1
|
Raju S, Cowdell F, Dyson J. Barriers and facilitators to healthy gestational weight gain amongst pregnant women from ethnic minority groups: A systematic search and narrative synthesis. Midwifery 2024; 135:104051. [PMID: 38870776 DOI: 10.1016/j.midw.2024.104051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 04/02/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Excessive weight gain can be detrimental to the health and wellbeing of both mother and child. There is evidence that women from ethnic minority groups are more likely to gain excessive weight during pregnancy. For the purpose of this review, ethnic minority women are defined as those with different national or cultural traditions from the main population. AIM Our aim was to identify barriers and facilitators to healthy gestational weight gain in pregnant women in ethnic minority groups. METHODS Databases searched were MEDLINE, CINAHL, PsycInfo and PsycArticles between 2011 and 2022. Inclusion criteria were empirical studies of any method considering gestational weight gain in ethnic minority women published in English. Data were extracted according to aim, participants, methods, and findings in relation to barriers and facilitators. Included papers were assessed for quality according to relevant Joanna Briggs Institute checklists. FINDINGS Twenty-six studies were identified. Five themes were revealed: (1) knowledge and beliefs, (2) cultural and social influences, (3) confidence, (4) physical experiences, and (5) personal and environmental factors. DISCUSSION Some barriers and facilitators were relevant to all groups and others were more specific to ethnic minority groups. The latter included social and cultural influences, which were reported extensively. Our search was comprehensive, although it is possible we may not have captured all relevant papers. CONCLUSION We recommend that the barriers and facilitators identified here are considered in designing future, or adjusting current, health care practitioner mediated interventions to support healthy gestational weight gain in ethnic minority women.
Collapse
Affiliation(s)
- Sereena Raju
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham B15 3TN, England, UK.
| | - Fiona Cowdell
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham B15 3TN, England, UK
| | - Judith Dyson
- Birmingham City University, Faculty of Health, Education and Life Sciences, Westbourne Road, Birmingham B15 3TN, England, UK
| |
Collapse
|
2
|
Wixe S, Lobo J, Mellander C, Bettencourt LMA. Evidence of COVID-19 fatalities in Swedish neighborhoods from a full population study. Sci Rep 2024; 14:2998. [PMID: 38316904 PMCID: PMC10844299 DOI: 10.1038/s41598-024-52988-3] [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: 03/06/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024] Open
Abstract
The COVID-19 pandemic has highlighted a debate about whether marginalized communities suffered the disproportionate brunt of the pandemic's mortality. Empirical studies addressing this question typically suffer from statistical uncertainties and potential biases associated with uneven and incomplete reporting. We use geo-coded micro-level data for the entire population of Sweden to analyze how local neighborhood characteristics affect the likelihood of dying with COVID-19 at individual level, given the individual's overall risk of death. We control for several individual and regional characteristics to compare the results in specific communities to overall death patterns in Sweden during 2020. When accounting for the probability to die of any cause, we find that individuals residing in socioeconomically disadvantaged neighborhoods were not more likely to die with COVID-19 than individuals residing elsewhere. Importantly, we do find that individuals show a generally higher probability of death in these neighborhoods. Nevertheless, ethnicity is an important explanatory factor for COVID-19 deaths for foreign-born individuals, especially from East Africa, who are more likely to pass away regardless of residential neighborhood.
Collapse
Affiliation(s)
- Sofia Wixe
- Centre for Entrepreneurship and Spatial Economics, Jönköping International Business School, Jönköping University, Jönköping, Sweden
| | - José Lobo
- School of Sustainability, College of Global Futures, Arizona State University, Tempe, AZ, USA
| | - Charlotta Mellander
- Centre for Entrepreneurship and Spatial Economics, Jönköping International Business School, Jönköping University, Jönköping, Sweden.
| | - Luís M A Bettencourt
- Mansueto Institute for Urban Innovation, University of Chicago, Chicago, IL, USA
- Department of Ecology & Evolution, Department of Sociology, University of Chicago, Chicago, IL, USA
| |
Collapse
|
3
|
Er YT, Chan YM, Mohd Shariff Z, Abdul Hamid H, Mat Daud Z'A, Yong HY. Dietitian-led cluster randomised controlled trial on the effectiveness of mHealth education on health outcomes among pregnant women: a protocol paper. BMJ Open 2023; 13:e075937. [PMID: 37989361 PMCID: PMC10660825 DOI: 10.1136/bmjopen-2023-075937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Nutrition education is the cornerstone to maintain optimal pregnancy outcomes including gestational weight gain (GWG). Nevertheless, default for appointments is common and often lead to suboptimal achievement of GWG, accompanied with unfavourable maternal and child health outcomes. While mobile health (mHealth) usage is increasing and helps minimising barriers to clinic appointments among pregnant mothers, its effectiveness on health outcomes has been inconclusive. Therefore, this study aimed to address the gap between current knowledge and clinical care, by exploring the effectiveness of mHealth on GWG as the primary outcome, hoping to serve as a fundamental work to achieve optimal health outcomes with the improvement of secondary outcomes such as physical activity, psychosocial well-being, dietary intake, quality of life and sleep quality among pregnant mothers. METHODS AND ANALYSIS A total of 294 eligible participants will be recruited and allocated into 3 groups comprising of mHealth intervention alone, mHealth intervention integrated with personal medical nutrition therapy and a control group. Pretested structured questionnaires are used to obtain the respondents' personal information, anthropometry data, prenatal knowledge, physical activity, psychosocial well-being, dietary intake, quality of life, sleep quality and GWG. There will be at least three time points of data collection, with all participants recruited during their first or second trimester will be followed up prospectively (after 3 months or/and after 6 months) until delivery. Generalised linear mixed models will be used to compare the mean changes of outcome measures over the entire study period between the three groups. ETHICS AND DISSEMINATION Ethical approvals were obtained from the ethics committee of human subjects research of Universiti Putra Malaysia (JKEUPM-2022-072) and medical research & ethics committee, Ministry of Health Malaysia: NMRR ID-22-00622-EPU(IIR). The results will be disseminated through journals and conferences targeting stakeholders involved in nutrition research. TRIAL REGISTRATION NUMBER Clinicaltrial.gov ID: NCT05377151.
Collapse
Affiliation(s)
- Ying Ting Er
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Yoke Mun Chan
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Research Centre of Excellence Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Zalilah Mohd Shariff
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Habibah Abdul Hamid
- Department of Obstetrics & Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Zulfitri 'Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
- Research Centre of Excellence Nutrition and Non-communicable Diseases, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Heng Yaw Yong
- Division of Nutrition and Dietetics, School of Health Sciences, International Medical University, Bukit Jalil, 57000 Kuala Lumpur, Wilayah Persekutuan, Malaysia
| |
Collapse
|
4
|
Perumal N, Wang D, Darling AM, Liu E, Wang M, Ahmed T, Christian P, Dewey KG, Kac G, Kennedy SH, Subramoney V, Briggs B, Fawzi WW. Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis. BMJ 2023; 382:e072249. [PMID: 37734757 PMCID: PMC10512803 DOI: 10.1136/bmj-2022-072249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries. DESIGN Individual participant data meta-analysis. SETTING Prospective pregnancy studies from 24 low and middle income countries. MAIN OUTCOME MEASURES Nine neonatal outcomes related to timing (preterm birth) and anthropometry (weight, length, and head circumference) at birth, stillbirths, and neonatal death. ANALYSIS METHODS A systematic search was conducted in PubMed, Embase, and Web of Science which identified 53 prospective pregnancy studies published after the year 2000 with data on GWG, timing and anthropometry at birth, and neonatal mortality. GWG adequacy was defined as the ratio of the observed maternal weight gain over the recommended weight gain based on the Institute of Medicine body mass index specific guidelines, which are derived from data in high income settings, and the INTERGROWTH-21st GWG standards. Study specific estimates, adjusted for confounders, were generated and then pooled using random effects meta-analysis models. Maternal age and body mass index before pregnancy were examined as potential modifiers of the associations between GWG adequacy and neonatal outcomes. RESULTS Overall, 55% of participants had severely inadequate (<70%) or moderately inadequate (70% to <90%) GWG, 22% had adequate GWG (90-125%), and 23% had excessive GWG (≥125%). Severely inadequate GWG was associated with a higher risk of low birthweight (adjusted relative risk 1.62, 95% confidence interval 1.51 to 1.72; 48 studies, 93 337 participants; τ2=0.006), small for gestational age (1.44, 1.36 to 1.54; 51 studies, 93 191 participants; τ2=0.016), short for gestational age (1.47, 1.29 to 1.69; 40 studies, 83 827 participants; τ2=0.074), and microcephaly (1.57, 1.31 to 1.88; 31 studies, 80 046 participants; τ2=0.145) compared with adequate GWG. Excessive GWG was associated with a higher risk of preterm birth (1.22, 1.13 to 1.31; 48 studies, 103 762 participants; τ2=0.008), large for gestational age (1.44, 1.33 to 1.57; 47 studies, 90 044 participants; τ2=0.009), and macrosomia (1.52, 1.33 to 1.73; 29 studies, 68 138 participants; τ2=0) compared with adequate GWG. The direction and magnitude of the associations between GWG adequacy and several neonatal outcomes were modified by maternal age and body mass index before pregnancy. CONCLUSIONS Inadequate and excessive GWG are associated with a higher risk of adverse neonatal outcomes across settings. Interventions to promote optimal GWG during pregnancy are likely to reduce the burden of adverse neonatal outcomes, however further research is needed to assess optimal ranges of GWG based on data from low and middle income countries.
Collapse
Affiliation(s)
- Nandita Perumal
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Biostatistics, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Tahmeed Ahmed
- Nutrition & Clinical Services, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, CA, USA
| | - Gilberto Kac
- Nutritional Epidemiology Observatory, Josué de Castro Nutrition Institute, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | | | - Brittany Briggs
- Certara USA, on behalf of the Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Epidemiology, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Nutrition, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| |
Collapse
|
5
|
Malmström N, Lydell M, Carlsson IM. “Womanhood,” a shared experience of participating in a lifestyle intervention with a focus on integration and physical activity to promote health among pregnant women: perspectives from pregnant women, midwives, and cultural interpreter doulas. Int J Qual Stud Health Well-being 2022; 17:2043527. [PMID: 35212612 PMCID: PMC8925914 DOI: 10.1080/17482631.2022.2043527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Migrating women, have an overall increased risk of adverse outcomes and poorer health during pregnancy and childbirth. In addition, they do not participate in planned antenatal care to the same extent as natives. These disparities among migrants and native pregnant women point to the need for interventions to improve equal health and care during pregnancy and childbirth. This study aimed to explore the experiences of participating in a lifestyle intervention, named “Dancing for birth,” focusing on integration and physical activity, from the perspectives of the participating pregnant women, midwives, and cultural interpreter doulas. Method Qualitative interviews were conducted from March 2019 to December 2020, with ten women who participated in a lifestyle intervention in Sweden: four pregnant women, three midwives, and three cultural interpreter doulas. Thematic analysis was used to analyse the data. Results The lifestyle intervention ”Dancing for birth” provided positive shared Health-promoting experiences among the participants with social inclusivness and a commitment to supporting each other. This seemed to encourage the sense of strength as a woman- a strengthboth for the individual woman and as a kind of women´s power. Conclusions Interventions targeting physical activity, social inclusiveness, and health literacy are of utmost importance in promoting positive pregnancy experiences and equal healthcare during pregnancy. Further research is needed on how to implement antenatal education that includes all women in society.
Collapse
Affiliation(s)
- Nina Malmström
- Department of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Marie Lydell
- Department of Health and Welfare, Halmstad University, Halmstad, Sweden
| | | |
Collapse
|
6
|
SANDBORG JOHANNA, MIGUELES JAIROH, SÖDERSTRÖM EMMIE, BLOMBERG MARIE, HENRIKSSON PONTUS, LÖF MARIE. Physical Activity, Body Composition, and Cardiometabolic Health during Pregnancy: A Compositional Data Approach. Med Sci Sports Exerc 2022; 54:2054-2063. [PMID: 36069838 PMCID: PMC9671591 DOI: 10.1249/mss.0000000000002996] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to examine the cross-sectional and longitudinal associations of 24-h movement behaviors (sleep, sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA)) with body composition and cardiometabolic health in i) early and ii) late pregnancy (gestational weeks 14 and 37). METHODS This observational study utilized cross-sectional ( n = 273) and longitudinal data ( n = 242) from the HealthyMoms trial. Time spent in movement behaviors over seven consecutive 24-h periods (ActiGraph wGT3x-BT accelerometer), body composition (Bod Pod), and cardiometabolic health indicators (glucose levels, homeostatic model for insulin resistance (HOMA-IR), systolic and diastolic blood pressure, metabolic syndrome (MetS) score) were measured in early and late pregnancy. RESULTS In early pregnancy, reallocating time to MVPA from LPA, SB, and sleep was associated with lower MetS score (adjusted γ = -0.343, P = 0.002). Correspondingly, reallocating time to LPA from SB and sleep in early pregnancy was associated with lower body weight (adjusted γ = -5.959, P = 0.047) and HOMA-IR (adjusted γ = -0.557, P = 0.031) at the same time point. Furthermore, reallocating time to LPA from SB and sleep in early pregnancy was associated with lower fat mass index (adjusted γ = -0.668, P = 0.028), glucose levels (adjusted γ = -0.315, P = 0.006), HOMA-IR (adjusted γ = -0.779, P = 0.004), and MetS score (adjusted γ = -0.470, P = 0.027) in late pregnancy. The changes in behaviors throughout pregnancy were not associated with body weight, body composition, and MetS score in late pregnancy. CONCLUSIONS Our results demonstrated that increasing LPA or MVPA while reducing SB and sleep was associated with lower weight and more favorable cardiometabolic health in early pregnancy. In contrast, LPA in early pregnancy seems to be a stimulus of enough intensity to improve body composition and cardiometabolic health indicators in late pregnancy.
Collapse
Affiliation(s)
- JOHANNA SANDBORG
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, SWEDEN
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SWEDEN
| | - JAIRO H. MIGUELES
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, SWEDEN
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Research Institute of Sport and Health, University of Granada, Granada, SPAIN
| | - EMMIE SÖDERSTRÖM
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, SWEDEN
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SWEDEN
| | - MARIE BLOMBERG
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, SWEDEN
| | - PONTUS HENRIKSSON
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SWEDEN
| | - MARIE LÖF
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, SWEDEN
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SWEDEN
| |
Collapse
|
7
|
Henriksson P, Migueles JH, Söderström E, Sandborg J, Maddison R, Löf M. User engagement in relation to effectiveness of a digital lifestyle intervention (the HealthyMoms app) in pregnancy. Sci Rep 2022; 12:13793. [PMID: 35963935 PMCID: PMC9376088 DOI: 10.1038/s41598-022-17554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/27/2022] [Indexed: 11/11/2022] Open
Abstract
Although user engagement is generally considered important for the effectiveness of digital behavior change interventions, there is a lack of such data in pregnancy. The aim of this study was therefore to examine the associations of user engagement with the HealthyMoms app with gestational weight gain, diet quality and physical activity in pregnancy. The study involved secondary analyses of participant data from the intervention group (n = 134) in a randomized controlled trial to determine the effectiveness of a 6-month mHealth intervention (the HealthyMoms app) on gestational weight gain, diet quality and physical activity. In adjusted regression models, the total number of registrations from three self-monitoring features (i.e., for weight-, diet- and physical activity) was associated with lower gestational weight gain (β = − 0.18, P = 0.043) and improved diet quality (β = 0.17, P = 0.019). These findings were mainly attributable to the associations of physical activity registrations with lower gestational weight gain (β = − 0.20, P = 0.026) and improved diet quality (β = 0.20, P = 0.006). However, the number of app sessions and page views were not associated with any of the outcomes. Our results may motivate efforts to increase user engagement in digital lifestyle interventions in pregnancy. However, additional studies are needed to further elucidate the influence of different types of user engagement in digital pregnancy interventions on their effectiveness. Trial registration: ClinicalTrials.gov (NCT03298555); https://clinicaltrials.gov/ct2/show/NCT03298555 (date of registration: October 2, 2017; date of first enrolled participant: October 24, 2017).
Collapse
Affiliation(s)
- Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Jairo H Migueles
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Emmie Söderström
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Johanna Sandborg
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| |
Collapse
|
8
|
Sandborg J, Henriksson P, Söderström E, Migueles JH, Bendtsen M, Blomberg M, Löf M. The effects of a lifestyle intervention (the HealthyMoms app) during pregnancy on infant body composition: Secondary outcome analysis from a randomized controlled trial. Pediatr Obes 2022; 17:e12894. [PMID: 35106942 PMCID: PMC9285397 DOI: 10.1111/ijpo.12894] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pregnancy has been identified as a window for childhood obesity prevention. Although lifestyle interventions in pregnancy can prevent excessive gestational weight gain (GWG), little is known whether such interventions also affect infant growth and body composition. OBJECTIVES To investigate (i) the effects of a 6-month lifestyle intervention (the HealthyMoms app) on infant body composition 1-2 weeks postpartum, and (ii) whether a potential intervention effect on infant body composition is mediated through maternal GWG. METHODS This is a secondary outcome analysis of the HealthyMoms randomized controlled trial. Air-displacement plethysmography was used to measure body composition in 305 healthy full-term infants. RESULTS We observed no statistically significant effect on infant weight (β = -0.004, p = 0.94), length (β = -0.19, p = 0.46), body fat percentage (β = 0.17, p = 0.72), or any of the other body composition variables in the multiple regression models (all p ≥ 0.27). Moreover, we observed no mediation effect through GWG on infant body composition. CONCLUSIONS Our findings support that HealthyMoms may be implemented in healthcare to promote a healthy lifestyle in pregnant women without compromising offspring growth. Further research is required to elucidate whether lifestyle interventions in pregnancy also may result in beneficial effects on infant body composition and impact future obesity risk.
Collapse
Affiliation(s)
- Johanna Sandborg
- Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden,Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping
| | - Pontus Henriksson
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping
| | - Emmie Söderström
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping
| | - Jairo H. Migueles
- Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden,Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping,PROFITH (PROmoting FITness and Health Through Physical Activity) Research Group, Department of Physical Education and Sports, Faculty of Sport SciencesResearch Institute of Sport and Health, University of GranadaGranadaSpain
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| | - Marie Löf
- Department of Biosciences and NutritionKarolinska InstitutetStockholmSweden,Department of Health, Medicine and Caring SciencesLinköping UniversityLinköping
| |
Collapse
|
9
|
Söderström E, Müssener U, Löfgren M, Sandell L, Thomas K, Löf M. Healthcare Professionals’ Perceptions of Promoting Healthy Lifestyle Behaviors in Pregnant Migrant Women and the Potential of a Digital Support Tool—A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042328. [PMID: 35206516 PMCID: PMC8872577 DOI: 10.3390/ijerph19042328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 12/04/2022]
Abstract
Eating healthily and being physically active during pregnancy are important for maternal and offspring health. Maternity healthcare is a key arena for health promotion; however, 20% of pregnant women in Sweden are foreign-born, which may reduce reach due to language and cultural barriers. The aims of this study were to explore healthcare professionals’ perceptions about (a) promoting health behaviors (i.e., healthy diet, physical activity, and weight gain) among Arabic- and Somali-speaking pregnant women and (b) how a translated version of the previously evaluated Swedish app (HealthyMoms) can be tailored and used as a tool in their clinical work. Healthcare professionals in Swedish maternity care (n = 14) were interviewed. Data were analyzed using inductive thematic analysis. Healthcare professionals expressed challenges in health promotion work, including cultural and educational aspects and low awareness of health behaviors among women themselves and their social environment. Further, a lack of resources within the clinical practice and a need for cultural awareness among healthcare professionals were highlighted. Finally, it was perceived that a translated app has potential to provide basic and culturally adjusted information, facilitate communication and thus has potential to become a helpful tool in maternity care to support healthy lifestyle behaviors in Arabic- and Somali-speaking pregnant women.
Collapse
Affiliation(s)
- Emmie Söderström
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden; (U.M.); (M.L.); (L.S.); (K.T.); (M.L.)
- Group MLÖ, Department of Biosciences and Nutrition, Karolinska Institutet, NEO, 141 83 Huddinge, Sweden
- Correspondence:
| | - Ulrika Müssener
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden; (U.M.); (M.L.); (L.S.); (K.T.); (M.L.)
| | - Mikaela Löfgren
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden; (U.M.); (M.L.); (L.S.); (K.T.); (M.L.)
| | - Linnea Sandell
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden; (U.M.); (M.L.); (L.S.); (K.T.); (M.L.)
| | - Kristin Thomas
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden; (U.M.); (M.L.); (L.S.); (K.T.); (M.L.)
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Division of Society and Health, Linköping University, 581 83 Linköping, Sweden; (U.M.); (M.L.); (L.S.); (K.T.); (M.L.)
- Group MLÖ, Department of Biosciences and Nutrition, Karolinska Institutet, NEO, 141 83 Huddinge, Sweden
| |
Collapse
|
10
|
Leppälä S, Lamminpää R, Gissler M, Vehviläinen-Julkunen K. Prenatal care adequacy of migrants born in conflict-affected countries and country-born parturients in Finland. J Migr Health 2022; 6:100122. [PMID: 35677660 PMCID: PMC9168177 DOI: 10.1016/j.jmh.2022.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/14/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Migrants from conflict-affected areas had a 3.5-fold risk for delayed prenatal care. Less prenatal visits prior to term birth compared with country-born parturients. No differences in prepartum hospitalization between migrants and country-born parturients.
Background The 2015 refugee crisis led into a forced migration of millions of people globally. As a consequence, many countries experienced a quick change in the proportion of conflict-area born migrants. This group being stated as an especially vulnerable group for suboptimal maternal health, a timely inspection of preventive maternity care was required. This study investigated prenatal care in terms of gestation trimester at the first prenatal visit, number of check-ups prior to birth, and prepartum hospitalization in conflict-country born migrants and Finnish parturients in Finland. Material and methods Cross-sectional study included all pregnancies of migrants born in conflict-affected countries (n = 3 155) and country-born parturients (n = 93 600) in Finland in 2015–16. The data were obtained through Medical Birth Registry and Population Information System. Statistical analysis employed T-test, Chi-square test, and logistic regression analysis. Odds ratios with 95% Confidence Intervals (CI) were adjusted for sociodemographic and health-related background variables. Results Migrant parturients had a higher probability for delayed enter in prenatal care compared with Finnish-born parturients (adjusted odds ratio aOR = 3.46; 95% Confidence Interval CI 3.06, 3.91). Recommended minimum number of check-ups was participated by 95.3% of the migrant, and 96.4% of the Finnish-born group (P <0.000). Migrants’ probability for more than ten visits prior to term birth was significantly lower (aOR = 0.58; 95% CI 0.51, 0.66). No significant differences in prepartum hospitalization yielded between the groups. Conclusions Migrant parturients had significantly smaller number of check-ups and later entry in care compared with the country-born parturients. These findings add to earlier reported challenges in the organizing of conflict-affected country born migrants’ prenatal care in a high-income setting, in which the proportion of conflict-area born migrants has risen rapidly and unexpectedly.
Collapse
Affiliation(s)
- Satu Leppälä
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
- Corresponding author.
| | - Reeta Lamminpää
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
- Kuopio University Hospital, Finland
| |
Collapse
|
11
|
Henriksson P, Sandborg J, Söderström E, Leppänen MH, Snekkenes V, Blomberg M, Ortega FB, Löf M. Associations of body composition and physical fitness with gestational diabetes and cardiovascular health in pregnancy: Results from the HealthyMoms trial. Nutr Diabetes 2021; 11:16. [PMID: 34099629 PMCID: PMC8184768 DOI: 10.1038/s41387-021-00158-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to examine associations of body composition (fat mass index, % fat mass, fat-free mass index, body mass index) and physical fitness (cardiorespiratory fitness and handgrip strength) with gestational diabetes and cardiovascular health in early pregnancy. This cross-sectional study utilized baseline data (n = 303) collected in early pregnancy from the HealthyMoms trial. Body composition was measured using air-displacement plethysmography, cardiorespiratory fitness was assessed by means of the 6-min walk test and handgrip strength using a dynamometer. Logistic regression was used to estimate odds ratios (ORs) for gestational diabetes as well as high (defined as 1 SD above the mean) blood pressure, homeostatic model assessment for insulin resistance (HOMA-IR), and metabolic syndrome score (MetS score) per 1 SD increase in body composition and fitness variables. Fat mass index, % fat mass and body mass index were all strongly associated with gestational diabetes (ORs: 1.72–2.14, P ≤ 0.003), HOMA-IR (ORs: 3.01–3.80, P < 0.001), blood pressure (ORs: 1.81–2.05, P < 0.001) and MetS score (ORs: 3.29–3.71, P < 0.001). Associations with fat-free mass index were considerably weaker (ORs: 1.26–1.82, P = 0.001–0.15) and were strongly attenuated after adjustments for fat mass index (ORs: 0.88–1.54, P = 0.039–0.68). Finally, greater cardiorespiratory fitness was associated with lower risk of high HOMA-IR and MetS score (ORs: 0.57–0.63, P ≤ 0.004) although these associations were attenuated when accounting for fat mass index (ORs: 1.08-1.11, P ≥ 0.61). In conclusion, accurately measured fat mass index or % fat mass were strongly associated with gestational diabetes risk and markers of cardiovascular health although associations were not stronger than the corresponding ones for body mass index. Fat-free mass index had only weak associations with gestational diabetes and cardiovascular health which support that the focus during clinical care would be on excess fat mass and not fat-free mass.
Collapse
Affiliation(s)
- Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Johanna Sandborg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Emmie Söderström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marja H Leppänen
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Folkhälsan Research Center, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Victoria Snekkenes
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Obstetrics and Gynecology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Francisco B Ortega
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden.,PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Research Institute of Sport and Health, University of Granada, Granada, Spain
| | - Marie Löf
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Stockholm, Sweden
| |
Collapse
|
12
|
Sandborg J, Söderström E, Henriksson P, Bendtsen M, Henström M, Leppänen MH, Maddison R, Migueles JH, Blomberg M, Löf M. Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e26091. [PMID: 33704075 PMCID: PMC7995071 DOI: 10.2196/26091] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/19/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
Background Excessive gestational weight gain (GWG) during pregnancy is a major public health concern associated with negative health outcomes for both mother and child. Scalable interventions are needed, and digital interventions have the potential to reach many women and promote healthy GWG. Most previous studies of digital interventions have been small pilot studies or have not included women from all BMI categories. We therefore examined the effectiveness of a smartphone app in a large sample (n=305) covering all BMI categories. Objective To investigate the effectiveness of a 6-month intervention (the HealthyMoms app) on GWG, body fatness, dietary habits, moderate-to-vigorous physical activity (MVPA), glycemia, and insulin resistance in comparison to standard maternity care. Methods A 2-arm parallel randomized controlled trial was conducted. Women in early pregnancy at maternity clinics in Östergötland, Sweden, were recruited. Eligible women who provided written informed consent completed baseline measures, before being randomized in a 1:1 ratio to either an intervention (n=152) or control group (n=153). The control group received standard maternity care while the intervention group received the HealthyMoms smartphone app for 6 months (which includes multiple features, eg, information; push notifications; self-monitoring; and feedback features for GWG, diet, and physical activity) in addition to standard care. Outcome measures were assessed at Linköping University Hospital at baseline (mean 13.9 [SD 0.7] gestational weeks) and follow-up (mean 36.4 [SD 0.4] gestational weeks). The primary outcome was GWG and secondary outcomes were body fatness (Bod Pod), dietary habits (Swedish Healthy Eating Index) using the web-based 3-day dietary record Riksmaten FLEX, MVPA using the ActiGraph wGT3x-BT accelerometer, glycemia, and insulin resistance. Results Overall, we found no statistically significant effect on GWG (P=.62); however, the data indicate that the effect of the intervention differed by pre-pregnancy BMI, as women with overweight and obesity before pregnancy gained less weight in the intervention group as compared with the control group in the imputed analyses (–1.33 kg; 95% CI –2.92 to 0.26; P=.10) and completers-only analyses (–1.67 kg; 95% CI –3.26 to –0.09; P=.031]). Bayesian analyses showed that there was a 99% probability of any intervention effect on GWG among women with overweight and obesity, and an 81% probability that this effect was over 1 kg. The intervention group had higher scores for the Swedish Healthy Eating Index at follow-up than the control group (0.27; 95% CI 0.05-0.50; P=.017). We observed no statistically significant differences in body fatness, MVPA, glycemia, and insulin resistance between the intervention and control group at follow up (P≥.21). Conclusions Although we found no overall effect on GWG, our results demonstrate the potential of a smartphone app (HealthyMoms) to promote healthy dietary behaviors as well as to decrease weight gain during pregnancy in women with overweight and obesity. Trial Registration ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID) RR2-10.2196/13011
Collapse
Affiliation(s)
- Johanna Sandborg
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Emmie Söderström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marcus Bendtsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria Henström
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Marja H Leppänen
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Folkhälsan Research Center, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Jairo H Migueles
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,PROFITH "PROmoting FITness and Health through physical activity" research group, Department of Physical Education and Sports, Faculty of Sport Sciences, Research Institute of Sport and Health, University of Granada, Granada, Spain
| | - Marie Blomberg
- Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| |
Collapse
|
13
|
Sandborg J, Henriksson P, Larsen E, Lindqvist AK, Rutberg S, Söderström E, Maddison R, Löf M. Participants' Engagement and Satisfaction With a Smartphone App Intended to Support Healthy Weight Gain, Diet, and Physical Activity During Pregnancy: Qualitative Study Within the HealthyMoms Trial. JMIR Mhealth Uhealth 2021; 9:e26159. [PMID: 33666554 PMCID: PMC7980113 DOI: 10.2196/26159] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/19/2021] [Accepted: 01/30/2021] [Indexed: 01/08/2023] Open
Abstract
Background Excessive gestational weight gain (GWG) is common and associated with negative health outcomes for both mother and child. Mobile health–delivered lifestyle interventions offer the potential to mitigate excessive GWG. The effectiveness of a smartphone app (HealthyMoms) was recently evaluated in a randomized controlled trial. To explore the users’ experiences of using the app, a qualitative study within the HealthyMoms trial was performed. Objective This qualitative study explored participants’ engagement and satisfaction with the 6-month usage of the HealthyMoms app. Methods A total of 19 women (mean age: 31.7, SD 4.4 years; mean BMI: 24.6, SD 3.4 kg/m2; university degree attainment: 13/19, 68%; primiparous: 11/19, 58%) who received the HealthyMoms app in a randomized controlled trial completed semistructured exit interviews. The interviews were audiorecorded and fully transcribed, coded, and analyzed using thematic analysis with an inductive approach. Results Thematic analysis revealed a main theme and 2 subthemes. The main theme, “One could suit many: a multifunctional tool to strengthen women’s health during pregnancy,” and the 2 subthemes, “Factors within and beyond the app influence app engagement” and “Trust, knowledge, and awareness: aspects that can motivate healthy habits,” illustrated that a trustworthy and appreciated health and pregnancy app that is easy to use can inspire a healthy lifestyle during pregnancy. The first subtheme discussed how factors within the app (eg, regular updates and feedback) were perceived to motivate both healthy habits and app engagement. Additionally, factors beyond the app were described to both motivate (eg, interest, motivation, and curiosity) and limit (eg, pregnancy-related complications, lack of time) app engagement. The second subtheme reflected important aspects, such as high trustworthiness of the app, increased knowledge, and awareness from using the app, which motivated participants to improve or maintain healthy habits during pregnancy. Conclusions The HealthyMoms app was considered a valuable and trustworthy tool to mitigate excessive GWG, with useful features and relevant information to initiate and maintain healthy habits during pregnancy. Trial Registration ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID) RR2-10.2196/13011
Collapse
Affiliation(s)
- Johanna Sandborg
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pontus Henriksson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Erica Larsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna-Karin Lindqvist
- Division of Health, Medicine and Rehabilitation, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Stina Rutberg
- Division of Health, Medicine and Rehabilitation, Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Emmie Söderström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Melbourne, Australia
| | - Marie Löf
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Melbourne, Australia
| |
Collapse
|