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Chowdhury K, Sinha S, Ahmad R, Lugova H, Mehta M, Kumar S, Haque M. Type 2 Diabetes Mellitus and Cardiometabolic Prospects: A Rapid Narrative Review. Cureus 2024; 16:e65808. [PMID: 39092382 PMCID: PMC11293072 DOI: 10.7759/cureus.65808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024] Open
Abstract
Cardiometabolic syndrome (CMS), type 2 diabetes mellitus (T2DM), and cardiovascular diseases are among the major altruists to the international liability of disease. The lifestyle and dietary changes attributable to economic growth have resulted in an epidemiological transition towards non-communicable diseases (NCDs) as the leading causes of death. Low- and middle-income countries (LMICs) bear a more substantial disease burden due to limited healthcare sector capacities to address the rapidly growing number of chronic disease patients. The purpose of this narrative review paper was to explore the interrelationships between CMS, T2DM, and cardiovascular impairments in the context of NCDs, as well as major preventative and control interventions. The role of insulin resistance, hyperglycemia, and dyslipidemia in the pathogenesis of T2DM and the development of severe cardiovascular impairments was highlighted. This paper elaborated on the pivotal role of lifestyle modifications, such as healthy diets and physical activity, as cornerstones of addressing the epidemics of metabolic diseases. Foods high in calories, refined sugar, red meat, and processed and ready-to-eat meals were associated with an amplified risk of CMS and T2DM. In contrast, diets based on fruits, legumes, vegetables, and whole grain, home-cooked foods demonstrated protective effects against metabolic diseases. Additionally, the role of a psychological and behavioral approach in addressing metabolic diseases was highlighted, especially regarding its impact on patient empowerment and the patient-centered approach to preventative and therapeutic interventions.
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Affiliation(s)
- Kona Chowdhury
- Department of Pediatrics, Enam Medical College Hospital, Dhaka, BGD
| | - Susmita Sinha
- Department of Physiology, Enam Medical College Hospital, Dhaka, BGD
| | - Rahnuma Ahmad
- Department of Physiology, Medical College for Women and Hospital, Dhaka, BGD
| | - Halyna Lugova
- Department of Medicine and Health Sciences, UCSI (University College Sedaya International) University Bandar Springhill Campus, Port Dickson, MYS
| | - Miral Mehta
- Department of Pedodontics and Preventive Dentistry, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati School of Dentistry, Karnavati University, Gandhinagar, IND
| | - Mainul Haque
- Department of Research, Karnavati Scientific Research Center (KSRC) School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
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Daglas V, Kostopoulos N, Mrvoljak-Theodoropoulou I, Mitrotasios M, Dagla M, Lykeridou A, Antoniou E. Healthcare Professionals' Attitudes and Practices According to Their Recommendations on Exercise during the First Trimester of Pregnancy: A Greek Cross-Sectional Study. Sports (Basel) 2024; 12:173. [PMID: 39058064 PMCID: PMC11281032 DOI: 10.3390/sports12070173] [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: 04/29/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The aim of this study is to investigate healthcare professionals' attitudes and practices when it comes to their recommendations on exercise during the first trimester of pregnancy and to highlight the factors that influence or predict these attitudes. METHODS This cross-sectional study was conducted between January 2022 and March 2023, on a sample of 237 Greek healthcare professionals (midwives and obstetricians) employed in healthcare settings in Attica/Greece. In the statistical analysis, eight independent models of multivariate analyses of variance were conducted. RESULTS Only half of the participants (54.89%) report that they recommend exercise to pregnant women in the first trimester of pregnancy. The majority do not routinely recommend a specific frequency and duration of exercise. Participants who believe that exercise during pregnancy is of little benefit to pregnant women were less likely to recommend the following, in the first trimester of pregnancy: (a) exercise in general (p = 0.002), (b) resistance/muscle strengthening exercises (p = 0.039), (c) relaxation exercises (p = 0.002), and (d) a specific exercise duration (p = 0.011). Those who report being very familiar with the international guidelines are (a) more likely to recommend exercise in general (p = 0.013), as well as aerobic exercises (p = 0.023); (b) less likely to not recommend a specific frequency (p = 0.027); and (c) more likely to recommend a duration of 30-45 min of exercise in the first trimester (p = 0.017). CONCLUSIONS I this study, a significant proportion of health professionals' attitudes appear to diverge from the recommendations set forth by international scientific bodies regarding exercise during pregnancy. Furthermore, health professionals' beliefs regarding the benefits of exercise during pregnancy, along with their familiarity with international guidelines, appear to influence their usual practices in recommending exercise during the first trimester of pregnancy to pregnant women.
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Affiliation(s)
- Vasileios Daglas
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.D.); (A.L.); (E.A.)
| | - Nikolaos Kostopoulos
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (N.K.); (M.M.)
| | | | - Michalis Mitrotasios
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Athens, Greece; (N.K.); (M.M.)
| | - Maria Dagla
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.D.); (A.L.); (E.A.)
| | - Aikaterini Lykeridou
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.D.); (A.L.); (E.A.)
| | - Evangelia Antoniou
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece; (M.D.); (A.L.); (E.A.)
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Ruart S, Sinnapah S, Hue O, Janky E, Antoine-Jonville S. Physical activity counseling received throughout pregnancy and effect on behaviors: a quasi-experimental study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023:S1701-2163(23)00405-X. [PMID: 37263525 DOI: 10.1016/j.jogc.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The objective was to examine the frequency of physical activity counseling for pregnant women over the course of their pregnancies and the effect on the women's physical activity behaviors. METHODS A quasi-experimental study was conducted in the Maternity Unit of a hospital. Seventy-two pregnant women were randomized into a control or intervention group. Counseling about physical activity was dispensed to the women in the intervention group throughout pregnancy by health professionals who had been sensitized to its importance and the recommendations. The women in the control group received the usual consultation content. The physical activity behavior of the pregnant women in the intervention group who reported receiving physical activity counseling was evaluated. The counseling and physical activity levels were evaluated by Chi2 tests and repeated measures ANOVAs, respectively. RESULTS Overall, the women received little counseling in accordance with the recommendations, although the intervention group women received this counseling more frequently (p=0.049). All women in the intervention group who reported received counseling throughout pregnancy limited their decline in physical activity compared to those in the control group. The decline in total physical activity among normal-weight and overweight pregnant women was reduced in the intervention group (respectively, p=0.043 and p=0.044). CONCLUSION Our intervention showed the effectiveness of counseling on physical activity behaviors, although the effect was observed at the end of pregnancy. Training and sensitizing for professionals should be strengthened to ensure that counseling in line with the recommendations to maintain or increase physical activity levels throughout pregnancy is provided.
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Affiliation(s)
- Shelly Ruart
- Univ Antilles, Sport Sciences Department Laboratory ACTES EA3596, Pointe-à-Pitre, Guadeloupe (France).
| | - Stéphane Sinnapah
- Univ Antilles, Sport Sciences Department Laboratory ACTES EA3596, Pointe-à-Pitre, Guadeloupe (France)
| | - Olivier Hue
- Univ Antilles, Sport Sciences Department Laboratory ACTES EA3596, Pointe-à-Pitre, Guadeloupe (France)
| | - Eustase Janky
- Gynecology, Obstetrics Department, University Hospital of Guadeloupe, Pointe-à-Pitre, Guadeloupe (France)
| | - Sophie Antoine-Jonville
- Univ Antilles, Sport Sciences Department Laboratory ACTES EA3596, Pointe-à-Pitre, Guadeloupe (France)
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Wynne O, Szewczyk Z, Hollis J, Farragher E, Doherty E, Tully B, Paolucci F, Gillham K, Reeves P, Wiggers J, Kingsland M. Study protocol for an economic evaluation and budget impact of implementation strategies to support routine provision of antenatal care for gestational weight gain: a stepped-wedge cluster trial. Implement Sci Commun 2023; 4:40. [PMID: 37072809 PMCID: PMC10114337 DOI: 10.1186/s43058-023-00420-8] [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: 02/13/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Antenatal clinical practice guidelines recommend routine assessment of weight and provision of advice on recommended weight gain during pregnancy and referral to additional services when appropriate. However, there are barriers to clinicians adopting such best-practice guidelines. Effective, cost-effective, and affordable implementation strategies are needed to ensure the intended benefits of guidelines are realised. This paper describes the protocol for evaluating the efficiency and affordability of implementation strategies compared to the usual practice in public antenatal services. METHOD The prospective trial-based economic evaluation will identify, measure, and value key resource and outcome impacts arising from the implementation strategies compared with usual practice. The evaluation will comprise of (i) costing, (ii) cost-consequence analyses, where a scorecard approach will be used to show the costs and benefits given the multiple primary outcomes included in the trial, and (iii) cost-effectiveness analysis, where the primary outcome will be incremental cost per percent increase in participants reporting receipt of antenatal care for gestational weight gain consistent with the guideline recommendations. Affordability will be evaluated using (iv) budget impact assessment and will estimate the financial implications of adoption and diffusion of this implementation strategy from the perspective of relevant fund-holders. DISCUSSION Together with the findings from the effectiveness trial, the outcomes of this economic evaluation will inform future healthcare policy, investment allocation, and research regarding the implementation of antenatal care to support healthy gestational weight gain. TRIAL REGISTRATION Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819 (22/01/2021) http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=true .
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Affiliation(s)
- Olivia Wynne
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia.
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Zoe Szewczyk
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Jenna Hollis
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Eva Farragher
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- , Tamworth, Australia
| | - Francesco Paolucci
- College of Human and Social Futures, Newcastle Business School, University of Newcastle, Callaghan, NSW, Australia
- Department of Sociology and Business Law, School of Economics and Statistics, University of Bologna, Bologna, Italy
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Penny Reeves
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Melanie Kingsland
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Doherty E, Kingsland M, Wiggers J, Wolfenden L, Hall A, McCrabb S, Tremain D, Hollis J, Licata M, Wynne O, Dilworth S, Daly JB, Tully B, Dray J, Bailey KA, Elliott EJ, Hodder RK. The effectiveness of implementation strategies in improving preconception and antenatal preventive care: a systematic review. Implement Sci Commun 2022; 3:121. [PMID: 36419177 PMCID: PMC9682815 DOI: 10.1186/s43058-022-00368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical guideline recommendations for addressing modifiable risk factors are not routinely implemented into preconception and antenatal care. This review assessed the effectiveness of implementation strategies in improving health professional provision of preconception and antenatal care addressing tobacco smoking, weight management and alcohol consumption. METHODS A systematic review of randomised and non-randomised studies with a parallel comparison group was conducted. Eligible studies used implementation strategy/ies targeted at health professionals to improve at least one element of preconception and/or antenatal care (smoking: ask, advise, assess, assist, arrange; weight/alcohol: assess, advise, refer) compared to usual practice/control or alternative strategies. Eligible studies were identified via CENTRAL, MEDLINE, EMBASE, Maternity and Infant Care, CINAHL and other sources. Random-effects meta-analyses were conducted where appropriate, with other findings summarised using the direction of effect. The certainty of the pooled evidence was assessed using the GRADE approach. RESULTS Fourteen studies were included in the review. Thirteen were in the antenatal period and 12 tested multiple implementation strategies (median: three). Meta-analyses of RCTs found that implementation strategies compared to usual practice/control probably increase asking (OR: 2.52; 95% CI: 1.13, 5.59; 3 studies; moderate-certainty evidence) and advising (OR: 4.32; 95% CI: 3.06, 6.11; 4 studies; moderate-certainty evidence) about smoking and assessing weight gain (OR: 57.56; 95% CI: 41.78, 79.29; 2 studies; moderate-certainty evidence), and may increase assessing (OR: 2.55; 95% CI: 0.24, 27.06; 2 studies; low-certainty evidence), assisting (OR: 6.34; 95% CI: 1.51, 26.63; 3 studies; low-certainty evidence) and arranging support (OR: 3.55; 95% CI: 0.50, 25.34; 2 studies; low-certainty evidence) for smoking. The true effect of implementation strategies in increasing advice about weight gain (OR: 3.37; 95% CI: 2.34, 4.84; 2 non-randomised studies; very low-certainty evidence) and alcohol consumption (OR: 10.36; 95% CI: 2.37, 41.20; 2 non-randomised studies; very low-certainty evidence) is uncertain due to the quality of evidence to date. CONCLUSIONS Review findings provide some evidence to support the effectiveness of implementation strategies in improving health professional delivery of antenatal care addressing smoking and weight management. Rigorous research is needed to build certainty in the evidence for improving alcohol and weight gain advice, and in preconception care. TRIAL REGISTRATION PROSPERO-CRD42019131691.
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Affiliation(s)
- Emma Doherty
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Melanie Kingsland
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - John Wiggers
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
| | - Luke Wolfenden
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
| | - Alix Hall
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Sam McCrabb
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Danika Tremain
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Jenna Hollis
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Milly Licata
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Olivia Wynne
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Sophie Dilworth
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Justine B. Daly
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Belinda Tully
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Julia Dray
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia
| | - Kylie A. Bailey
- grid.266842.c0000 0000 8831 109XSchool of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW Australia
| | - Elizabeth J. Elliott
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, NSW 2006 Australia ,grid.413973.b0000 0000 9690 854XSydney Children’s Hospital Network, Kids’ Research Institute, Westmead, NSW 2145 Australia
| | - Rebecca K. Hodder
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
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Kavle JA. Strengthening maternal nutrition counselling during routine health services: a gap analysis to guide country programmes. Public Health Nutr 2022; 26:1-18. [PMID: 36210775 DOI: 10.1017/s1368980022002129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The WHO recommends counselling on healthy eating, weight gain, and physical activity during antenatal care (ANC) and postnatal care (PNC), yet advice and information are often not tailored to women's nutritional needs and contexts. The purpose of the gap analysis was to identify key elements related to the provision of maternal nutrition counselling during routine health contacts and provide programme considerations to strengthen quality service delivery. DESIGN A search of PubMed, Cochrane Library, CINAHL Plus and Scopus databases was conducted to retrieve studies from January 2010 to December 2021. Using inclusion criteria, quantitative, qualitative and mixed methods studies were included in the final gap analysis. SETTING Low-, middle- and high-income country contexts. PARTICIPANTS Following application of gap analysis criteria, thirty-seven articles from sixteen countries were included in the analysis. RESULTS Gaps in delivery of maternal nutrition counselling include provider capacity building, frequency, content and delivery platforms. Globally, counselling on appropriate weight gain during pregnancy is often not delivered with the desired content nor quality, while targeted counselling to overweight and obese women was provided in several high-income country contexts. Delivery of maternal nutrition counselling through multiple delivery platforms demonstrated improvements in maternal diet and/or weight gain during pregnancy. CONCLUSIONS Strengthening the integration of maternal nutrition counselling into pre- and in-service curricula, routine health provider training, supportive supervision and provider mentoring is needed. Future efforts may consider generating global and regional weight gain guidelines and incorporating maternal nutrition counselling indicators as part of quality-of-care ANC/PNC standards and routine health systems.
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Affiliation(s)
- Justine A Kavle
- Kavle Consulting, LLC, 200 Massachusetts Ave NW, Washington, DC20001, USA
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Cilar Budler L, Budler M. Physical activity during pregnancy: a systematic review for the assessment of current evidence with future recommendations. BMC Sports Sci Med Rehabil 2022; 14:133. [PMID: 35842718 PMCID: PMC9288689 DOI: 10.1186/s13102-022-00524-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022]
Abstract
Background Physical activity is essential to maternal and infant health. Healthcare professionals should inform pregnant women about benefits of physical activity to prevent possible health issues. Those recommendations should elaborate on relevant contemporary evidence. The aim of this study was to review evidence-based recommendations for physical activity during pregnancy. Methods A systematic search, analysis and synthesis of conducted randomised controlled trials (RCTs) was conducted from October 2021 to June 2022 in following databases: PubMed, CINAHL, ScienceDirect and Web of Science. Literature was searched using inclusion and exclusion criteria and following PRISMA recommendations. Results Benefits for pregnant-women health and well-being were reported while performing aerobic exercise, lumbar stabilization and stretching exercise, water exercise, nerve and tendon-slip exercise, resistance training and strength training. For all exercise modalities it is recommended to perform moderate intensity activities during the whole time of pregnancy. Conclusions This systematic literature review supplements current knowledge on physical activity of pregnant women. Exercise interventions are listed and suggested in an integrative model with physical-fitness components to contextualize and promote physical activity among pregnant women. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00524-z.
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Affiliation(s)
- Leona Cilar Budler
- Faculty of Health Sciences, University of Maribor, Zitna ulica 15, 2000, Maribor, Slovenia.
| | - Marko Budler
- School of Economics and Business, University of Ljubljana, Kardeljeva ploscad 17, 1000, Ljubljana, Slovenia.,Fitness Association of Slovenia, Cesta 24. junija 23, 1231, Ljubljana, Slovenia
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8
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Okafor UB, Goon DT. Uncovering Barriers to Prenatal Physical Activity and Exercise Among South African Pregnant Women: A Cross-Sectional, Mixed-Method Analysis. Front Public Health 2022; 10:697386. [PMID: 35433615 PMCID: PMC9010665 DOI: 10.3389/fpubh.2022.697386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe barriers to prenatal physical activity and exercise have been widely reported in the literature, highlighting context-specific challenges. However, generally, research on prenatal physical activity and exercise among pregnant women in South Africa is rare; and particularly concerning the barriers to their prenatal physical activity practice. This study assessed the barriers to physical activity participation among pregnant women in the Eastern Cape, South Africa.MethodsThis was a sequential explanatory mixed method, predominantly quantitative study involving 1,082 pregnant women. A structured self-administered questionnaire on perceived barriers to physical participation was applied to collect quantitative data; while a subset of 15 pregnant women participated in individual in-depth semi-structured interviews to augment quantitative data. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis, respectively.ResultsThe results of the quantitative analysis presented major barriers: lack of advice on prenatal physical activity and inadequate or conflicting information about prenatal physical activity; tiredness; work commitments; discomfort; lack of time; low energy; non-accessibility to physical activity; lack of financial resources, and safety concerns for the mother and the baby. Qualitatively, the barriers identified relate to four main themes: individual, lack of information, lack of resources, and environmental barriers.ConclusionThe major barriers cited by the women were tiredness, lack of time, discomfort, and low energy. They also include lack of support, advice and information about prenatal physical activity. The multiple constraining factors responsible for low or non-prenatal physical activity of pregnant women in this setting highlight the need to tailor interventions to address their individual uniquely perceived barriers.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, Alice, South Africa
- *Correspondence: Uchenna Benedine Okafor
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, Alice, South Africa
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Ruart S, Sinnapah S, Hue O, Janky E, Antoine-Jonville S. Association Between Maternal Body Mass and Physical Activity Counseling During Pregnancy. Front Psychol 2021; 12:612420. [PMID: 34899448 PMCID: PMC8656300 DOI: 10.3389/fpsyg.2021.612420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: The antenatal period provides an important opportunity for giving advice on healthy lifestyle choices. However, the prevalence of maternal obesity is increasing, and women report that they do not receive counseling. We investigated the information given to pregnant women on gestational weight gain, physical activity, and nutrition during pregnancy in relation with their initial weight status, current gestational weight gain and diagnoses of either pre-pregnancy overweight/obesity or excessive gestational weight gain. Methods: Cross-sectional survey using a questionnaire. Pregnant participants (n = 141) were recruited from a midwife center. They completed a structured questionnaire on the information they received during their pregnancy and we assessed its relationship with their weight. Results: We found that many pregnant women did not receive advice about physical activity, gestational weight gain and nutrition (37.5, 53.2, and 66.2%, respectively). Women with weight problems (pre-pregnancy overweight/obesity and excessive gestational weight gain) were less targeted for counseling, although more than 80% of the women viewed receiving information on these topics as positive. Also, being informed of a weight problem was associated with a greater chance of receiving information about physical activity, gestational weight gain and nutrition (all p < 0.05). However, verbalization of the weight problems was low (14.0% of women with pre-pregnancy overweight were informed of their status). Conclusion: Health professionals should dispense more information, especially on PA and particularly for women with weight problems. Verbalization of the weight problem seems associated with more frequent transmission of information.
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Affiliation(s)
- Shelly Ruart
- Laboratoire Adaptations au Climat Tropical Exercices et Santé (ACTES) (EA 3596), Université des Antilles, Pointe-à-Pitre, France
| | - Stéphane Sinnapah
- Laboratoire Adaptations au Climat Tropical Exercices et Santé (ACTES) (EA 3596), Université des Antilles, Pointe-à-Pitre, France
| | - Olivier Hue
- Laboratoire Adaptations au Climat Tropical Exercices et Santé (ACTES) (EA 3596), Université des Antilles, Pointe-à-Pitre, France
| | - Eustase Janky
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de la Guadeloupe, Pointe-à-Pitre, France
| | - Sophie Antoine-Jonville
- Laboratoire Adaptations au Climat Tropical Exercices et Santé (ACTES) (EA 3596), Université des Antilles, Pointe-à-Pitre, France
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10
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Okafor UB, Goon DT. Development and Validation of Prenatal Physical Activity Intervention Strategy for Women in Buffalo City Municipality, South Africa. Healthcare (Basel) 2021; 9:healthcare9111445. [PMID: 34828491 PMCID: PMC8622375 DOI: 10.3390/healthcare9111445] [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: 08/24/2021] [Revised: 10/12/2021] [Accepted: 10/23/2021] [Indexed: 11/24/2022] Open
Abstract
Women rarely participate in physical activity during pregnancy, despite scientific evidence emphasising its importance. This study sought to develop an intervention strategy to promote prenatal physical activity in Buffalo City Municipality, Eastern Cape Province, South Africa. A multi-stage approach was utilised. The Strength, Weakness, Opportunity and Threat (SWOT) approach was applied to the interfaced empirical findings on prenatal physical activity in the setting. Subsequently, the Build, Overcome, Explore and Minimise model was then used to develop strategies based on the SWOT findings. A checklist was administered to key stakeholders to validate the developed strategies. Key strategies to promote prenatal physical activity include the application of the Mom-Connect (a technological device already in use in South Africa to promote maternal health-related information for pregnant women) in collaboration with cellphone and network companies; the South African government to integrate prenatal physical activity and exercise training in the medical and health curricula to empower the healthcare providers with relevant knowledge and skills to support pregnant women in prenatal physical activity counselling; provision of increased workforce and the infrastructure necessary in antenatal sessions and antenatal physical exercise classes and counselling; the government, in partnership with various stakeholders, to provide periodical prenatal physical activity campaigns based in local, community town halls and clinics to address the lack of awareness, misrepresentations and concerns regarding the safety and benefits of physical activity during pregnancy. The effective implementation of this developed prenatal physical activity by policymakers and health professionals may help in the promotion of physical activity practices in the context of women in the setting.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, East London 5201, South Africa
- Correspondence:
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, East London 5201, South Africa;
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Kingsland M, Hollis J, Farragher E, Wolfenden L, Campbell K, Pennell C, Reeves P, Tully B, Daly J, Attia J, Oldmeadow C, Hunter M, Murray H, Paolucci F, Foureur M, Rissel C, Gillham K, Wiggers J. An implementation intervention to increase the routine provision of antenatal care addressing gestational weight gain: study protocol for a stepped-wedge cluster trial. Implement Sci Commun 2021; 2:118. [PMID: 34666840 PMCID: PMC8525056 DOI: 10.1186/s43058-021-00220-y] [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: 08/29/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Weight gain during pregnancy that is outside of recommended levels is associated with a range of adverse outcomes for the mother and child, including gestational diabetes, pre-eclampsia, preterm birth, and obesity. Internationally, 60–80% of pregnant women report gaining weight outside of recommended levels. While guideline recommendations and RCT evidence support the provision of antenatal care that supports healthy gestational weight gain, less than 10% of health professionals routinely weigh pregnant women; discuss weight gain, diet, and physical activity; and provide a referral for additional support. This study aims to determine the effectiveness of an implementation intervention in increasing the provision of recommended gestational weight gain care by maternity services. Methods A stepped-wedge controlled trial, with a staggered implementation intervention, will be conducted across maternity services in three health sectors in New South Wales, Australia. The implementation intervention will consist of evidence-based, locally-tailored strategies including guidelines and procedures, reminders and prompts, leadership support, champions, training, and monitoring and feedback. Primary outcome measures will be the proportion of women who report receiving (i) assessment of gestational weight gain; (ii) advice on gestational weight gain, dietary intake, and physical activity; and (iii) offer of referral to a telephone coaching service or local dietetics service. Measurement of outcomes will occur via telephone interviews with a random sample of women who attend antenatal appointments each week. Economic analyses will be undertaken to assess the cost, cost-consequence, cost-effectiveness, and budget impact of the implementation intervention. Receipt of all care elements, acceptance of referral, weight gain during pregnancy, diet quality, and physical activity will be measured as secondary outcomes. Process measures including acceptability, adoption, fidelity, and reach will be reported. Discussion This will be the first controlled trial to evaluate the effectiveness of a implementation intervention in improving antenatal care that addresses gestational weight gain. The findings will inform decision-making by maternity services and policy agencies and, if the intervention is demonstrated to be effective, could be applied at scale to benefit the health of women and children across Australia and internationally. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819. Registered on 22 January 2021
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Affiliation(s)
- Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia. .,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. .,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia.
| | - Jenna Hollis
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Eva Farragher
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Craig Pennell
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Department of Maternal Fetal Medicine, Maternity and Gynaecology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Penny Reeves
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Justine Daly
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Mandy Hunter
- Nursing and Midwifery Services, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | - Henry Murray
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Department of Maternal Fetal Medicine, Maternity and Gynaecology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Francesco Paolucci
- Faculty of Business and Law, The University of Newcastle, Newcastle, New South Wales, Australia.,The School of Economics and Management, University of Bologna, Bologna, Italy
| | - Maralyn Foureur
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Hunter New England Health Nursing and Midwifery Research Centre, Newcastle, New South Wales, Australia
| | - Chris Rissel
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales, Australia.,Flinders University, Darwin, Northern Territory, Australia.,Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney, New South Wales, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
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12
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Malta MB, Gomes CDB, Barros AJD, Baraldi LG, Takito MY, Benício MHD, Carvalhaes MADBL. Effectiveness of an intervention focusing on diet and walking during pregnancy in the primary health care service. CAD SAUDE PUBLICA 2021; 37:e00010320. [PMID: 34037070 DOI: 10.1590/0102-311x00010320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/17/2020] [Indexed: 11/22/2022] Open
Abstract
Interventions during prenatal care can mitigate negative outcomes of a sedentary lifestyle and unhealthy diet during pregnancy. We aimed to evaluate the effectiveness of an intervention that promoted healthy diet and leisure-time walking during antenatal care in a pragmatic, controlled, non-randomized intervention study. Physicians and nurses from all health care units of the Family Health Strategy model of health assistance participated in educational training to promote leisure-time walking and healthy diet during antenatal care visits. Pregnant women who received health care from these professionals constituted the intervention group (n = 181). The control group (n = 172) included pregnant women who received routine antenatal care, in health care units of the traditional model of health assistance. Data were collected in each trimester of pregnancy. Diet was investigated using a food frequency questionnaire adapted from Risk and Protective Factors Surveillance System for Chronic Non-Comunicable Diseases Through Telephone Interview (Vigitel). Leisure-time walking in a typical week was assessed using questions from the Physical Activity in Pregnancy Questionnaire. There were positive effects on leisure-time walking during the second trimester and the third trimester of pregnancy and on the women who achieved 150 minutes per week of walking during the third trimester. The intervention reduced the risk of pregnant women consuming soft drinks and/or commercially prepared cookies in the third trimester. This lifestyle intervention was partially effective, tripling the proportion of pregnant women who achieved the recommended walking time and reducing by half the proportion of women who had a high weekly consumption of soft drinks and industrially processed cookies.
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Affiliation(s)
- Maíra Barreto Malta
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.,Programa de Pós-graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
| | - Caroline de Barros Gomes
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, Brasil
| | - Aluísio J D Barros
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
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13
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Okafor UB, Goon DT. Physical Activity Advice and Counselling by Healthcare Providers: A Scoping Review. Healthcare (Basel) 2021; 9:609. [PMID: 34069474 PMCID: PMC8159082 DOI: 10.3390/healthcare9050609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Despite scientific evidence on prenatal physical activity and exercise, synthesized evidence is lacking on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers. The scoping review seeks to fill this gap by synthesizing available literature on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers to women during antenatal visits. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) search framework for scoping reviews was applied to retrieve original research articles on the prenatal physical activity and exercise practices of healthcare providers with pregnant women, published between 2010-2020, and available in English. The search databases included Google Scholar, PubMed, Science Direct, Scopus, EMBASE, The Cumulative Index for Nursing and Allied Health Literature (CINAHL), BIOMED Central, Medline and African Journal Online. Studies that fulfilled the eligibility criteria were retrieved for analysis. Results: Out of the 82 articles that were retrieved for review, 13 met the eligibility criteria. Seven of the articles were quantitative, four qualitative, one mixed-method and one controlled, non-randomised study, respectively. Three themes emerged as major findings. Healthcare providers affirmed their responsibility in providing prenatal physical activity advice and counselling to pregnant women; however, they seldom or rarely performed this role. Major barriers to prenatal physical activity and exercise included insufficient time, lack of knowledge and skills, inadequate or insufficient training, and lack of resources. Conclusion: This review highlights salient features constraining the uptake of prenatal physical activity and exercise advice/counselling by prenatal healthcare providers in both community and clinical settings. Prenatal physical activity advice and counselling are key components to the promotion of physical activity adherence during and post-partum pregnancy; this requires adequate knowledge of physical activity prescriptions and recommendations, which are personalised and contextual to environment. Research is needed to examine the prenatal physical activity advice and counselling from prenatal healthcare providers on issues hindering effective delivery of the aforementioned in the context of promoting prenatal physical activity in clinical or community settings.
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Affiliation(s)
- Uchenna Benedine Okafor
- Department of Nursing Science, University of Fort Hare, 50 Church Street, East London 5021, South Africa
| | - Daniel Ter Goon
- Department of Public Health, University of Fort Hare, 5 Oxford Street, East London 5021, South Africa;
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Teweldemedhin LG, Amanuel HG, Berhe SA, Gebreyohans G, Tsige Z, Habte E. Effect of nutrition education by health professionals on pregnancy-specific nutrition knowledge and healthy dietary practice among pregnant women in Asmara, Eritrea: a quasi-experimental study. BMJ Nutr Prev Health 2021; 4:181-194. [PMID: 34308126 PMCID: PMC8258087 DOI: 10.1136/bmjnph-2020-000159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/13/2021] [Accepted: 03/18/2021] [Indexed: 11/04/2022] Open
Abstract
Background Healthy pregnancy and birth outcomes are greatly influenced by the intake of adequate and balanced nutrition. Pregnant women's nutritional knowledge and practice have been identified as an important prerequisites for their proper nutritional intake. The antenatal period with the opportunities for regular contact with health professionals appears to be the ideal time and setting to institute the intervention which could maximise pregnant women's outcome and that of their baby by motivating them to make nutritional changes. Objective To assess the effect of nutrition education on the appropriate nutritional knowledge and practice of pregnant women. Methodology A facility-based single-group pre-post quasi-experimental study design was employed in five health facilities providing antenatal care (ANC) service in Asmara on 226 pregnant women. A predesigned and pretested questionnaire was used to collect data regarding nutritional knowledge via interview by trained data collectors during the pretest, immediate post-test and 6 weeks later. The practice was assessed at pre-intervention and 6 weeks later only. Repeated measures analysis of variance and paired t-test were used to make comparisons in knowledge and practice scores, respectively, using SPSS (V.22). Results Training provided to pregnant women resulted in a significant increase on the mean scores of their knowledge from 29.01/47 (SE=0.35) pre-intervention to 42.73/47 (SE=0.24) immediate post-intervention. However, the score declined significantly from immediate after intervention to 6-week follow-up by 1.79 (SE=0.22). Although the score declined, knowledge at 6-week follow-up was still significantly greater than that of pre-intervention (p<0.0001). Health professionals (70.2%) were the primary source of information for pregnant women. The pregnancy-specific dietary practice score at 6-week follow-up (M=13.13/16, SE=0.09) was significantly higher than that of pre-intervention (M=12.55/16, SE=0.16). There was no significant interaction between the categories of demographic characteristics and change in practice and knowledge. Conclusion This study has shown that the nutrition messages given to pregnant women by trained health professionals using a holistic approach in a sustained manner played a huge role in increasing their knowledge and in introducing positive dietary practices among them. Thus, ANC clinics must play a leading role in coordinating the effort of awareness creation regarding nutrition during pregnancy.
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Affiliation(s)
| | - Helen Gebretatyos Amanuel
- Department of Midwifery, School of Nursing, Asmara College of Health Sciences, Ministry of Health, Asmara, Eritrea
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GOMES CDB, CARVALHAES MADBL. Insufficient choline intake during pregnancy: cohort study. REV NUTR 2021. [DOI: 10.1590/1678-9865202134e200187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To investigate the intake of choline during pregnancy and associated factors. Methods Cohort study with 353 pregnant women recruited from the primary health care network in an inland city of the State of São Paulo. In-house interviews were conducted in each of the gestational trimesters. In each of these points in time, a 24-hour dietary recall was collected. Subsequently, a new dietary recall collection was performed by telephone in the same trimester on a non-consecutive day, differentiating weekday versus weekend/holiday. Dietary intake data were included in the Nutrition Data System for Research software, and the habitual food intake throughout pregnancy was determined, with intra-individual variation correction in the MSM software. The influence of socioeconomic, obstetric and lifestyle factors, and of the actual diet, on choline intake during pregnancy was assessed using linear regression models, that were developed with the Stata software version 14.2, at a significance level of 95%. Results Choline intake (281.1±68.6 milligrams) was below the recommended adequate intake, and only energy was positively associated with this micronutrient intake. Conclusion Choline intake in the population studied fell far short of current recommendations, and only higher energy intake was found as a factor associated with a higher intake.
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Consumption of ultra-processed foods in the third gestational trimester and increased weight gain: a Brazilian cohort study. Public Health Nutr 2020; 24:3304-3312. [DOI: 10.1017/s1368980020001883] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To investigate whether the consumption of ultra-processed foods (UPF) during pregnancy is associated with gestational weight gain (GWG).Design:Cohort study with collection of two 24-h dietary recalls during each gestational trimester obtained on non-consecutive days and differentiating weekday v. weekend/holiday. The foods were classified according to the NOVA system into fresh or minimally processed foods and their culinary preparations, processed and UPF and subsequently analysed as a percentage contribution to dietary energy. The outcome was average GWG in the second and in the third trimesters, expressed in g/week.Setting:Botucatu, a medium-sized Brazilian city.Participants:Pregnant women with regular obstetric risk (n 259) undergoing prenatal care in primary healthcare.Results:In a multiple linear regression model, it was found that an increase of 1 percentage point in energy consumption from UPF in the third gestational trimester led to an average increase of 4·17 (95 % CI 0·55; 7·79) g in weekly GWG in this period. There was no association between second-trimester UPF consumption and GWG.Conclusions:Consumption of UPF in the third gestational trimester is positively associated with average weekly GWG in this period.
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The association of dietary glycaemic index and glycaemic load with gestational weight gain and newborn birth weight. Br J Nutr 2020; 123:818-825. [PMID: 31865921 DOI: 10.1017/s0007114519003362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diet during pregnancy is related to several maternal and infant health outcomes; however, the relationship between maternal dietary glycaemic index (GI) and glycaemic load (GL) and gestational weight gain (GWG) or newborn birth weight is controversial. The purpose of the present study was to investigate the relationship between maternal dietary GI and GL and GWG and birth weight. A cohort of adult pregnant women with usual obstetric risk was followed in Botucatu, SP, Brazil. Two 24-h dietary recalls were collected in each gestational trimester (<14, 24-27, 31-34 weeks), one in person and the other by telephone. GI and GL were determined using the software Nutrition Data System for Research. GWG was obtained from medical records and evaluated as the weekly GWG between the second and third gestational trimesters. Newborn birth weight z-score in relation to gestational age was evaluated according to Intergrowth-21st Project recommendations. A multiple linear regression model, adjusted for potential confounders, showed a one-point increase in the GI resulted in a mean decrease of 12·9 (95 % CI -21·48, -4·24) g in weekly GWG; GL was not associated with this outcome. The birth weight z-score was not associated with GI (P = 0·763) or GL (P = 0·317). In conclusion, in a cohort of pregnant women considered at usual risk for obstetric complications, maternal dietary GI was negatively associated with weekly GWG in the second and third gestational trimesters. No association was observed between GL and GWG, and neither GI nor GL was associated with birth weight z-score.
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"…or else I close my ears" How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study. PLoS One 2019; 14:e0222543. [PMID: 31536545 PMCID: PMC6752788 DOI: 10.1371/journal.pone.0222543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/01/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The importance of helping pregnant women maintain a healthy lifestyle and prevent excessive gestational weight gain is well recognized, but pregnant women do not always perceive communication about body weight as respectful or helpful. Furthermore, fear of inducing shame or guilt can prohibit some midwives from talking about body weight, especially if the woman has obesity. We aimed to explore what women of reproductive age with obesity regard to be the most important and relevant aspects when discussing gestational weight management. METHODS Qualitative interview study using focus groups and individual semi-structured interviews with 17 women of reproductive age (19-39 y) with obesity. Thematic analysis was used to analyze the data. RESULTS We identified three themes: 1) Importance of obtaining vital medical information; 2) A wish to feel understood and treated with respect; 3) Midwives' approach is crucial in sensitive key situations, which include bringing up the subject of body weight, weighing, providing weight-related information, coaching lifestyle modification, dealing with emotional reactions and ending a conversation. CONCLUSIONS A majority of the interviewed women wished to receive information about risks about obesity and gestational weight gain, and recommendations on weight management. However, the risk of midwives offending someone by raising the topic may be increased if the pregnant woman believe that gestational weight gain is uncontrollable by the individual. Also, several situations during maternity care meetings can be stigmatizing and make women less receptive to advice or support. Women suggest that a good working alliance is likely to be achieved if midwives have knowledge about the causes of obesity, take interest in the patients' background, have a non-judgmental approach and refrain from giving unsolicited advice.
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Adherence to dietary patterns during pregnancy and association with maternal characteristics in pregnant Brazilian women. Nutrition 2019; 62:85-92. [DOI: 10.1016/j.nut.2018.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 10/19/2018] [Accepted: 10/30/2018] [Indexed: 01/18/2023]
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Gomes CDB, Vasconcelos LG, Cintra RMGDC, Dias LCGD, Carvalhaes MADBL. Hábitos alimentares das gestantes brasileiras:revisão integrativa da literatura. CIENCIA & SAUDE COLETIVA 2019; 24:2293-2306. [DOI: 10.1590/1413-81232018246.14702017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/04/2017] [Indexed: 12/24/2022] Open
Abstract
Resumo Os hábitos alimentares das mulheres grávidas são influenciados por diversos fatores, sendo essencial conhecê-los para poder realizar intervenções nutricionais na atenção pré-natal. O objetivo desta revisão integrativa foi analisar a produção bibliográfica sobre hábitos alimentares de gestantes brasileiras. Foram buscados artigos na Biblioteca Virtual em Saúde (BVS), PubMed, Scopus, Web of Science e na Scientific Eletronic Library Online (SciELO) utilizando os seguintes descritores: “Gestantes” OR “Grávidas” AND “Hábitos Alimentares” e os termos “Pregnant women” AND “Food habits” AND “Brazil” para busca em inglês. Após a adoção dos critérios de inclusão e exclusão foram analisados 18 estudos. Alguns estudos contemplaram populações específicas como adolescentes ou gestantes não obesas. O instrumento mais utilizado para investigação do consumo alimentar de gestantes foi o Questionário de Frequência Alimentar. A maioria mostrou que a dieta das gestantes precisa de melhorias, especialmente pelo baixo consumo de frutas, verduras e hortaliças, elevado consumo de açúcares, doces e gorduras. A maioria dos estudos concluiu e reforçou a importância e a necessidade da educação nutricional pelos profissionais atuantes no pré-natal. Mais estudos são necessários para compreensão mais acurada destes hábitos alimentares.
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Ultra-processed Food Consumption by Pregnant Women: The Effect of an Educational Intervention with Health Professionals. Matern Child Health J 2019; 23:692-703. [DOI: 10.1007/s10995-018-2690-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Christenson A, Johansson E, Reynisdottir S, Torgerson J, Hemmingsson E. Shame and avoidance as barriers in midwives’ communication about body weight with pregnant women: A qualitative interview study. Midwifery 2018; 63:1-7. [DOI: 10.1016/j.midw.2018.04.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 01/20/2023]
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Wattanapisit A, Tuangratananon T, Thanamee S. Physical activity counseling in primary care and family medicine residency training: a systematic review. BMC MEDICAL EDUCATION 2018; 18:159. [PMID: 29970092 PMCID: PMC6029015 DOI: 10.1186/s12909-018-1268-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Physical inactivity is a global public health challenge. Physical activity (PA) promotion in healthcare delivery systems is effective to reduce physical inactivity. A primary care setting provides an appropriate environment for PA counseling since it is a primary contact with primary care or family physicians encounter the majority of the population. Lack of knowledge and inadequate training in PA counseling is one of the most important barriers to PA promotion. The purpose of this systematic review was to evaluate PA counseling training in primary care residency programs. METHODS The authors systematically searched PubMed, Web of Science, Scopus and The Cochrane Library for articles published in English from 2000 to 2017. Articles regarding PA counseling in primary care residency training were extracted and outcomes assessed for this systematic review. RESULTS Based on the initial review, 378 articles were excluded (362 articles excluded based on titles and abstracts and 16 articles excluded based on full texts). Four articles were included in this review, addressed PA counseling curricula in primary care residency training. All studies included PA counseling training as part of obesity and healthy lifestyle training. The training improved knowledge among primary care residents, but may not necessarily result in better attitudes or self-efficacy, which could be improved by elective rotations that focus on improved attitudes, self-efficacy, and professional norms for PA counseling. Brief training in counseling did not improve quality nor increase the rate of counseling. CONCLUSIONS This systematic review demonstrates a lack of evidence due to a small number of included studies. The heterogeneous outcomes from the minimal programs are needed to carefully interpret. However, this review sheds light on the importance of training in PA counseling in primary care residency programs. The development of training in PA counseling should focus on an approach that improves attitudes and the self-efficacy of primary care residents. Elective rotations, where residents voluntarily choose their subject, may provide the appropriate training period for PA counseling. Policymakers and academics should play an active role in the implementation of PA counseling as an essential competency for primary care physicians.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, 80161 Thailand
| | - Titiporn Tuangratananon
- International Health Policy Program, Thailand, Ministry of Public Health, Muang, Nonthaburi, 11000 Thailand
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Evaluation of Interprofessional Education Implementation Among Nutrition Program Directors in the United States. TOP CLIN NUTR 2018. [DOI: 10.1097/tin.0000000000000143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Szumilewicz A. Who and how should prescribe and conduct exercise programs for pregnant women? Recommendation based on the European educational standards for pregnancy and postnatal exercise specialists. DEVELOPMENTAL PERIOD MEDICINE 2018; 22. [PMID: 30056396 PMCID: PMC8522896 DOI: 10.34763/devperiodmed.20182202.107112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Extensive scientific evidence has shown that prenatal physical activity is a prerequisite for the proper course of pregnancy, fetal development, labour and delivery, and the postpartum period. In 2015, the American College of Obstetricians and Gynecologists published a breakthrough statement that inactivity in pregnancy is risky behaviour. The aim of this paper is to provide answers to the questions concerning who and how should prescribe and conduct exercise programs for pregnant women. Close cooperation between the woman, her obstetric care provider and exercise specialists is necessary to promote exercise in pregnancy. Obstetricians should carefully evaluate women with medical or obstetric complications before starting the exercises. They should also provide women with general information about the benefits of prenatal exercise and the risks of physical inactivity. On the other hand, the design and implementation of the exercise program are tasks for exercise professionals, preferably ones qualified according to the European educational standards for Pregnancy and Postnatal Exercise Specialists. Both empirical observation and scientific research confirm the need to educate obstetric care providers, exercise professionals, and both pregnant women and their families about prenatal physical activity. They all require constantly updated information on how to use exercise to stimulate the positive development of pregnancy, ensure the greatest possible well-being for the future mother, and prepare her for childbirth and the postpartum period. These educational activities should be evidence-based. They must not perpetuate unfounded opinions, often harmful to the woman's health, on what she should or should not do while exercising during pregnancy. The presented update underlines some pertinent recommendations in this area.
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Affiliation(s)
- Anna Szumilewicz
- Department of Fitness and Strength Conditioning, Gdańsk University of Physical Education and Sport, Gdańsk, Poland,Anna Szumilewicz, PhD, Assistant Professor Department of Fitness and Strength Conditioning, Faculty of Tourism and Recreation, Gdańsk University of Physical Education and Sport, K. Górskiego 1, 80-336 Gdańsk, Poland
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