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Gagnon M, Plante AS, Turcotte M, Bégin C, Michaud A, Provencher V, Morisset AS. Determinants of weight gain and body changes during pregnancy: A qualitative study of French-Canadian pregnant people. J Gynecol Obstet Hum Reprod 2023; 52:102519. [PMID: 36529367 DOI: 10.1016/j.jogoh.2022.102519] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE More than half of pregnant Canadian people exceed current gestational weight gain recommendations, which has been associated with adverse outcomes for both parent and child. Although the physiological causes of excessive gestational weight gain have been well investigated, few studies have evaluated the context of gestational weight gain and body changes through the perspective of pregnant people. Therefore, we aim to explore factors influencing body changes and weight gain during pregnancy as experienced by pregnant individuals. METHODS A total of three focus groups and six individual interviews were conducted with pregnant people (n=21) recruited in the 2nd or 3rd trimester. A semi-structured interview guide was developed according to a pre-existing conceptual model by Hill et al., 2013. Focus groups and interviews were recorded, transcribed, and thematically analysed using NVivo software. FINDINGS Results were categorized into four main themes, based on the conceptual model: (1) parental psychological, social and cognitive factors, (2) outcomes, (3) parental behaviors and (4) health behavior change constructs. Participants identified structural, social, professional, and especially partner support (1), health-related strategies (2), body image (1) and knowledge of gestational weight gain recommendations (3) as influent components of their body changes experience. CONCLUSIONS In this study, the themes addressed affect both pregnant individuals and their relatives. Enhanced knowledge of gestational weight gain recommendations in this population, support from relatives and quality of follow-up offered by health professionals must therefore be considered as possible avenues of intervention.
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Affiliation(s)
- Marianne Gagnon
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec City, QC, Canada; School of Nutrition, Université Laval, Quebec City, QC, Canada; Endocrinology and Nephrology Unit, CHU of Quebec-Université Laval Research Center, Quebec City, QC, Canada
| | - Anne-Sophie Plante
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec City, QC, Canada; Endocrinology and Nephrology Unit, CHU of Quebec-Université Laval Research Center, Quebec City, QC, Canada
| | - Mylène Turcotte
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec City, QC, Canada
| | - Catherine Bégin
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec City, QC, Canada; School of Psychology, Université Laval, Quebec City, Canada
| | - Andréanne Michaud
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec City, QC, Canada; School of Nutrition, Université Laval, Quebec City, QC, Canada; Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Quebec City, QC, Canada
| | - Véronique Provencher
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec City, QC, Canada; School of Nutrition, Université Laval, Quebec City, QC, Canada
| | - Anne-Sophie Morisset
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Quebec City, QC, Canada; School of Nutrition, Université Laval, Quebec City, QC, Canada; Endocrinology and Nephrology Unit, CHU of Quebec-Université Laval Research Center, Quebec City, QC, Canada.
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Cheng TS, Ali N, Elbarazi I, Al‐Rifai RH, Al‐Maskari F, Loney T, Ahmed LA. Sociodemographic determinants of prepregnancy body mass index and gestational weight gain: The Mutaba'ah study. Obes Sci Pract 2022; 8:308-319. [PMID: 35664246 PMCID: PMC9159565 DOI: 10.1002/osp4.573] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022] Open
Abstract
Objective This study examined the associations of sociodemographic and lifestyle factors with prepregnancy body mass index (BMI) and gestational weight gain (GWG). Methods In the Mutaba'ah Study in the United Arab Emirates, repeated measurements throughout pregnancy from medical records were used to determine prepregnancy BMI and GWG. Associations of sociodemographic and lifestyle factors with prepregnancy BMI and GWG (separately by normal weight, overweight, and obesity status) were tested using multivariable regression models, adjusted for maternal age at delivery. Results Among 3536 pregnant participants, more than half had prepregnancy overweight (33.2%) or obesity (26.9%), and nearly three‐quarters had inadequate (34.2%) or excessive (38.2%) GWG. Higher parity (β for 1–2 to ≥5 children = 0.94 to 1.73 kg/m2), lower maternal education (β for tertiary = −1.42), infertility treatment (β = 0.69), and maternal prepregnancy active smoking (β = 1.95) were independently associated with higher prepregnancy BMI. Higher parity was associated with a lower risk for excessive GWG among women with prepregnancy normal weight (odds ratios (ORs) for 1–2 to ≥5 children = 0.61 to 0.39). Higher maternal education was negatively associated with inadequate GWG among women with normal weight and overweight (ORs for tertiary education = 0.75 and 0.69, respectively). Conclusions Sociodemographic factors, especially parity and maternal education, were differentially associated with prepregnancy BMI and GWG adequacy across weight status.
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Affiliation(s)
- Tuck Seng Cheng
- MRC Epidemiology Unit Institute of Metabolic Science University of Cambridge Cambridge UK
| | - Nasloon Ali
- Institute of Public Health College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates
| | - Iffat Elbarazi
- Institute of Public Health College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates
| | - Rami H. Al‐Rifai
- Institute of Public Health College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates
| | - Fatma Al‐Maskari
- Institute of Public Health College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates
- Zayed Centre for Health Sciences United Arab Emirates University Al Ain United Arab Emirates
| | - Tom Loney
- College of Medicine Mohammed Bin Rashid University of Medicine and Health Sciences Dubai United Arab Emirates
| | - Luai A. Ahmed
- Institute of Public Health College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates
- Zayed Centre for Health Sciences United Arab Emirates University Al Ain United Arab Emirates
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de Jersey S, Meloncelli N, Guthrie T, Powlesland H, Callaway L, Chang AT, Wilkinson S, Comans T, Eakin E. Outcomes from a hybrid implementation-effectiveness study of the living well during pregnancy Tele-coaching program for women at high risk of excessive gestational weight gain. BMC Health Serv Res 2022; 22:589. [PMID: 35501807 PMCID: PMC9063237 DOI: 10.1186/s12913-022-08002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background Excess gestational weight gain (GWG) is associated with short-term perinatal complications and longer term cardiometabolic risks for mothers and their babies. Dietitian counselling and weight gain monitoring for women at risk of high pregnancy weight gain is recommended by clinical practice guidelines. However, face-to-face appointments, during a time with high appointment burden, can introduce barriers to engaging with care. Telephone counselling may offer a solution. The Living Well during Pregnancy (LWdP) program is a dietitian-delivered telephone coaching program implemented within routine antenatal care for women at risk of excess GWG. This program evaluation used a hybrid implementation-effectiveness design guided by the RE-AIM framework to report on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention. Methods The LWdP program evaluation compared data from women participating in the LWdP program with a historical comparison group (pregnant women receiving dietetic counselling for GWG in the 12 months prior to the study). The primary outcomes were described for the LWdP program. Between group comparisons were used to determine effectiveness of achieving appropriate GWG and pre and post intervention comparisons of LWdP participants was used to determine changes to dietary intake and physical activity. Results The LWdP intervention group (n = 142) were compared with women in the historical comparison group (n = 49). Women in the LWdP intervention group attended 3.4 (95% CI 2.9–3.8) appointments compared with 1.9 (95% CI, 1.6–2.2) in the historical comparison group. GWG was similar between the two groups, including the proportion of women gaining weight above the Institute of Medicine recommendations (70% vs 73%, p = 0.69). Within group comparison showed that total diet quality, intake of fruit and vegetables and weekly physical activity were all significantly improved from baseline to follow-up for the women in LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p < 0.05). Conclusion The LWdP program resulted in more women accessing care and positive improvements in diet quality, intuitive eating behaviours and physical activity. It was as effective as face-to-face appointments for GWG, though more research is required to identify how to engage women earlier in pregnancy and reduce appointment burden. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08002-5.
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Affiliation(s)
- Susan de Jersey
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia. .,The University of Queensland, Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia.
| | - Nina Meloncelli
- The University of Queensland, Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia
| | - Taylor Guthrie
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Hilary Powlesland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Leonie Callaway
- The University of Queensland, Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia.,Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Angela T Chang
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Shelley Wilkinson
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Mothers, Babies and Women's Theme, Mater Research Institute - The University of Queensland, Brisbane, Queensland, Australia
| | - Tracy Comans
- Centre for Allied Health Research, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Rahmawati W, van der Pligt P, Worsley A, Willcox JC. Indonesian antenatal nutrition education: A qualitative study of healthcare professional views. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211066077. [PMID: 34892998 PMCID: PMC8669879 DOI: 10.1177/17455065211066077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early lifestyle intervention, including antenatal nutrition education, is required to reduce the triple burden of malnutrition. Understanding healthcare professionals' views and experiences is essential for improving future nutrition education programmes for Indonesian pregnant women. This study aimed to investigate the views of Indonesian antenatal healthcare professionals regarding nutrition education for pregnant women and the improvements required to provide more effective antenatal nutrition education. METHODS A descriptive qualitative study involved semi-structured interviews was conducted with 24 healthcare professionals, including nutritionists (n = 10), midwives (n = 9) and obstetricians (n = 5) in Malang, Indonesia, between December 2018 and January 2019. Data were analysed using thematic analysis. RESULTS The study identified four main themes. First, healthcare professionals were aware of the importance of providing antenatal nutrition education, which included supporting its targeted delivery. Second, there were differing views on who should provide nutrition education. Most midwives and obstetricians viewed nutritionists as the prime nutrition education provider. Nutritionists were confident in their capability to provide nutrition education. However, some nutritionists reported that only a few women visited primary health centres and received nutrition counselling via this pathway. Third, healthcare professionals revealed some barriers in providing education for women. These barriers included a limited number of nutritionists, lack of consistent guidelines, lack of healthcare professionals' nutrition knowledge and lack of time during antenatal care services. Fourth, participants expressed the need to strengthen some system elements, including reinforcing collaboration, developing guidelines, and enhancing capacity building to improve future antenatal nutrition education. CONCLUSIONS Healthcare professionals play a central role in the provision of antenatal nutrition education. This study highlighted the importance of educational models that incorporate various antenatal nutrition education delivery strategies. These methods include maximizing referral systems and optimizing education through multiple delivery methods, from digital modes to traditional face-to-face nutrition education in pregnancy classes and community-based health services.
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Affiliation(s)
- Widya Rahmawati
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
- Department of Nutrition Science, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Paige van der Pligt
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Anthony Worsley
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Jane C Willcox
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
- Centre for Quality and Patient Safety Research–Epworth HealthCare Partnership, Institute of Health Transformation, School of Nursing & Midwifery, Deakin University, Burwood, VIC, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
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The Healthy Pregnancy Service to Optimise Excess Gestational Weight Gain for Women with Obesity: A Qualitative Study of Health Professionals' Perspectives. J Clin Med 2020; 9:jcm9124073. [PMID: 33348671 PMCID: PMC7766467 DOI: 10.3390/jcm9124073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
Maternal obesity is associated with health risks for women and their babies, exacerbated by excess gestational weight gain. We describe health professionals’ perspectives in the provision of a Healthy Pregnancy service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity. Semi-structured interviews were conducted with health professionals. Questions were based on the Theoretical Domains Framework (TDF) and deductive thematic analysis was performed. A total of 14 multidisciplinary staff were interviewed. Six themes were identified: 1. health professionals view themselves as part of a team; 2. health professionals reported having necessary skills; 3. experience generated confidence in discussing gestational weight gain; 4. gestational weight gain is considered of variable importance; 5. health professionals want women to be comfortable; 6. the environmental context and resources presented some barriers. Staff were supportive of the Healthy Pregnancy service and valued developing teamwork with staff and rapport with women. Most felt relatively comfortable discussing weight gain with women. Barriers included ability to navigate sensitive topics with women, limited awareness of the intervention among new staff, communication between teams, and waiting time for women. Barriers and enablers to the delivery of an integrated model of maternity care were identified. These findings should inform and improve implementation of service models integrating healthy lifestyle in the antenatal care of women with obesity.
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"They Just Need to Come Down a Little Bit to your Level": A Qualitative Study of Parents' Views and Experiences of Early Life Interventions to Promote Healthy Growth and Associated Behaviours. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103605. [PMID: 32455567 PMCID: PMC7277501 DOI: 10.3390/ijerph17103605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/28/2022]
Abstract
The first 1000 days is a critical window of opportunity to promote healthy growth and associated behaviours. Health professionals can play an important role, in part due to the large number of routine contacts they have with parents. There is an absence of research on the views of parents towards obesity prevention and the range of associated behaviours during this time period. This study aimed to elicit parents’ views on early life interventions to promote healthy growth/prevent childhood obesity, particularly those delivered by health professionals. Semi-structured interviews were conducted with 29 parents (24 mothers, 5 fathers) who were resident in Ireland and had at least one child aged under 30 months. Data were analysed using reflexive thematic analysis. Two central themes were generated: (1) navigating the uncertainty, stress, worries, and challenges of parenting whilst under scrutiny and (2) accessing support in the broader system. Parents would welcome support during this critical time period; particularly around feeding. Such support, however, needs to be practical, realistic, evidence-based, timely, accessible, multi-level, non-judgemental, and from trusted sources, including both health professionals and peers. Interventions to promote healthy growth and related behaviours need to be developed and implemented in a way that supports parents and their views and circumstances.
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Walker R, Morris H, Lang S, Hampton K, Boyle J, Skouteris H. Co-designing preconception and pregnancy care for healthy maternal lifestyles and obesity prevention. Women Birth 2019; 33:473-478. [PMID: 31812498 DOI: 10.1016/j.wombi.2019.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 01/17/2023]
Abstract
PROBLEM A recognised gap exists between current and recommended practices in the provision of lifestyle advice and weight management support for women across preconception and pregnancy care. BACKGROUND Preconception and pregnancy are critical stages for promoting healthy maternal lifestyles and obesity prevention. Co-design is a novel approach with the potential to strengthen existing models of care to facilitate the implementation of clinical practice guidelines promoting preconception and pregnancy health, especially in relation to preconception weight management and preventing excessive gestational weight gain. AIM AND METHODS The aims of this discussion paper are to (i) define co-design in the context of preconception and pregnancy care, (ii) outline key considerations when planning co-design initiatives and (iii) describe co-design opportunities in preconception and pregnancy care for promoting women's health and obesity prevention. DISCUSSION While several definitions of co-design exist, one critical element is the meaningful involvement of all key stakeholders. In this discussion, we specifically identified the involvement of women and expanding the role of practice nurses in primary care may assist to overcome barriers to the provision of healthy lifestyle advice and support for women during preconception. Co-designing pregnancy care will involve input from women, nurses, midwives, obstetricians, allied health and administration and management staff. Additional attention is required to co-design care for women considered most at-risk. CONCLUSION There is potential to enhance current provision of preconception and pregnancy care using co-design. Nursing and midwifery professions are active across both preconception and pregnancy and therefore, they have an important role to play.
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Affiliation(s)
- Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 41-52 Kanooka Grove, Clayton, Victoria 3168, Australia.
| | - Heather Morris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 41-52 Kanooka Grove, Clayton, Victoria 3168, Australia
| | - Sarah Lang
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Level 1 264 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia
| | - Kerry Hampton
- Department of Nursing and Midwifery, School of Clinical Sciences, Monash University, Clayton Road, Clayton, Victoria, 3168, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 41-52 Kanooka Grove, Clayton, Victoria 3168, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 41-52 Kanooka Grove, Clayton, Victoria 3168, Australia; Warwick Business School, Warwick University, Coventry, CV4 7AL, United Kingdom.
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