The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy

Opinions and Knowledge of Midwives Regarding Physical Exercise During Pregnancy: Insights and Implications for Midwifery Practice

Background Physical exercise during pregnancy offers significant benefits for maternal and fetal health, improving cardiovascular fitness, managing weight, and reducing risks of gestational diabetes and hypertension. Despite these benefits, the role of midwives in promoting exercise is critical but often underexplored. Materials and methods This cross-sectional quantitative study surveyed 172 midwives using a structured questionnaire to assess their knowledge and attitudes towards physical exercise during pregnancy. Descriptive and inferential statistics, including chi-square tests, were used to analyze the data. Data collected through the questionnaires were analyzed using IBM SPSS Statistics v. 29 (IBM Corp., Armonk, NY). Results Among the 172 participants, 97.7% were female with a median age of 36 years. While 65.1% engaged in physical exercise themselves, only 26.7% recommended exercise during pregnancy to their patients. The knowledge level of midwives about the benefits of exercise was high, with 95.3% recognizing its role in maintaining hormonal balance and 88.4% understanding its benefits in reducing gestational diabetes. However, 32.6% of midwives reported not feeling confident in guiding pregnant women on how to exercise. Statistically significant correlations were found between midwives' opinion level and their knowledge of exercise benefits, including proper weight gain (rho = 0.263, p = 0.01) and reduced likelihood of gestational diabetes (rho = 0.492, p = 0.01). Conclusions Midwives recognize the importance of exercise during pregnancy but require more training to provide effective guidance. Enhancing midwives' education on exercise can improve maternal and fetal health outcomes by promoting physical activity during pregnancy.

Cross-cultural adaptation of the empowerment scale of pregnant women in China context: An integrative method of translation and linguistic validation

AIM

To translate the Empowerment Scale for Pregnant Women (ESPW) into Chinese and to assess its linguistic validity.

METHODS

The integrative method of the translation process, the Delphi technique, and cognitive interviews were used to implement cross-cultural adaptation and enhance comprehensibility and linguistic validation. This study recruited 14 experts in the expert review and cognitively reviewed 15 pregnant women.

RESULTS

The two-round Delphi method created agreement on cultural applicability. The results of content validity achieved good levels: The item-level content validity index (CVI) ranged from 0.78 to 1.00, and the scale-level content validity index, calculated using two different formulas, were 0.97 and 0.81, respectively. Kappa values ranged from 0.74 to 1.00. Pregnant women could understand most of the items and response options in the cognitive interview. The revisions to the wording were made based on suggestions from experts and pregnant women.

CONCLUSION

The prefinal simplified Chinese ESPW was semantically and conceptually equivalent to the English version, which was well prepared for further psychometric tests in the next stage of cross-cultural adaptation.

PATIENT OR PUBLIC CONTRIBUTION

This comprehensive method successfully developed a Chinese tool to measure the empowerment of pregnant women, indicating the international applicability of this tool and the methodological scientific nature. The simplified Chinese ESPW has the potential to support the identification of empowerment levels of pregnant women and the evaluation of the effectiveness of health education and promotion programmes.

Associations of primiparous pre-pregnancy body mass index and gestational weight gain with cesarean delivery after induction: a prospective cohort study

Objective

The effects of Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in primiparas remain unclear. This study examines the associations of pre-pregnancy BMI and GWG with cesarean delivery after induction (CDaI) in primiparous women.

Methods

This prospective cohort study included 3,054 primiparous women. We recorded pre-pregnancy BMI, first, second, and third trimester weight values, as well as instances of CDaI and other pregnancy outcomes. We analyzed the associations of pre-pregnancy BMI and GWG with CDaI by conducting a multivariate logistic regression analysis after adjusting for covariates, and adjusted risk ratios (aRR) and 95% confidence intervals were reported.

Results

We recorded 969 CDaIs. In the vaginal delivery group, each increase of 1 standard deviation in the pre-pregnancy BMI was correlated with a 6% increase in the CDaI risk [aRR (95% CI), 1.06 (1.01-1.11)]. Each increase of 1 standard deviation in the rate of weight gain during the entire pregnancy was correlated with a 21% increase in the CDaI risk [aRR (95% CI), 1.21 (1.14-1.29)]. Compared to women with a normal weekly GWG in the second and third trimester, those with slow GWG had a 19% increased risk of CDaI [aRR (95% CI), 1.19 (1.01-1.37)]. The subgroup analysis results showed that increases in pre-pregnancy BMI could increase the CDaI risk regardless of the induction method.

Conclusion

High pre-pregnancy BMI, excessive GWG, and rapid first trimester weight gain are risk factors for CDaI in primiparous women. Excessive first trimester weight gain, may associated with increased risks of CDaI in primiparous women.

Assessment of Diet Quality Based on Selected Dietary Quality Indices and Consumption of Specific Food Items of Midwives Working on a Shift Schedule in Wroclaw, Poland

The aim of this study was to assess the quality of diets among midwives working in a shift system and to analyze variations in their dietary habits according to their working hours. In a group of fifty midwives employed in four public hospitals in Wrocław, the HDI-2015, HEI-2015, AHEI-2010, and Mellen's DASH diet index were calculated. The significance of differences in terms of the prevalence of selected dietary habits, meal frequency, average content of selected food items, and the percentage of energy obtained from them was assessed. Over half of the diets of the participants exhibited low adherence to the selected dietary indices. Only the scores on Mellen's DASH diet index were significantly associated with other components of the diet. Diets scoring ≥ 4.5 points were characterized by significantly lower processed meat content, meal frequency, and energy value, as well as lower sugar content and lower dietary energy value, compared to diets scoring < 4.5 points. Regardless of their working hours, the diets of midwives are characterized by low quality. Therefore, it appears essential to introduce targeted educational programs and provide guidance on appropriate dietary models, such as the DASH diet.

Clinicians Address Gestational Weight Gain and Nutrition Using the International Federation of Gynecology and Obstetrics (FIGO) Nutrition Checklist

The negative effects of excessive gestational weight gain (GWG) and obesity during pregnancy are well documented in the literature. However, lack of time, education, comfort, and confidence among health care providers often make it difficult to provide proper nutrition and weight gain guidance for pregnant persons. In response, the International Federation of Gynecology and Obstetrics (FIGO) has developed a nutrition checklist that can standardize recommendations for GWG, facilitate discussions with pregnant persons, and aid providers with nutrition education. The checklist is an innovative tool that can help reduce complications associated with excessive GWG. This article discusses the benefits of FIGO Nutrition Checklist and its implementation at a midwifery clinic that primarily serves Native American women. By using this quick, simple, guided, time-efficient tool, clinics can be successful in facilitating important conversations and education about nutrition and GWG during pregnancy.

Could commercial meal kits be part of the solution to food insecurity during pregnancy? An Australian exploratory study

AIM

To explore the nutritional content of meal kits from two main Australian companies over a 6-week period against healthy eating guidelines for pregnancy.

METHOD

Across the 6-week period, weekly meal kits from both Provider 1 and Provider 2 were purchased, 36 individual meals were assessed. All data were analysed for the development of a macronutrient and micronutrient profile of meals. Extracted data were macronutrient, vitamin, and mineral composition, which were compared against the healthy eating guidelines for pregnant women in Australia and New Zealand.

RESULTS

Meal kits include higher levels of sodium, and lower levels of dietary fibre, calcium, magnesium, zinc, iron, thiamin, riboflavin, grains, and dairy when compared against the guidelines for healthy eating for pregnant women in Australia and New Zealand.

CONCLUSIONS AND IMPLICATIONS

Meal kits may increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation. They have the potential to provide nutritionally adequate meals to pregnant women as a way to mitigate food insecurity or hunger during pregnancy and may provide some nutritional benefits and have the potential to remove some of the challenges with maintaining an adequate diet when pregnant.

Consumption of Acetaminophen During Pregnancy: A Survey on Knowledge, Attitudes and Practices of Lebanese Women

OBJECTIVES

Use of acetamoniphen (paracetamol or N-acetyl-para-aminophenol [APAP]) during pregnancy is considered safe; however certain practices have been related to the risk of developing neurodevelopmental disorders in offspring. Therefore, the present study aimed to assess women's knowledge, attitudes and practices (KAP) towards the use APAP during pregnancy and its associated factors.

METHODS

This cross-sectional study was conducted between May 15 and August 31, 2020, among pregnant Lebanese women and those who had given birth in the last 12 months. Online self-administered questionnaire was used for data collection. KAP were described and a knowledge score was generated. Multivariable linear models were used to test the association of participants' sociodemographic characteristics with their knowledge and practices related to the use of APAP.

RESULTS

Out of 305 participants, 72.8% had moderate knowledge about the use of APAP during pregnancy. Actually, more than 50% of them were unable to differentiate between APAP and other pain medications, determine the maximum recommended daily dose, specify the minimum time to wait between doses and identify potential effects of APAP on both mother and unborn child. A higher level of education was associated with a higher knowledge score (β = 2.32, 95%CI=[0.91; 3.73]; p = 0.001). Moreover, women had positive attitudes towards APAP use, perceiving a low risk of toxicity. Indeed, 70.5% of women used APAP at least once during their pregnancy, with 63.7% using it safely. Women with higher knowledge, experiencing at least five somatic symptoms and having a low socioeconomic level tended to be more APAP users (p < 0.05).

CONCLUSIONS FOR PRACTICE

Health professionals have the responsibility to give adequate and personalized advice to women regarding their medicines.

Designing the future of prenatal care: an algorithm for a telemedicine-enhanced team-based care model

This study provides a conceptual exploration of an innovative telemedicine-enhanced team-based care (TETC) model, tailored to prenatal care, integrating a multidisciplinary team approach with advanced telemedicine technologies. The algorithm developed for TETC aims to optimize communication and coordination among healthcare professionals, including obstetricians, midwives, nutritionists, and mental health experts. This cohesive team structure ensures a comprehensive care plan encompassing all facets of maternal and fetal health. Leveraging telemedicine tools like video conferencing and digital health records, the model supports remote consultations and coordinated care, proving particularly advantageous during pandemics or in regions with limited healthcare access. Central to the TETC model is patient-centered care, focusing on personalized care plans attuned to the individual needs, health status, and socioeconomic backgrounds of pregnant women. This approach not only enhances accessibility and convenience by diminishing the necessity for physical consultations but also ensures continuity of care throughout pregnancy. This continuity is crucial for consistent health parameter tracking and early risk identification. The paper discusses the model's design, operational workflow, and ethical and legal considerations, providing implementation guidelines and potential applications. The TETC model, rooted in current technological capabilities and healthcare frameworks, underscores the need for close collaboration with healthcare professionals to adhere to medical standards and address real-world requirements effectively.

Exploring the Experiences of Health-Promoting Behavior in the Workplace among Thai Pregnant Women: A Phenomenological Approach

Background

Inappropriate working conditions during pregnancy can negatively affect health-promoting behaviors and pregnancy outcomes. This study aimed to explore the experiences of health-promoting behavior in the workplace among Thai pregnant women.

Materials and Methods

Giorgi's phenomenological methodology was used, and data were gathered through semi-structured interviews with 21 working-pregnant women in large industries in two regions of Thailand. Data were collected from December 2019 to June 2020. Purposive and snowball sampling were used to recruit pregnant women at 13-42 weeks of gestation. To analyze the data, three steps of Giorgi's phenomenological approach were employed.

Results

The pregnant women described their lived experiences with health-promoting behaviors in the workplace into four major categories. Firstly, "positive attitude toward work in promoting health behaviors" contained three subcategories ("self-discipline," "social interaction," and "self-esteem"). Secondly, the idea that "changing temporary health behaviors is worthwhile for infants" was expressed into two subcategories ("eating adaptation" and "managing negative emotions"). Thirdly, "insufficient support from workplace policy" had three subcategories ("inconvenient accommodations," "inflexible break times," and "lack of healthcare support"). Finally, "negative perception of new work positions" consisted of two subcategories ("stress" and "low self-efficacy").

Conclusions

Positive attitudes toward work and infant health may encourage pregnant women to engage in healthy behaviors, while workplace support and policies are important in promoting healthy behavior and avoiding negative emotions. Health promotion interventions should encourage the value of work, promote maternal-fetal attachment, and increase health support policy to avoid mental health issues and promote healthy behaviors among working-pregnant women.

Exploring Barriers to Healthy Eating Among Women in Their Role as New Mothers with a Theory-Driven Questionnaire

OBJECTIVES

This study aims to propose and evaluate a theory-driven questionnaire addressing barriers to healthy eating among mothers of young children.

METHODS

Statements drawing upon the Social Cognitive Theory were developed/gathered based on literature review and previous qualitative research. Part I (43 items) included general barriers, attitudes to nutrition advice and outcome expectations. Part II (9 items) included subjective knowledge and general self-efficacy scales. An online survey was undertaken with 267 Danish women. The validation process included content and face validity, exploratory factor analysis (EFA) and reliability analysis. Confirmatory factor analysis (CFA) tested possible associations between the constructs and potential health outcomes (BMI and healthiness of eating habits).

RESULTS

The EFA supported an adequate factorial validity with a 5-factor, 37-item structure model for Part I, and a high internal reliability of Parts I and II (Cronbach's alpha > 0.7). The CFA revealed an association between certain constructs and perceived healthiness of eating and BMI. Results support the reliability and factorial validity of the social cognitive measures assessing barriers to healthy eating among mothers.

CONCLUSIONS FOR PRACTICE

These promising findings of reliability and initial validity suggest that researchers and practitioners interested in identifying women who face difficulties in the family food environment may find the scales useful. We propose a short version of the questionnaire for health practitioners.

'Torn in two': Experiences of Mothers Who Are Pregnant when Their Child Is Diagnosed With Cancer

Mothers of children diagnosed with cancer have been shown to experience high rates of psychological distress and poor physical health. Pregnancy further increases the healthcare needs of mothers due to the marked physiological changes and psychological adaptations. Our study aimed to explore the experiences of mothers who were pregnant and/or had a baby while their older child was receiving treatment for cancer. Our study employed a qualitative description methodology using semi-structured interviews. Participants were recruited from across Australia via notices on social media sites and the distribution of flyers. The sample comprised 13 mothers who were pregnant and/or had a baby and had a child diagnosed with cancer who was under 17 years old. Thematic analysis was used to analyse the data from which six themes were identified: (1) an impossible balancing act, (2) mother's health and well-being, (3) creating certainty: birthing plans, (4) a bit of sunshine and a time to rest, (5) challenges of caring for the baby and (6) an unenviable position: doing my best versus feeling guilty. Our study demonstrates the additional challenges faced by mothers who are pregnant while their child is receiving cancer treatment. There is a need for a comprehensive and coordinated program that provides pregnant mothers with practical and psychological support. The implementation of such a program has the potential to improve health outcomes for all family members, particularly the mother and their newborn.

Polyphenol Intake in Pregnant Women on Gestational Diabetes Risk and Neurodevelopmental Disorders in Offspring: A Systematic Review

The intake of foods containing polyphenols can have a protective role to avoid comorbidities during pregnancy and, at the same time, promote transgenerational health. This review aims to describe the effect of polyphenol intake through supplements or polyphenol-rich foods during pregnancy on the incidence and evolution of gestational diabetes mellitus (GDM), as well as the link with the neurodevelopment of the fetus. Using PRISMA procedures, a systematic review was conducted by searching in biomedical databases (PubMed, Cinahl and Scopus) from January to June 2022. Full articles were screened (n = 419) and critically appraised. Fourteen studies were selected and were divided into two different thematic blocks considering (i) the effect of polyphenols in GDM and (ii) the effect of GDM to mental disorders in the offspring. A positive relationship was observed between the intake of polyphenols and the prevention and control of cardiometabolic complications during pregnancy, such as GDM, which could be related to thwarted inflammatory and oxidative processes, as well as neuronal factors. GDM is related to a greater risk of suffering from diseases related to neurodevelopment, such as attention deficit hyperactivity disorder, autism spectrum disorder and learning disorder. Further clinical research on the molecule protective mechanism of polyphenols on pregnant women is required to understand the transgenerational impact on fetal neurodevelopment.

Application of Caring Life-Course Theory to explore care needs in women with pregnancy-related pelvic girdle pain

AIMS

To describe the care needs of women with pregnancy-related pelvic girdle pain based on the Caring Life-Course Theory.

DESIGN

A descriptive qualitative research design.

METHODS

Data were collected between November 2019 and February 2021 from 20 purposively selected pregnant women with pelvic girdle pain aged between 22 and 39 years in antenatal care at a tertiary hospital in Australia. Individual semi-structured interviews were recorded via a digital audio recorder and transcribed verbatim. Qualitative content analysis method was used to analyse the data.

FINDINGS

Five broad themes were identified: pain is an added burden to pregnancy; knowledge is power to own what happens to me; engaging in self-help; care from others is useful; and pain deserves more attention from healthcare professionals.

CONCLUSION

Caring Life-Course Theory presented a useful and applicable scaffold for describing care needs of pregnant women with pelvic girdle pain. The study revealed experiencing pelvic girdle pain led to additional care needs during pregnancy, highlighting the importance of self-management strategies and an appreciation of care from others to assist women in limiting the effects of the pain. Participants identified the need for more information and attention from healthcare professionals to be able to better manage their condition.

IMPACT

This study presents a comprehensive picture of the change in care needs triggered by experiencing pelvic girdle pain during pregnancy. The findings have the potential to facilitate better care provision by considering novel methods of delivery, such as information and communication technology, whilst acknowledging the value placed on credible and trusted sources. Knowledge acquired through this study may be used by nurses and midwives, along with other healthcare professionals, to enhance the provision of comprehensive care that is acceptable to women with pelvic girdle pain during pregnancy.

Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: a narrative review

The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre‐pregnancy body mass index greater than 25 kg m^–2 are more likely than those with a body mass index in the ideal range (20–24.99 kg m^–2) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care.

Overweight and obesity before pregnancy and excessive gestational weight gain are major determinants of risk for pregnancy loss, gestational diabetes, hypertensive conditions, labour complications and maternal death.

Pregnancy is regarded as a teachable moment when women are at their most receptive to messages about their health. However, unclear guidance on diet and physical activity, weight stigma from health professionals, inexperience and reluctance among professionals about raising issues about weight, and stretched resources put the health of women and babies at risk.

Excessive weight gain in pregnancy and post‐partum weight retention compromise future fertility and increase risk for future pregnancies.

Large randomised controlled trials have had little success in addressing excessive gestational weight gain or antenatal complications. Individualised, culturally sensitive and responsive interventions appear to have greater success.