scholarly journals An implementation intervention to increase the routine provision of antenatal care addressing gestational weight gain: study protocol for a stepped-wedge cluster trial

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Melanie Kingsland ◽  
Jenna Hollis ◽  
Eva Farragher ◽  
Luke Wolfenden ◽  
Karen Campbell ◽  
...  
Keyword(s):  
Physical Activity ◽  
Weight Gain ◽  
Antenatal Care ◽  
Gestational Weight Gain ◽  
Controlled Trial ◽  
Implementation Intervention ◽  
Stepped Wedge ◽  
Maternity Services ◽  
Gestational Weight ◽  
Weight Gain During Pregnancy

Abstract Background Weight gain during pregnancy that is outside of recommended levels is associated with a range of adverse outcomes for the mother and child, including gestational diabetes, pre-eclampsia, preterm birth, and obesity. Internationally, 60–80% of pregnant women report gaining weight outside of recommended levels. While guideline recommendations and RCT evidence support the provision of antenatal care that supports healthy gestational weight gain, less than 10% of health professionals routinely weigh pregnant women; discuss weight gain, diet, and physical activity; and provide a referral for additional support. This study aims to determine the effectiveness of an implementation intervention in increasing the provision of recommended gestational weight gain care by maternity services. Methods A stepped-wedge controlled trial, with a staggered implementation intervention, will be conducted across maternity services in three health sectors in New South Wales, Australia. The implementation intervention will consist of evidence-based, locally-tailored strategies including guidelines and procedures, reminders and prompts, leadership support, champions, training, and monitoring and feedback. Primary outcome measures will be the proportion of women who report receiving (i) assessment of gestational weight gain; (ii) advice on gestational weight gain, dietary intake, and physical activity; and (iii) offer of referral to a telephone coaching service or local dietetics service. Measurement of outcomes will occur via telephone interviews with a random sample of women who attend antenatal appointments each week. Economic analyses will be undertaken to assess the cost, cost-consequence, cost-effectiveness, and budget impact of the implementation intervention. Receipt of all care elements, acceptance of referral, weight gain during pregnancy, diet quality, and physical activity will be measured as secondary outcomes. Process measures including acceptability, adoption, fidelity, and reach will be reported. Discussion This will be the first controlled trial to evaluate the effectiveness of a implementation intervention in improving antenatal care that addresses gestational weight gain. The findings will inform decision-making by maternity services and policy agencies and, if the intervention is demonstrated to be effective, could be applied at scale to benefit the health of women and children across Australia and internationally. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819. Registered on 22 January 2021

Maternal gestational weight gain during pregnancy: prioritising the conversation

2018 ◽  
Vol 24 (1) ◽  
pp. 4 ◽  
Author(s):  
Ruth Walker ◽  
Danielle Mazza ◽  
Michelle Blumfield ◽  
Christie Bennett ◽  
Helen Truby
Keyword(s):  
Primary Care ◽  
Weight Gain ◽  
Antenatal Care ◽  
Gestational Weight Gain ◽  
Health Professionals ◽  
Overweight And Obesity ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain ◽  
Care Guidelines ◽  
Weight Gain During Pregnancy

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.

Acceptability of a mobile-health intervention to increase physical activity among pregnant patients with overweight or obesity: A feasibility randomized controlled trial (Preprint)

2021 ◽  
Author(s):  
Tainayah Thomas ◽  
Fei Xu ◽  
Sneha Sridhar ◽  
Tali Sedgwick ◽  
Linda Nkemere ◽  
...  
Keyword(s):  
Physical Activity ◽  
Weight Gain ◽  
Gestational Weight Gain ◽  
Controlled Trial ◽  
Moderate Intensity ◽  
Moderate Intensity Physical Activity ◽  
Gestational Weight ◽  
Randomized Controlled ◽  
Intensity Physical Activity ◽  
Overweight Or Obesity

BACKGROUND Pregnant patients with overweight or obesity are at high risk of perinatal complications. Excess gestational weight gain further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess gestational weight gain, reduce intervention costs, and increase scalability by improving access. OBJECTIVE To test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate-intensity physical activity, encourage guideline-concordant gestational weight gain, and inform the design of a larger pragmatic cluster randomized controlled trial. METHODS We conducted a mixed-methods acceptability and feasibility randomized controlled trial among pregnant patients with a pre-pregnancy body mass index 25.0-40.0 kg/m2. Patients with singletons at 8–15 weeks’ gestation, and aged 21 years or older with Wi-Fi access were randomly assigned (1:1) to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and a monthly call from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. Physical activity outcomes were assessed using the Pregnancy Physical Activity Questionnaire and gestational weight gain was assessed using electronic health record data in both arms. RESULTS Thirty-three patients were randomly assigned to the intervention arm and 35 patients to the usual care arm. 100% of participants in the intervention arm weighed themselves at least once a week compared with 20% of participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days/week, weighed themselves 5.3 times/week, and 87.9% rated the program “good to excellent.” Focus groups found participants desired more support related to nutrition to help them manage gestational weight gain and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 MET-hours greater change in total physical activity per week (95% CI:1.13, 45.8) and a 247.2-minute greater change in moderate intensity physical activity per week (95% CI: 36.2, 530.6) in unadjusted models, but these effects were attenuated in adjusted models (change in total physical activity: 15.55 MET-hours per week; 95% CI: -6.32, 37.42; change in moderate intensity physical activity: 199.6 minutes per week; 95% CI: -43.7, 442.9). We found no difference in total gestational weight gain (mean difference: 1.14 kg; 95% CI: -0.71, 3.00) compared to usual care. CONCLUSIONS A pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively impact physical activity and gestational weight gain among pregnant patients with overweight or obesity. CLINICALTRIAL ClinicalTrials.gov NCT03936283

scholarly journals 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 ◽  
Vol 9 (9) ◽  
pp. e030174 ◽  
Author(s):  
Amanda Daley ◽  
Kate Jolly ◽  
Susan A Jebb ◽  
Andrea Roalfe ◽  
Lucy Mackilllop ◽  
...  
Keyword(s):  
Physical Activity ◽  
Weight Gain ◽  
Gestational Weight Gain ◽  
Controlled Trial ◽  
Behavioural Intervention ◽  
Maximum Weight ◽  
Gestational Weight ◽  
Excessive Gestational Weight Gain ◽  
Community Midwives ◽  
Randomised Controlled

ObjectivesTo 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).DesignRandomised controlled trial.SettingAntenatal clinic in England.ParticipantsWomen between 10+0and 14+6weeks gestation, not requiring specialist obstetric care.InterventionsParticipants 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 measuresExcessive gestational weight gain, depression, anxiety and physical activity.ResultsSix 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.ConclusionsA 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 numberISRCTN67427351

scholarly journals A Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Protocol for a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Pontus Henriksson ◽  
Johanna Sandborg ◽  
Marie Blomberg ◽  
Christina Alexandrou ◽  
Ralph Maddison ◽  
...  
Keyword(s):  
Physical Activity ◽  
Weight Gain ◽  
Gestational Weight Gain ◽  
Controlled Trial ◽  
Intervention Group ◽  
Smartphone App ◽  
Healthy Weight ◽  
Gestational Weight ◽  
Randomized Controlled ◽  
Diet And Physical Activity

BACKGROUND Excessive gestational weight gain is common and associated with adverse outcomes both in the short and long term. Although traditional lifestyle-based interventions have shown to mitigate excess gestational weight gain, little is known about whether mobile Health (mHealth) apps can promote healthy weight gain, diet, and physical activity during pregnancy. OBJECTIVE The primary aim of the HealthyMoms trial is to determine the effectiveness of a smartphone app (HealthyMoms) for mitigating excess gestational weight gain during pregnancy. Secondary aims are to determine the effectiveness of the app on dietary habits, physical activity, body fatness, and glycemia during pregnancy. METHODS HealthyMoms is a two-arm randomized controlled trial. Women are being recruited at routine visits at the maternity clinics in Linköping, Norrköping and Motala, Sweden. Women are randomized to the control or intervention group (n=150 per group). All women will receive standard care, and women in the intervention group will also receive the HealthyMoms smartphone app. RESULTS Recruitment of participants to the trial was initiated in October 2017, and 190 women have so far completed the baseline measurement. The baseline measures are estimated to be finalized in December 2019, and the follow-up measures are estimated to be completed in June 2020. CONCLUSIONS This project will evaluate a novel smartphone app intervention integrated with existing maternity health care. If successful, it has great potential to be implemented nationally in order to promote healthy weight gain and health behaviors during pregnancy. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/13011

Use of the Pregnancy Physical Activity Questionnaire (PPAQ) to Identify Behaviors Associated With Appropriate Gestational Weight Gain During Pregnancy

2013 ◽  
Vol 10 (7) ◽  
pp. 1000-1007 ◽  
Author(s):  
Tamara R. Cohen ◽  
Hugues Plourde ◽  
Kristine G. Koski
Keyword(s):  
Physical Activity ◽  
Weight Gain ◽  
Pregnant Women ◽  
Gestational Weight Gain ◽  
Third Trimester ◽  
Physical Activity Questionnaire ◽  
Energy Expenditures ◽  
Gestational Weight ◽  
Weight Gain During Pregnancy ◽  
Activity Questionnaire

Background:The Pregnancy Physical Activity Questionnaire (PPAQ) assesses physical activity practices of pregnant women. The purpose of this study was to identify specific pregnancy practices that were associated with a healthy gestational weight gain (GWG).Methods:Associations between PPAQ scores, pedometer steps, energy intakes (EI), energy expenditures (EE), and rate of GWG were assessed for 61 pregnant women in their second or third trimester during a home visit. Principle component analyses (PCA) were used to cluster PPAQ questions into Factors associated with either rate or total GWG, physical activity (PA), EE, EI, and parity.Results:PCA identified 3 Factors: Factor 1 associated EE with parity and child care; Factor 2 clustered several structured exercise activities; and Factor 3 grouped walking, playing with pets, and shopping with pedometer steps. Only Factor 3 clustered steps with weekly rate of GWG. EI was not associated with PA or GWG.Conclusions:PCA analysis identified 15 of 32 PPAQ questions that were related to increased physical activity in pregnant women, but only walking and pedometer steps were associated with GWG. Our analysis supports daily walking as the preferred PA for achieving a healthy rate of GWG.

Rationale, design, and challenges with implementing a clinical intervention to teach appropriate gestational weight gain (TAGG): Protocol of a Randomized controlled trial (Preprint)

2019 ◽  
Author(s):  
Awathif Mackeen ◽  
Danielle Downs ◽  
Vonda Hetherington ◽  
Shawnee Lutcher ◽  
Jacob Mowery ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Usual Care ◽  
Gestational Weight Gain ◽  
Perceived Stress ◽  
Controlled Trial ◽  
Household Food Security ◽  
Gestational Weight ◽  
Randomized Controlled

BACKGROUND Excessive gestational weight gain (GWG) has public health implications including preterm birth, preeclampsia, gestational diabetes, and cesarean delivery. In an effort to mitigate adverse consequences of excessive GWG, this study tests a health intervention that includes enhancements to improve knowledge and awareness of appropriate GWG, and patient-centered nutritional counseling to promote appropriate GWG. OBJECTIVE The primary objective of the study was to increase the proportion of women who are managing their GWG as recommended by the IOM.4,5 METHODS This randomized controlled trial was conducted at Geisinger in Pennsylvania where excessive GWG is common among women with pre-conception obesity. Eligible, consenting participants with pre-pregnancy body mass index >30.0 kg/m2 were randomized (1:1) to: 1) Usual Care: usual written educational materials and counseling by an obstetric care provider or 2) Enhanced Care: Usual Care plus a) a personalized letter from a physician detailing appropriate GWG, b) exposure to individualized GWG chart in the electronic health record via the patient portal, and c) a consult with a Registered Dietitian Nutritionist and follow-up via tele-health counseling (10-20 mins/1-2 weeks) for the duration of the pregnancy. RESULTS The primary outcome was the proportion of women that gain less than 20 pounds over the course of the pregnancy. Secondary outcomes include knowledge, expectations, and attitude about pregnancy weight gain; increased self-efficacy for ability to eat healthy and being physically active to manage weight; and eating behavior. Potential moderators that will be explored include sleep, perceived stress, perceived involvement in care, and household food security. Data collection has been completed as of November 2019. CONCLUSIONS As GWG care was initiated for mothers with pre-pregnancy BMI >30 kg/m2 within the first and second trimesters, the intervention may have the additional benefit of reducing other adverse pregnancy outcomes including the incidence of gestational diabetes due to healthier rates of GWG. In addition to assessing appropriate GWG, this project will assess eating habits, physical activity, GWG attitudes, sleep quality, and psychological measures, all of which are associated with GWG. Exploratory mediators including perceived stress and food insecurity will also be evaluated. CLINICALTRIAL ClinicalTrials.gov NCT02963428

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