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Hollis JL, Deroover K, Licata M, Tully B, Farragher E, Lecathelinais C, Bennett N, Foster M, Pennell CE, Wiggers J, Daly J, Kingsland M. Antenatal care addressing gestational weight gain (GWG): a cross sectional study of pregnant women's reported receipt and acceptability of recommended GWG care and associated characteristics. BMC Pregnancy Childbirth 2024; 24:111. [PMID: 38321389 PMCID: PMC10845753 DOI: 10.1186/s12884-023-06158-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/25/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The Australian Clinical Practice Guidelines for Pregnancy Care recommend that during the first and subsequent antenatal visits all pregnant women are weighed; advised of recommended gestational weight gain (GWG), dietary intake and physical activity; and offered referrals for additional support if needed. The extent to which these recommendations are implemented and women's acceptability of recommended care is unknown. This study examines women's reported receipt and acceptability of guideline care for GWG, and characteristics associated with receipt of such care and its acceptability. METHODS From September 2018 to February 2019 a telephone survey was undertaken with women who had recently had a baby and received antenatal care from five public maternity services within a health district in Australia. Women self-reported their demographic characteristics, and receipt and acceptability of recommended GWG care. Receipt and acceptability of such care, and their association with the characteristics of women and the maternity service they attended, were examined using descriptive statistics and multivariable logistic regression analyses. RESULTS Of 514 women, 13.1% (95%CI:10.3-16.5) reported that they received an assessment of weight at both their first and a subsequent antenatal visit, and less than one third (30.0%; 95%CI:26.0-33.9) received advice on their recommended GWG range, dietary intake and physical activity. Just 6.6% (95%CI:4.8-9.1) of women reported receiving all assessment and advice components of recommended antenatal care, and 9.9% (95%CI:7.6-12.8) of women reported being referred for extra support. Women who were younger (OR = 1.13;95%CI:1.05-1.21), identifying as Aboriginal and Torres Strait Islander (OR = 24.54;95%CI:4.98-120.94), had a higher pre-pregnancy BMI (OR = 1.13;95%CI:1.05-1.21), were experiencing their first pregnancy (OR = 3.36;95%CI:1.27-8.86), and lived in a least disadvantaged area (compared to mid-disadvantaged area (OR = 18.5;95%CI:2.6-130.5) and most disadvantaged area (OR = 13.1;95%CI:2.09-82.4)) were more likely to receive recommended assessment and advice. Most Aboriginal (92%) and non-Aboriginal (93%) women agreed that recommended GWG care is acceptable. CONCLUSION Most women perceive antenatal care for GWG as recommended by the Clinical Practice Guidelines as acceptable, but did not receive it. When provided, such care is not delivered consistently to all women regardless of their characteristics or those of the maternity service they attend. There is a need for service-wide practice change to increase routine GWG care in pregnancy for all women.
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Affiliation(s)
- Jenna L Hollis
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia.
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Kristine Deroover
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Milly Licata
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Belinda Tully
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Gomeroi Nation, New England North West, NSW, Australia
| | - Eva Farragher
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Nicole Bennett
- Hunter New England Local Health District Nursing and Midwifery Services, Newcastle, NSW, 2305, Australia
| | - Michelle Foster
- Hunter New England Local Health District Nursing and Midwifery Services, Newcastle, NSW, 2305, Australia
| | - Craig E Pennell
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - John Wiggers
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Justine Daly
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
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Nicoll E, Wilkinson SA, Braithwaite S, de Jersey S. A prospective observational evaluation of an online health care professional training program to promote healthy pregnancy weight gain. Health Promot J Austr 2024; 35:90-99. [PMID: 36896565 DOI: 10.1002/hpja.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/03/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
ISSUE ADDRESSED A lack of programs to develop clinician knowledge and confidence to address weight gain within pregnancy is a barrier to the provision of evidence-based care. AIM To examine the reach and effectiveness of the Healthy Pregnancy Healthy Baby online health professional training program. METHODS A prospective observational evaluation applied the reach and effectiveness elements of the RE-AIM framework. Health professionals from a range of disciplines and locations were invited to complete questionnaires before and after program completion assessing objective knowledge and perceived confidence around aspects of supporting healthy pregnancy weight gain, and process measures. RESULTS There were 7577 views across all pages over a year period, accessed by participants across 22 Queensland locations. Pre- and post- training questionnaires were completed 217 and 135 times, respectively. The proportion of participants with scores over 85% and of 100% for objective knowledge was higher post training (P ≤ .001). Perceived confidence improved across all areas for 88%-96% of those who completed the post- training questionnaire. All respondents would recommend the training to others. CONCLUSIONS Clinicians from a range of disciplines, experience and locations accessed and valued the training, and knowledge of, and confidence in delivering care to support healthy pregnancy weight gain improved after completion. SO WHAT?: This effective program to build the capacity of clinicians to support healthy pregnancy weight gain offers a model for online, flexible training highly valued by clinicians. Its adoption and promotion could standardise the support provided to women to encourage healthy weight gain during pregnancy.
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Affiliation(s)
- Evelyn Nicoll
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- School of Human Movements and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Shelley A Wilkinson
- School of Human Movements and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Simone Braithwaite
- Prevention Strategy Branch, Queensland Department of Health, Brisbane, Queensland, Australia
| | - Susan de Jersey
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
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Jevitt CM, Ketchum K. Pairing Evidence-Based Strategies With Motivational Interviewing to Support Optimal Nutrition and Weight Gain in Pregnancy. J Perinat Neonatal Nurs 2024; 38:25-36. [PMID: 38278641 DOI: 10.1097/jpn.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Because eating, nutrition, and weight management patterns adopted during pregnancy may persist beyond the postpartum period, pregnancy provides an opportunity for health education that affects the future health of the pregnant person, the fetus, and the family. This systematic review aimed to find nutrition and weight management behaviors that could be used safely during pregnancy to optimize gestational weight gain. METHODS PubMed, MEDLINE, and Web of Science were searched for research or systematic reviews published in English from 2018 to 2023 using terms including gestational weight gain maintenance, weight, management, pregnancy, behavior, strategy, and strategies. Excluded research used pediatric or adolescent populations, restrictive diets such as no carbohydrate or no fat diets, fasting, bariatric surgery, weight loss medications, private industry, or profit-earning programs using food brands or specific diet programs. RESULTS The abstracts reviewed in these areas: excessive gestational weight gain (1019), low-glycemic index diet (640), Mediterranean diet (220), MyPlate diet (2), the Dietary Approaches to Stop Hypertension (DASH) diet (50), portion control (6), home meal preparation (6), mindful eating (13), intuitive eating (10), self-weighing (10), and motivational interviewing during pregnancy (107), were reduced to 102 studies. Studies in those 10 areas were reviewed for nutrition and eating behaviors that are safe to use during pregnancy and could be used along with motivational interviewing. CONCLUSION Clinicians can discuss these behaviors using motivational interviewing techniques to assist clients in optimizing gestational weight gain. Dialogue examples pairing these strategies with motivational interviewing principles are included.
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Affiliation(s)
- Cecilia M Jevitt
- Midwifery Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Hoch M, Meloncelli N, de Jersey S. Examining Enhanced Implementation of Routine Antenatal Care Practices to Support Healthy Pregnancy Weight Gain. J Midwifery Womens Health 2023; 68:449-457. [PMID: 36789484 DOI: 10.1111/jmwh.13477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Current antenatal guidelines advocate for regular weighing of women during their pregnancy, with supportive conversations to assist healthy gestational weight gain (GWG). To facilitate overcoming weight monitoring barriers, a pregnancy weight gain chart (PWGC), coupled with brief intervention advice, was implemented in 2016 to guide provider and woman-led routine weight monitoring. This study aimed to examine the extent to which the use of PWGCs and routine advice provision were normalized into routine antenatal care following enhanced implementation strategies and whether this led to a change in GWG. METHODS This pre-post study included data from 2010 (preimplementation), 2016, and 2019 (postimplementation). A retrospective audit of health records and PWGCs was undertaken to assess adherence to chart use and evaluate GWG outcomes. A survey was sent to women in 2010 and repeated in 2019 to understand the advice women received from health care professionals. RESULTS Compared with the preimplementation cohort (2010), more women achieved a healthy GWG in 2019 (42% vs 31%, P = .04). In 2019, having 3 or more weights recorded was associated with a reduction in excess GWG (P = .028). More women reported receiving helpful advice about healthy GWG in 2019 compared with 2010, although minimal changes to advice received about nutrition and physical activity were observed. DISCUSSION Enhanced implementation strategies and ongoing efforts to optimize supportive antenatal care practices are required to effect positive change in GWG. Further evaluation of the perspectives of pregnant women and counseling practices of health professionals is needed.
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Affiliation(s)
- Mikeeley Hoch
- School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia
| | - Nina Meloncelli
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Susan de Jersey
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Wilkinson SA, Fjeldsoe B, Willcox JC. Evaluation of the Pragmatic Implementation of a Digital Health Intervention Promoting Healthy Nutrition, Physical Activity, and Gestational Weight Gain for Women Entering Pregnancy at a High Body Mass Index. Nutrients 2023; 15:nu15030588. [PMID: 36771295 PMCID: PMC9921852 DOI: 10.3390/nu15030588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
txt4two is a multi-modality intervention promoting healthy pregnancy nutrition, physical activity (PA), and gestational weight gain (GWG), which had been previously evaluated in a pilot randomized controlled trial (RCT). This study aimed to evaluate a pragmatic implementation of an adapted version of txt4two in a public tertiary hospital. Using a consecutive cohort design, txt4two was delivered to women with a pre-pregnancy BMI > 25 kg/m2, between 10 + 0 to 17 + 6 weeks. Control and intervention cohorts (n = 150) were planned, with surveys and weight measures at baseline and 36 weeks. The txt4two cohort received a dietetic goal-setting appointment and program (SMS, website, and videos). The navigation of disparate hospital systems and the COVID-19 pandemic saw adaptation and adoption take two years. The intervention cohort (n = 35; 43% full data) demonstrated significant differences (mean (SD)), compared to the control cohort (n = 97; 45% full data) in vegetable intake (+0.9 (1.2) versus +0.1 (0.7), p = 0.03), fiber-diet quality index (+0.6 (0.8) versus 0.1 (0.5), p = 0.012), and total diet quality index (+0.7 (1.1) versus +0.2 (±0.6), p = 0.008), but not for PA or GWG. Most (85.7%) intervention participants found txt4two extremely or moderately useful, and 92.9% would recommend it. Embedding the program in a non-RCT context raised implementation challenges. Understanding the facilitators and barriers to adaptation and adoption will strengthen the evidence for the refinement of implementation plans.
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Affiliation(s)
- Shelley A. Wilkinson
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
- Correspondence: ; Tel.: +61-7-3365-6849
| | | | - Jane C. Willcox
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
- Centre for Quality and Patient Safety, Institute of Health Transformation, Deakin University, Burwood, VIC 3125, Australia
- Impact Obesity, South Melbourne, VIC 3205, Australia
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Pragnia P, Arora A, Patil AN, Sikka P, Jain V, Suri V. Developing locoregional evidence through comparison of WHO and national maternal near miss criteria: a cross sectional study experience from low resource setting. J OBSTET GYNAECOL 2022; 42:2535-2539. [PMID: 35321630 DOI: 10.1080/01443615.2022.2039906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Poloju Pragnia
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aashima Arora
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amol N Patil
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pooja Sikka
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Jain
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Tennekoon VS. The impact of IOM recommendations on gestational weight gain among US women: An analysis of birth records during 2011-2019. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000815. [PMID: 36962437 PMCID: PMC10021552 DOI: 10.1371/journal.pgph.0000815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/27/2022] [Indexed: 11/19/2022]
Abstract
The prevailing guidelines of the Institute of Medicine (IOM) of United States on gestational weight gain (GWG) are based on women's prepregnancy body mass index (BMI) categories. Previous research has shown that the guidelines issued in 1990 and revised in 2009 had no effect. We investigate the effectiveness of new guidelines issued in 2009 analyzing the records of all singleton births in the U.S. during 2011-2019 (34.0 million observations). We use the discontinuity in recommended guidelines at the threshold values of BMI categories in a regression discontinuity (RD) research design to investigate the effect of IOM guidelines on GWG. We also use an RD analysis in a difference in difference (DID) framework where we compare the effect on women who had any prenatal care to others who did not receive prenatal care. The naïve RD estimator predicts an effect in the expected direction at the threshold BMI values of 18.5 and 25.0 but not at 30.0. After the DID based correction, the RD analyses show that the GWG, measured in kg, drop at the BMI values of 18.5, 25.0 and 30.0 by 0.189 [CI: 0.341, 0.037], 0.085 [CI: 0.179, -0.009] and 0.200 [CI: 0.328, 0.072] respectively when the midpoint of the recommended range in kg drops by 1.5, 4.5 and 2.25. This implies a responsiveness of 12.6%, 1.9% and 8.9% respectively to changes in guidelines at these BMI values. The findings show that the national guidelines have induced some behavioral changes among US women during their pregnancy resulting in a change in GWG in the expected direction. However, the magnitude of the change has not been large compared to the expectations, implying that the existing mechanisms to implement these guidelines have not been sufficiently strong.
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Affiliation(s)
- Vidhura S Tennekoon
- Department of Economics, School of Liberal Arts, Indiana University Purdue University Indianapolis (IUPUI), Indianapolis, Indiana, United States of America
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Fealy S, Jones D, Davis D, Hazelton M, Foureur M, Attia J, Hure A. Pregnancy weight gain a balancing act: The experience and perspectives of women participating in a pilot randomised controlled trial. Midwifery 2021; 106:103239. [PMID: 35026536 DOI: 10.1016/j.midw.2021.103239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Supporting women to achieve healthy gestational weight gain is a global health challenge. Inadequate and excessive gestational weight gains are associated with short and long-term adverse maternal and infant health outcomes. Qualitative studies suggest that symptoms of pregnancy, health professional attitudes, lack of guidance, personal knowledge and beliefs, lack of support, weight stigma, and lack of time and money, are barriers to achieving healthy weight gain. Less is known about women's perceptions and experience of gestational weight gain within normal body mass index categories with even less known about the experience of women motivated to participate in pregnancy weight management intervention trials. AIM To describe the experience and perspectives of women participating in an Australian weight management pilot randomised controlled trial. METHODS Five women from regional New South Wales enrolled in the Eating 4 Two trial, participated in semi - structured interviews during the post-natal period. A qualitative descriptive methodology and inductive thematic analysis was applied. FINDINGS Two main themes emerged: 1) Addressing weight gain in pregnancy; and 2) Pregnancy weight the balancing act. Women identified weight gain as an important topic, the need for improvements within maternity services, responsive feedback and realistic support strategies. Women identified pregnancy symptoms, occurring during early and late pregnancy as barriers to achieving healthy weight gain. CONCLUSION Further investigation into the effects of pregnancy symptoms on eating and physical activity patterns across pregnancy is warranted. Both qualitative and quantitative research is needed to monitor the translation of guideline recommendations into clinical practice.
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Affiliation(s)
- Shanna Fealy
- Charles Sturt University, Faculty of Science, School of Nursing, Paramedicine and Healthcare Sciences, 7 Major Innes Road, Port Macquarie, NSW, Australia, 2444; University of Newcastle, College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia, 2308; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia, 2305.
| | - Donovan Jones
- Charles Sturt University, Faculty of Science, School of Nursing, Paramedicine and Healthcare Sciences, 7 Major Innes Road, Port Macquarie, NSW, Australia, 2444; University of Newcastle, College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia, 2308
| | - Deborah Davis
- University of Canberra and ACT Government Health Directorate
| | - Michael Hazelton
- Charles Sturt University, Faculty of Science, School of Nursing, Paramedicine and Healthcare Sciences, 7 Major Innes Road, Port Macquarie, NSW, Australia, 2444; University of Newcastle, College of Health, Medicine and Wellbeing, School of Nursing and Midwifery, University Drive, Callaghan, NSW, Australia, 2308; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia, 2305
| | - Maralyn Foureur
- University of Newcastle, College of Health, Medicine and Wellbeing, School of Nursing and Midwifery, University Drive, Callaghan, NSW, Australia, 2308; Hunter New England Health Nursing and Midwifery Research Centre
| | - John Attia
- University of Newcastle, College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia, 2308; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia, 2305
| | - Alexis Hure
- University of Newcastle, College of Health, Medicine and Wellbeing, School of Medicine and Public Health, University Drive, Callaghan, NSW, Australia, 2308; Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia, 2305
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Kingsland M, Hollis J, Farragher E, Wolfenden L, Campbell K, Pennell C, Reeves P, Tully B, Daly J, Attia J, Oldmeadow C, Hunter M, Murray H, Paolucci F, Foureur M, Rissel C, Gillham K, Wiggers J. An implementation intervention to increase the routine provision of antenatal care addressing gestational weight gain: study protocol for a stepped-wedge cluster trial. Implement Sci Commun 2021; 2:118. [PMID: 34666840 PMCID: PMC8525056 DOI: 10.1186/s43058-021-00220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
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
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Affiliation(s)
- Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia. .,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. .,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia.
| | - Jenna Hollis
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Eva Farragher
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Craig Pennell
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Department of Maternal Fetal Medicine, Maternity and Gynaecology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Penny Reeves
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Justine Daly
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Mandy Hunter
- Nursing and Midwifery Services, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | - Henry Murray
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Department of Maternal Fetal Medicine, Maternity and Gynaecology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Francesco Paolucci
- Faculty of Business and Law, The University of Newcastle, Newcastle, New South Wales, Australia.,The School of Economics and Management, University of Bologna, Bologna, Italy
| | - Maralyn Foureur
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Hunter New England Health Nursing and Midwifery Research Centre, Newcastle, New South Wales, Australia
| | - Chris Rissel
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales, Australia.,Flinders University, Darwin, Northern Territory, Australia.,Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney, New South Wales, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
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10
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Olander EK, Hill B, Skouteris H. Healthcare Professional Training Regarding Gestational Weight Gain: Recommendations and Future Directions. Curr Obes Rep 2021; 10:116-124. [PMID: 33609271 PMCID: PMC8159776 DOI: 10.1007/s13679-021-00429-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The aim of this review was to summarise recent evaluations of healthcare professional training regarding gestational weight gain and provide recommendations for future training. RECENT FINDINGS A number of evaluated healthcare professional training sessions regarding gestational weight gain show promising results in terms of increased participant confidence and knowledge and impact on women's outcomes. It is clear that the interventions which have also implemented resources in the practice environment to support training are the ones most likely to influence gestational weight gain. Support from healthcare professionals are key to influence pregnant women's weight gain and should be offered within the standard curriculum and through mandatory training. Factors influencing this support include women's and healthcare professional characteristics, interpersonal and healthcare system and policy factors. All of these need to be considered when developing healthcare professional training to support women with their gestational weight gain.
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Affiliation(s)
- Ellinor K. Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB UK
| | - Briony Hill
- National Health and Medical Research Council Early Career Fellow, Monash Centre for Health Research and Implementation, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3169 Australia
| | - Helen Skouteris
- Health and Social Care Improvement and Implementation Science, Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-51 Kanooka Grove, Clayton, VIC 3169 Australia
- Warwick Business School, Warwick University, Coventry, CV47AL UK
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11
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Yim SY, Guthrie T, de Jersey SJ. Impact of service-wide initiatives to support healthy pregnancy weight gain on weight-related documentation. Aust N Z J Obstet Gynaecol 2019; 60:355-360. [PMID: 31578721 DOI: 10.1111/ajo.13053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/09/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Excess gestational weight gain is associated with adverse pregnancy outcomes. Addressing barriers to the provision of best practice care that supports healthy pregnancy weight gain could assist staff in clinical care; however, little is known about changes to staff practices after ameliorating barriers. AIMS To evaluate if service initiatives to promote healthy pregnancy weight gain improve weight-related documentation by antenatal staff throughout pregnancy care. MATERIALS AND METHODS Service initiatives including staff training, familiarisation with a pregnancy weight gain chart and placement of scales in clinic rooms were introduced. Pregnancy health records were audited for deliveries pre- (2014) and post-implementation (2017) to obtain weight-related measures. Measures assessed included the documentation of pre-pregnancy weight, height, pre-pregnancy body mass index (BMI), referral to dietetic services (if overweight) and the accuracy of pre-pregnancy BMI calculation. The proportion of visits with weight recorded during pregnancy was also audited. RESULTS A total of 1003 and 1050 records were included from the pre- and post-intervention groups respectively. Significant improvements over time were observed in the documentation of pre-pregnancy weight (P < 0.001), BMI (P < 0.001), accuracy of BMI calculation (P < 0.001) and for obese women proportion of visits with weight recorded (P = 0.02). There was a non-significant increase in the documentation of dietetic referral for overweight women (1.1% vs 2.2%, P = 0.27) and proportion of visits with weight recorded for women across all pre-pregnancy BMI groups (49% vs 51%, P = 0.07). CONCLUSIONS Addressing barriers to supporting healthy pregnancy weight gain through service-wide initiatives may improve weight-related documentation by antenatal staff.
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Affiliation(s)
- Shi Ying Yim
- Department of Nutrition and Dietetics, Khoo Teck Puat Hospital, Singapore City, Singapore.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Taylor Guthrie
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Susan J de Jersey
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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