed, PsychINFO, CINAHL Complete, ProQuest Dissertations and Thesis A&I, and Web of Science to identify studies with at least one sleep measure, and either eating behaviours, physical activity and/or gestational weight gain. In summary, 11 studies met the review criteria and generated 11 total effect size across 10,900 participants. The majority of the studies were conducted after 2010, which highlights the infancy of this research. Overall, the strengths of the effect size were small: sleep-gestational weight gain (effect size = 0.29), sleep-eating behaviours (effect size = 0.13) and sleep-physical activity (effect size = 0.13). The only effect size that emerged as significant was for the pooled sleep behaviours-physical activity association; good sleep behaviours were positively associated with higher levels of physical activity. These findings summarize and provide insight on how sleep behaviours are related to prenatal gestational weight gain, eating behaviours and physical activity by identifying the strength and direction of the associations that have been previously unknown. Results support the rationale for future longitudinal and randomized control trials to examine the effects of sleep behaviours on gestational weight gain, eating behaviours and physical activity over the course of pregnancy.
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Affiliation(s)
- Abigail M Pauley
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Ginger A Moore
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Peter Molenaar
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Danielle Symons Downs
- Exercise Psychology Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania, USA.,Department of OBGYN, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Simmons SS, Hagan JE, Schack T. Then and Now: Investigating Anthropometrics and Child Mortality among Females in Malawi. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106171. [PMID: 35627708 PMCID: PMC9140720 DOI: 10.3390/ijerph19106171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
Information on the concentration of body mass index and child death among females in Malawi, where the epidemics of weight gain have been disconcerting and preventable deaths among children linger, is limited. Therefore, the study examined the polarity of body mass index and the death of children among females. Using data from the Malawian Demographic and Health Survey from 2000 to 2015–2016, the study applied for the first time the index of concentration at the extremes and indirect demographic techniques to estimate the polarity of body mass index and child mortality among 65,499 females aged 15 to 49 years. The preponderance of obesity more than doubled from 2000 to 2015–2016 and was highest among females who were older (35–49 years), urban dwellers, rich, and located in districts within the central and southern regions. In addition, child survival was low among underweight, overweight, and obese females. While national-, regional-, and individual-level statistics are in development, these findings provide helpful information for health experts and other stakeholders to initiate appropriate age-region specific programs and interventions in Malawi, including targeting females in the high socio-economic bracket.
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Affiliation(s)
- Sally Sonia Simmons
- Department of Social Policy, London School of Economics and Political Science, London WC2A 2AE, UK;
- Institute of Demography, National Research University-Higher School of Economics, 101000 Moscow, Russia
| | - John Elvis Hagan
- Department of Health, Physical Education & Recreation, College of Education Studies, University of Cape Coast, Cape Coast PMB TF0494, Ghana
- Neurocognition and Action Research Group—Biomechanics, Faculty of Psychology & Sport Sciences/CITEC, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany;
- Correspondence:
| | - Thomas Schack
- Neurocognition and Action Research Group—Biomechanics, Faculty of Psychology & Sport Sciences/CITEC, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany;
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4
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Talebi E, Mohaddesi H, Vahabzadeh D, Rasuli J. Examination of influence of social media education through mobile phones on the change in physical activity and sedentary behavior in pregnant women: a randomized controlled trial. BMC Womens Health 2022; 22:152. [PMID: 35538523 PMCID: PMC9092843 DOI: 10.1186/s12905-022-01725-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 04/20/2022] [Indexed: 12/23/2022] Open
Abstract
Background Nowadays because of some necessities and demands for virtual and remote education, a new model of health approach through mobile-phones is widely used to deal with improving physical activity and its beneficial effect on pregnancy. There are a small number of studies for showing this importance and the efficacy of such methods, so this study was aimed to determine the influence of social networking through mobile phones on changing the physical activity behavior in pregnant women. Methods This randomized controlled trial was conducted with parallel groups on 90 pregnant women referring to Urmia health centers in 2018–2019. The participants from various social and economic backgrounds were included. The participants were randomly assigned to a control and a treatment group. Demographic and Pregnancy Physical Activity Questionnaire (PPAQ) questionnaires were filled. In addition to routine cares, the treatment group received educational intervention through social network within 16 training sessions related to physical activity and nutrition in 8 weeks. Results The mean weight in both control and treatment groups changed significantly during the study, but in different trends (P < 0.001, Mean Difference (MD) = 4.43). At the beginning of the study, control and treatment groups were not different in terms of daily physical activity level (P = 0.17, MD = 0.62), meanwhile, there was a statistically significant difference at the end of intervention in the level of daily physical activity (P < 0.001, MD = 0.69). Comparison of both groups, based on different categories of activity level at the end of the treatment, showed a non-significant difference in sedentary activities (P = 0.89, MD = 0.46), but the intervention led to a significant difference based on the other level of activities; light (P < 0.001, MD = 51.94), moderate (P < 0.001, MD = 46.87), and sever (P = 0.05, MD = 1.07). Conclusion Educational intervention based on social networks through mobile phones had an effective role in behavior change in physical activity during pregnancy. Trial registration IRCT20151004024340N15, Registration date05/06/2020.
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Affiliation(s)
- Erfaneh Talebi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamideh Mohaddesi
- Non Communicable Disease Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Davoud Vahabzadeh
- Non Communicable Disease Research Center, Ilam University of Medical Sciences, Ilam, Iran. .,Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran.
| | - Javad Rasuli
- Maternal and Childhood Obesity Research Center, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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Kiani N, Pirzadeh A. Mobile-application intervention on physical activity of pregnant women in Iran during the COVID-19 epidemic in 2020. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:328. [PMID: 34761014 PMCID: PMC8552263 DOI: 10.4103/jehp.jehp_56_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Considering the low level of physical activity in pregnant women in the COVID-19 pandemic period, and on the other hand, the benefits of mobile application (mobile app) learning, we decided to conduct a study to determine the impact of educational intervention based on mobile app on physical activity in pregnant women. MATERIALS AND METHODS The present study was quasi-experimental and examined 93 pregnant women aged 16-20 weeks of gestation. Sampling was done on pregnant women participating in the childbirth preparation classes in Isfahan. We used the validated and reliable questionnaire including perceived benefits, perceived barriers, perceived enjoyment, perceived social support, and Pregnancy Physical Activity Questionnaire. The intervention was based on mobile app, and the content of the application contained 12 main domains such as description of physical activity and benefits and barriers of exercise in the pregnancy, different types of proper pregnancy exercise, planning for exercise, and different types of exercise. Finally, data were analyzed using SPSS20, and the Chi-square test, independent t-test Paired t-test were employed. The significance level was considered to be <0.05. RESULTS The results showed that, after the intervention based on mobile app, the mean score of perceived benefits and enjoyment were significantly higher than before the intervention in the intervention group. Finally, total mean score of physical activity significantly increased in the intervention group, while the change decreased in the control group. CONCLUSION The results indicated that the use of mobile app can be used to promote physical activity in pregnant women. Therefore, it is recommended that mobile app education should apply with face-to-face classes in health centers for physical activity in pregnant women in the pandemic situation.
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Affiliation(s)
- Neda Kiani
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asiyeh Pirzadeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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6
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Daley AJ, Jolly K, Ives N, Jebb SA, Tearne S, Greenfield SM, Yardley L, Little P, Tyldesley-Marshall N, Bensoussane H, Pritchett RV, Frew E, Parretti HM. Practice nurse-supported weight self-management delivered within the national child immunisation programme for postnatal women: a feasibility cluster RCT. Health Technol Assess 2021; 25:1-130. [PMID: 34382932 DOI: 10.3310/hta25490] [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: 11/22/2022] Open
Abstract
BACKGROUND Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies. OBJECTIVE The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable. DESIGN The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up. SETTING The trial took place in Birmingham, UK. PARTICIPANTS Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women's Hospital or general practices. Nine intervention participants and seven nurses were interviewed. INTERVENTIONS The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child's health record ('red book') or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet. MAIN OUTCOME MEASURES The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). RESULTS The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight. LIMITATIONS Fewer participants were recruited than planned. CONCLUSIONS Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention. FUTURE WORK Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention. TRIAL REGISTRATION Current Controlled Trials ISRCTN12209332. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amanda J Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucy Yardley
- School of Psychological Science, University of Bristol, Bristol, UK.,Department of Psychology, University of Southampton, Southampton, UK
| | - Paul Little
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Hannah Bensoussane
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ruth V Pritchett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen M Parretti
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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7
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Tyldesley-Marshall N, Greenfield SM, Parretti HM, Jolly K, Jebb S, Daley AJ. The experiences of postnatal women and healthcare professionals of a brief weight management intervention embedded within the national child immunisation programme. BMC Pregnancy Childbirth 2021; 21:462. [PMID: 34187564 PMCID: PMC8243541 DOI: 10.1186/s12884-021-03905-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 05/27/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND After childbirth, most women do not lose the extra weight gained during pregnancy. This is important because postnatal weight retention contributes to the development of obesity in later life. Research shows that postnatal women living with overweight would prefer to weigh less, are interested in implementing weight loss strategies, and would like support. Without evidence for the benefit of weight management interventions during pregnancy, postnatal interventions are increasingly important. Research has focused on intensive weight loss programmes, which cannot be offered to all postnatal women. Instead, we investigated the feasibility of a brief intervention delivered to postnatal women at child immunisation appointments. This qualitative study explored the views of women who received the intervention and healthcare professionals who delivered it. METHODS The intervention was delivered within the context of the national child immunisation programme. The intervention group were offered brief support encouraging self-management of weight when attending general practices to have their child immunised at two, three and four months of age. The intervention involved motivation and support from practice nurses to encourage women to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. Nurses provided external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a weight record card. Nested within this trial, semi-structured interviews explored the experiences of postnatal women who received the intervention and nurses who delivered it. RESULTS The intervention was generally acceptable to participants and child immunisation appointments considered a suitable intervention setting. Nurses were hesitant to discuss maternal weight, viewing the postnatal period as a vulnerable time. Whilst some caveats to implementation were discussed by nurses, they felt the intervention was easy to deliver and would motivate postnatal women to lose weight. CONCLUSIONS Participants were keen to lose weight after childbirth. Overall, they reported that the intervention was acceptable, convenient, and, appreciated support to lose weight after childbirth. Although nurses, expressed concerns about raising the topic of weight in the early postnatal period, they felt the intervention was easy to deliver and would help to motivate women to lose weight.
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Affiliation(s)
- Natalie Tyldesley-Marshall
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire LE11 3TU UK
| | - Sheila M Greenfield
- Institute for Applied Health Research, University of Birmingham, Birmingham, Edgbaston B15 2TT UK
| | - Helen M Parretti
- Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ UK
| | - Kate Jolly
- Institute for Applied Health Research, University of Birmingham, Birmingham, Edgbaston B15 2TT UK
| | - Susan Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG UK
| | - Amanda J Daley
- The Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire LE11 3TU UK
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8
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Terrell RM, Soucy NL, Chedid RA, Phillips KP. Ottawa prenatal educator e-survey: Experiences and perceptions of public health nurses and allied childbirth educators. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:161. [PMID: 34222536 PMCID: PMC8224507 DOI: 10.4103/jehp.jehp_734_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/30/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Prenatal education provides opportunities for health promotion of healthy behaviors and risk reduction. Quality and coherence with prenatal health promotion best practices depend on an individual class instructor. The objective of our study was to document the experiences, practices, and perceptions of our diverse Ottawa, Canada community of prenatal educators. MATERIALS AND METHODS In this quantitative, mixed methods e-survey conducted in Ottawa, Canada, prenatal educators were asked to describe their prenatal class settings, delivery formats, content, perceptions of pregnant women, and recommendations. Data were analyzed by descriptive statistics and thematic content analysis. RESULTS Respondents included public health nurses and a diverse group of "allied childbirth educators" (ACE). Topics related to pregnancy, labor, and postpartum issues were well addressed; however, established and emerging risks to pregnancy were omitted. Nurses were more likely to discuss lifestyle risks to pregnancy and general prenatal health promotion, whereas ACE respondents emphasized informed consent and individualized counseling. Women marginalized by social exclusion including Indigenous women, immigrants, and women with disabilities were perceived as missing from prenatal educational settings. CONCLUSIONS Heterogeneity of prenatal education provides opportunities for collaboration; however, established and emerging risk factors to pregnancy are neglected topics. Addressing the needs of diverse communities of pregnant women requires timely, evidence-based, inclusive, and culturally safe delivery of prenatal health promotion.
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Affiliation(s)
- Rowan M. Terrell
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Nura L. Soucy
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Rebecca A. Chedid
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Karen P. Phillips
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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9
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Daley AJ, Jolly K, Bensoussane H, Ives N, Jebb SA, Tearne S, Greenfield SM, Yardley L, Little P, Tyldesley-Marshall N, Pritchett RV, Frew E, Parretti HM. Feasibility and acceptability of a brief routine weight management intervention for postnatal women embedded within the national child immunisation programme in primary care: randomised controlled cluster feasibility trial. Trials 2020; 21:757. [PMID: 32873323 PMCID: PMC7466790 DOI: 10.1186/s13063-020-04673-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 08/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of obesity in women continues to rise and pregnancy is a high-risk time for excessive weight gain. The period after childbirth represents an opportunity to offer women support to manage their weight. The primary aim here was to investigate the acceptability and feasibility of delivering a self-management intervention to postnatal women to support weight loss, embedded within the national child immunisation programme. METHODS The research involved a randomised controlled cluster feasibility trial. Data were collected at baseline and 3 months later. Twenty-eight postnatal women living with overweight or obesity were recruited via Birmingham Women Hospital or general practices. Babies are routinely immunised at 2, 3 and 4 months of age; the intervention was embedded within these appointments. The intervention involved brief motivation/support by practice nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme, when they attended their practice to have their child immunised. The role of the nurse was to provide external accountability for weight loss. Participants were asked to weigh themselves weekly and record this on a record card or using the online programme. The weight goal was for participants to lose 0.5 to 1 kg per week. Usual care received a healthy lifestyle leaflet. The primary outcome was the feasibility of a phase III trial to test the subsequent effectiveness of the intervention, as assessed against three stop-go traffic light criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). RESULTS The traffic light stop-go criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. DISCUSSION Whilst participants and nurses followed the trial protocol well and adherence to self-weighing was acceptable, recruitment was challenging and there is scope to improve engagement with the online weight management programme component of the intervention. TRIAL REGISTRATION ISRCTN 12209332 . Registration date is 04/12/18.
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Affiliation(s)
- A J Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.
| | - K Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - H Bensoussane
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - N Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - S Tearne
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - S M Greenfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - L Yardley
- School of Psychological Science, University of Bristol, Bristol, BS8 1TH, UK.,Department of Psychology, University of Southampton, Southampton, S017 1BJ, UK
| | - P Little
- Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK
| | - N Tyldesley-Marshall
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - R V Pritchett
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - E Frew
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - H M Parretti
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
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10
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Adam LM, Jarman M, Barker M, Manca DP, Lawrence W, Bell RC. Use of healthy conversation skills to promote healthy diets, physical activity and gestational weight gain: Results from a pilot randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2020; 103:1134-1142. [PMID: 32035738 DOI: 10.1016/j.pec.2020.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 12/06/2019] [Accepted: 01/01/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES This study evaluated the use of Healthy Conversation Skills (a client-centered communication approach to behaviour change) in supporting women to achieve optimal gestational-weight-gain and health behaviours. METHODS Seventy pregnant women were randomised to the control or intervention group. Study visits and phone calls were delivered by Registered Dietitians (RDs) to women in the intervention and control groups. The intervention RD was trained in Healthy Conversation Skills while the control RD was not. Diet, physical activity and gestational-weight-gain were assessed at baseline and again at follow-up in the intervention and control groups. RESULTS Women in the intervention group improved their diet score between baseline and visit 2, while the control group did not. At 34 weeks, women in the control group reported being sedentary for longer than women in the intervention group. There were no differences in total gestational-weight-gain between the groups. CONCLUSIONS Pregnant women who interacted with an RD using Healthy Conversation Skills reported positive outcomes in health behaviours. PRACTICE IMPLICATIONS Healthy Conversation Skills shows promise as an approach to initiate, and maintain discussions promoting health behaviour change in pregnancy.
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Affiliation(s)
- Laura M Adam
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, T6G 2H3, Canada
| | - Megan Jarman
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, T6G 2H3, Canada
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Donna P Manca
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, T6G 2T4, Canada
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rhonda C Bell
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, T6G 2H3, Canada.
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11
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Daley A, Jolly K, Jebb SA, Roalfe A, Mackilllop L, Lewis A, Clifford S, Usman M, Ohadike C, Kenyon S, MacArthur C, Aveyard P. Effectiveness of a behavioural intervention involving regular weighing and feedback by community midwives within routine antenatal care to prevent excessive gestational weight gain: POPS2 randomised controlled trial. BMJ Open 2019; 9:e030174. [PMID: 31530608 PMCID: PMC6756421 DOI: 10.1136/bmjopen-2019-030174] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of a brief behavioural intervention based on routine antenatal weighing to prevent excessive gestational weight gain (defined by US Institute of Medicine). DESIGN Randomised controlled trial. SETTING Antenatal clinic in England. PARTICIPANTS Women between 10+0 and 14+6 weeks gestation, not requiring specialist obstetric care. INTERVENTIONS Participants were randomised to usual antenatal care or usual care (UC) plus the intervention. The intervention involved community midwives weighing women at antenatal appointments, setting maximum weight gain limits between appointments and providing brief feedback. Women were encouraged to monitor and record their own weight weekly to assess their progress against the maximum limits set by their midwife. The comparator was usual maternity care. PRIMARY AND SECONDARY OUTCOME MEASURES Excessive gestational weight gain, depression, anxiety and physical activity. RESULTS Six hundred and fifty-six women from four maternity centres were recruited: 329 women were randomised to the intervention group and 327 to UC. We found no evidence that the intervention decreased excessive gestational weight gain. At 38 weeks gestation, the proportions gaining excessive gestational weight were 27.6% (81/305) versus 28.9% (90/311) (adjusted OR 0.84, 95% CI: 0.53 to 1.33) in the intervention and UC group, respectively. There were no significant difference between the groups in anxiety or depression scores (anxiety: adjusted mean -0.58, 95% CI:-1.25 to -0.8; depression: adjusted mean -0.60, 95% CI:-1.24 to -0.05). There were no significant differences in physical activity scores between the groups. CONCLUSIONS A behavioural intervention delivered by community midwives involving routine weighing throughout pregnancy, setting maximum weight gain targets and encouraging women to weigh themselves each week to check progress did not prevent excessive gestational weight gain. There was no evidence of psychological harm. TRIAL REGISTRATION NUMBER ISRCTN67427351.
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Affiliation(s)
- Amanda Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kate Jolly
- Institute of Applied Health Research,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Andrea Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Lucy Mackilllop
- Nuffield Department of Women's and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Amanda Lewis
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - Sue Clifford
- Institute of Applied Health Research,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Muhammad Usman
- Institute of Applied Health Research,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Corah Ohadike
- Sherwood Forest Hospitals NHS FoundationTrust, Nottinghamshire, UK
| | - Sara Kenyon
- Institute of Applied Health Research,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Christine MacArthur
- Institute of Applied Health Research,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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12
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Watson ED, Brage S, White T, Westgate K, Norris SA, Van Poppel MNM, Micklesfield LK. The Influence of Objectively Measured Physical Activity During Pregnancy on Maternal and Birth Outcomes in Urban Black South African Women. Matern Child Health J 2019. [PMID: 29516229 PMCID: PMC6060755 DOI: 10.1007/s10995-018-2504-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives Research indicates the beneficial effects of physical activity during pregnancy on maternal health, although controversy still exists regarding its influence on birth outcomes. Little research has been done to objectively measure physical activity during pregnancy in black African women from low-to-middle income countries. The purpose of this study was to examine the association between physical activity and maternal and birth outcomes in this unique population. Methods This observational, longitudinal study assessed total physical activity using a hip-mounted triaxial accelerometer at 14–18 weeks (second trimester, n = 120) and 29–33 weeks (third trimester, n = 90) gestation. Physical activity is expressed as gravity-based acceleration units (mg). Maternal outcomes included both weight and weight gain at 29–33 weeks gestation. Birth outcomes included gestational age, birth weight, ponderal index and Apgar score, measured within 48 h of delivery. Results There was a significant decline in physical activity from the second to the third trimester (12.8 ± 4.1 mg vs. 9.7 ± 3.6 mg, p ≤ 0.01). Physical activity at 29–33 weeks as well as a change in PA was inversely associated with weight change at 29–33 weeks (β = − 0.24; 95% CI − 0.49; − 0.00; p = 0.05 and β = − 0.36; 95% CI − 0.62; − 0.10; p = 0.01, respectively). No significant associations were found between physical activity and birth outcomes. Conclusions for Practice Physical activity during pregnancy may be an effective method to control gestational weight gain, whilst presenting no adverse risk for fetal development, in women from a low-income urban setting.
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Affiliation(s)
- Estelle D Watson
- Centre for Exercise Science and Sports Medicine, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Physical Education Building, WITS Education Campus, 27 St Andrews Rd, Parktown, Johannesburg, 2194, South Africa. .,MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa.
| | - Søren Brage
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Tom White
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Kate Westgate
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, School of Clinical Medicine, Box 285, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Shane A Norris
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa
| | - Mireille N M Van Poppel
- Institute of Sport Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria.,Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Lisa K Micklesfield
- MRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa
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13
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Relationship Between Psychosocial Factors, Dietary Intake and Gestational Weight Gain: A Narrative Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 41:495-504. [PMID: 30393057 DOI: 10.1016/j.jogc.2018.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 12/25/2022]
Abstract
Inadequate gestational weight gain (GWG), which has reached almost two-thirds of Canadian pregnant women, is associated with several adverse effects both in the mother and her child. The aim of this review was to establish how psychosocial factors, diet and GWG are interrelated during pregnancy. More specifically, it aimed to evaluate how psychosocial factors can impact on diet and, thus, influence GWG. Studies published through May 2017 that examined factors related to GWG were included. Of 3268 non-duplicate titles and abstract, 77 articles underwent full-text review. Regarding dietary intakes, the majority of the included studies demonstrated that a higher caloric intake was associated with an elevated GWG. Also, a negative body image and attitude toward weight gain as well as a poor knowledge of GWG recommendations and inadequate prenatal care is associated with an increased GWG. Only few studies examined altogether the factors included and conclusions about how psychosocial factors can impact on diet and, thus, influence GWG cannot be drawn at this point. In the few studies that evaluated the interrelationships between psychosocial factors, diet and GWG, energy intake was not identified as a mediator of the association between psychosocial factors and GWG. This review highlights the scarcity of findings regarding psychosocial and dietary factors in relation to GWG and the need for high quality prospective cohort studies that will include all these factors to provide a better understanding of how they are interrelated to influence short- and long-term health.
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14
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Quantitative assessment of physical activity in pregnant women with sonographic short cervix and the risk for preterm delivery: A prospective pilot study. PLoS One 2018; 13:e0198949. [PMID: 29889906 PMCID: PMC5995449 DOI: 10.1371/journal.pone.0198949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/29/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Bed rest or activity restriction is a common obstetrical practice, despite a paucity of data to support its efficacy. The aim of this study was to determine whether physical activity, as assessed by a smart band activity tracker, is associated with preterm birth in pregnant women at high risk for preterm delivery. Methods This was a pilot prospective cohort study including pregnant women at high risk for preterm delivery between 24 and 32 weeks-of-gestation. Physical activity level was assessed by smart band activity. Patients with sonographic short cervical length (≤ 20 mm) were asked to wear the smart band activity tracker continuously for at least one week, including one weekend. Both physicians and patients were blinded to the data stored in the smart band activity tracker. No specific recommendations were given to participants as to the level or intensity of physical activity. The primary outcome was the rate of preterm birth (< 37 weeks-of-gestation). Secondary outcomes included the rate of delivery before 34 weeks of gestation and neonatal outcome. Parametric and nonparametric statistics were used for analysis. Results Study population included 49 pregnant women: 37 women (75.7%) delivered preterm and 12 (24.5%) delivered at or after 37 weeks-of-gestation. The median steps per day was significantly lower in patients who delivered preterm (3576, IQR: 2478–4775 vs. 4554, IQR: 3632–6337, p = 0.02). Regression analysis revealed that the median number of steps per day was independently inversely associated with preterm birth, after adjustment for maternal age, body mass index, gestational age at recruitment, cervical length, cervical dilatation and plurality. Conclusion This pilot study represents the first quantitative assessment of the association between physical activity and preterm birth. The results of this pilot study do not support the efficacy of decreased physical activity in the prevention of preterm birth in patients with sonographic short cervical length.
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15
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Ledoux T, Daundasekara S, Van Den Berg P, Leung P, Walker L, Berens PD. Association Between Health Beliefs and Gestational Weight Gain. J Womens Health (Larchmt) 2017; 27:341-347. [PMID: 28933637 DOI: 10.1089/jwh.2016.6185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The Institute of Medicine (IOM) provides recommendations for optimal weight gain during pregnancy to minimize complications associated with obesity and excessive weight gain. The Health Belief Model and prior research suggest knowledge of health recommendations and associated risks motivate health behaviors. This study determined whether knowledge of maternal and infant obesity risks during pregnancy (ORDP) and knowledge of IOM gestational weight gain (GWG) recommendations were associated with total GWG and likelihood of adhering to IOM recommendations. MATERIALS AND METHODS In this prospective survey study, healthy women with a singleton pregnancy were recruited from prenatal clinic waiting rooms of a university medical center to complete a one-time survey of prepregnancy weight and height, demographic variables, knowledge of infant-related ORDP (e.g., large for gestational age), knowledge of maternal-related ORDP (e.g., Cesarean delivery), and knowledge of IOM GWG recommendations. Total GWG was obtained from clinic medical records. Logistic and multiple regression analyses were performed. RESULTS The sample consisted of 159 women with average age of 25 and prepregnancy body mass index of 28. Women in the sample were predominantly African American (57%) and from low socioeconomic conditions. Results showed (1) knowledge of GWG recommendations was inversely related to total GWG among normal and underweight women and (2) knowledge of infant-related ORDP was positively related to total GWG among overweight and obese women and the likelihood of exceeding recommendations among normal and underweight women. Knowledge of maternal-related ORDP was not related to GWG. CONCLUSION As the Health Belief Model suggests, knowledge appears to be a modifiable factor in preventing excess GWG. However, there may be misinformation regarding how to adhere to clinical recommendations.
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Affiliation(s)
- Tracey Ledoux
- 1 Department of Health and Human Performance, University of Houston , Houston, Texas
| | - Saumali Daundasekara
- 1 Department of Health and Human Performance, University of Houston , Houston, Texas
| | - Patricia Van Den Berg
- 2 Department of Obstetrics & Gynecology, University of Texas Medical Branch , Galveston, Texas
| | - Patrick Leung
- 1 Department of Health and Human Performance, University of Houston , Houston, Texas
| | - Lorraine Walker
- 3 School of Nursing, University of Texas at Austin , Austin, Texas
| | - Pamela D Berens
- 4 University of Texas Health Science Center , McGovern Medical School, Houston, Texas
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16
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Ockenden H, Gunnell K, Giles A, Nerenberg K, Goldfield G, Manyanga T, Adamo K. Development and Preliminary Validation of a Comprehensive Questionnaire to Assess Women's Knowledge and Perception of the Current Weight Gain Guidelines during Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121187. [PMID: 27916921 PMCID: PMC5201328 DOI: 10.3390/ijerph13121187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/09/2016] [Accepted: 11/22/2016] [Indexed: 12/20/2022]
Abstract
The aim of this study was to develop and validate an electronic questionnaire, the Electronic Maternal Health Survey (EMat Health Survey), related to women's knowledge and perceptions of the current gestational weight gain guidelines (GWG), as well as pregnancy-related health behaviours. Constructs addressed within the questionnaire include self-efficacy, locus of control, perceived barriers, and facilitators of physical activity and diet, outcome expectations, social environment and health practices. Content validity was examined using an expert panel (n = 7) and pilot testing items in a small sample (n = 5) of pregnant women and recent mothers (target population). Test re-test reliability was assessed among a sample (n = 71) of the target population. Reliability scores were calculated for all constructs (r and intra-class correlation coefficients (ICC)), those with a score of >0.5 were considered acceptable. The content validity of the questionnaire reflects the degree to which all relevant components of excessive GWG risk in women are included. Strong test-retest reliability was found in the current study, indicating that responses to the questionnaire were reliable in this population. The EMat Health Survey adds to the growing body of literature on maternal health and gestational weight gain by providing the first comprehensive questionnaire that can be self-administered and remotely accessed. The questionnaire can be completed in 15-25 min and collects useful data on various social determinants of health and GWG as well as associated health behaviours. This online tool may assist researchers by providing them with a platform to collect useful information in developing and tailoring interventions to better support women in achieving recommended weight gain targets in pregnancy.
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Affiliation(s)
- Holly Ockenden
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Heathy Active Living and Obesity Research Group (HALO), Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON K1H 8L1, Canada.
| | - Katie Gunnell
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Heathy Active Living and Obesity Research Group (HALO), Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON K1H 8L1, Canada.
| | - Audrey Giles
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Kara Nerenberg
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | - Gary Goldfield
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Heathy Active Living and Obesity Research Group (HALO), Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON K1H 8L1, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Department of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Taru Manyanga
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Heathy Active Living and Obesity Research Group (HALO), Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON K1H 8L1, Canada.
| | - Kristi Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
- Heathy Active Living and Obesity Research Group (HALO), Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON K1H 8L1, Canada.
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
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17
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Daley AJ, Jolly K, Jebb SA, Roalfe AK, Mackillop L, Lewis AL, Clifford S, Kenyon S, MacArthur C, Aveyard P. Effectiveness of regular weighing, weight target setting and feedback by community midwives within routine antenatal care in preventing excessive gestational weight gain: randomised controlled trial. BMC OBESITY 2016; 3:7. [PMID: 26885375 PMCID: PMC4743115 DOI: 10.1186/s40608-016-0086-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/27/2016] [Indexed: 11/29/2022]
Abstract
Background Many pregnant women gain excess weight during pregnancy which increases the health risks to the mother and her baby. Interventions to prevent excess weight gain need to be given to the whole population to prevent excess weight gain. The aim of this study was to assess the effectiveness of a simple and brief intervention embedded withinroutine antenatal care to prevent excessive gestation weight gain. Methods Six hundred and ten pregnant women (between 10-14 weeks gestation), aged ≥18 years with a body mass index (BMI) ≥18.5 kg/m2, planned to receive community midwife led care or shared care at the time of recruitment are eligible to take part in the study. Women will be recruited from four maternity centres in England. Community midwives complete a short training module before delivering the intervention. In the intervention, midwives weigh women, set maximum weight limits for weight gain at each antenatal appointment and ask women to monitor their weight at home. Themaximum weight limit is adjusted by the midwife at each antenatal appointment if women have exceeded their maximum weight gain limit set at their previous appointment. The intervention will be compared with usual antenatal care. The primary outcome is the proportion of women per group who exceed the Institute of Medicine guidelines for gestational weight gain at 38 weeks of pregnancy according to their early pregnancy BMI category. Discussion The proposed trial will test a brief intervention comprising regular weighing, target setting and monitoring ofweight during pregnancy that can be delivered at scale as part of routine antenatal care. Using the professional expertise of community midwives, but without specialist training in weight management, the intervention will incur minimal additionalhealthcare costs, and if effective at reducing excess weight gain, is likely to be very cost effective. Trial registration Current controlled trials ISRCTN67427351. Date assigned 29/10/2014.
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Affiliation(s)
- Amanda J Daley
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - K Jolly
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - A K Roalfe
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - L Mackillop
- Women's Centre, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU UK
| | - A L Lewis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - S Clifford
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - S Kenyon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - C MacArthur
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
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18
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Australian Pregnant Women's Awareness of Gestational Weight Gain and Dietary Guidelines: Opportunity for Action. J Pregnancy 2016; 2016:8162645. [PMID: 26881080 PMCID: PMC4736585 DOI: 10.1155/2016/8162645] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/15/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Excessive gestational weight gain (GWG) can negatively impact on maternal and foetal health. Guidelines based on Institute of Medicine (IOM) encourage managing GWG by following healthy eating recommendations and increasing physical activity. This study investigated pregnant women's knowledge of their optimal GWG and recommended dietary approaches for GWG management. Method. English-speaking pregnant women were recruited from five hospitals in New South Wales (Australia) and an online link. Prepregnancy Body Mass Index (BMI) was calculated from self-reported height and prepregnancy weight. Participants identified their recommended GWG. A survey assessed practical dietary knowledge and asked about broad dietary recommendations to prevent excessive GWG. Chi square and logistic regression analyses were used. Results. N = 326 pregnant women completed the surveys; 49% entered pregnancy overweight (25.2%) or obese (23.6%); and knowledge of recommended GWG was lacking. Prepregnancy BMI was a significant predictor of GWG recommendation knowledge (P < 0.000). Pregnant women were highly knowledgeable about broad dietary recommendations but had poor knowledge of detailed recommendations. Conclusions. Limited knowledge of IOM's GWG guidelines and of specific dietary recommendations for pregnancy should be addressed by health care providers and education initiatives to assist the high number of women who enter pregnancy overweight or obese.
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Daley AJ, Jolly K, Jebb SA, Lewis AL, Clifford S, Roalfe AK, Kenyon S, Aveyard P. Feasibility and acceptability of regular weighing, setting weight gain limits and providing feedback by community midwives to prevent excess weight gain during pregnancy: randomised controlled trial and qualitative study. BMC OBESITY 2015; 2:35. [PMID: 26401345 PMCID: PMC4572649 DOI: 10.1186/s40608-015-0061-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/30/2015] [Indexed: 12/02/2022]
Abstract
Background Regular weighing in pregnant women is not currently recommended in many countries but has been suggested to prevent excessive gestational weight gain. This study aimed to establish the feasibility and acceptability of incorporating regular weighing, setting maximum weight gain targets and feedback by community midwives. Methods Low risk pregnant women cared for by eight community midwives were randomised to usual care or usual care plus the intervention at 10–14 weeks of pregnancy. The intervention involved community midwives weighing and plotting weight on a weight gain chart, setting weight gain limit targets, giving brief feedback at each antenatal appointment and encouraging women to weigh themselves weekly between antenatal appointments. Women and midwives were interviewed about their views of the intervention. The focus of the study was on process evaluation. Results Community midwives referred 123 women and 115 were scheduled for their dating scan within the study period. Of these, 84/115 were approached at their dating scan and 76/84 (90.5 %) randomised. Data showed a modest difference favouring the intervention group in the percentage of women gaining excessive gestational weight (23.5 % versus 29.4 %). The intervention group consistently reported smaller increases in depression and anxiety scores throughout pregnancy compared with usual care. Most women commented the intervention was useful in encouraging them to think about their weight and believed it should be part of routine antenatal care. Community midwives felt the intervention could be implemented within routine care without adding substantially to consultation length, thus not perceived as adding substantially to their workload. Conclusions The intervention was feasible and acceptable to pregnant women and community midwives and was readily implemented in routine care. Trial registration ISRCTN81605162
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Affiliation(s)
- A J Daley
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - K Jolly
- Public Health, Epidemiology and Biostatistics, School of Health and Population Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - A L Lewis
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS South West England
| | - S Clifford
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - A K Roalfe
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
| | - S Kenyon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG UK
| | - P Aveyard
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT West Midlands
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20
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Ledoux T, Van Den Berg P, Leung P, Berens PD. Factors associated with knowledge of personal gestational weight gain recommendations. BMC Res Notes 2015; 8:349. [PMID: 26268578 PMCID: PMC4534067 DOI: 10.1186/s13104-015-1306-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 07/30/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives Excess adiposity (obesity and excess gestational weight gain, GWG) during pregnancy (EADP) increases risk for gestational diabetes, preeclampsia, and child and maternal obesity. Personal GWG goals predict total GWG. Some estimates suggest only 30% of pregnant women have personal GWG goals that are congruent with Institute of Medicine GWG recommendations. The primary purpose of this study was to determine the extent to which perceived pre-pregnancy weight status, healthcare provider advice, knowledge of EADP risks, and value for healthy GWG predicted knowledge of GWG recommendations. The secondary purpose was to determine sources of GWG information among pregnant women. Methods Pregnant women with a confirmed singleton pregnancy completed a one-time survey in obstetric clinic waiting rooms. Logistic regression analysis was used. Results 246 predominantly African American, low income, overweight/obese women completed surveys. Average age was 25 (SD 5.3) and gestation age ranged from 7 to 40 weeks. Knowledge of pre-pregnancy weight status was the only unique predictor of GWG recommendation knowledge (B = .642, p = .03). The top three sources of GWG information were physicians, internet, and books. The least frequently reported sources of GWG information were other healthcare providers, community programs, and television. Conclusion In low income diverse overweight/obese pregnant women, accurate pre-pregnancy weight status perception was the only significant unique predictor of knowledge of GWG recommendations. Physicians were the preferred source of GWG information. Clinicians should have frequent, ongoing conversations about weight status with women before, during, and after pregnancy.
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Affiliation(s)
- Tracey Ledoux
- University of Houston, 3855 Holman Street, Garrison Gym Rm 104, Houston, TX, 77204-6015, USA.
| | - Patricia Van Den Berg
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, 300 University Blvd, Galveston, TX, 77555-0587, USA.
| | - Patrick Leung
- University of Houston Graduate College of Social Work, Houston, TX, 77204-4013, USA.
| | - Pamela D Berens
- University of Texas Health Sciences Center, 6431 Fannin St. Suite 3.116, Houston, TX, 77030, USA.
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Merkx A, Ausems M, Budé L, de Vries R, Nieuwenhuijze MJ. Dutch Midwives’ Behavior and Determinants in Promoting Healthy Gestational Weight Gain, Phase 1: A Qualitative Approach. INTERNATIONAL JOURNAL OF CHILDBIRTH 2015. [DOI: 10.1891/2156-5287.5.3.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: A significant contributor to the global threat of obesity is excessive gestational weight gain (GWG). The aim of this article is to explore Dutch primary care midwives’ behaviors in promoting healthy GWG.METHODS: We used the attitude–social influence–self-efficacy (ASE) model to guide interviews with a purposive sample of 6 midwives working in primary care.RESULTS: Midwives reported activities in 3 areas related to GWG: GWG monitoring (weighing and discussing GWG), diet education, and to a lesser degree physical activity education. The determinants from the ASE model were confirmed and other relevant determinants, including midwives’ perception of their role in health promotion, were added.PRACTICE IMPLICATIONS: The identified determinants can be used for quantitative research. Quantitative research is necessary to identify the magnitude of the determinants associated with midwives’ behavior in promoting healthy GWG.
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Wander PL, Hochner H, Sitlani CM, Enquobahrie DA, Lumley T, Lawrence GM, Burger A, Savitsky B, Manor O, Meiner V, Hesselson S, Kwok PY, Siscovick DS, Friedlander Y. Maternal genetic variation accounts in part for the associations of maternal size during pregnancy with offspring cardiometabolic risk in adulthood. PLoS One 2014; 9:e91835. [PMID: 24670385 PMCID: PMC3966761 DOI: 10.1371/journal.pone.0091835] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 02/12/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Maternal pre-pregnancy body-mass index (ppBMI) and gestational weight gain (GWG) are associated with cardiometabolic risk (CMR) traits in the offspring. The extent to which maternal genetic variation accounts for these associations is unknown. METHODS/RESULTS In 1249 mother-offspring pairs recruited from the Jerusalem Perinatal Study, we used archival data to characterize ppBMI and GWG and follow-up data from offspring to assess CMR, including body mass index (BMI), waist circumference, glucose, insulin, blood pressure, and lipid levels, at an average age of 32. Maternal genetic risk scores (GRS) were created using a subset of SNPs most predictive of ppBMI, GWG, and each CMR trait, selected among 1384 single-nucleotide polymorphisms (SNPs) characterizing variation in 170 candidate genes potentially related to fetal development and/or metabolic risk. We fit linear regression models to examine the associations of ppBMI and GWG with CMR traits with and without adjustment for GRS. Compared to unadjusted models, the coefficient for the association of a one-standard-deviation (SD) difference in GWG and offspring BMI decreased by 41% (95%CI -81%, -11%) from 0.847 to 0.503 and the coefficient for a 1SD difference in GWG and WC decreased by 63% (95%CI -318%, -11%) from 1.196 to 0.443. For other traits, there were no statistically significant changes in the coefficients for GWG with adjustment for GRS. None of the associations of ppBMI with CMR traits were significantly altered by adjustment for GRS. CONCLUSIONS Maternal genetic variation may account in part for associations of GWG with offspring BMI and WC in young adults.
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Affiliation(s)
- Pandora L. Wander
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Hagit Hochner
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Colleen M. Sitlani
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
| | - Daniel A. Enquobahrie
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Gabriela M. Lawrence
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ayala Burger
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Bella Savitsky
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Vardiella Meiner
- Department of Human Genetics, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Stephanie Hesselson
- Institute of Human Genetics, University of California San Francisco, San Francisco, California, United States of America
| | - Pui Y. Kwok
- Institute of Human Genetics, University of California San Francisco, San Francisco, California, United States of America
- Cardiovascular Research Institute, University of California San Francisco, San Francisco, California, United States of America
- Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America
| | - David S. Siscovick
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, United States of America
| | - Yechiel Friedlander
- Braun School of Public Health, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
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Raiten DJ, Raghavan R, Porter A, Obbagy JE, Spahn JM. Executive summary: Evaluating the evidence base to support the inclusion of infants and children from birth to 24 mo of age in the Dietary Guidelines for Americans--"the B-24 Project". Am J Clin Nutr 2014; 99:663S-91S. [PMID: 24500158 PMCID: PMC3927696 DOI: 10.3945/ajcn.113.072140] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Dietary Guidelines for Americans (DGA) are the cornerstone of US government efforts to promote health and prevent disease through diet and nutrition. The DGA currently provides guidelines for ages ≥ 2 y. In an effort to determine the strength of the evidence to support the inclusion of infants and children from birth to age 24 mo, the partner agencies led by the Department of Health and Human Services Office of Disease Prevention and Health Promotion and the USDA Center for Nutrition Program and Policy initiated the project entitled "Evaluating the evidence base to support the inclusion of infants and children from birth to 24 months of age in the Dietary Guidelines for Americans--the B-24 Project." This project represents the first step in the process of applying systematic reviews to the process of deciding whether the evidence is sufficient to include this age group in future editions of the DGA. This supplement includes the B-24 Executive Summary, which describes the B-24 Project and the deliberations of the 4 working groups during the process of developing priority topics for the systematic review, and a research agenda to address the critical gaps. Also included in this supplement issue is an article on the Nutrition Evidence Library methodology for developing systematic review questions and articles from the invited content presenters at the B-24 Prime meeting.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (DJR, RR, and AP); and the US Department of Agriculture, Center for Nutrition Policy and Promotion, Evidence Analysis Library Division, Alexandria, VA (JEO and JMS)
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