Maternal Well-Being and Stage of Behaviour Change during Pregnancy: A Secondary Analysis of the PEARS Randomised Controlled Trial

Associations between lifestyle and well-being in early and late pregnancy in women with overweight or obesity: Secondary analyses of the PEARS RCT

OBJECTIVES

The associations between individual lifestyle behaviours and well-being are still poorly understood, particularly in the antenatal period when women are exposed to physiological changes and increased psychological distress. A healthy lifestyle score (HLS) comprising protective lifestyle behaviours may be useful for studying links between overall lifestyle and psychosocial outcomes. This study aimed to examine bidirectional associations between a HLS and its components and psychological well-being in pregnant women with overweight/obesity.

DESIGN

Secondary analyses of data from the PEARS trial.

METHODS

Healthy lifestyle scores (scored 0-5) based on maternal diet (AHEI-P), physical activity (MET-minutes), alcohol consumption, smoking, and sleep habits were created for 330 and 287 mothers with overweight/obesity in early (14-16 weeks gestation) and late pregnancy (28 weeks gestation), respectively. Psychological well-being was measured with the WHO-5 well-being index. Cross-lagged path models (crude/adjusted) tested the directionality of relationships between lifestyle (composite score/individual components) and well-being cross-sectionally and over time in pregnancy.

RESULTS

The mean early pregnancy BMI was 29.2 kg/m2. The mean well-being score was 56.3% in early and 60.7% in late pregnancy. Significant autoregressive effects were observed for the HLS, all individual components, and well-being from early to late pregnancy. Well-being was positively correlated with the HLS, physical activity, and sleep variables within time points (in early and/or late pregnancy). Sleep and no smoking in early pregnancy predicted higher well-being in late pregnancy.

CONCLUSIONS

Overall healthy lifestyle, physical activity, and especially sleep duration and quality are associated with psychological well-being in pregnancy, and should be promoted antenatally.

Gestational weight gain and daily life impact of pregnancy symptoms in healthy women: A multivariable analysis

OBJECTIVE

To study the relationship between gestational weight gain (GWG) and Daily Life Impact of Pregnancy Symptoms (DLIPS) scores.

METHODS

A multivariable analysis of a clinical trial (the Walking Preg_Project (WPP), ClinicalTrials.gov NCT03735381) was conducted. The cohort data concerning GWG across gestational trimesters (T1, T2 and T3) was categorized into adequate, excessive, and reduced based on published criteria. DLIPS was measured using the pregnancy symptoms inventory (PSI) a validated tool, across the gestational trimesters. Univariable and multivariable analyses were employed to assess the association between the GWG categories and DLIPS scores in each trimester of pregnancy estimating the β-coefficients and 95% confidence intervals (CI).

RESULTS

There were 221 participants in the cohort. DLIPS mean score in the overall sample and within adequate, excessive, and reduced GWG categories significantly increased across pregnancy (p < 0.005). DLIPS mean score was higher in the excessive GWG category compared to adequate and reduced GWG, in T1 and T2 (p = 0.035; p = 0.031, respectively). An excessive GWG at T1 [β-coefficient (95 % CI) = 3.88, (0.84, 6.93)] and T2 [β-coefficient (95 % CI) = 4.47 (1.24; 7.70)] was associated with higher DLIPS score compared to an adequate GWG.

CONCLUSION

The impact of pregnancy symptoms on daily life increased throughout pregnancy, overall. Excessive GWG was associated with daily life impact of pregnancy symptoms, particularly in the first and second trimester.

Factors influencing participation and regular attendance in a program combining physical activity and nutritional advice for overweight and obese pregnant women

BACKGROUND

Educational programs incorporating physical activity (PA) sessions and nutritional workshops have demonstrated potential benefits for overweight and obese pregnant women. However, participation in such programs remains challenging. This prospective study aimed to investigate the factors influencing participation and regular attendance, while examining changes in health behaviors, along with obstetric and neonatal outcomes.

METHODS

Pregnant women with at 12-22 weeks' gestation a BMI ≥ 25 kg/m2 were invited to join an educational program combining three nutritional workshops conducted in groups and 12 weekly PA sessions. They self-selected their participation into the program. Regardless of program uptake and regularity of attendance, the women's PA levels, eating behaviors, and affectivity were assessed using validated questionnaires at 20-24 weeks, 32-34 weeks, and postpartum. A multivariable logistic regression model was used to determine the factors influencing participation.

RESULTS

Of the 187 women enrolled in the study, 61.5% agreed to participate in the program. Of these, only 45% attended six or more sessions (regardless of the nature of sessions, i.e. nutritional workshops and/or PA sessions), while only 8.7% attended six or more PA sessions. Participation was associated with higher rates of problematic eating behaviors and lower PA levels at baseline, while regular attendance was mainly associated with higher household incomes. No significant difference was observed between participants and non-participants in terms of changes in eating behaviors, PA levels, or affectivity. However, at the 32-34 week visit, regular participants displayed a higher change in positive affectivity, but unexpectedly also in cognitive restraint, than non-regular participants, a difference that did not persist at postpartum.

CONCLUSION

The educational program combining nutrition and PA was shown to be safe. Women facing challenges related to health behavior displayed a willingness to sign up for the program, but tailored interventions addressing their individual challenges are needed to improve attendance. Accordingly, four recommendations are proposed for the design of future interventions.

TRIAL REGISTRATION

ClinicalTrials.gov; Identifier: NCT02701426; date of first registration: 08/03/2016.

Implementing weight management during and after pregnancy to reduce diabetes and CVD risk in maternal and child populations

Maintaining a healthy weight during pregnancy is critical for both women's and children's health. Excessive gestational weight gain (GWG) can lead to complications such as gestational diabetes, hypertension and caesarean delivery. Insufficient GWG can cause fetal growth restriction and increase infant mortality risk. Additionally, postpartum weight retention raises risk of obesity, type 2 diabetes and other chronic diseases for both mother and child. This review seeks to identify current obstacles in weight management research during and after pregnancy and explore evidence-based strategies to overcome them. Pregnancy offers a window of opportunity for health behaviour changes as women are more receptive to education and have regular contact with health services. Staying within Institute of Medicine's recommended GWG ranges is associated with better maternal and fetal outcomes. Systematic review evidence supports structured diet and physical activity pregnancy interventions, leading to reduced GWG and fewer complications. Health economic evaluation indicates significant returns from implementation, surpassing investment costs due to decreased perinatal morbidity and adverse events. However, the most effective way to implement interventions within routine antenatal care remains unclear. Challenges increase in the postpartum period due to competing demands on women physically, mentally and socially, hindering intervention reach and retention. Flexible, technology-supported interventions are needed, requiring frameworks such as penetration-implementation-participation-effectiveness and template-for-intervention-description-and-replication for successful implementation. Greater research efforts are necessary to inform practice and investigate fidelity aspects through pragmatic implementation trials during the pregnancy and postpartum periods. Understanding the best ways to deliver interventions will empower women to maintain a healthy weight during their reproductive years.