1
|
Herman A, Hand LK, Gajewski B, Krase K, Sullivan DK, Goetz J, Hull HR. A high fiber diet intervention during pregnancy: The SPROUT (Single goal in PRegnancy to optimize OUTcomes) protocol paper. Contemp Clin Trials 2024; 137:107420. [PMID: 38145714 DOI: 10.1016/j.cct.2023.107420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Interventions to prevent excessive gestational weight gain (GWG) have had a limited impact on maternal and infant outcomes. Dietary fiber is a nutrient with benefits that counters many of the metabolic and inflammatory changes that occur during pregnancy. We will determine if a high dietary fiber (HFib) intervention provides benefit to maternal and infant outcomes. METHODS AND DESIGN Pregnant women will be enrolled in an 18-week intervention and randomized in groups of 6-10 women/group into the intervention or control group. Weekly lessons will include information on high-dietary fiber foods and behavior change strategies. Women in the intervention group will be given daily snacks high in dietary fiber (10-12 g/day) to facilitate increasing dietary fiber intake. The primary aim will assess between-group differences for the change in maternal weight, dietary fiber intake, dietary quality, and body composition during pregnancy and up to two months post-partum. The secondary aim will assess between-group differences for the change in maternal weight, dietary fiber intake, and dietary quality from two months to one year post-partum and infant body composition from birth to one-year-old. DISCUSSION Effective and simple intervention strategies to improve maternal and offspring outcomes are lacking. Changes during the perinatal period are related to the risk of disease development in the mother and offspring. However, it is unknown which changes can be successfully targeted to have a meaningful impact. We will test the effect of an intervention designed to counter many of the metabolic and inflammatory changes that occur during pregnancy. ETHICS AND DISSEMINATION The University of Kansas Medical Center Institutional Review Board (IRB) approved the study protocol (STUDY00145397). The results of the trial will be disseminated at conferences and in peer reviewed publications. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04868110.
Collapse
Affiliation(s)
- Amy Herman
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Lauren K Hand
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Byron Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Kelli Krase
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Jeannine Goetz
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Holly R Hull
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States of America.
| |
Collapse
|
2
|
Mooney J, Dahl AA. Digital Self-Monitoring Tools for the Management of Gestational Weight Gain: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e50145. [PMID: 37883145 PMCID: PMC10636618 DOI: 10.2196/50145] [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: 06/20/2023] [Revised: 08/21/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Gestational weight gain (GWG) exceeding the recommendations of the Institute of Medicine (in the United States) is associated with numerous adverse maternal and infant health outcomes. While many behavioral interventions targeting nutrition and physical activity have been developed to promote GWG within the Institute of Medicine guidelines, engagement and results are variable. Technology-mediated interventions can potentially increase the feasibility, acceptability, and reach of interventions, particularly for pregnant women, for whom integration of interventions into daily life may be critical to retention and adherence. Previous reviews highlight GWG self-monitoring as a common intervention component, and emerging work has begun to integrate digital self-monitoring into technology-mediated interventions. With rapid advances in technology-mediated interventions, a focused synthesis of literature examining the role of digital self-monitoring tools in managing GWG is warranted to guide clinical practice and inform future studies. OBJECTIVE The proposed review aims to synthesize the emerging research base evaluating digital GWG self-monitoring interventions, primarily focusing on whether the intervention is effective in managing GWG. Depending on the characteristics of the included research, secondary focus areas will comprise intervention recruitment and retention, feasibility, acceptability, and differences between stand-alone and multicomponent interventions. METHODS This protocol was developed following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines for systematic review protocols. The proposed review would use a planned and systematic approach to identify, evaluate, and synthesize relevant and recent empirical quantitative studies (reported in English) examining the use of digital weight self-monitoring tools in the context of technology-mediated interventions to manage GWG in pregnant US adults, with at least 2 instances of data collection. Literature eligible for inclusion will have a publication date between January 2010 and July 2020. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies will be used to assess the methodological quality of included studies across various domains, and results will be synthesized and summarized per the synthesis without meta-analysis guidelines. RESULTS The initial queries of 1150 records have been executed and papers have been screened for inclusion. Data extractions are expected to be finished by December 2023. Results are expected in 2024. The systematic review that will be generated from this protocol will offer evidence for the use of digital self-monitoring tools in the management of GWG. CONCLUSIONS The planned, focused synthesis of relevant literature has the potential to inform the use of digital weight self-monitoring tools in the context of future technology-mediated interventions to manage GWG. In addition, the planned review has the potential to contribute as part of a broader movement in research toward empirically supporting the inclusion of specific components within more extensive, multicomponent interventions to balance parsimony and effectiveness. TRIAL REGISTRATION PROSPERO CRD42020204820; https://tinyurl.com/ybzt6bvr. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50145.
Collapse
Affiliation(s)
- Jan Mooney
- Department of Psychological Science, College of Liberal Arts and Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Alicia A Dahl
- Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, NC, United States
| |
Collapse
|
3
|
Perumal N, Wang D, Darling AM, Liu E, Wang M, Ahmed T, Christian P, Dewey KG, Kac G, Kennedy SH, Subramoney V, Briggs B, Fawzi WW. Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis. BMJ 2023; 382:e072249. [PMID: 37734757 PMCID: PMC10512803 DOI: 10.1136/bmj-2022-072249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries. DESIGN Individual participant data meta-analysis. SETTING Prospective pregnancy studies from 24 low and middle income countries. MAIN OUTCOME MEASURES Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death. ANALYSIS METHODS A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes. RESULTS Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ2=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ2=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ2=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ2=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ2=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ2=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy. CONCLUSIONS Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.
Collapse
Affiliation(s)
- Nandita Perumal
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tahmeed Ahmed
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, CA, USA
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | | | - Brittany Briggs
- Certara USA, on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| |
Collapse
|
4
|
Hoch M, Meloncelli N, de Jersey S. Examining Enhanced Implementation of Routine Antenatal Care Practices to Support Healthy Pregnancy Weight Gain. J Midwifery Womens Health 2023; 68:449-457. [PMID: 36789484 DOI: 10.1111/jmwh.13477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Current antenatal guidelines advocate for regular weighing of women during their pregnancy, with supportive conversations to assist healthy gestational weight gain (GWG). To facilitate overcoming weight monitoring barriers, a pregnancy weight gain chart (PWGC), coupled with brief intervention advice, was implemented in 2016 to guide provider and woman-led routine weight monitoring. This study aimed to examine the extent to which the use of PWGCs and routine advice provision were normalized into routine antenatal care following enhanced implementation strategies and whether this led to a change in GWG. METHODS This pre-post study included data from 2010 (preimplementation), 2016, and 2019 (postimplementation). A retrospective audit of health records and PWGCs was undertaken to assess adherence to chart use and evaluate GWG outcomes. A survey was sent to women in 2010 and repeated in 2019 to understand the advice women received from health care professionals. RESULTS Compared with the preimplementation cohort (2010), more women achieved a healthy GWG in 2019 (42% vs 31%, P = .04). In 2019, having 3 or more weights recorded was associated with a reduction in excess GWG (P = .028). More women reported receiving helpful advice about healthy GWG in 2019 compared with 2010, although minimal changes to advice received about nutrition and physical activity were observed. DISCUSSION Enhanced implementation strategies and ongoing efforts to optimize supportive antenatal care practices are required to effect positive change in GWG. Further evaluation of the perspectives of pregnant women and counseling practices of health professionals is needed.
Collapse
Affiliation(s)
- Mikeeley Hoch
- School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia
| | - Nina Meloncelli
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Susan de Jersey
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Brisbane, Australia
| |
Collapse
|
5
|
Buchholtz S, Fangmann L, Siedentopf N, Bührer C, Garten L. Perinatal Palliative Care: Additional Costs of an Interprofessional Service and Outcome of Pregnancies in a Cohort of 115 Referrals. J Palliat Med 2023; 26:393-401. [PMID: 36251802 DOI: 10.1089/jpm.2022.0172] [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] [Indexed: 12/28/2022] Open
Abstract
Background: An increasing number of life-limiting conditions (LLCs) is diagnosed prenatally, presenting providers with the ability to present perinatal palliative care (PnPC) services as an option. Objective: To (1) determine the profile characteristics of patients referred for prenatal palliative care counseling to Charité Universitätsmedizin Berlin, Germany; (2) evaluate pregnancy outcome; and (3) analyze the additional human resources per family required to provide specialized PnPC. Methods: Retrospective chart review of pregnant women and infants with potentially LLCs referred for prenatal palliative care counseling between 2016 and 2020. Results: A total of 115 women were referred for prenatal palliative care counseling. Most cases (57.6%) comprised trisomy 13 or 18 (n = 36) and complex congenital conditions (n = 32). Other life-limiting diagnoses included renal agenesis/severe dysplasia (n = 19), congenital heart diseases (n = 18), neurological anomalies (n = 8), and others (n = 5). In 72.0% of cases (n = 85) parents decided to continue pregnancy and plan for palliative birth. Fifty deliveries resulted in a liveborn infant: 33 of these died in the delivery room, 9 neonates died after admission to rooming-in on one of our neonatal wards, and 8 were discharged home or to a hospice. Total human resources (median, range) provided were 563 (0-2940) minutes for psychosocial and 300 (0-720) minutes for medical specialized PnPC per referral. Conclusions: Our data confirm previously observed characteristics of diagnoses, referrals, and outcomes. The provision of specialized and interprofessional PnPC services accounted for ∼14 hours per case of additional human resources.
Collapse
Affiliation(s)
- Stefan Buchholtz
- Department of Neonatology, and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Laura Fangmann
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nina Siedentopf
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Garten
- Department of Neonatology, and Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
6
|
Wilkinson SA, Fjeldsoe B, Willcox JC. Evaluation of the Pragmatic Implementation of a Digital Health Intervention Promoting Healthy Nutrition, Physical Activity, and Gestational Weight Gain for Women Entering Pregnancy at a High Body Mass Index. Nutrients 2023; 15:nu15030588. [PMID: 36771295 PMCID: PMC9921852 DOI: 10.3390/nu15030588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
txt4two is a multi-modality intervention promoting healthy pregnancy nutrition, physical activity (PA), and gestational weight gain (GWG), which had been previously evaluated in a pilot randomized controlled trial (RCT). This study aimed to evaluate a pragmatic implementation of an adapted version of txt4two in a public tertiary hospital. Using a consecutive cohort design, txt4two was delivered to women with a pre-pregnancy BMI > 25 kg/m2, between 10 + 0 to 17 + 6 weeks. Control and intervention cohorts (n = 150) were planned, with surveys and weight measures at baseline and 36 weeks. The txt4two cohort received a dietetic goal-setting appointment and program (SMS, website, and videos). The navigation of disparate hospital systems and the COVID-19 pandemic saw adaptation and adoption take two years. The intervention cohort (n = 35; 43% full data) demonstrated significant differences (mean (SD)), compared to the control cohort (n = 97; 45% full data) in vegetable intake (+0.9 (1.2) versus +0.1 (0.7), p = 0.03), fiber-diet quality index (+0.6 (0.8) versus 0.1 (0.5), p = 0.012), and total diet quality index (+0.7 (1.1) versus +0.2 (±0.6), p = 0.008), but not for PA or GWG. Most (85.7%) intervention participants found txt4two extremely or moderately useful, and 92.9% would recommend it. Embedding the program in a non-RCT context raised implementation challenges. Understanding the facilitators and barriers to adaptation and adoption will strengthen the evidence for the refinement of implementation plans.
Collapse
Affiliation(s)
- Shelley A. Wilkinson
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
- Correspondence: ; Tel.: +61-7-3365-6849
| | | | - Jane C. Willcox
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
- Centre for Quality and Patient Safety, Institute of Health Transformation, Deakin University, Burwood, VIC 3125, Australia
- Impact Obesity, South Melbourne, VIC 3205, Australia
| |
Collapse
|
7
|
Matsushita T, Honda A, Hasegawa T, Inoue E, Noma H, Ota E. Regular weighing to prevent excessive gestational weight gain: a study protocol for a systematic review and meta-analysis. Syst Rev 2022; 11:104. [PMID: 35619165 PMCID: PMC9137211 DOI: 10.1186/s13643-022-01977-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/06/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Excessive weight gain during pregnancy results in maternal and fetal complications and could further impact offspring. The evidence regarding the association between regular weighing during the antenatal period and excessive weight gain is limited. METHODS We will systematically review individual and cluster randomized controlled trials that evaluated regular weighing as an intervention compared to weighing only at the first booking of the antenatal visit. Trials that assessed the effectiveness of exercise, diet, or other behavioral interventions will be excluded. Pregnant women with a singleton pregnancy and no preexisting health complications are eligible for the review. The primary outcome will be the proportion of women at term who exceed the upper limit of the target range of weight as defined by the guidelines or recommendations for the population. We will search MEDLINE (via PubMed), Embase (via EMBASE.com ), Scopus, the Cumulative Index to Nursing and Allied Health Literature (CINAHL via EBSCO), The Cochrane Central Register of Controlled Trials (CENTRAL) and the trial protocol registers, ClinicalTrials.gov , and the International Clinical Trials Registry Platform (ICTRP) search portal. Full-text articles, unpublished studies, and ongoing trials reported in any language will be included. Two review authors will independently examine and screen for eligible studies and extract data for synthesis. DISCUSSION We will discuss the effectiveness of regular weighing as a single intervention on reducing the proportion of women who have excessive gestational weight gain. This study will provide key information for countries to develop guidelines on antenatal care and strategies to tackle excessive gestational weight gain. We will create a "Summary of findings" table (Summary of findings table 1) according to the methods described in the Cochrane Handbook for Systematic Reviews of Interventions. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020212581.
Collapse
Affiliation(s)
- Tomomi Matsushita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan.
| | - Aiko Honda
- Department of Pediatrics, Showa University Hospital, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Takeshi Hasegawa
- Showa University Research Administration Center (SURAC); Department of Hygiene, Public Health, and Preventive Medicine, School of Medicine; Division of Nephrology, Department of Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Eisuke Inoue
- Showa University Research Administration Center, Showa University, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, 10-3 Midori-cho, Tachikawa, Tokyo, 190-8562, Japan
| | - Erika Ota
- St. Luke's International University, Graduate School of Nursing, Global Health Nursing, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan.,Tokyo Foundation for Policy Research, Tokyo, Japan
| |
Collapse
|
8
|
de Jersey S, Guthrie T, Callaway L, Tyler J, New K, Nicholson J. A theory driven, pragmatic trial implementing changes to routine antenatal care that supports recommended pregnancy weight gain. BMC Pregnancy Childbirth 2022; 22:416. [PMID: 35585502 PMCID: PMC9118702 DOI: 10.1186/s12884-022-04750-8] [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: 02/07/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Prevention of weight gain outside recommendations is a challenge for health services, with several barriers to best practice care identified. The aim of this pragmatic implementation study with a historical control was to examine the impact of implementing a service wide education program, and antenatal care pregnancy weight gain chart combined with brief advice on women’s knowledge of recommended gestational weight gain (GWG), the advice received and actual GWG. Methods The PRECEDE PROCEED Model of Health Program planning guided intervention and evaluation targets and an implementation science approach facilitated service changes. Pregnant women < 22 weeks’ gestation attending the antenatal clinic at a metropolitan birthing hospital in Australia were recruited pre (2010, n = 715) and post (2016, n = 478) implementation of service changes. Weight measurements and questionnaires were completed at recruitment and 36 weeks’ gestation. Questionnaires assessed advice received from health professionals related to healthy eating, physical activity, GWG, and at recruitment only, pre-pregnancy weight and knowledge of GWG recommendations. Results Women who correctly reported their recommended GWG increased from 34% (pre) to 53% (post) (p < 0.001). Between pre and post implementation, the advice women received from midwives on recommended GWG was significantly improved at both recruitment- and 36-weeks’ gestation. For normal weight women there was a reduction in GWG (14.2 ± 5.3 vs 13.3 ± 4.7 kg, p = 0.04) and clinically important reduction in excess GWG between pre and post implementation (31% vs 24%, p = 0.035) which remained significant after adjustment (AOR 0.53 [95%CI 0.29–0.96]) (p = 0.005). Conclusions Service wide changes to routine antenatal care that address identified barriers to supporting recommended GWG are likely to improve the care and advice women receive and prevent excess GWG for normal weight women. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04750-8.
Collapse
Affiliation(s)
- Susan de Jersey
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, QLD, 4029, Australia. .,Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4029, Australia.
| | - Taylor Guthrie
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, QLD, 4029, Australia
| | - Leonie Callaway
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, 4029, Australia.,School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4029, Australia
| | - Jeanette Tyler
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, 4029, Australia
| | - Karen New
- Academic Consultant, Healthcare Evidence and Research, Brisbane, QLD, 4006, Australia
| | - Jan Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, 3086, Australia.,School of Early Childhood and Inclusive Education, Faculty of Education, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
| |
Collapse
|
9
|
Teede HJ, Bailey C, Moran LJ, Bahri Khomami M, Enticott J, Ranasinha S, Rogozinska E, Skouteris H, Boyle JA, Thangaratinam S, Harrison CL. Association of Antenatal Diet and Physical Activity-Based Interventions With Gestational Weight Gain and Pregnancy Outcomes: A Systematic Review and Meta-analysis. JAMA Intern Med 2022; 182:106-114. [PMID: 34928300 PMCID: PMC8689430 DOI: 10.1001/jamainternmed.2021.6373] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Excessive gestational weight gain (GWG) is common and associated with adverse pregnancy outcomes. Antenatal lifestyle interventions limit GWG; yet benefits of different intervention types and specific maternal and neonatal outcomes are unclear. OBJECTIVE To evaluate the association of different types of diet and physical activity-based antenatal lifestyle interventions with GWG and maternal and neonatal outcomes. DATA SOURCES A 2-stage systematic literature search of MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database was conducted from February 1, 2017, to May 31, 2020. Search results from the present study were integrated with those from a previous systematic review from 1990 to February 2017. STUDY SELECTION Randomized trials reporting GWG and maternal and neonatal outcomes. DATA EXTRACTION AND SYNTHESIS Data were extracted for random-effects meta-analyses to calculate the summary effect estimates and 95% CIs. MAIN OUTCOMES AND MEASURES Outcomes were clinically prioritized, with mean GWG as the primary outcome. Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy, cesarean section, preterm delivery, large or small for gestational age neonates, neonatal intensive care unit admission, or fetal death. RESULTS A total of 117 randomized clinical trials of antenatal lifestyle interventions (involving 34 546 women) were included. Overall lifestyle intervention was associated with reduced GWG (-1.15 kg; 95% CI, -1.40 to -0.91), risk of gestational diabetes (odds ratio [OR], 0.79; 95% CI, 0.70-0.89), and total adverse maternal outcomes (OR, 0.89; 95% CI, 0.84-0.94) vs routine care. Compared with routine care, diet was associated with less GWG (-2.63 kg; 95% CI, -3.87 to -1.40) than physical activity (-1.04 kg; 95% CI, -1.33 to -0.74) or mixed interventions (eg, unstructured lifestyle support, written information with weight monitoring, or behavioral support alone) (-0.74 kg; 95% CI, -1.06 to -0.43). Diet was associated with reduced risk of gestational diabetes (OR, 0.61; 95% CI, 0.45-0.82), preterm delivery (OR, 0.43; 95% CI, 0.22-0.84), large for gestational age neonate (OR, 0.19; 95% CI, 0.08-0.47), neonatal intensive care admission (OR, 0.68; 95% CI, 0.48-0.95), and total adverse maternal (OR, 0.75; 95% CI, 0.61-0.92) and neonatal outcomes (OR, 0.44; 95% CI, 0.26-0.72). Physical activity was associated with reduced GWG and reduced risk of gestational diabetes (OR, 0.60; 95% CI, 0.47-0.75), hypertensive disorders (OR, 0.66; 95% CI, 0.48-0.90), cesarean section (OR, 0.85; 95% CI, 0.75-0.95), and total adverse maternal outcomes (OR, 0.78; 95% CI, 0.71-0.86). Diet with physical activity was associated with reduced GWG (-1.35 kg; 95% CI, -1.95 to -0.75) and reduced risk of gestational diabetes (OR, 0.72; 95% CI, 0.54-0.96) and total adverse maternal outcomes (OR, 0.81; 95% CI, 0.69-0.95). Mixed interventions were associated with reduced GWG only. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found level 1 evidence that antenatal structured diet and physical activity-based lifestyle interventions were associated with reduced GWG and lower risk of adverse maternal and neonatal outcomes. The findings support the implementation of such interventions in routine antenatal care and policy around the world.
Collapse
Affiliation(s)
- Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Endocrinology and Diabetes Units, Monash Health, Melbourne, Victoria, Australia.,Warwick Business School, Warwick University, Coventry, United Kingdom
| | - Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Endocrinology and Diabetes Units, Monash Health, Melbourne, Victoria, Australia
| | - Mahnaz Bahri Khomami
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ewelina Rogozinska
- Meta-Analysis Group, Institute of Clinical Trials and Methodology, Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Warwick Business School, Warwick University, Coventry, United Kingdom
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom.,Birmingham Women's and Children's National Health Service Foundation Trust, Birmingham, United Kingdom
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Endocrinology and Diabetes Units, Monash Health, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Harrison CL, Teede H, Khan N, Lim S, Chauhan A, Drakeley S, Moran L, Boyle J. Weight management across preconception, pregnancy, and postpartum: A systematic review and quality appraisal of international clinical practice guidelines. Obes Rev 2021; 22:e13310. [PMID: 34312965 DOI: 10.1111/obr.13310] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 01/02/2023]
Abstract
This systematic review and quality appraisal evaluated clinical practice guidelines (CPGs) for weight management and weight-related behaviors across preconception, pregnancy, and postpartum. CPGs published in English were identified from research and guideline-specific databases between 2010 and 2019. Recommendations were categorized into weight (body mass index screening, weight loss, weight gain prevention, and gestational weight gain), diet, food safety, physical activity, and behavioral strategies. Three independent appraisers assessed CPG quality using the Appraisal of Guidelines Research and Evaluation II instrument. Twenty-two CPGs were included across preconception (n = 2), pregnancy (n = 8), postpartum (n = 2), or a combination (n = 10). Overall, 45% of CPGs were appraised as poor quality, 32% as moderate, and 23% as high. Evaluation of body mass index and supplementation recommendations were most common across CPGs, alongside secondary weight management recommendations for women with obesity in fewer CPGs. Accompanying recommendations for diet, physical activity, and behavior were highly variable between guidelines. We report significant ambiguity in existing guidance and an absence of important considerations, including targeting weight gain prevention and limiting excess gestational weight gain. Results emphasize the need for development of robust, comprehensive, and high quality guidelines on healthy lifestyle and weight management across these formative reproductive life stages.
Collapse
Affiliation(s)
- Cheryce L Harrison
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
| | - Nadia Khan
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Ayushi Chauhan
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Sheila Drakeley
- School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
A Review of the Clinician's Role in Women's Weight Management and Implications for Women's Health and Pregnancy Outcomes. Obstet Gynecol Surv 2021; 76:493-503. [PMID: 34449852 DOI: 10.1097/ogx.0000000000000908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Ten years have passed since the Institute of Medicine (IOM) released its recommendations for gestational weight gain (GWG), based on a woman's prepregnancy body mass index. Despite this, the majority of women do not gain the appropriate gestational weight; most women gain too much weight, and a small but substantial number gain too little. Objective We review the literature concerning GWG, the opinions and practices of clinicians in managing their patients' weight, and how these practices are perceived by patients. We also review several randomized control trials that investigate the efficacy of clinical intervention in managing GWG. Evidence Acquisition A literature review search was conducted with no limitations on the number of years searched. Results The number of clinicians who are aware of and use the IOM recommendations has increased, but the prevalence of inappropriate GWG has not decreased. Clinicians report feeling less than confident in their ability to have an impact on their patients' weight gain, and there are discrepancies between what clinicians and patients report regarding counseling. Many randomized control trials demonstrate a beneficial impact of clinical intervention, highlighting the importance of collaboration and technology to provide educational information and support throughout a pregnancy. Conclusions Pregnancy provides an opportunity for clinicians to have open and direct conversations with their patients about their weight. Providing clinicians with the tools, skillset, and confidence to assist in the management of GWG is essential to the health of women and their children, and warrants further investigation.
Collapse
|
12
|
A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Health Care in Pregnancy Panel. Obstet Gynecol 2021; 138:603-615. [PMID: 34352841 DOI: 10.1097/aog.0000000000004535] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To perform a literature review of key aspects of prenatal care delivery to inform new guidelines. DATA SOURCES A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov. METHODS OF STUDY SELECTION We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction. TABULATION, INTEGRATION, AND RESULTS Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth. CONCLUSION Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.
Collapse
|
13
|
Daley AJ, Jolly K, Ives N, Jebb SA, Tearne S, Greenfield SM, Yardley L, Little P, Tyldesley-Marshall N, Bensoussane H, Pritchett RV, Frew E, Parretti HM. Practice nurse-supported weight self-management delivered within the national child immunisation programme for postnatal women: a feasibility cluster RCT. Health Technol Assess 2021; 25:1-130. [PMID: 34382932 DOI: 10.3310/hta25490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies. OBJECTIVE The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable. DESIGN The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up. SETTING The trial took place in Birmingham, UK. PARTICIPANTS Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women's Hospital or general practices. Nine intervention participants and seven nurses were interviewed. INTERVENTIONS The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child's health record ('red book') or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet. MAIN OUTCOME MEASURES The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme). RESULTS The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight. LIMITATIONS Fewer participants were recruited than planned. CONCLUSIONS Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention. FUTURE WORK Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention. TRIAL REGISTRATION Current Controlled Trials ISRCTN12209332. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Amanda J Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Tearne
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucy Yardley
- School of Psychological Science, University of Bristol, Bristol, UK.,Department of Psychology, University of Southampton, Southampton, UK
| | - Paul Little
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Hannah Bensoussane
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ruth V Pritchett
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen M Parretti
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
14
|
A Revalidation of the Weight Related Behaviours Questionnaire within an Australian Pregnancy Cohort. Midwifery 2021; 97:102951. [PMID: 33677171 DOI: 10.1016/j.midw.2021.102951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/17/2020] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
PROBLEM Studies investigating the direct and indirect relationships between psychosocial factors (i.e. attitudes, beliefs and values), health related behaviour (diet and physical activity) and gestational weight gain are increasing. To date heterogeneity of psychosocial measurement tools has limited research progress in this area, preventing measurement of effects by meta-analysis techniques. AIM To conduct a revalidation analysis of a Weight Related Behaviours Questionnaire, originally developed by Kendall, Olson and Frangelico within the United States of America and assess its performance for use within the Australian context. METHODS A revalidation study using Exploratory Factor Analysis was undertaken to assess the factor structure and internal consistency of the six psychosocial scales of the Weight Related Behaviours Questionnaire, within the Woman and Their Children's Health (WATCH), pregnancy cohort. The questionnaire was self-completed between 18 - 20 weeks gestation. Psychosocial factors included; Weight locus of control; Self-efficacy; Attitudes towards weight gain; Body image, Feelings about the motherhood role; and Career orientation. FINDINGS Weight locus of control, Self-efficacy and Body image, retained the same factor structure as the original analysis. The remaining psychosocial factors observed a different factor structure in terms of loadings or number of factors. Deleted items modelling suggests the questionnaire could be strengthened and shortened. CONCLUSION Weight Locus of control, Self-efficacy and Body image were observed as consistent, valid and reliable psychosocial measures for use within the Australian context. Further research is needed to confirm the model and investigate the potential for combining these scales into a shorter psychosocial measurement tool.
Collapse
|
15
|
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.
Collapse
|
16
|
Fealy S, Attia J, Leigh L, Oldmeadow C, Hazelton M, Foureur M, Collins CE, Smith R, Hure A. Demographic and social-cognitive factors associated with gestational weight gain in an Australian pregnancy cohort. Eat Behav 2020; 39:101430. [PMID: 32942238 DOI: 10.1016/j.eatbeh.2020.101430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 08/19/2020] [Accepted: 09/01/2020] [Indexed: 01/01/2023]
Abstract
AIM To identify and describe the demographic and social-cognitive factors associated with excessive gestational weight gain using the Weight-Related Behaviours Questionnaire, within an Australian pregnancy cohort. BACKGROUND Supporting women to achieve optimal weight gain in pregnancy is complex. Social-cognitive factors are recognised antecedents to, and mediators of, weight related behaviour change. Less is known about their role during pregnancy. METHODS 159 women enrolled in a pregnancy cohort study completed the Weight-Related Behaviours Questionnaire (WRBQ) at approximately 19 weeks gestation, and total gestational weight gain was later measured at 36 weeks. Summary scores were reported descriptively. Multivariable logistic regression was used to test demographic (maternal age, pre pregnancy body mass index, parity, smoking status, marital status, education) and social-cognitive factors (weight locus of control, self- efficacy, attitudes towards weight gain, body image, feelings about motherhood, career orientation) as predictors of excessive gestational weight gain. FINDINGS Maternal age was the sole demographic factor predictive of excessive gestational weight gain. Older participants (34-41 yrs) were less likely to gain excessive weight when compare to younger participants (18-24 yrs): Odds Ratio 0.20, 95% Confidence Interval 0.05, 0.82. Body image (measured as personal satisfaction and perception of own weight) was the sole social-cognitive factor associated with excessive gestational weight gain. For every one unit improvement in body image score, there was a 33% decreased odds of excessive gestational weight gain (OR 0.67, 95% CI 0.53, 0.85). CONCLUSION This study suggests that younger maternal age and lower perceived body image are predictive of excessive gestational weight gain.
Collapse
Affiliation(s)
- Shanna Fealy
- Charles Sturt University, Faculty of Science, School of Nursing, Midwifery and Indigenous Health, 7 Major Innes Road, Port Macquarie, NSW 2444, Australia; University of Newcastle, Faculty of Health and Medicine, School of Nursing and Midwifery, University Drive, Callaghan, NSW 2308, Australia; University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - John Attia
- University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Michael Hazelton
- Charles Sturt University, Faculty of Science, School of Nursing, Midwifery and Indigenous Health, 7 Major Innes Road, Port Macquarie, NSW 2444, Australia; University of Newcastle, Faculty of Health and Medicine, School of Nursing and Midwifery, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; Priority Research Centre for Brain and Mental Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Maralyn Foureur
- University of Newcastle, Faculty of Health and Medicine, School of Nursing and Midwifery, University Drive, Callaghan, NSW 2308, Australia; Hunter New England Health Nursing and Midwifery Research Centre, Australia
| | - Clare E Collins
- University of Newcastle, Faculty of Health and Medicine, School of Health Sciences, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Ring Road, Callaghan, NSW 2308, Australia
| | - Roger Smith
- University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; University of Newcastle Priority Research Centre for Reproductive Science, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia; Department of Endocrinology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Alexis Hure
- University of Newcastle, Faculty of Health and Medicine, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| |
Collapse
|
17
|
Goldstein RF, Harrison CL, Teede HJ. Editorial: The importance of gestational weight gain. Obes Rev 2020; 21:e13073. [PMID: 32608189 DOI: 10.1111/obr.13073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Rebecca F Goldstein
- Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia.,Centre for Research Excellence in Healthy Lifestyle in Preconception and Pregnancy (HiPP), Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia.,Monash Health, Melbourne, Victoria, Australia.,Centre for Research Excellence in Healthy Lifestyle in Preconception and Pregnancy (HiPP), Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
18
|
Arthur C, Di Corleto E, Ballard E, Kothari A. A randomized controlled trial of daily weighing in pregnancy to control gestational weight gain. BMC Pregnancy Childbirth 2020; 20:223. [PMID: 32299371 PMCID: PMC7164155 DOI: 10.1186/s12884-020-02884-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 03/20/2020] [Indexed: 12/30/2022] Open
Abstract
Background Excessive gestational weight gain is a modifiable risk factor for the development of obstetric and neonatal complications, and can have a lifelong impact on the health of both mother and offspring. The purpose of this study was to assess whether in addition to standardized medical advice regarding weight gain in pregnancy (including adherence to the Institute of Medicine (IOM) guidelines) (IOM (Institute of Medicine) and NRC (National Research Council, Weight Gain During Pregnancy: Re-examining the guidelines, 2009)), the addition of daily weighing would provide a low cost and simple intervention to reduce excessive weight gain in pregnancy by maintaining weight gain within the target range. Methods Women presenting for antenatal care to a secondary level hospital were randomised to routine care or daily weight monitoring. Both groups received nutrition and exercise advice. Results Three hundred and ninety-six women were randomised to either the daily weight monitoring group or control group with complete data available for 326 women. The percentage weight gain above target (86.9% (SD 52.3) v 92.7% (SD 50.8) p = 0.31) and change in weight per week during the study period (0.59 kg (SD 0.30) v 0.63 kg (SD 0.31) p = 0.22) were lesser in those undergoing daily weighing compared to routine management, however these did not reach statistical significance. Conclusion Daily weight monitoring as a stand-alone intervention has potential to reduce excessive gestational weight gain. It may have a role as a part of a larger intervention involving dietary and exercise modifications. Trial registration The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry. (ACTRN12613001165774, 23/10/ 2013).
Collapse
Affiliation(s)
| | - Ellen Di Corleto
- University of Queensland, St Lucia, Queensland, Australia.,Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, Australia
| | - Emma Ballard
- University of Queensland, St Lucia, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Alka Kothari
- University of Queensland, St Lucia, Queensland, Australia. .,Redcliffe Hospital, Anzac Avenue, Redcliffe, Queensland, Australia.
| |
Collapse
|
19
|
Sanders J, Channon S, Cannings-John R, Coulman E, Hunter B, Paranjothy S, Warren L, Drew C, Phillips B. Pregnancy and weight monitoring: A feasibility study of weight charts and midwife support. MATERNAL AND CHILD NUTRITION 2020; 16:e12996. [PMID: 32222041 PMCID: PMC7507507 DOI: 10.1111/mcn.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 11/28/2022]
Abstract
Around half of pregnant women in the United Kingdom are overweight or obese. The antenatal period provides an opportunity for encouraging women to adopt positive lifestyle changes, and in recent years, this has included development of strategies to support women in avoiding excessive gestational weight gain. The objective of this interventional cohort study was to incorporate individualised gestational weight monitoring charts supported by motivational interviewing (MI)-based conversations into midwifery-led antenatal care and assess potential of the intervention for further development and evaluation. The study setting was a community midwifery team within a large maternity unit. The study explored the facilitators and barriers to engagement with the intervention as experienced by women and midwives; 52 women were recruited, of whom 48 were included in the analysis. A single training session was found adequate to prepare midwives to use antenatal weight charts but was insufficient to result in the incorporation of motivational interview techniques into clinical practice. We did not find sufficient evidence to recommend effectiveness testing of this intervention, and there is currently insufficient evidence to support reintroducing regular weighing of pregnant women into UK antenatal care. Given the public health importance of reducing rates of obesity, future interventions aimed at controlling gestational weight gain should continue to be developed but need to include innovative strategies particularly for women who are already obese or gain weight above that recommended.
Collapse
Affiliation(s)
- Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Billie Hunter
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Lucie Warren
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Cheney Drew
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | |
Collapse
|
20
|
Fealy S, Davis D, Foureur M, Attia J, Hazelton M, Hure A. The return of weighing in pregnancy: A discussion of evidence and practice. Women Birth 2020; 33:119-124. [DOI: 10.1016/j.wombi.2019.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/27/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
|
21
|
Yim SY, Guthrie T, de Jersey SJ. Impact of service-wide initiatives to support healthy pregnancy weight gain on weight-related documentation. Aust N Z J Obstet Gynaecol 2019; 60:355-360. [PMID: 31578721 DOI: 10.1111/ajo.13053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/09/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Excess gestational weight gain is associated with adverse pregnancy outcomes. Addressing barriers to the provision of best practice care that supports healthy pregnancy weight gain could assist staff in clinical care; however, little is known about changes to staff practices after ameliorating barriers. AIMS To evaluate if service initiatives to promote healthy pregnancy weight gain improve weight-related documentation by antenatal staff throughout pregnancy care. MATERIALS AND METHODS Service initiatives including staff training, familiarisation with a pregnancy weight gain chart and placement of scales in clinic rooms were introduced. Pregnancy health records were audited for deliveries pre- (2014) and post-implementation (2017) to obtain weight-related measures. Measures assessed included the documentation of pre-pregnancy weight, height, pre-pregnancy body mass index (BMI), referral to dietetic services (if overweight) and the accuracy of pre-pregnancy BMI calculation. The proportion of visits with weight recorded during pregnancy was also audited. RESULTS A total of 1003 and 1050 records were included from the pre- and post-intervention groups respectively. Significant improvements over time were observed in the documentation of pre-pregnancy weight (P < 0.001), BMI (P < 0.001), accuracy of BMI calculation (P < 0.001) and for obese women proportion of visits with weight recorded (P = 0.02). There was a non-significant increase in the documentation of dietetic referral for overweight women (1.1% vs 2.2%, P = 0.27) and proportion of visits with weight recorded for women across all pre-pregnancy BMI groups (49% vs 51%, P = 0.07). CONCLUSIONS Addressing barriers to supporting healthy pregnancy weight gain through service-wide initiatives may improve weight-related documentation by antenatal staff.
Collapse
Affiliation(s)
- Shi Ying Yim
- Department of Nutrition and Dietetics, Khoo Teck Puat Hospital, Singapore City, Singapore.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Taylor Guthrie
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Susan J de Jersey
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
22
|
Daley A, Jolly K, Jebb SA, Roalfe A, Mackilllop L, Lewis A, Clifford S, Usman M, Ohadike C, Kenyon S, MacArthur C, Aveyard P. Effectiveness of a behavioural intervention involving regular weighing and feedback by community midwives within routine antenatal care to prevent excessive gestational weight gain: POPS2 randomised controlled trial. BMJ Open 2019; 9:e030174. [PMID: 31530608 PMCID: PMC6756421 DOI: 10.1136/bmjopen-2019-030174] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of a brief behavioural intervention based on routine antenatal weighing to prevent excessive gestational weight gain (defined by US Institute of Medicine). DESIGN Randomised controlled trial. SETTING Antenatal clinic in England. PARTICIPANTS Women between 10+0 and 14+6 weeks gestation, not requiring specialist obstetric care. INTERVENTIONS Participants were randomised to usual antenatal care or usual care (UC) plus the intervention. The intervention involved community midwives weighing women at antenatal appointments, setting maximum weight gain limits between appointments and providing brief feedback. Women were encouraged to monitor and record their own weight weekly to assess their progress against the maximum limits set by their midwife. The comparator was usual maternity care. PRIMARY AND SECONDARY OUTCOME MEASURES Excessive gestational weight gain, depression, anxiety and physical activity. RESULTS Six hundred and fifty-six women from four maternity centres were recruited: 329 women were randomised to the intervention group and 327 to UC. We found no evidence that the intervention decreased excessive gestational weight gain. At 38 weeks gestation, the proportions gaining excessive gestational weight were 27.6% (81/305) versus 28.9% (90/311) (adjusted OR 0.84, 95% CI: 0.53 to 1.33) in the intervention and UC group, respectively. There were no significant difference between the groups in anxiety or depression scores (anxiety: adjusted mean -0.58, 95% CI:-1.25 to -0.8; depression: adjusted mean -0.60, 95% CI:-1.24 to -0.05). There were no significant differences in physical activity scores between the groups. CONCLUSIONS A behavioural intervention delivered by community midwives involving routine weighing throughout pregnancy, setting maximum weight gain targets and encouraging women to weigh themselves each week to check progress did not prevent excessive gestational weight gain. There was no evidence of psychological harm. TRIAL REGISTRATION NUMBER ISRCTN67427351.
Collapse
Affiliation(s)
- Amanda Daley
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kate Jolly
- Institute of Applied Health Research,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Andrea Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Lucy Mackilllop
- Nuffield Department of Women's and Reproductive Health, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Amanda Lewis
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - Sue Clifford
- Institute of Applied Health Research,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Muhammad Usman
- Institute of Applied Health Research,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Corah Ohadike
- Sherwood Forest Hospitals NHS FoundationTrust, Nottinghamshire, UK
| | - Sara Kenyon
- Institute of Applied Health Research,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Christine MacArthur
- Institute of Applied Health Research,College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| |
Collapse
|
23
|
Mutabazi JC, Werfalli MM, Rawat A, Musa E, Norris SA, Murphy K, Trottier H, Levitt N, Zarowsky C. Integrated management of type 2 diabetes and gestational diabetes within multi-morbidity conditions in Africa: a systematic review protocol. BMJ Open 2019; 9:e023684. [PMID: 30862631 PMCID: PMC6429749 DOI: 10.1136/bmjopen-2018-023684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Multi-morbidity, defined as the co-existence of more than one chronic condition in one person, has been increasing due to comorbid non-communicable and infectious chronic diseases (CNCICDs). Type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) incidences within the CNCICDs conditions are increasing and overwhelming already weak and under-resourced healthcare systems in Africa. There is then an urgent need for the integrated management of CNCICDs. We aim to review the integrated management of T2D and GDM within multi-morbidity conditions in Africa. METHODS Studies that have assessed the integrated management of T2D and GDM within multi-morbidity conditions in Africa will be considered based on the Population, Intervention, Comparator and Outcome method: population (adult diagnosed with T2D and GDM, who also have other diseases, non-communicable diseases (NCDs) and infectious, in public primary and secondary healthcare facilities in Africa); Intervention (integrated management of T2D and GDM, also suffering from other diseases in Africa), Comparator (Unintegrated management of T2D and GDM in Africa) and Outcomes (integrated management of T2D and GDM in Africa). The following databases Cochrane Library, MEDLINE, PubMed and SCOPUS, the WHO International Clinical Trials Registry Platform, among others will be searched. Two reviewers (JCM and MW) will independently screen, select eligible studies and extract data. Discrepancies will be resolved by consensus or by a discussion with the third author (AR). Quality of included studies will be assessed using both the newly developed tool, 'the Cochrane Collaboration Risk of Bias Tool' and 'Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I)". A narrative synthesis of extracted data and meta-analysis, if necessary will be conducted and then reported according to the preferred reporting items for systematic review and meta-analysis. ETHICS CONSIDERATION AND DISSEMINATION By only using the published data, there is no ethics approval required for this study. This systematic review will be included in JCM's PhD thesis and its findings will also be disseminated through peer-reviewed publication and conference presentation. PROSPERO REGISTRATION NUMBER CRD42016046630.
Collapse
Affiliation(s)
- Jean Claude Mutabazi
- Département de Médecine Sociale et Préventive - Santé Mondiale, École de Santé Publique, Université de Montréal, Montréal, Quebec, Canada
- École de santé publique, Université de Montréal, Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montreal, Quebec, Canada
| | - Mahmoud M Werfalli
- Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, South Africa
| | - Angeli Rawat
- School of Population and Public Health, University of British Colombia, Vancouver, British Columbia, Canada
| | - Ezekiel Musa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, South Africa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Cape Town, South Africa
| | - Shane A Norris
- Department of Medicine, Faculty of Health Science, University of Cape Town, Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Cape Town, South Africa
- Paediatrics and Child Health, University of Witwatersrand, Johannesburg, South Africa
| | - Katherine Murphy
- Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, South Africa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Cape Town, South Africa
| | - Helen Trottier
- Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montréal, Quebec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montréal, Quebec, Canada
| | - Naomi Levitt
- Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape Town, South Africa
- Department of Medicine, Faculty of Health Science, University of Cape Town, Integrated Intervention for DIAbetes risks after GestatiOnal diabetes (IINDIAGO), Cape Town, South Africa
| | - Christina Zarowsky
- École de santé publique, Université de Montréal, Institut de Recherche en Santé Publique de l'Université de Montréal (IRSPUM), Montreal, Quebec, Canada
- Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, Montréal, Quebec, Canada
| |
Collapse
|
24
|
Walker R, Mazza D, Blumfield M, Bennett C, Truby H. Maternal gestational weight gain during pregnancy: prioritising the conversation. Aust J Prim Health 2019; 24:4-8. [PMID: 29262983 DOI: 10.1071/py17111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022]
Abstract
Pregnancy is a critical stage of life requiring urgent attention when taking a lifespan approach to obesity prevention. Excessive gestational weight gain (GWG) is highly predictive of overweight and obesity later in life for women and their offspring. This discussion describes the challenges faced by health professionals (general practitioners, midwives, allied health) in primary care in Australia when addressing GWG, presents evidence that supports re-prioritising GWG and highlights strategies that can be used to address GWG. The revised National Health and Medical Research Council antenatal care guidelines (to be formally released in early 2018) indicate it will be the responsibility of health professionals in antenatal care to initiate conversations about GWG with women. Women are open to discussing this sensitive topic and health professionals in primary care have an opportunity to be proactive in addressing barriers that have hindered conversations about GWG in the past so that women are supported to manage their weight during pregnancy.
Collapse
Affiliation(s)
- Ruth Walker
- Department of Nutrition and Dietetics and Food, School of Clinical Sciences, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Michelle Blumfield
- Department of Nutrition and Dietetics and Food, School of Clinical Sciences, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Christie Bennett
- Department of Nutrition and Dietetics and Food, School of Clinical Sciences, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| | - Helen Truby
- Department of Nutrition and Dietetics and Food, School of Clinical Sciences, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia
| |
Collapse
|
25
|
Wilkinson S, Beckmann M, Donaldson E, McCray S. Implementation of gestational weight gain guidelines - what's more effective for ensuring weight recording in pregnancy? BMC Pregnancy Childbirth 2019; 19:19. [PMID: 30744580 PMCID: PMC6371612 DOI: 10.1186/s12884-018-2162-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 12/21/2018] [Indexed: 11/22/2022] Open
Abstract
Background Pregnant women who gain weight in accordance with guidelines have the lowest risk of pregnancy and birth-related complications. However, evidence-practice gaps often exist. To address pregnancy weight management barriers, a stepped implementation science approach was used, comprising targeted in-services, provision of scales for clinic rooms, and changes to routine weight recording in a hospital electronic medical record. The aim of this study was to assess the cumulative influence of evidence-based interventions on staff’s compliance to recording of antenatal weights. Methods Retrospective data analysis of weight recording over three 15-month cohorts across April 2014–December 2017. Variables calculated from data included: proportion of women with weight recorded at booking and proportion of women who had a weight recorded at each visit. Generalised estimating equation modelling was used to examine differences in weight recording compliance rates between cohorts, pre-pregnancy body mass index categories, model of care and clinicians. Results There were approximately 13,000 pregnancies in each cohort. The proportion of women who had a weight recorded at each visit per cohort differed significantly between cohorts from 4.2% (baseline), 18.9% (scales and in-services) to 61.8% (medical record prompts), p < 0.001. Conclusion Significant improvements were achieved through systematic barrier analysis and subsequent mapping and implementation of appropriate and effective interventions. Improvements were observed across the entire service, in all models of care with all professional groups demonstrating increased recording of weights.
Collapse
Affiliation(s)
- Shelley Wilkinson
- Department of Dietetics and Foodservices, Mater Health, Brisbane, Queensland, 4101, Australia. .,Mater Research Institute - University of Queensland, Mothers, Babies and Women's Theme, Brisbane, 4101, Australia. .,Mater Mothers' Hospitals, Mater Health, Brisbane, 4101, Australia.
| | - Michael Beckmann
- Mater Research Institute - University of Queensland, Mothers, Babies and Women's Theme, Brisbane, 4101, Australia.,Mater Mothers' Hospitals, Mater Health, Brisbane, 4101, Australia
| | - Elin Donaldson
- Department of Dietetics and Foodservices, Mater Health, Brisbane, Queensland, 4101, Australia.,Mater Mothers' Hospitals, Mater Health, Brisbane, 4101, Australia
| | - Sally McCray
- Department of Dietetics and Foodservices, Mater Health, Brisbane, Queensland, 4101, Australia.,Mater Research Institute - University of Queensland, Mothers, Babies and Women's Theme, Brisbane, 4101, Australia
| |
Collapse
|
26
|
de Jersey S, Guthrie T, Tyler J, Ling WY, Powlesland H, Byrne C, New K. A mixed method study evaluating the integration of pregnancy weight gain charts into antenatal care. MATERNAL AND CHILD NUTRITION 2018; 15:e12750. [PMID: 30423601 DOI: 10.1111/mcn.12750] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/16/2018] [Accepted: 11/06/2018] [Indexed: 11/29/2022]
Abstract
Monitoring pregnancy weight can reduce excess gestational weight gain (GWG), and is recommended in clinical practice guidelines as part of routine care. This study aimed to evaluate the implementation of routine weight monitoring using a pregnancy weight gain chart (PWGC), and assess health care professionals (HCPs) and pregnant women's attitudes and practices around its use. A semiquantitative survey was conducted with a consecutive sample of antenatal women at 16 and 36 weeks gestation. Women were weighed, and a PWGC audit done at 36 weeks gestation to assess adherence to chart use and GWG. A cross-sectional survey of antenatal HCPs at the Australian facility assessed staff attitudes and practices relating to weight monitoring and PWGC use. Of the 291 women surveyed, 68% reported being given a PWGC. Of the audited PWGCs (n = 258), 54% had less than three weights recorded, 36% had errors, and 3% were unused. All HCPs surveyed (n = 42) were aware of the PWGC, 63% reported using it to track GWG regularly and 26% believed it to be only the woman's responsibility (i.e., not the midwife's role) to complete it. Seventy-six percent reported they needed more training in counselling pregnant women, and insufficient time was a main barrier to weighing and conversing with women. It is feasible to implement a PWGC into routine antenatal care. Clarity over women's and HCPs responsibility for monitoring GWG and completion of the PWGC is needed. Training on correct PWGC use and counselling and workforce engagement are required to overcome barriers and support healthy GWG.
Collapse
Affiliation(s)
- Susan de Jersey
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Taylor Guthrie
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jeanette Tyler
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Wan Yin Ling
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hilary Powlesland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Clare Byrne
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Karen New
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|
27
|
McDowell M, Cain MA, Brumley J. Excessive Gestational Weight Gain. J Midwifery Womens Health 2018; 64:46-54. [PMID: 30548447 DOI: 10.1111/jmwh.12927] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 09/15/2018] [Accepted: 09/27/2018] [Indexed: 02/01/2023]
Abstract
Excessive gestational weight gain (GWG) is associated with an increasing incidence of maternal and neonatal complications, including hypertensive disorders of pregnancy, fetal macrosomia, and increased cesarean birth rates. In the United States, it is recommended that health care providers use an individualized approach to counsel a woman about pregnancy weight gain goals that is based on the woman's initial body mass index (BMI) and to track GWG throughout the pregnancy by evaluating maternal weight at each visit. Studies have shown that women entering pregnancy with a higher BMI are at increased risk for excessive GWG and postpartum weight retention. Research also demonstrates an increased risk of childhood obesity in children born to women with excessive GWG. Specific counseling about exercise and diet, as well as technology and motivational interviewing, are some tools prenatal care providers can use that have been shown to be effective in reducing excessive GWG. This article reviews the current research regarding maternal and neonatal risks associated with excessive GWG, as well as the interventions that have demonstrated promise for addressing this problem.
Collapse
|
28
|
Farpour-Lambert NJ, Ells LJ, Martinez de Tejada B, Scott C. Obesity and Weight Gain in Pregnancy and Postpartum: an Evidence Review of Lifestyle Interventions to Inform Maternal and Child Health Policies. Front Endocrinol (Lausanne) 2018; 9:546. [PMID: 30319539 PMCID: PMC6168639 DOI: 10.3389/fendo.2018.00546] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 08/28/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Maternal obesity, excessive gestational weight gain (GWG) and post-partum weight retention (PPWR) constitute new public health challenges, due to the association with negative short- and long-term maternal and neonatal outcomes. The aim of this evidence review was to identify effective lifestyle interventions to manage weight and improve maternal and infant outcomes during pregnancy and postpartum. Methods: A review of systematic reviews and meta-analyses investigating the effects of lifestyle interventions on GWG or PPWR was conducted (Jan 2009-2018) via electronic searches in the databases Medline, Pubmed, Web of Science and Cochrane Library using all keywords related to obesity/weight gain/loss, pregnancy or postpartum and lifestyle interventions;15 relevant reviews were selected. Results: In healthy women from all BMI classes, diet and physical activity interventions can decrease: GWG (mean difference -1.8 to -0.7 kg, high to moderate-quality evidence); the risks of GWG above the IOM guidelines (risk ratio [RR] 0.72 to 0.80, high to low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low to very low-quality evidence); cesarean section (RR 0.91 to 0.95; high to moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.56, high-quality evidence); without any maternal/fetal/neonatal adverse effects. In women with overweight/obesity, multi-component interventions can decrease: GWG (-0.91 to -0.63 kg, moderate to very low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low-quality evidence); macrosomia (RR 0.85, 0.73 to 1.0, moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.47, 0.26 to 0.85, moderate-quality evidence). Diet is associated with greater reduction of the risks of GDM, pregnancy-induced hypertension and preterm birth, compared with any other intervention. After delivery, combined diet and physical activity interventions reduce PPWR in women of any BMI (-2.57 to -2.3 kg, very low quality evidence) or with overweight/obesity (-3.6 to -1.22, moderate to very low-quality-evidence), but no other effects were reported. Conclusions: Multi-component approaches including a balanced diet with low glycaemic load and light to moderate intensity physical activity, 30-60 min per day 3-5 days per week, should be recommended from the first trimester of pregnancy and maintained during the postpartum period. This evidence review should help inform recommendations for health care professionals and women of child-bearing age.
Collapse
Affiliation(s)
- Nathalie J. Farpour-Lambert
- Obesity Prevention and Care Program “Contrepoids,” Service of Therapeutic Education for Chronic Diseases, Department of Community Medicine, Primary Care and Emergency, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Pediatric Sports Medicine Consultation, Service of General Pediatrics, Department of Child and Adolescent, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- *Correspondence: Nathalie J. Farpour-Lambert
| | - Louisa J. Ells
- School of Health and Social Care, Teesside University, Middlesbrough, United Kingdom
| | - Begoña Martinez de Tejada
- Service of Obstetrics, Department of Gynaecology and Obstetrics, University Hospitals of Geneva and University of Geneva, Geneva, Switzerland
| | - Courtney Scott
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| |
Collapse
|