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Nightingale H, Mnatzaganian G, Hooker L, Barrett S, Kingsley M. The effect of motivational interviewing and/or cognitive behaviour therapy techniques on gestational weight gain - a systematic review and meta-analysis. BMC Public Health 2023; 23:626. [PMID: 37005572 PMCID: PMC10067184 DOI: 10.1186/s12889-023-15446-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/15/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Women with gestational weight gain (GWG) that is below or above recommendations are at risk of adverse perinatal outcomes. Motivational interviewing and/or cognitive behaviour therapy have demonstrated efficacy in initiating and sustaining behaviour change, including weight control. The objective of this review was to investigate the effect of antenatal interventions that include components of motivational interviewing and/or cognitive behaviour therapy on gestational weight gain. METHODS This review was designed and reported in accordance with guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Five electronic databases were systematically searched to March 2022. Randomised controlled trials evaluating interventions with identified components of motivational interviewing and/or cognitive behaviour therapies were included. Pooled proportions of appropriate GWG and GWG above or below guidelines, and standardised mean difference for total gestational weight gain, were calculated. Risk of bias in included studies was evaluated using the Risk of Bias 2 tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. RESULTS Twenty-one studies (8030 participants) were included. Overall, MI and/or CBT interventions had a small effect on the total gestational weight gain (SMD: -0.18, 95% confidence interval: -0.27 to -0.09, p < 0.001) and improved the proportion of women achieving recommended gestational weight gain (29% versus 23% in the comparison, p < 0.001). The GRADE assessment indicated that overall quality of evidence is very uncertain, however sensitivity analyses to account for high risk of bias produced similar results to original meta-analyses. The magnitude of effect was greater in women with overweight or obesity when compared to women with BMI < 25 kg/m2. CONCLUSION Motivational interviewing and/or cognitive behaviour therapy techniques may be effective for promoting healthy gestational weight gain. Nevertheless, a high proportion of women do not achieve recommended gestational weight gain. Future interventions should consider factors, including clinician and consumer perspectives, in the design and delivery of psychosocial interventions that aim to support healthy gestational weight gain. TRIAL REGISTRATION The protocol for this review was registered with the PROSPERO International register of systematic reviews (registration number CRD42020156401).
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Affiliation(s)
- Helen Nightingale
- Rural Department of Nursing & Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Australia.
| | - George Mnatzaganian
- Rural Department of Community Health, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Leesa Hooker
- Rural Department of Nursing & Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Stephen Barrett
- Research and Innovation, Bendigo Health, Bendigo, Australia
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Michael Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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2
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Noonan SHJ, Larkin TA. Associations among maternal characteristics, labour interventions, delivery mode and maternal antenatal complications in a NSW large rural town, and comparison to NSW state data. Aust J Rural Health 2022. [DOI: 10.1111/ajr.12959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 11/17/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Sarah Helen Joy Noonan
- Graduate School of Medicine University of Wollongong Wollongong New South Wales Australia
| | - Theresa Anne Larkin
- Graduate School of Medicine University of Wollongong Wollongong New South Wales Australia
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3
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Brodowski L, Rochow N, Yousuf EI, Kohls F, von Kaisenberg CS, Berlage S, Voigt M. The impact of parity and maternal obesity on the fetal outcomes of a non-selected Lower Saxony population. J Perinat Med 2022; 50:167-175. [PMID: 34695308 DOI: 10.1515/jpm-2020-0614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 10/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Maternal obesity during pregnancy is associated with adverse intrauterine events and fetal outcomes and may increase the risk of obesity and metabolic disease development in offspring. Higher parity, regardless of socioeconomic status, is associated with increased maternal body mass index (BMI). In this study, we examined the relationship between parity, maternal obesity, and fetal outcomes in a large sample of mother-neonate pairs from Lower Saxony, Germany. METHODS This retrospective cohort study examined pseudonymized data of a non-selected singleton cohort from Lower Saxony's statewide quality assurance initiative. 448,963 cases were included. Newborn outcomes were assessed in relation to maternal BMI and parity. RESULTS Maternal obesity was associated with an increased risk of placental insufficiency, chorioamnionitis, and fetal distress while giving birth. This effect was present across all parity groups. Fetal presentation did not differ between BMI groups, except for the increased risk of high longitudinal position and shoulder dystocia in obese women. Maternal obesity was also associated with an increased risk of premature birth, low arterial cord blood pH and low 5-min APGAR scores. CONCLUSIONS Maternal obesity increases the risk of adverse neonatal outcomes. There is a positive correlation between parity and increased maternal BMI. Weight-dependent fetal risk factors increase with parity, while parity-dependent outcomes occur less frequently in multipara. Prevention and intervention programs for women planning to become pregnant can be promising measures to reduce pregnancy and birth complications.
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Affiliation(s)
- Lars Brodowski
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Niels Rochow
- Department of Pediatrics, Paracelsus Medical University, Nuremberg, Germany.,Department of Pediatrics, Univesity Hospital Rostock, Rostock, Germany.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Efrah I Yousuf
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Fabian Kohls
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | | | - Silvia Berlage
- Center for Quality and Management in Health Care, Ärztekammer Niedersachsen, Hannover, Germany
| | - Manfred Voigt
- Faculty of Medicine, Department of Obstetrics and Gynecology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,Biological Anthropology, Medical Faculty, University of Freiburg, Freiburg, Germany
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Neel A, Cunningham CE, Teale GR. A routine third trimester growth ultrasound in the obese pregnant woman does not reliably identify fetal growth abnormalities: A retrospective cohort study. Aust N Z J Obstet Gynaecol 2020; 61:116-122. [PMID: 33098339 DOI: 10.1111/ajo.13256] [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: 06/24/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In response to the challenges of assessing fetal growth in obese women, guidelines recommend routine third trimester ultrasound scans. AIM The aim of this study was to assess the diagnostic performance of this routine scan in obese women (body mass index (BMI) ≥ 35 kg/m2 ). METHODS A retrospective cohort study of 1008 pregnancies with maternal BMI ≥ 35 kg/m2 born after 37 weeks gestation at a Victorian hospital from 2015 to 2017. Multiple pregnancies and those affected by diabetes were excluded. Growth ultrasounds were performed between 34 + 0 and 36 + 6 weeks gestation. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of large for gestational age (LGA > 90%) and small for gestational age (SGA < 10%) were calculated using ultrasound estimated fetal weight (EFW) or abdominal circumference (AC) and compared with gestational age and gender-based birthweight percentiles. RESULTS Using EFW, sensitivity for detecting SGA at birth was 8.1% (six of 74) with a PPV of 100%. Sensitivity for detecting LGA at birth was 61.0% (119 of 195), PPV 54.8%. Sensitivity, specificity, PPV and NPV percentages were all lower using AC. Only 40% of actual birthweight percentiles (405/1008) were within ±10 percentiles of their growth ultrasound EFW percentile. CONCLUSION The performance of a routine third trimester ultrasound in women with BMI ≥ 35 kg/m2 suggests limited utility in helping identify aberrant fetal growth. This has important implications for the management of obese pregnant women.
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Affiliation(s)
- Aekta Neel
- Women's and Children's Division, Joan Kirner Women's and Children's at Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
| | - Chris E Cunningham
- Rural Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Glyn R Teale
- Women's and Children's Division, Joan Kirner Women's and Children's at Sunshine Hospital, Western Health, Melbourne, Victoria, Australia
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Ward MC, Agarwal A, Bish M, James R, Faulks F, Pitson J, Yuen N, Mnatzaganian G. Trends in obesity and impact on obstetric outcomes in a regional hospital in Victoria, Australia. Aust N Z J Obstet Gynaecol 2019; 60:204-211. [PMID: 31353441 DOI: 10.1111/ajo.13035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/06/2019] [Indexed: 12/28/2022]
Abstract
AIMS Obesity-related complications have been identified across the entire childbearing journey. This study investigated changes in obesity prevalence and their impact on obstetric outcomes in a regional hospital in Victoria, Australia. METHODS All women delivering during 1 January 2010 and 31 December 2016 were eligible to participate. Trends over time and outcomes were assessed on body mass indices (BMI). Incidences of complications were compared by BMI categories. The effect of obesity on hospital length of stay (LoS) was further assessed using the Generalised Estimating Equations approach. RESULTS During the study period a total of 6661 women of whom 27.5% were overweight, and 16.1, 7.7, and 5.5% were respectively obese class I, class II, and class III, contributed to 8838 births. An increased trend over time in the prevalence of obesity (BMI > 35.0) (P = 0.041) and a decreased trend for vaginal deliveries for the whole sample (P = 0.003) were found. Multiple adverse outcomes were associated with increasing maternal BMI including increased risk of gestational diabetes, gestational hypertension, preeclampsia, emergency caesarean section, shoulder dystocia, macrosomia, and admission to special care. The multivariable analysis showed no associations between LoS and BMI. CONCLUSIONS Over a short period of seven years, this study provides evidence of a significant trend toward more obesity and fewer vaginal births in a non-urban childbearing population, with increasing trends of poorer health outcomes. Assessing needs and risk factors tailored to this population is crucial to ensuring a model of care that safeguards a sustainable and effective regional maternity health service.
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Affiliation(s)
- Madeleine C Ward
- Department of Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Anju Agarwal
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - Melanie Bish
- Department of Rural Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Rachel James
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - Fiona Faulks
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia.,Department of Rural Nursing and Midwifery, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Jennifer Pitson
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - Nicola Yuen
- Department of Women's & Children's Services, Bendigo Health, Bendigo, Victoria, Australia
| | - George Mnatzaganian
- Department of Community and Allied Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Kothe E, Bailey C, Weiner C, Nagle C, Nowson C, Hill B, McPhie S, Savaglio M, Skouteris H. An investigation of Australian midwifery curricula for obesity management and health behaviour change training. Nurse Educ Pract 2019; 36:54-57. [PMID: 30861412 DOI: 10.1016/j.nepr.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Fifty percent of Australian women enter pregnancy overweight or obese. Unfortunately, few women receive weight management advice from health professionals during pregnancy. The aim of this study was to investigate current midwifery curricula from Australian universities to identify strengths and deficits in the teaching of preconception and antenatal weight management. METHODS Midwifery courses from 20 universities were identified. Of the 568 units taught at these universities, 252 course outlines were obtained. Data were coded using the qualitative analysis technique of Framework Analysis for the following main themes: 1) the effect of weight, diet and physical activity on health outcomes for women who are pregnant or planning a pregnancy; 2) weight management advice in any population; and 3) health behaviour change techniques in any context. RESULTS Analysis revealed a variety of teaching methods and skills training that emphasised the importance of clinical judgement and autonomous clinical practice, in conjunction with critical enquiry and sourcing reputable evidence. There was little evidence, however, that weight management advice was taught explicitly to midwifery students in the curricula. DISCUSSION A greater emphasis on skilling midwifery students to address weight gain during pregnancy, and behavioural techniques to achieve this, is required.
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Affiliation(s)
- Emily Kothe
- Deakin University, School of Psychology, Geelong, Australia
| | - Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Carlye Weiner
- Deakin University, School of Psychology, Geelong, Australia
| | - Cate Nagle
- Centre for Nursing and Midwifery Research, James Cook University, Townsville, Australia; Townsville Hospital and Health Service, Townsville, Australia
| | - Caryl Nowson
- School of Exercise and Nutrition Sciences, Deakin University, Australia
| | - Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Skye McPhie
- Deakin University, School of Psychology, Geelong, Australia
| | - Melissa Savaglio
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Australia.
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Kothe E, Lamb M, Bruce L, McPhie S, Klas A, Hill B, Skouteris H. Student midwives' intention to deliver weight management interventions: A theory of planned behaviour & self-determination theory approach. NURSE EDUCATION TODAY 2018; 71:10-16. [PMID: 30212705 DOI: 10.1016/j.nedt.2018.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/23/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Overweight and obesity during pregnancy is a risk to the health of mother and child. Midwives can modify this key risk factor by providing weight management interventions to women before and during pregnancy. This study investigated social cognitive determinants of pre-clinical student midwives' intention to provide weight management intervention in preconception and antenatal clinical contexts. Social cognitive determinants from the theory of planned behaviour (attitudes, subjective norms, perceived behavioural control) and self-determination theory (autonomous motivation) were used to predict pre-clinical students' intentions once they enter practice. METHOD The sample was 183 female pre-clinical student midwives from 17 Australian universities (age range = 18-54 years). Participants received a cross-sectional questionnaire that measured demographic items, attitudes, subjective norms, perceived behavioural control and autonomous motivation towards providing weight management intervention at two different stages of pregnancy - preconception and antenatal. RESULTS Attitudes, subjective norms, and perceived behavioural control accounted for 56% of intention to provide weight management interventions to women planning pregnancy; however, the addition of autonomous motivation was non-significant. In contrast, attitudes and subjective norms (but not perceived behavioural control) accounted for 39% of intention to provide weight management interventions to women during pregnancy. Furthermore, the addition of autonomous motivation to the model was significant and accounted for an additional 3.1% of variance being explained. IMPLICATIONS AND CONCLUSIONS Curriculum changes that support and increase pre-clinical student midwives' intention should focus on these specific correlates of intention in order to foster long term changes in clinical practice. Changes to the education and training of midwives should be carefully considered to understand their impact on these important determinants of intention to engage in this critical clinical skill.
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Affiliation(s)
- Emily Kothe
- Deakin University, School of Psychology, Geelong, Australia.
| | - Michelle Lamb
- Deakin University, School of Psychology, Geelong, Australia
| | - Lauren Bruce
- Monash Centre for Health Research & Implementation, Monash University, Australia
| | - Skye McPhie
- Deakin University, School of Psychology, Geelong, Australia
| | - Anna Klas
- Deakin University, School of Psychology, Geelong, Australia
| | - Briony Hill
- Monash Centre for Health Research & Implementation, Monash University, Australia
| | - Helen Skouteris
- Deakin University, School of Psychology, Geelong, Australia; Monash Centre for Health Research & Implementation, Monash University, Australia
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Clements V, Leung K, Khanal S, Raymond J, Maxwell M, Rissel C. Pragmatic cluster randomised trial of a free telephone-based health coaching program to support women in managing weight gain during pregnancy: the Get Healthy in Pregnancy Trial. BMC Health Serv Res 2016; 16:454. [PMID: 27578294 PMCID: PMC5006383 DOI: 10.1186/s12913-016-1704-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/24/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain can result in poor maternal and child health outcomes. Estimates from single studies indicate the prevalence of excessive gestational weight gain in Australia could lie between 38 and 67 %. The risk of excessive weight gain can be reduced through healthy eating and exercise. We describe the rationale and methods of the Get Healthy in Pregnancy Service, a trial service which aims to support women in achieving appropriate gestational weight gain through an existing telephone-based health coaching service. METHODS/DESIGN This study aims to compare the effectiveness of a telephone-based health coaching program versus provision of information only in supporting pregnant women to achieve appropriate gestational weight gain. A pragmatic stratified clustered randomised controlled trial will be conducted with 710 women who present to 5 hospitals for their first antenatal appointment during the recruitment period (6-8 months), have a pre-pregnancy body mass index (BMI) ≥ 18.50 (healthy weight or above), are 18 years and over, singleton gestation, English speaking, have no pre-existing medical conditions that may limit their ability to exercise or require a restricted diet and are 18 weeks or less gestation. Hospitals will be randomised into one of two intervention models: a) information only; or b) information plus 10 telephone-based health coaching sessions with a university qualified coach. Both interventions will set a weight-range target with pregnant women. The women attending antenatal clinics at participating hospitals will be screened at their initial hospital appointment to assess their eligibility. Women recruited to the trial will have a number of measures recorded including anthropometrics (self-reported height and weight) and dietary and physical activity scores during and following pregnancy. These measurements will be collected at baseline (prior to 18 weeks gestation), 36 weeks gestation and 12 months post-birth. DISCUSSION This study responds to a need for an effective intervention that targets excessive gestational weight gain at a population level. This study investigates the potential for an innovative intervention combining two existing services; a free state-wide telephone-based health coaching service and hospital-based antenatal care to support pregnant women to achieve healthy weight gain during pregnancy. The use of existing services provides the potential for immediate post-study implementation. While the impacts of telephone-based lifestyle programmes have been tested in a number of settings, there are few studies which evaluate the effectiveness and acceptability of telephone support in achieving healthy gestational weight gain in association with routine antenatal care. TRIAL REGISTRATION ACTRN12615000397516 (Registration date: 26 June 2014, retrospectively registered).
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Affiliation(s)
| | - Kit Leung
- Public Health Officer Training Program, NSW Ministry of Health, Sydney, Australia
| | | | | | - Michelle Maxwell
- Centre for Population Health, NSW Ministry of Health, Sydney, Australia
| | - Chris Rissel
- NSW Office of Preventive Health, Sydney, Australia
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9
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Knight-Agarwal CR, Williams LT, Davis D, Davey R, Cochrane T, Zhang H, Rickwood P. Association of BMI and interpregnancy BMI change with birth outcomes in an Australian obstetric population: a retrospective cohort study. BMJ Open 2016; 6:e010667. [PMID: 27165646 PMCID: PMC4874127 DOI: 10.1136/bmjopen-2015-010667] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/22/2016] [Accepted: 04/05/2016] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population. METHODS A retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (≤18 kg/m(2)); normal weight (19-24 kg/m(2)); overweight (25-29 kg/m(2)); obese class I (30-34 kg/m(2)); obese class II (35-39 kg/m(2)) and obese class III (40+ kg/m(2)). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined. RESULTS Within this cohort, 751 (5.1%) women were underweight, 7431 (50.0%) had normal BMI, 3748 (25.1%) were overweight, 1598 (10.8%) were obese class I, 737 (5.0%) were obese class II and 592 (4.0%) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of ≥3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of ≥3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862). CONCLUSIONS Women who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless of parity and baseline BMI, also increases various adverse outcomes. Effective weight management strategies are needed.
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Affiliation(s)
- Catherine R Knight-Agarwal
- School of Public Health and Nutrition, The University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Lauren T Williams
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
| | - Deborah Davis
- Department of Midwifery, The University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Rachel Davey
- Centre for Research and Action in Public Health, The University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Tom Cochrane
- Centre for Research and Action in Public Health, The University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Huanhua Zhang
- School of Public Health and Nutrition, The University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Peter Rickwood
- Institute for Sustainable Futures, The University of Technology Sydney, Broadway, New South Wales, Australia
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Mahizir D, Briffa JF, Hryciw DH, Wadley GD, Moritz KM, Wlodek ME. Maternal obesity in females born small: Pregnancy complications and offspring disease risk. Mol Nutr Food Res 2015; 60:8-17. [DOI: 10.1002/mnfr.201500289] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/05/2015] [Accepted: 07/07/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Dayana Mahizir
- Department of Physiology; The University of Melbourne; Parkville Victoria Australia
| | - Jessica F. Briffa
- Department of Physiology; The University of Melbourne; Parkville Victoria Australia
| | - Deanne H. Hryciw
- Department of Physiology; The University of Melbourne; Parkville Victoria Australia
| | - Glenn D. Wadley
- Centre for Physical Activity and Nutrition Research; School of Exercise and Nutrition Sciences; Deakin University; Burwood Victoria Australia
| | - Karen M. Moritz
- School of Biomedical Sciences; University of Queensland; St. Lucia Queensland Australia
| | - Mary E. Wlodek
- Department of Physiology; The University of Melbourne; Parkville Victoria Australia
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11
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Fealy S, Hure A, Browne G, Prince C. Developing a clinical care pathway for obese pregnant women: A quality improvement project. Women Birth 2014; 27:e67-71. [PMID: 25245862 DOI: 10.1016/j.wombi.2014.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/22/2014] [Accepted: 09/01/2014] [Indexed: 11/18/2022]
Abstract
PROBLEM Obesity in pregnancy is associated with an increased incidence of maternal and foetal morbidity and mortality, from conditions like preeclampsia, gestational diabetes, preterm birth and stillbirth. Between 20% and 25% of pregnant women in Australia are presenting to their first antenatal appointment with a body mass index (BMI) ≥ 30 kg/m(2), defined as obesity in pregnancy. These figures are concerning for midwifery and obstetric staff directly involved in the clinical care of these women and their families. In the absence of national or state clinical practice guidelines for managing the risks for obese pregnant women, a local quality improvement project was conducted. AIM To plan, implement, and evaluate the impact of an alternative clinical care pathway for pregnant women with a BMI ≥ 35 kg/m(2) at their first antenatal visit. PROJECT SETTING The project was undertaken in the antenatal clinic of a rural referral hospital in NSW, Australia. SUBJECTS Eighty-two women with a BMI ≥ 35 kg/m(2) were eligible for the alternative care pathway, offered between January and December 2010. INTERVENTION The alternative care pathway included the following options, in addition to usual care: written information on obesity in pregnancy, referral to a dietitian, early plus repeat screening for gestational diabetes, liver and renal function pathology tests, serial self-weighing, serial foetal growth ultrasounds, and a pre-labour anaesthetic consultation. FINDINGS Despite being educated on the risk associated with obesity in pregnancy, women did not take up the offers of dietetic support or self-weighing at each antenatal visit. Ultrasounds were well received and most women underwent gestational diabetes screening.
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Affiliation(s)
- Shanna Fealy
- Port Macquarie Base Hospital, Wrights Road, NSW, Australia; The University of Newcastle, University Drive, Callaghan, NSW, Australia.
| | - Alexis Hure
- The University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Graeme Browne
- The University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Carol Prince
- Port Macquarie Base Hospital, Wrights Road, NSW, Australia
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12
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Paxton JL, Presneill J, Aitken L. Characteristics of obstetric patients referred to intensive care in an Australian tertiary hospital. Aust N Z J Obstet Gynaecol 2014; 54:445-9. [PMID: 24738907 DOI: 10.1111/ajo.12211] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/20/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND The low mortality rate of 8.4 deaths per 100,000 women giving birth in Australia is well described; however, less is known about the spectrum of morbidity evident in pregnant and postpartum women admitted to an intensive care unit. AIM A detailed description of the demographics, comorbidities, diagnoses and interventions of pregnant and postpartum women admitted to an Australian intensive care unit (ICU). MATERIALS AND METHODS A retrospective observational study was conducted in a large metropolitan hospital co-located with a quaternary-level maternity hospital. The participants were women admitted to intensive care between 1 January 2007 and 30 June 2009 who were pregnant at any gestational age, or within 6 weeks postpartum. RESULTS Two hundred and forty-nine women were admitted to ICU within the study period constituting 19% of all ICU admissions. The main reasons for admission were hypertensive disease of pregnancy and obstetric haemorrhage. The median (range) age was 32 (17-51) years, and ICU duration was 32 (8-228) h. The median APACHE III-J severity of illness score was 32 (8-80). Almost one-quarter of admissions could be classified as primarily observational. The most common interventions in ICU were invasive arterial pressure monitoring, central venous access with pressure monitoring and magnesium infusions. One-fifth of admissions were invasively ventilated. CONCLUSION A substantial number of pregnant and postpartum women admitted to ICU did not receive interventions typical of other critical illness, such as mechanical ventilation, inotropes or renal replacement therapy. This confounds the use of an ICU admission as a measure of maternal morbidity.
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Affiliation(s)
- Joanne L Paxton
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland; Gold Coast University Hospital, Gold Coast, Queensland, Australia
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13
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Bohensky M, Barker A, Morello R, De Steiger RN, Gorelik A, Brand C. Geographical variation in incidence of knee arthroscopy for patients with osteoarthritis: a population-based analysis of Victorian hospital separations data. Intern Med J 2014; 44:537-45. [PMID: 24697847 DOI: 10.1111/imj.12438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 03/16/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND/AIM To evaluate the frequency and geographical variation in knee arthroscopy for adults (>25 years) with a concomitant diagnosis of osteoarthritis. METHODS This was a retrospective cohort study of hospital separations involving an elective knee arthroscopy in public and private hospitals in Victoria, Australia. Participants included patients receiving knee arthroscopies with a diagnosis code indicating osteoarthritis (OA) from 1 July 2008 to 30 June 2009. Records were excluded if the patient was under 25 years or their arthroscopy involved a ligament reconstruction. Crude rates per 100 000 population and negative binomial regression offset by total knee arthroscopy volume were used to analyse differences by region. RESULTS There were 9620 arthroscopic procedures meeting the inclusion criteria. There were 5500 (57.2%) admissions where the principal diagnosis was knee OA (gonarthrosis) and 3510 (36.5%) where the principal diagnosis indicated a mechanical derangement and there was a primary or associated diagnosis of OA. When we examined the incidence rate ratios (IRR) by region, after adjustment for relevant factors and accounting for the total knee arthroscopy volume within each region, we identified significant variation in knee arthroscopy rates for patients with OA. The region with the highest adjusted IRR was Barwon South Western (IRR: 1.26, 95% confidence interval (CI): 1.16-1.36) and the region with lowest adjusted incidence rate ratio was the Gippsland region (IRR: 0.89, 95% CI: 0.80-0.98). CONCLUSIONS We identified considerable geographical variation in arthroscopies for people with OA across Victoria. Further investigation is needed to understand whether this variation is a reflection of differences in OA prevalence, clinical decision-making or access.
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Affiliation(s)
- M Bohensky
- Melbourne EpiCentre, Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Melbourne Health, Melbourne, Victoria, Australia
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Skouteris H, Morris H, Nagle C, Nankervis A. Behavior modification techniques used to prevent gestational diabetes: a systematic review of the literature. Curr Diab Rep 2014; 14:480. [PMID: 24554382 DOI: 10.1007/s11892-014-0480-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The prevalence of gestational diabetes mellitus (GDM) and obesity is increasing in developed countries, presenting significant challenges to acute care and public health. The aim of this study is to systematically review published controlled trials evaluating behavior modification interventions to prevent the development of GDM. Nine studies were identified involving such techniques as repetition of information, use of verbal and written educational information, goal setting, and planning, in addition to group and individual counseling sessions. Of the 3 trials with GDM incidence as a primary outcome, only 1 showed a significant reduction. GDM was a secondary outcome in 6 studies where the prevention of excessive gestational weight gain was the primary outcome and only 1 trial study determined an effective intervention. The small number of effective interventions highlights a significant gap in evidence to inform maternity health policy and practice.
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Affiliation(s)
- Helen Skouteris
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia,
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15
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Affiliation(s)
- Michelle M. Kett
- From the Department of Physiology, Monash University, Victoria, Australia
| | - Kate M. Denton
- From the Department of Physiology, Monash University, Victoria, Australia
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16
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Nagle C, Skouteris H, Morris H, Nankervis A, Rasmussen B, Mayall P, Kennedy RL. Primary prevention of gestational diabetes for women who are overweight and obese: a randomised controlled trial. BMC Pregnancy Childbirth 2013; 13:65. [PMID: 23497264 PMCID: PMC3669050 DOI: 10.1186/1471-2393-13-65] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/26/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gestational Diabetes Mellitus (GDM) has well recognised adverse health implications for the mother and her newborn that are both short and long term. Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally. It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes. The primary aim of this study is to measure the impact of a telephone based intervention that promotes positive lifestyle modifications on the incidence of GDM. Secondary aims include: the impact on gestational weight gain; large for gestational age babies; differences in blood glucose levels taken at the Oral Glucose Tolerance Test (OGTT) and selected factors relating to self-efficacy and psychological wellbeing. METHOD/DESIGN A randomised controlled trial (RCT) will be conducted involving pregnant women who are overweight (BMI >25 to 29.9 k/gm2) or obese (BMI >30 kgm/2), less than 14 weeks gestation and recruited from the Barwon South West region of Victoria, Australia. From recruitment until birth, women in the intervention group will receive a program informed by the Theory of Self-efficacy and employing Motivational Interviewing. Brief ( less than 5 minute) phone contact will alternate with a text message/email and will involve goal setting, behaviour change reinforcement with weekly weighing and charting, and the provision of health information. Those in the control group will receive usual care. Data for primary and secondary outcomes will be collected from medical record review and a questionnaire at 36 weeks gestation. DISCUSSION Evidence based strategies that reduce the incidence of GDM are a priority for contemporary maternity care. Changing health behaviours is a complex undertaking and trialling a composite intervention that can be adopted in various primary health settings is required so women can be accessed as early in pregnancy as possible. Using a sound theoretical base to inform such an intervention will add depth to our understanding of this approach and to the interpretation of results, contributing to the evidence base for practice and policy. TRIAL REGISTRATION This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000125729.
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Affiliation(s)
- Cate Nagle
- School of Nursing and Midwifery, Deakin University, Geelong Waterfront campus, Locked bag 20000, Geelong, Victoria 3220, Australia
| | - Helen Skouteris
- School of Psychology, Burwood campus, 221 Burwood Hwy, Burwood, Victoria 3125, Australia
| | - Heather Morris
- School of Psychology, Burwood campus, 221 Burwood Hwy, Burwood, Victoria 3125, Australia
| | | | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood 3125, Victoria, Australia
| | - Peter Mayall
- Department of Obstetrics and Gynaecology, Barwon Health, Ryrie St, Geelong 3215 Victoria, Australia
| | - Richard L Kennedy
- School of Medicine, Deakin University, Geelong Waurn Ponds campus, 75 Pidgons Road Waurn Ponds, Geelong, Victoria 3216, Australia
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