1
|
Gestational Weight Gain in Pregnant People with Obesity. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2023. [DOI: 10.1007/s13669-023-00346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
2
|
Channon S, Coulman E, Cannings-John R, Henley J, Lau M, Lugg-Widger F, Strange H, Davies F, Sanders J, Scherf C, Couzens Z, Morantz L. Acceptability and feasibility of a planned preconception weight loss intervention in women with long-acting reversible contraception: the Plan-it mixed-methods study. Health Technol Assess 2023; 27:1-224. [PMID: 36688498 PMCID: PMC9885302 DOI: 10.3310/nkix8285] [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: 01/24/2023] Open
Abstract
BACKGROUND Women with overweight (a body mass index of ≥ 25 kg/m2) or obesity (a body mass index of ≥ 30 kg/m2) are at greater risk of experiencing complications during pregnancy and labour than women with a healthy weight. Women who remove their long-acting reversible contraception (i.e. coils or implants) are one of the few groups of people who contact services as part of their preparation for conception, creating an opportunity to offer a weight loss intervention. OBJECTIVES The objectives were to understand if routine NHS data captured the pathway from long-acting reversible contraception removal to pregnancy and included body mass index; to identify the suitable components of a preconception weight loss intervention; and to engage with key stakeholders to determine the acceptability and feasibility of asking women with overweight/obesity to delay the removal of their long-acting reversible contraception in order to take part in a preconception weight loss intervention. DESIGN This was a preparatory mixed-methods study, assessing the acceptability and feasibility of a potential intervention, using routine NHS data and purposefully collected qualitative data. PARTICIPANTS The NHS routine data included all women with a long-acting reversible contraception code. There were three groups of participants in the surveys and interviews: health-care practitioners who remove long-acting reversible contraception; weight management consultants; and women of reproductive age with experience of overweight/obesity and of using long-acting reversible contraception. SETTING UK-based health-care practitioners recruited at professional meetings; and weight management consultants and contraceptive users recruited via social media. DATA SOURCES Anonymised routine data from UK sexual health clinics and the Clinical Practice Research Datalink, including the Pregnancy Register; and online surveys and qualitative interviews with stakeholders. RESULTS The records of 2,632,871 women aged 16-48 years showed that 318,040 had at least one long-acting reversible contraception event, with 62% of records including a body mass index. Given the identified limitations of the routine NHS data sets, it would not be feasible to reliably identify women with overweight/obesity who request a long-acting reversible contraception removal with an intention to become pregnant. Online surveys were completed by 100 health-care practitioners, four weight management consultants and 243 contraceptive users. Ten health-care practitioners and 20 long-acting reversible contraception users completed qualitative interviews. A realist-informed approach generated a hypothesised programme theory. The combination of weight discussions and the delay of long-acting reversible contraception removal was unacceptable as an intervention to contraceptive users for ethical and practical reasons. However, a preconception health intervention incorporating weight loss could be acceptable, and one potential programme is outlined. LIMITATIONS There was very limited engagement with weight management consultants, and the sample of participating stakeholders may not be representative. CONCLUSIONS An intervention that asks women to delay long-acting reversible contraception removal to participate in a preconception weight loss intervention would be neither feasible nor acceptable. A preconception health programme, including weight management, would be welcomed but requires risk communication training of health-care practitioners. FUTURE WORK Work to improve routine data sets, increase awareness of the importance of preconception health and overcome health-care practitioner barriers to discussing weight as part of preconception care is a priority. TRIAL REGISTRATION This trial is registered as ISRCTN14733020. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 1.
Collapse
Affiliation(s)
- Susan Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Elinor Coulman
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Josie Henley
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Freya Davies
- The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Caroline Scherf
- Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
| | - Leah Morantz
- 1Centre for Trials Research, Cardiff University, Cardiff, UK
- 2The Welsh Centre for Primary and Emergency Care Research (PRIME), Division of Population Medicine, Cardiff University, Cardiff, UK
- 3School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
- 4Cardiff and Vale University Health Board, Department of Sexual Health, Cardiff Royal Infirmary, Cardiff, UK
- 5Public Health Wales NHS Trust, Public Health Wales, Cardiff, UK
| |
Collapse
|
3
|
Knudsen SDP, Roland CB, Alomairah SA, Jessen AD, Molsted S, Clausen TD, Løkkegaard E, Stallknecht B, Bønnelycke J, Bendix JM, Maindal HT. Physical activity in pregnancy: a mixed methods process evaluation of the FitMum randomised controlled trial interventions. BMC Public Health 2022; 22:2283. [PMID: 36474181 PMCID: PMC9724308 DOI: 10.1186/s12889-022-14717-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Physical activity (PA) at moderate intensity is recommended for healthy pregnant women. The three-arm FitMum randomised controlled trial showed that it was possible to increase PA level during pregnancy with structured supervised exercise training (EXE) compared to standard care. Motivational counselling on PA (MOT) did not increase PA. This process evaluation aims to understand the implementation and mechanisms of impact of EXE and MOT. METHODS A mixed methods process evaluation was conducted using the UK Medical Research Council's process evaluation framework by assessing implementation (reach, fidelity, and dose) and mechanisms of impact of the two interventions provided to pregnant women in FitMum. Data was collected both quantitatively (n = 220) and qualitatively (n = 20). RESULTS The FitMum trial reached educated pregnant women (80% having an educational level ≥ bachelor's degree) with high autonomy of everyday life. Most participants (58%) were recruited at their first-trimester ultrasonic scan. Reasons to participate were personal (91%) and altruistic (56%). The intervention dose was delivered as intended with high fidelity in the original physical intervention setup and in the altered online setup during the COVID-19 restrictions. A low dose received in EXE (1.3 [95% CI, 1.1; 1.5] sessions/week) was partly explained by the pre-scheduled EXE sessions favouring participants with a flexible everyday life and a supportive social network. Dose received in EXE increased during online intervention delivery. Participants in MOT received 5.2 [4.7; 5.7] of 7 sessions. Mechanisms of impact comprised a perception of intervention commitment among participants in EXE due to the scheduled EXE sessions, whereas participants in MOT considered themselves as PA self-determined. PA was considered as constrained activities in EXE and included in daily activities in MOT. CONCLUSION The FitMum interventions was delivered with high fidelity. During COVID-19, the dose received in EXE increased compared to the previous physical setup. Mechanisms of impact as commitment, perception of empowerment and perception of PA as well as the paradox between prioritising PA and family and the need of a flexible everyday life need to be considered when offering pregnant women PA interventions. Future interventions should consider a combination of physical and online exercise training for pregnant women.
Collapse
Affiliation(s)
- Signe de Place Knudsen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark. .,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Caroline Borup Roland
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Saud Abdulaziz Alomairah
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
| | - Anne Dsane Jessen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stig Molsted
- Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ellen Løkkegaard
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bente Stallknecht
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Julie Bønnelycke
- Department of Visual Culture and Performance Design, Roskilde University, Roskilde, Denmark
| | - Jane M Bendix
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital - North Zealand, Hillerod, Denmark.,Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hillerod, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Steno Diabetes Center Copenhagen, Herlev, Denmark
| |
Collapse
|
4
|
Harreiter J, Desoye G, van Poppel MNM, Kautzky-Willer A, Dunne F, Corcoy R, Devlieger R, Simmons D, Adelantado JM, Damm P, Mathiesen ER, Jensen DM, Anderson LLT, Lapolla A, Dalfrà MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill DJ, Snoek FJ. The Effects of Lifestyle and/or Vitamin D Supplementation Interventions on Pregnancy Outcomes: What Have We Learned from the DALI Studies? Curr Diab Rep 2019; 19:162. [PMID: 31845115 DOI: 10.1007/s11892-019-1282-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW The DALI (vitamin D and lifestyle intervention in the prevention of gestational diabetes mellitus (GDM)) study aimed to prevent GDM with lifestyle interventions or Vitamin D supplementation (1600 IU/day). This review summarizes the learnings from the DALI studies among pregnant women with a BMI ≥ 29 kg/m2. RECENT FINDINGS Women diagnosed with GDM earlier in pregnancy had a worse metabolic profile than those diagnosed later. A combined physical activity (PA) and healthy eating (HE) lifestyle intervention improved both behaviours, limited gestational weight gain (GWG) and was cost-effective. Although GDM risk was unchanged, neonatal adiposity was reduced due to less sedentary time. Neither PA nor HE alone limited GWG or GDM risk. Fasting glucose was higher with HE only intervention, and lower with Vitamin D supplementation. Our combined intervention did not prevent GDM, but was cost-effective, limited GWG and reduced neonatal adiposity.
Collapse
Affiliation(s)
- Jürgen Harreiter
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gernot Desoye
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | | | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | | | - Rosa Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III, Madrid, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Roland Devlieger
- KU Leuven Department of Development and Regeneration: Pregnancy, Fetus and Neonate, Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - David Simmons
- Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, England.
- School of Medicine, Macarthur Clinical School, Western Sydney University, Locked Bag 1797, Campbelltown, NSW, 2751, Australia.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
"…or else I close my ears" How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study. PLoS One 2019; 14:e0222543. [PMID: 31536545 PMCID: PMC6752788 DOI: 10.1371/journal.pone.0222543] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/01/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The importance of helping pregnant women maintain a healthy lifestyle and prevent excessive gestational weight gain is well recognized, but pregnant women do not always perceive communication about body weight as respectful or helpful. Furthermore, fear of inducing shame or guilt can prohibit some midwives from talking about body weight, especially if the woman has obesity. We aimed to explore what women of reproductive age with obesity regard to be the most important and relevant aspects when discussing gestational weight management. METHODS Qualitative interview study using focus groups and individual semi-structured interviews with 17 women of reproductive age (19-39 y) with obesity. Thematic analysis was used to analyze the data. RESULTS We identified three themes: 1) Importance of obtaining vital medical information; 2) A wish to feel understood and treated with respect; 3) Midwives' approach is crucial in sensitive key situations, which include bringing up the subject of body weight, weighing, providing weight-related information, coaching lifestyle modification, dealing with emotional reactions and ending a conversation. CONCLUSIONS A majority of the interviewed women wished to receive information about risks about obesity and gestational weight gain, and recommendations on weight management. However, the risk of midwives offending someone by raising the topic may be increased if the pregnant woman believe that gestational weight gain is uncontrollable by the individual. Also, several situations during maternity care meetings can be stigmatizing and make women less receptive to advice or support. Women suggest that a good working alliance is likely to be achieved if midwives have knowledge about the causes of obesity, take interest in the patients' background, have a non-judgmental approach and refrain from giving unsolicited advice.
Collapse
|
6
|
van Poppel MNM, Simmons D, Devlieger R, van Assche FA, Jans G, Galjaard S, Corcoy R, Adelantado JM, Dunne F, Harreiter J, Kautzky-Willer A, Damm P, Mathiesen ER, Jensen DM, Andersen LL, Tanvig M, Lapolla A, Dalfra MG, Bertolotto A, Wender-Ozegowska E, Zawiejska A, Hill D, Snoek FJ, Jelsma JGM, Desoye G. A reduction in sedentary behaviour in obese women during pregnancy reduces neonatal adiposity: the DALI randomised controlled trial. Diabetologia 2019; 62:915-925. [PMID: 30840112 PMCID: PMC6509072 DOI: 10.1007/s00125-019-4842-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/06/2019] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS Offspring of obese women are at increased risk of features of the metabolic syndrome, including obesity and diabetes. Lifestyle intervention in pregnancy might reduce adverse effects of maternal obesity on neonatal adiposity. METHODS In the Vitamin D And Lifestyle Intervention for Gestational Diabetes Mellitus (GDM) Prevention (DALI) lifestyle trial, 436 women with a BMI ≥29 kg/m2 were randomly assigned to counselling on healthy eating (HE), physical activity (PA) or HE&PA, or to usual care (UC). In secondary analyses of the lifestyle trial, intervention effects on neonatal outcomes (head, abdominal, arm and leg circumferences and skinfold thicknesses, estimated fat mass, fat percentage, fat-free mass and cord blood leptin) were assessed using multilevel regression analyses. Mediation of intervention effects by lifestyle and gestational weight gain was assessed. RESULTS Outcomes were available from 334 neonates. A reduction in sum of skinfolds (-1.8 mm; 95% CI -3.5, -0.2; p = 0.03), fat mass (-63 g; 95% CI -124, -2; p = 0.04), fat percentage (-1.2%; 95% CI -2.4%, -0.04%; p = 0.04) and leptin (-3.80 μg/l; 95% CI -7.15, -0.45; p = 0.03) was found in the HE&PA group, and reduced leptin in female neonates in the PA group (-5.79 μg/l; 95% CI -11.43, -0.14; p = 0.05) compared with UC. Reduced sedentary time, but not gestational weight gain, mediated intervention effects on leptin in both the HE&PA and PA groups. CONCLUSIONS/INTERPRETATION The HE&PA intervention resulted in reduced adiposity in neonates. Reduced sedentary time seemed to drive the intervention effect on cord blood leptin. Implications for future adiposity and diabetes risk of the offspring need to be elucidated. TRIAL REGISTRATION ISRCTN70595832.
Collapse
Affiliation(s)
- Mireille N M van Poppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Institute of Sport Science, University of Graz, Mozartgasse 14, 8010, Graz, Austria.
| | - David Simmons
- Macarthur Clinical School, Western Sydney University, Sydney, NSW, Australia
- Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
| | - Roland Devlieger
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, KU Leuven, Leuven, Belgium
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - F Andre van Assche
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, KU Leuven, Leuven, Belgium
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Goele Jans
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, KU Leuven, Leuven, Belgium
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Sander Galjaard
- Department of Development and Regeneration: Pregnancy, Fetus and Neonate, KU Leuven, Leuven, Belgium
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
- Division of Obstetrics and Prenatal Medicine, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rosa Corcoy
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) Bioengineering, Biomaterials and Nanotechnology, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Juan M Adelantado
- Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Fidelma Dunne
- Galway Diabetes Research Centre, National University of Ireland, Galway, Ireland
- College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Jürgen Harreiter
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth R Mathiesen
- Center for Pregnant Women with Diabetes, Departments of Endocrinology and Obstetrics, Rigshospitalet, Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lise-Lotte Andersen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Mette Tanvig
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- , Region of Southern Denmark, Denmark
| | - Annunziata Lapolla
- Dipartimento di Medicina, Università Degli Studi di Padova, Padua, Italy
| | - Maria G Dalfra
- Dipartimento di Medicina, Università Degli Studi di Padova, Padua, Italy
| | - Alessandra Bertolotto
- Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | - David Hill
- Recherche en Santé Lawson SA, Bronschhofen, Switzerland
| | - Frank J Snoek
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Judith G M Jelsma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Gernot Desoye
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| |
Collapse
|