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Nguyen G, Bell Z, Andreae G, Scott S, Sermin-Reed L, Lake AA, Heslehurst N. Food insecurity during pregnancy in high-income countries, and maternal weight and diet: A systematic review and meta-analysis. Obes Rev 2024:e13753. [PMID: 38693587 DOI: 10.1111/obr.13753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 02/15/2024] [Accepted: 03/26/2024] [Indexed: 05/03/2024]
Abstract
Food insecurity is a well-established obesity driver. Less is known about food insecurity during pregnancy. This review (PROSPERO:CRD42022311669) aimed to explore associations between food insecurity, maternal obesity, gestational weight gain (GWG), and nutrition. Searches included seven databases, gray literature, references, citations, and contacting authors. Observational studies reporting data from January 1st, 2008 to 21 November 2023 in high-income countries were included. Duplicate screening, data extraction, and quality assessments were performed. Random effects meta-analysis estimated odds ratios (OR), mean difference (MD), and 95% confidence intervals (CI). Narrative synthesis was conducted when data could not be pooled. Database searches identified 22,272 results; 20 studies were included (n = 19 North America, n = 1 Europe; n = 32,803 women). Food insecurity significantly increased obesity (OR 1.53 95%CI 1.39, 1.66), but not underweight (OR 1.12 95%CI 0.89, 1.34) or overweight (OR 1.18 95%CI 0.90, 1.46). Food insecurity significantly reduced GWG (MD -0.42 kg 95%CI -0.62, -0.22) and increased inadequate GWG (OR 1.16 95%CI 1.05, 1.28), but not excessive GWG (OR 1.04 95%CI 0.96, 1.13). Diet outcomes were inconsistent, with some evidence of reduced vitamin E and diet quality and increased red/processed meat consumption. Further studies outside of North America are needed to inform practice and policy to support maternal health.
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Affiliation(s)
- Giang Nguyen
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Zoë Bell
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- Department of Nutritional Sciences, King's College London, London, UK
| | - Gemma Andreae
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Stephanie Scott
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - Letitia Sermin-Reed
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Amelia A Lake
- Fuse, The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Nicola Heslehurst
- Population Health Science Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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Fong M, Kenny RPW, Thomson K, Jesurasa A, Lavans A, Patterson M, Sermin-Reed L, Nguyen G, Aquino MRJ, Cullen E, O'Keefe H, Moffat M, Heslehurst N. Effectiveness and implementation of lower-intensity weight management interventions delivered by the non-specialist workforce in postnatal women: a mixed-methods systematic review. Front Public Health 2024; 12:1359680. [PMID: 38605879 PMCID: PMC11008719 DOI: 10.3389/fpubh.2024.1359680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/14/2024] [Indexed: 04/13/2024] Open
Abstract
Lower-intensity interventions delivered in primary and community care contacts could provide more equitable and scalable weight management support for postnatal women. This mixed-methods systematic review aimed to explore the effectiveness, implementation, and experiences of lower-intensity weight management support delivered by the non-specialist workforce. We included quantitative and qualitative studies of any design that evaluated a lower-intensity weight management intervention delivered by non-specialist workforce in women up to 5 years post-natal, and where intervention effectiveness (weight-related and/or behavioural outcomes), implementation and/or acceptability were reported. PRISMA guidelines were followed, and the review was prospectively registered on PROSPERO (CRD42022371828). Nine electronic databases were searched to identify literature published between database inception to January 2023. This was supplemented with grey literature searches and citation chaining for all included studies and related reviews (completed June 2023). Screening, data extraction and risk of bias assessments were performed in duplicate. Risk of bias was assessed using the Joanna Briggs Institute appraisal tools. Narrative methods were used to synthesise outcomes. Seven unique studies described in 11 reports were included from the Netherlands (n = 2), and the United Kingdom, Germany, Taiwan, Finland, and the United States (n = 1 each). All studies reported weight-related outcomes; four reported diet; four reported physical activity; four reported intervention implementation and process outcomes; and two reported intervention acceptability and experiences. The longest follow-up was 13-months postnatal. Interventions had mixed effects on weight-related outcomes: three studies reported greater weight reduction and/or lower postnatal weight retention in the intervention group, whereas four found no difference or mixed effects. Most studies reporting physical activity or diet outcomes showed no intervention effect, or mixed effects. Interventions were generally perceived as acceptable by women and care providers, although providers had concerns about translation into routine practice. The main limitations of the review were the limited volume of evidence available, and significant heterogeneity in interventions and outcome reporting which limited meaningful comparisons across studies. There is a need for more intervention studies, including process evaluations, with longer follow-up in the postnatal period to understand the role of primary and community care in supporting women's weight management. Public Health Wales was the primary funder of this review.
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Affiliation(s)
- Mackenzie Fong
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Ryan Patrick William Kenny
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Innovation Observatory, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Evidence Synthesis Group, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Katie Thomson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
- NIHR Innovation Observatory, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Evidence Synthesis Group, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Amrita Jesurasa
- Primary Care Division, Public Health Wales, Cardiff, United Kingdom
| | - Amber Lavans
- Primary Care Division, Public Health Wales, Cardiff, United Kingdom
| | - Maddey Patterson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Letitia Sermin-Reed
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration (ARC) North East and North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Giang Nguyen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Emer Cullen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Hannah O'Keefe
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Innovation Observatory, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Evidence Synthesis Group, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Newcastle-upon-Tyne, United Kingdom
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Heslehurst N, McParlin C, Sniehotta FF, Rankin J, Crowe L, McColl E. The Gestational Obesity Weight Management: Implementation of National Guidelines (GLOWING) study: a pilot cluster randomised controlled trial. Pilot Feasibility Stud 2024; 10:47. [PMID: 38429853 PMCID: PMC10905942 DOI: 10.1186/s40814-024-01450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/12/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Pregnancy weight management interventions can improve maternal diet, physical activity, gestational weight gain, and postnatal weight retention. UK guidelines were published in 2010 but health professionals report multiple complex barriers to practice. GLOWING used social cognitive theory to address evidence-based barriers to midwives' implementation of weight management guidelines into routine practice. This paper reports the pilot trial outcomes relating to feasibility and acceptability of intervention delivery and trial procedures. METHODS GLOWING was a multi-centre parallel-group pilot cluster RCT comparing the delivery of a behaviour change intervention for midwives (delivered as training workshops) with usual practice. The clusters were four NHS Trusts in Northeast England, randomised to intervention or control arms. Blinding of allocation was not possible due to the nature of the intervention. We aimed to deliver the intervention to all eligible midwives in the intervention arm, in groups of 6 midwives per workshop, and to pilot questionnaire data collection for a future definitive trial. Intervention arm midwives' acceptability of GLOWING content and delivery was assessed using a mixed methods questionnaire, and pregnant women's acceptability of trial procedures by interviews. Quantitative data were analysed descriptively and qualitative data thematically. RESULTS In intervention arm Trusts, 100% of eligible midwives (n = 67) were recruited to, and received, the intervention; however, not all workshops had the planned number of attendees (range 3-8). The consent rate amongst midwives randomised (n = 100) to complete questionnaires was 74% (n = 74) (95% CI 65%, 83%), and overall completion rate 89% (n = 66) (95% CI 82%, 96%). Follow-up response rate was 66% (n = 49) (95% CI 55%, 77%), with a marked difference between intervention (39%, n = 15) and control (94%, n = 34) groups potentially due to the volume of research activities. Overall, 64% (n = 47) (95% CI 53%, 75%) completed both baseline and follow-up questionnaires. Midwives viewed the intervention as acceptable and directly relevant to routine practice. The least popular components related to scripted role-plays. Pregnant women viewed the recruitment and trial processes to be acceptable. CONCLUSIONS This rigorously conducted pilot study demonstrated feasibility intervention delivery and a high level of acceptability amongst participants. It has provided information required to refine the intervention and trial protocol, enhancing confidence that a definitive trial could be carried out. TRIAL REGISTRATION ISRCTN46869894; retrospectively registered 25th May 2016, www.isrctn.com/ISRCTN46869894 .
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK.
| | - Catherine McParlin
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
- Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Falko F Sniehotta
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Lisa Crowe
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Baddiley Clark Building, Newcastle Upon Tyne, NE2 4AX, UK
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Quotah OF, Andreeva D, Nowak KG, Dalrymple KV, Almubarak A, Patel A, Vyas N, Cakir GS, Heslehurst N, Bell Z, Poston L, White SL, Flynn AC. Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials. Diabetol Metab Syndr 2024; 16:8. [PMID: 38178175 PMCID: PMC10765912 DOI: 10.1186/s13098-023-01217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Women at risk of gestational diabetes mellitus (GDM) need preventative interventions. OBJECTIVE To evaluate targeted interventions before and during pregnancy for women identified as being at risk of developing GDM. METHODS Systematic review and meta-analysis conducted following PRISMA guidelines. MEDLINE, EMBASE and the Cochrane Library in addition to reference and citation lists were searched to identify eligible randomised controlled trials (RCTs) utilising risk stratification during the preconception period or in the first/early second trimester. Screening and data extraction were carried out by the authors independently. Quality assessment was conducted based on the Cochrane risk-of-bias tool. Random effects meta-analysis and narrative synthesis were performed. RESULTS Eighty-four RCTs were included: two during preconception and 82 in pregnancy, with a pooled sample of 22,568 women. Interventions were behavioural (n = 54), dietary supplementation (n = 19) and pharmacological (n = 11). Predictive factors for risk assessment varied; only one study utilised a validated prediction model. Gestational diabetes was reduced in diet and physical activity interventions (risk difference - 0.03, 95% CI 0.06, - 0.01; I2 58.69%), inositol (risk difference - 0.19, 95% CI 0.33, - 0.06; I2 92.19%), and vitamin D supplements (risk difference - 0.16, 95% CI 0.25, - 0.06; I2 32.27%). Subgroup analysis showed that diet and physical activity interventions were beneficial in women with ≥ 2 GDM risk factors (risk difference - 0.16, 95% CI 0.25, - 0.07; I2 11.23%) while inositol supplementation was effective in women with overweight or obesity (risk difference - 0.17, 95% CI 0.22, - 0.11; I2 0.01%). Effectiveness of all other interventions were not statistically significant. CONCLUSIONS This review provides evidence that interventions targeted at women at risk of GDM may be an effective strategy for prevention. Further studies using validated prediction tools or multiple risk factors to target high-risk women for intervention before and during pregnancy are warranted.
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Affiliation(s)
- Ola F Quotah
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK.
- Department of Clinical Nutrition, Faculty of Applied Medical Science, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Daria Andreeva
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Katarzyna G Nowak
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
- Department of Nutrition and Dietetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kathryn V Dalrymple
- Department of Nutritional Sciences, School of Life Course Sciences and Population Sciences, King's College London, London, UK
| | - Aljawharah Almubarak
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Anjali Patel
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Nirali Vyas
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Gözde S Cakir
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Zoe Bell
- Department of Nutritional Sciences, School of Life Course Sciences and Population Sciences, King's College London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Sara L White
- Department of Women and Children's Health, School of Life Course and Population Sciences, King's College London, London, UK
| | - Angela C Flynn
- Department of Nutritional Sciences, School of Life Course Sciences and Population Sciences, King's College London, London, UK
- School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
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Hill B, Azzari Wynn-Jones A, Botting KJ, Cassinelli EH, Daly MP, Gardiner CV, Hanley SJ, Heslehurst N, Steegers-Theunissen R, Verbiest S, Skouteris H. The Challenge of Weight Stigma for Women in the Preconception Period: Workshop Recommendations for Action from the 5th European Conference on Preconception Health and Care. Int J Environ Res Public Health 2023; 20:7034. [PMID: 37998265 PMCID: PMC10671694 DOI: 10.3390/ijerph20227034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Weight stigma is a well-recognised public health issue affecting many members of society including women during the preconception period. The impacts of preconception weight stigma on women are significant and may result in decreased access to and uptake of healthcare, and mental health concerns. The consequences of this weight stigma may translate to negative maternal outcomes and even intergenerational effects on the child. Eliminating weight stigma is therefore imperative. The aim of this paper is to report recommendations to reduce weight stigma for preconception women produced at a workshop with clinical and academic experts on preconception health and weight stigma at the 5th European Conference on Preconception Health and Care. The recommendations are related to two key areas: general societal recommendations prompting all people to acknowledge and adjust our attitudes towards larger-bodied people; and healthcare-specific recommendations imploring clinicians to upskill themselves to reduce weight stigma in practice. We therefore call for urgent approaches to address societal weight-stigmatising attitudes and norms related to both the general population and preconception women, while providing professional development opportunities for healthcare professionals relating to weight stigma. Eliminating weight stigma for preconception women may have positive impacts on the outcomes for mothers and children during pregnancy and beyond.
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Affiliation(s)
- Briony Hill
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
| | | | - Kimberley J. Botting
- Department of Maternal and Fetal Medicine, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London WC1E 6HX, UK;
| | - Emma H. Cassinelli
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast BT12 6BA, UK;
| | - Michael P. Daly
- Centre for Public Health, Bristol Medical School, University of Bristol, Canynge Hall, Whatley Road, Bristol BS8 2PN, UK;
| | - Caitlin Victoria Gardiner
- Department of Global Health and Social Medicine, Bush House, Strand Campus, King’s College London, 40 Aldwych, London WC2B 4BG, UK;
- Developmental Pathways for Health Research Unit, University of the Witwatersrand Faculty of Health Sciences, Johannesburg 2000, Gauteng, South Africa
| | - Stephanie J. Hanley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Regine Steegers-Theunissen
- Department of Obstetrics and Gynaecology, and Department of and Pediatrics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Sarah Verbiest
- School of Social Work, University of North Carolina at Chapel Hill, Pittsboro Road, Chapel Hill, NC 27599-3550, USA;
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Australia
- Warwick Business School, University of Warwick, Scarman Rd, Coventry CV4 7AL, UK
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Akhter Z, Rankin J, Shackford-Alizart A, Ackroyd R, Devlieger R, Heslehurst N. Preconception and Pregnancy Nutrition Support for Women with a History of Bariatric Surgery: A Mixed-Methods Survey of Healthcare Professionals in the UK. Nutrients 2023; 15:4415. [PMID: 37892490 PMCID: PMC10609851 DOI: 10.3390/nu15204415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Preconception bariatric surgery improves obesity-related maternal pregnancy complications but may reduce the absorption of nutrients required for healthy fetal growth and development. Women who receive preconception nutritional support after bariatric surgery are less likely to have adverse pregnancy outcomes. This study aimed to investigate the provision of preconception and pregnancy-specific nutritional support for women having bariatric surgery in the UK. A mixed-methods survey was distributed to healthcare professionals working in obesity or maternity services between December 2018 and October 2019. We collected both quantitative and qualitative data which were analysed using a mixed-methods approach. We received 135 responses from online (n = 99) and postal (n = 36) questionnaires. Only 45% of participants reported being 'very familiar' with the preconception/pregnancy nutritional needs of this population. Barriers to providing nutritional support included: a lack of resources and time; poor communication both across services and with women; not having contact with women preconception; and a lack of information and guidance. Respondents felt that dietitians have the expertise in nutrition necessary to provide support; however, GPs and midwives have the most frequent patient access post-surgery, both before and during pregnancy. Optimal preconception and pregnancy-related nutritional support requires multidisciplinary care pre- and post-surgery, and healthcare professionals require training and guidance to inform practice.
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Affiliation(s)
- Zainab Akhter
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (N.H.)
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (N.H.)
| | - Alice Shackford-Alizart
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (N.H.)
| | - Roger Ackroyd
- Department of Surgery, Sheffield Teaching Hospitals, Sheffield S10 2JF, UK
| | - Roland Devlieger
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (N.H.)
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7
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Bell Z, Scott S, Visram S, Rankin J, Bambra C, Heslehurst N. Children's nutritional health and wellbeing in food insecure households in Europe: A qualitative meta-ethnography. PLoS One 2023; 18:e0292178. [PMID: 37773922 PMCID: PMC10540950 DOI: 10.1371/journal.pone.0292178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
Since the 2008 global financial crisis, there has been a rise in the number of people experiencing food insecurity. Particularly vulnerable are households with children. This systematic review and meta-ethnography of qualitative studies focuses on families' perceptions of food insecurity and how it affects children's nutritional health and wellbeing. Six electronic databases (Medline, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), were searched for studies from European high-income countries between January 2008-July 2021, and supplemented by searches of grey literature databases, relevant websites, examination of reference lists and citation searches. We adhered to PRISMA and eMERGe guidelines to improve the completeness and clarity of meta-ethnographic reporting. Methodological quality of the studies were assessed using the Critical Appraisal Skills Programme qualitative checklist. We identified 11,596 records; we included 19 publications involving 813 participants in total. Data were synthesised according to Noblit & Hare's seven phases of meta-ethnography. We identified four key themes-food and eating practices, awareness, fragility, and networks of care-comprising five sub-themes. Our meta-ethnography provides a progressive 'storyline' of the children's experiences of food insecurity from both caregivers and children's perspectives. We found that children are aware of their family's limited resources and are often active in trying to help their families cope, and that food insecurity adversely impacts children's physical, psychological, and social experiences. Our analysis highlights gaps in knowledge about how food insecurity impacts children's nutritional health and wellbeing. It suggests that future research should prioritise minoritised ethnic communities, children living in temporary accommodation and caregivers of very young children.
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Affiliation(s)
- Zoë Bell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Steph Scott
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Shelina Visram
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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8
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Ngongalah L, Rapley T, Rankin J, Heslehurst N. Cultural Influences on African Migrant Pregnant and Postnatal Women's Dietary Behaviours and Nutrition Support Needs in the UK. Nutrients 2023; 15:4135. [PMID: 37836419 PMCID: PMC10574463 DOI: 10.3390/nu15194135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Black women in the UK face significantly higher risks of overweight and obesity and adverse pregnancy outcomes compared to women from other ethnic groups. Maternal nutrition plays a pivotal role in influencing the health outcomes of women and their children, especially during preconception and pregnancy. Cultural and environmental factors significantly influence the dietary experiences of African women after migration. This study explored the unique nutrition-related challenges faced by African migrant pregnant and postnatal women in the UK, and their nutrition support needs. Interviews were conducted with 23 African migrant women living in the UK, who were either pregnant or had a pregnancy within the past 3 years. These were analysed thematically, resulting in five overarching themes: food rituals and beliefs, pregnancy cravings, limited access to culturally appropriate food, limited access to culturally appropriate and evidence-based nutritional guidance, and the focus on healthy weight. The study identified challenges that African migrant women face in balancing their cultural heritage with the UK food environment and dietary recommendations, including potential implications on their health and pregnancy outcomes. It emphasised the importance of addressing these challenges through culturally sensitive approaches and tailored interventions, to enable informed decision making and enhance health outcomes for these women.
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Affiliation(s)
- Lem Ngongalah
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (J.R.); (N.H.)
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne NE7 7XA, UK;
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (J.R.); (N.H.)
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (J.R.); (N.H.)
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Heslehurst N, Vinogradov R, Nguyen GT, Bigirumurame T, Teare D, Hayes L, Lennie SC, Murtha V, Tothill R, Smith J, Allotey J, Vale L. Study of How Adiposity in Pregnancy has an Effect on outcomeS (SHAPES): protocol for a prospective cohort study. BMJ Open 2023; 13:e073545. [PMID: 37699635 PMCID: PMC10503385 DOI: 10.1136/bmjopen-2023-073545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Maternal obesity increases the risk of multiple maternal and infant pregnancy complications, such as gestational diabetes and pre-eclampsia. Current UK guidelines use body mass index (BMI) to identify which women require additional care due to increased risk of complications. However, BMI may not accurately predict which women will develop complications during pregnancy as it does not determine amount and distribution of adipose tissue. Some adiposity measures (eg, waist circumference, ultrasound measures of abdominal visceral fat) can better identify where body fat is stored, which may be useful in predicting those women who need additional care. METHODS AND ANALYSIS This prospective cohort study (SHAPES, Study of How Adiposity in Pregnancy has an Effect on outcomeS) aims to evaluate the prognostic performance of adiposity measures (either alone or in combination with other adiposity, sociodemographic or clinical measures) to estimate risk of adverse pregnancy outcomes. Pregnant women (n=1400) will be recruited at their first trimester ultrasound scan (11+2-14+1 weeks') at Newcastle upon Tyne National Health Service Foundation Trust, UK. Early pregnancy adiposity measures and clinical and sociodemographic data will be collected. Routine data on maternal and infant pregnancy outcomes will be collected from routine hospital records. Regression methods will be used to compare the different adiposity measures with BMI in terms of their ability to predict pregnancy complications. If no individual measure performs better than BMI, multivariable models will be developed and evaluated to identify the most parsimonious model. The apparent performance of the developed model will be summarised using calibration, discrimination and internal validation analyses. ETHICS AND DISSEMINATION Ethical favourable opinion has been obtained from the North East: Newcastle & North Tyneside 1 Research Ethics Committee (REC reference: 22/NE/0035). All participants provide informed consent to take part in SHAPES. Planned dissemination includes peer-reviewed publications and additional dissemination appropriate to target audiences, including policy briefs for policymakers, media/social-media coverage for public and conferences for research TRIAL REGISTRATION NUMBER: ISRCTN82185177.
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Raya Vinogradov
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Maternity Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Giang T Nguyen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Theophile Bigirumurame
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Teare
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Hayes
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Susan C Lennie
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Victoria Murtha
- Maternity Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rebecca Tothill
- Maternity Services, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Janine Smith
- Janine Smith Practice, Newcastle upon Tyne, Tyneside, UK
| | - John Allotey
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- WHO Collaborating Centre for Global Women's Health, Birmingham University, Birmingham, UK
| | - Luke Vale
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Nguyen G, Boath A, Heslehurst N. Addressing inequalities and improving maternal and infant outcomes: the potential power of nutritional interventions across the reproductive cycle. Proc Nutr Soc 2023; 82:241-252. [PMID: 36727523 DOI: 10.1017/s002966512300006x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Maternal nutrition is essential for optimal health and well-being of women and their infants. This review aims to provide a critical overview of the evidence-base relating to maternal weight, obesity-related health inequalities and dietary interventions encompassing the reproductive cycle: preconception, pregnancy, postnatal and interpregnancy. We provide an overview of UK data showing that overweight and obesity affects half of UK pregnancies, with increased prevalence among more deprived and minoritised ethnic populations, and with significant health and cost implications. The existing intervention evidence-base primarily focuses on the pregnancy period, where extensive evidence demonstrates the power of interventions to improve maternal diet behaviours, and minimise gestational weight gain and postnatal weight retention. There is a lack of consistency in the intervention evidence-base relating to interventions improving pregnancy health outcomes, although there is evidence of the potential power of the Mediterranean and low glycaemic index diets in improving short- and long-term health of women and their infants. Postnatal interventions focus on weight loss, with some evidence of cost-effectiveness. There is an evidence gap for preconception and interpregnancy interventions. We conclude by identifying that interventions do not address cumulative maternal obesity inequalities and overly focus on individual behaviour change. There is a lack of a joined-up approach for interventions throughout the entire reproductive cycle, with a current focus on specific stages (i.e. pregnancy) in isolation. Moving forward, the potential power of nutritional interventions using a more holistic approach across the different reproductive stages is needed to maximise the benefits on health for women and children.
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Affiliation(s)
- Giang Nguyen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Anna Boath
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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Heslehurst N, Cullen E, Flynn AC, Briggs C, Smart L, Rankin J, McColl E, Sniehotta FF, McParlin C. Maternal Obesity and Patterns in Postnatal Diet, Physical Activity and Weight among a Highly Deprived Population in the UK: The GLOWING Pilot Trial. Nutrients 2023; 15:3805. [PMID: 37686838 PMCID: PMC10490453 DOI: 10.3390/nu15173805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Preconception obesity is associated with adverse pregnancy outcomes and deprivation. The postnatal period provides an opportunity for preconception intervention. There is a lack of published postnatal behaviour and weight data to inform intervention needs. Secondary analysis of the GLOWING study explored postnatal diet, physical activity (PA) and weight among women living with obesity in deprivation. Thirty-nine women completed food frequency and PA questionnaires and provided weight measurement(s) between 3-12 months postnatal. Women's diet and PA fell short of national guidelines, especially for fruit/vegetables (median 1.6-2.0 portions/day) and oily fish (0-4 g/day). PA was predominantly light intensity. Patterns in weight change across time points indicated postnatal weight loss compared with 1st (median -0.8 to -2.3 kg) and 3rd-trimester weights (-9.0 to -11.6 kg). Weight loss was higher among women without excessive gestational weight gain (GWG) (-2.7 to -9.7 kg) than those with excessive GWG (2.3 to -1.8 kg), resulting in postnatal weight measurements lower than their 1st trimester. These pilot data suggest preconception interventions should commence in pregnancy with a focus on GWG, and postnatal women need early support to achieve guideline-recommendations for diet and PA. Further research in a larger population could inform preconception intervention strategies to tackle inequalities in maternal obesity and subsequent pregnancy outcomes.
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Emer Cullen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Angela C. Flynn
- Department of Nutritional Sciences, Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK;
| | - Chloe Briggs
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Lewis Smart
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Elaine McColl
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
| | - Catherine McParlin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne NE2 4AX, UK; (E.C.); (J.R.); (E.M.); (F.F.S.); (C.M.)
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12
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Luli M, Yeo G, Farrell E, Ogden J, Parretti H, Frew E, Bevan S, Brown A, Logue J, Menon V, Isack N, Lean M, McEwan C, Gately P, Williams S, Astbury N, Bryant M, Clare K, Dimitriadis GK, Finlayson G, Heslehurst N, Johnson B, Le Brocq S, Roberts A, McGinley P, Mueller J, O'Kane M, Batterham RL, Miras AD. The implications of defining obesity as a disease: a report from the Association for the Study of Obesity 2021 annual conference. EClinicalMedicine 2023; 58:101962. [PMID: 37090435 PMCID: PMC10119881 DOI: 10.1016/j.eclinm.2023.101962] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Unlike various countries and organisations, including the World Health Organisation and the European Parliament, the United Kingdom does not formally recognise obesity as a disease. This report presents the discussion on the potential impact of defining obesity as a disease on the patient, the healthcare system, the economy, and the wider society. A group of speakers from a wide range of disciplines came together to debate the topic bringing their knowledge and expertise from backgrounds in medicine, psychology, economics, and politics as well as the experience of people living with obesity. The aim of their debate was not to decide whether obesity should be classified as a disease but rather to explore what the implications of doing so would be, what the gaps in the available data are, as well as to provide up-to-date information on the topic from experts in the field. There were four topics where speakers presented their viewpoints, each one including a question-and-answer section for debate. The first one focused on the impact that the recognition of obesity could have on people living with obesity regarding the change in their behaviour, either positive and empowering or more stigmatising. During the second one, the impact of defining obesity as a disease on the National Health Service and the wider economy was discussed. The primary outcome was the need for more robust data as the one available does not represent the actual cost of obesity. The third topic was related to the policy implications regarding treatment provision, focusing on the public's power to influence policy. Finally, the last issue discussed, included the implications of public health actions, highlighting the importance of the government's actions and private stakeholders. The speakers agreed that no matter where they stand on this debate, the goal is common: to provide a healthcare system that supports and protects the patients, strategies that protect the economy and broader society, and policies that reduce stigma and promote health equity. Many questions are left to be answered regarding how these goals can be achieved. However, this discussion has set a good foundation providing evidence that can be used by the public, clinicians, and policymakers to make that happen.
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Affiliation(s)
- Migena Luli
- Division of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Giles Yeo
- Department of Clinical Biochemistry, Institute of Metabolic Science, Cambridge University, Cambridge, United Kingdom
| | - Emma Farrell
- School of Education, University College Dublin, Dublin, Ireland
| | - Jane Ogden
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Surrey, United Kingdom
| | - Helen Parretti
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, United Kingdom
| | - Emma Frew
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Stephen Bevan
- HR Research Development, Institute for Employment, Brighton, United Kingdom
| | - Adrian Brown
- Department of Experimental and Translational Medicine, Faculty of Medical Sciences, University College London, London, United Kingdom
| | - Jennifer Logue
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Vinod Menon
- Department of Upper Gastrointestinal Team, University Hospitals and Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Nadya Isack
- Obesity Empowerment Network, London, United Kingdom
| | - Michael Lean
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, United Kingdom
| | | | - Paul Gately
- Obesity Institute, Leeds Beckett University, Leeds, United Kingdom
| | | | - Nerys Astbury
- Nuffield Department of Primary Care Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, York, United Kingdom
| | - Kenneth Clare
- European Coalition for People Living with Obesity, United Kingdom
| | - Georgios K. Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Graham Finlayson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Brett Johnson
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Audrey Roberts
- European Coalition for People Living with Obesity, United Kingdom
| | - Patrick McGinley
- Department of Finance, Maidstone & Tunbridge Wells NHS Trust, Kent, United Kingdom
| | - Julia Mueller
- Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Mary O'Kane
- Dietetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rachel L. Batterham
- School of Life and Medical Sciences, University College London, London, United Kingdom
| | - Alexander Dimitri Miras
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
- School of Medicine, Ulster University, United Kingdom
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Boath A, Vale L, Hayes L, Allotey J, Heslehurst N. Differential effects of diet and physical activity interventions in pregnancy to prevent gestational diabetes mellitus and reduce gestational weight gain by level of maternal adiposity: a protocol for an individual patient data (IPD) meta-analysis of randomised controlled trials. BMJ Open 2023; 13:e065335. [PMID: 36940942 PMCID: PMC10030495 DOI: 10.1136/bmjopen-2022-065335] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Women and their infants are at increased risk of complications if gestational diabetes mellitus (GDM) or excessive gestational weight gain (GWG) occurs in pregnancy. Weight management interventions in pregnancy, consisting of diet and physical activity components are targeted based on maternal body mass index (BMI). However, the relative effectiveness of interventions targeted based on alternative measures of adiposity to BMI is unclear. This individual patient data (IPD) meta-analysis aims to explore whether interventions are more effective at preventing GDM and reducing GWG in women according to their level of adiposity. METHODS The International Weight Management in Pregnancy Collaborative Network has a living database of IPD from randomised trials of diet and/or physical activity interventions in pregnancy. This IPD meta-analysis will use IPD from trials identified from systematic literature searches up until March 2021, where maternal adiposity measures (eg, waist circumference) were collected prior to 20 weeks' gestation. A two-stage random effects IPD meta-analysis approach will be taken for each outcome (GDM and GWG) to understand the effect of early pregnancy adiposity measures on the effect of weight management interventions for GDM prevention and GWG reduction. Summary intervention effects with 95% CIs) will be derived along with treatment covariate interactions. Between-study heterogeneity will be summarised by I2 and tau2 statistics. Potential sources of bias will be evaluated, and the nature of any missing data will be explored and appropriate imputation methods adopted. ETHICS AND DISSEMINATION Ethics approval is not required. The study is registered on the International Prospective Register of Systematic Reviews (CRD42021282036). Results will be submitted to peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42021282036.
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Affiliation(s)
- Anna Boath
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John Allotey
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Heslehurst N, McParlin C, Sniehotta FF, Rankin J, McColl E. Midwives' survey of their weight management practice before and after the GLOWING guideline implementation intervention: A pilot cluster randomised controlled trial. PLoS One 2023; 18:e0280624. [PMID: 36662826 PMCID: PMC9858407 DOI: 10.1371/journal.pone.0280624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Maternal weight management is a priority due to pregnancy risks for women and babies. Interventions significantly improve maternal diet, physical activity, weight, and pregnancy outcomes. There are complex barriers to midwives' implementation of guidelines; low self-efficacy is a core implementation barrier. The GLOWING intervention uses social cognitive theory (SCT) to address evidence-based barriers to practice. The intervention aimed to support midwives' implementation of guidelines. METHODS An external rehearsal pilot cluster randomised controlled trial in four NHS Trusts (clusters) in England, UK. Clusters were randomised to intervention (where all eligible midwives received the intervention) or control (no intervention delivered) arms. A random sample of 100 midwives were invited to complete questionnaires pre- and post-intervention. UK guideline recommendations relating to midwives' practice were categorised into: 1) communication-related behaviours (including weight- and risk-communication), and 2) support/intervention-related behaviours (including diet/nutrition, physical activity, weight management, referrals/signposting). Questionnaires were developed using SCT constructs (self-efficacy, outcome expectancies, intentions, behaviours) and 7-point Likert scale, converted to a 0-100 scale. Higher scores were more positive. Descriptive statistics compared intervention and control arms, pre- and post-intervention. RESULTS Seventy-four midwives consented and 68 returned questionnaires. Pre-intervention, self-efficacy for support/intervention-related behaviours scored lowest. In controls, there was limited difference between the pre- and post-intervention scores. Post-intervention, mean (SD) scores were consistently higher among intervention midwives than controls, particularly for support/intervention self-efficacy (71.4 (17.1) vs. 58.4 (20.1)). Mean (SD) self-efficacy was higher post-intervention than pre-intervention for all outcomes among intervention midwives, and consistently higher than controls. Mean differences pre- and post-intervention were greatest for support/intervention self-efficacy (17.92, 95% CI 7.78-28.07) and intentions (12.68, 95% CI 2.76-22.59). Self-efficacy was particularly increased for diet/nutrition and physical activity (MD 24.77, 95% CI 14.09-35.44) and weight management (18.88, 95% CI 7.88-29.88) behaviours, which showed the largest increase in scores. CONCLUSIONS This study supports the theoretical models used to develop GLOWING, where low self-efficacy was a core implementation barrier. Results suggest that GLOWING successfully targets self-efficacy, potentially with a positive impact on guideline implementation. A definitive trial is required to determine effectiveness. TRIAL REGISTRATION ISRCTN46869894, retrospectively registered 25/05/2016, http://isrctn.com/ISRCTN46869894.
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Catherine McParlin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Falko F. Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
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Heslehurst N, Evans EH, Incollingo Rodriguez AC, Nagpal TS, Visram S. Newspaper media framing of obesity during pregnancy in the UK: A review and framework synthesis. Obes Rev 2022; 23:e13511. [PMID: 36268693 PMCID: PMC9788256 DOI: 10.1111/obr.13511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/29/2022] [Accepted: 10/05/2022] [Indexed: 12/30/2022]
Abstract
Two thirds of women report experiencing weight stigma during pregnancy. Newspaper media is powerful in framing health issues. This review synthesized UK newspaper media portrayal of maternal obesity. NexisUni was searched to identify newspaper articles, published January 2010 to May 2021, reporting content on obesity during pregnancy. Framework synthesis integrated quantitative and qualitative analysis of the content of articles. There were 442 articles included (59% tabloids and 41% broadsheets). Three overarching themes with interacting sub-themes were as follows: (1) Women were blamed for their weight, risks, and NHS impact. (2) Women were solely responsible for solving obesity, gendered from school age. (3) Women with obesity were a burden on individuals (e.g., themselves, their children, and health professionals), to society, and the NHS. Catastrophizing language framed the "problem," "scale," and "public health concern" of maternal obesity, emphasizing risk, and danger and was alarmist, aggressive, and violent as to elicit fear or devalue women. Articles platformed 'expert' voices rather than women's lived experiences. This review identified that UK newspaper media negatively frames and oversimplifies the topic of maternal obesity. Exposure to blaming and alarmist messaging could increase women's guilt, stigma, and internalized weight bias. The newspaper media should be harnessed to de-stigmatize maternal obesity and promote maternal well-being.
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Taniya S Nagpal
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Canada
| | - Shelina Visram
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Moore THM, Phillips S, Heslehurst N, Hodder RK, Dawson S, Gao Y, Hesketh K, Summerbell CD. Interventions to prevent obesity in children under 2 years old. Hippokratia 2022. [DOI: 10.1002/14651858.cd015324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Theresa HM Moore
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Sophie Phillips
- Department of Sport and Exercise Sciences; Durham University; Durham UK
- Fuse - Centre for Translational Research in Public Health; Newcastle Upon Tyne UK
| | - Nicola Heslehurst
- Fuse - Centre for Translational Research in Public Health; Newcastle Upon Tyne UK
- Population Health Sciences Institute; Newcastle University; Newcastle upon Tyne UK
| | - Rebecca K Hodder
- Hunter New England Population Health; Hunter New England Local Health District; Wallsend Australia
- School of Medicine and Public Health; The University of Newcastle; Callaghan Australia
- National Centre of Implementation Science; The University of Newcastle; Callaghan Australia
- Population Health Research Program; Hunter Medical Research Institute; New Lambton Heights Australia
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School; University of Bristol; Bristol UK
- NIHR Applied Research Collaboration West (ARC West); University Hospitals Bristol and Weston NHS Foundation Trust; Bristol UK
| | - Yang Gao
- Department of Sport, Physical Education and Health; Hong Kong Baptist University; Kowloon Hong Kong
| | - Kathryn Hesketh
- MRC Epidemiology Unit; University of Cambridge; Cambridge UK
| | - Carolyn D Summerbell
- Department of Sport and Exercise Sciences; Durham University; Durham UK
- Fuse - Centre for Translational Research in Public Health; Newcastle Upon Tyne UK
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17
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Bell Z, Scott S, Visram S, Rankin J, Bambra C, Heslehurst N. Family's experiences of their children's nutritional health and wellbeing among food-insecure households in Europe: a qualitative systematic review and meta-ethnography. Lancet 2022; 400 Suppl 1:S19. [PMID: 36929961 DOI: 10.1016/s0140-6736(22)02229-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There has been a rise in food insecurity in Europe since the 2008 global financial crisis and households with children are particularly vulnerable. We aimed to explore families' experiences of food insecurity and how these experiences affect children's nutritional health and wellbeing. METHODS In this systematic review and meta-ethnography, we searched Medline, Scopus, Web of Science, EMBASE, CINAHL, and ASSIA from Jan 1, 2008, to July 10, 2021, supplemented by grey literature, reference lists, and citation searches. Screening was done in duplicate to ensure consistent application of inclusion criteria and minimise random errors. Following title and abstract screening, full texts were screened against the inclusion criteria (qualitative research focussing on children's nutritional health and wellbeing, with data from 2008 onwards, from high-income European countries). Data extracted included study design, country of origin, caregiver type, gender, age, ethnic group, migration status, accommodation type, measure of food insecurity and other socioeconomic factors. Data were synthesised according to Noblit & Hare's seven phases of meta-ethnography. Our protocol was registered with PROSPERO (CRD42020214159). FINDINGS We identified 11 589 unique records; 19 were included, involving 813 participants. We identified four key themes: food and eating practices, awareness, fragility, and networks of care. Within the key themes, we identified five subthemes: diet, compromised infant feeding practices, psychological fragility, social fragility, and physical fragility. We found that children with food insecurity were aware of their family's scarce resources, with most active in trying to help their family while also forming their own networks of care. We found that food insecurity adversely affects children's physical, psychological, and social experiences setting them on a trajectory towards sub-optimal health. INTERPRETATION Children's nutritional health and wellbeing is adversely affected by food insecurity. This meta-ethnography highlights gaps in our knowledge about children's nutritional health relating to a range of sociodemographic factors. There is a need to actively involve children in more research and policy. A strength and limitation of this review is the diverse range of included studies from different European contexts, in which contextual factors could have affected our findings. FUNDING The Economic and Social Research Council.
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Affiliation(s)
- Zoë Bell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Steph Scott
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Shelina Visram
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Bell Z, Scott S, Visram S, Rankin J, Bambra C, Heslehurst N. Food insecure women's experiences of their nutritional health and wellbeing in Europe: a qualitative systematic review and meta-ethnography. Lancet 2022; 400 Suppl 1:S3. [PMID: 36929973 DOI: 10.1016/s0140-6736(22)02213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Food insecurity has increased since the 2008 global financial crisis. Particularly vulnerable are mothers with young children, pregnant women, and lone parents (the majority of whom are women). This systematic review and meta-ethnography of qualitative studies aimed to explore women's experiences of food insecurity and how it affects their nutritional health and wellbeing. METHODS Six electronic databases were searched from Jan 1, 2008, to July 10, 2021, with no language restrictions. Search terms included "food insecurity", "women", and "nutrition". This search was supplemented by grey literature, reference list, and citation searches. Screening was done in duplicate. Following title and abstract screening, full texts were screened against the inclusion criteria (ie, qualitative research, focus on women of childbearing age, pregnancy nutritional health or wellbeing, data from 2008 onwards, and high-income European countries). We adhered to PRISMA and eMERGe guidelines for meta-ethnographic reporting. Methodological quality was assessed using the CASP qualitative checklist. Data were synthesised according to Noblit and Hare's seven phases of meta-ethnography. FINDINGS We identified 11 589 unique records; 23 publications reporting data from 22 unique studies were included, comprising 647 women. We identified two key themes: accessing sufficient food and embodying food insecurity, comprising eight subthemes. Our meta-ethnography provides a progressive storyline of women's experiences of food insecurity. This storyline includes how women attempt to access sufficient food, they are unable to meet their nutritional needs, how this is embedded into their everyday lives, and embodied in unhealthful physical, social, and mental nutritional health and wellbeing. INTERPRETATION This meta-ethnography concludes a need for greater recognition of the psychosocial impact of food insecurity on vulnerable women, in addition to the impact on their nutritional health and wellbeing. The review demonstrates a lack of change over time, qualitatively for women's experiences. A strength and limitation of this review is the range of studies from different European contexts, where contextual factors could affect the experiences of women. FUNDING The Economic and Social Research Council.
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Affiliation(s)
- Zoë Bell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Steph Scott
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Shelina Visram
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Wigman I, Visram S, Bell Z, Heslehurst N. UK news media portrayal of mothers living in food insecurity since the 2008 global financial crisis: a mixed-methods news media analysis. Lancet 2022; 400 Suppl 1:S46. [PMID: 36929991 DOI: 10.1016/s0140-6736(22)02256-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND An estimated 5 million people in the UK are food insecure; with women and children being the most affected. Food insecurity is particularly concerning for pregnant women, lactating mothers, and young children, who have high nutrient requirements. News media can shape public perceptions, is powerful at framing health issues, and in creating public demand and support for health policy. We aimed to explore how UK newspapers portrayed food insecure pregnant women or mothers of children aged up to 1001 days (hereon called mothers). METHODS NexisUni was searched for newspaper articles published between Jan 1, 2008, and Dec 1, 2021, with content on food insecurity among mothers. Articles were screened against inclusion criteria. Descriptive quantitative analysis explored patterns in reporting over time, voices present in articles, and overall framing of mothers as deserving or undeserving of support. Thematic analysis of the content explored patterns in the portrayal of food insecure mothers. FINDINGS 254 articles were included. Reporting increased over the selected period, with peaks in 2020-21 attributed to Marcus Rashford's child poverty campaign. Articles mainly contained sympathetic voices, and occasionally the voices of mothers themselves. The narrative portrayed food insecure mothers as being deserving of support. The UK Government was portrayed as the main driver of food insecurity, linked with health and economic drivers. Mothers and children suffered the health consequences of food insecurity, and required access to informal and formal food aid strategies. INTERPRETATION Mothers were portrayed as victims of food insecurity, providing the public with an empathetic and sympathetic perspective that could promote public support for intervention. The UK Government was generally framed as a wrongdoer, whereas food aid providers were depicted as key helpers. Thus, newspapers could be used to call for government action, advocating for women's right to food, and calling attention to social determinants of health underlying food insecurity. The rigorous searches and mixed-methods analysis are strengths of this study. A limitation is the restricted focus on newspaper media. Future research should explore other media. FUNDING None.
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Affiliation(s)
- Ilse Wigman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Shelina Visram
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Zoë Bell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
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Andreae G, Scott S, Nguyen G, Bell Z, Mehmood H, Sermin-Reed L, Heslehurst N. Food insecurity among pregnant women living in high-income countries: a systematic review. Lancet 2022; 400 Suppl 1:S17. [PMID: 36929959 PMCID: PMC9691051 DOI: 10.1016/s0140-6736(22)02227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Food insecurity is an increasingly important public health concern in high-income countries following the 2008 global financial crash, and recently with the COVID-19 pandemic. Food insecurity has been understood as a highly gendered issue, affecting more women than men. As women have more complex nutritional needs because of their menstrual cycle, pregnancy, and breastfeeding, the nutritional impact of food insecurity is also greater for women than for men. This systematic review aims to explore pregnant women's experiences of food insecurity in high-income countries and to understand how food insecurity affects their health, wellbeing, diet, and nutrition. METHODS We did a systematic review following PRISMA reporting guidelines. A comprehensive search strategy was developed using search terms such as "food insecurity" and "pregnancy outcomes". We searched seven databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, and CINAHL), grey literature, reference lists, and citations, as well as contacted authors. No language restrictions were used, and only studies primarily containing data collected from Jan 1, 2008, onwards were included. Database searches were completed in April 2022; supplementary searches are ongoing. Inclusion criteria is based on PECOS. Screening, data extraction, and quality assessment were done by two authors independently. This systematic review is registered on PROSPERO, number CRD42022311669. FINDINGS 27 studies met the inclusion criteria, with all studies published between 2015 and 2022. 24 (89%) of 27 studies were done in the USA, two (7%) in Canada, and one (4%) in the UK. Outcomes reported include dietary intake or dietary quality during pregnancy (seven [26%] of 27), gestational weight gain (seven [26%]), mental health (five [19%]), pregnancy outcomes including pregnancy complications, preterm birth, or birthweight (five [19%]), and other health outcomes or combination of nutrition, health, and wellbeing (three [11%]). Evidence synthesis is ongoing and will be complete by August, 2022. INTERPRETATION This systematic review suggests that food insecurity experienced during pregnancy was associated with negative health and nutrition outcomes. The rigorous searches are strengths of this study. A limitation is the restricted focus on studies done from 2008 onward. More research to guide efficient interventions that address food insecurity among pregnant women is needed. FUNDING None.
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Affiliation(s)
- Gemma Andreae
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stephanie Scott
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Giang Nguyen
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Zoë Bell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah Mehmood
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Letitia Sermin-Reed
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
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Heslehurst N, McParlin C, Sniehotta FF, Rankin J, McColl E. Midwives' survey of weight management practices before and after implementation of the GLOWING guideline: a pilot, cluster, randomised controlled trial. Lancet 2022; 400 Suppl 1:S47. [PMID: 36929992 DOI: 10.1016/s0140-6736(22)02257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maternal weight management increases risks for women and babies and is a public health priority. Interventions can substantially improve maternal diet and physical activity behaviours and pregnancy outcomes. Low self-efficacy is a core barrier to midwives' implementation of guidelines. GLOWING used social cognitive theory to address evidence-based barriers to practice, aiming to support midwives' guidelines implementation. METHODS This study was a pilot cluster randomised controlled trial in four UK National Health Service Trusts (clusters) in England. Clusters were randomised to intervention (midwives received intervention) or control (no intervention). Guideline recommendations for midwives' practice were: first, communication-related behaviours (weight-communication and risk-communication); and second, support and intervention-related behaviours (diet and nutrition, physical activity, weight management, and referrals and signposting). Questionnaires were designed using social cognitive theory constructs (eg, self-efficacy, outcome expectancies, intentions, behaviours), higher scores being more positive. Following Consolidated Standards of Reporting Trials guidelines for pilot trials, descriptive statistics were used to compare arms, before and after the intervention. FINDINGS 100 midwives were randomised to complete questionnaires before and after the intervention. 74% consented, and 68% returned questionnaires. Pre-intervention, self-efficacy for support, and intervention-related behaviours scored lowest. In controls, the difference between pre-intervention and post-intervention scores were negligible. Post-intervention scores were consistently higher in midwives in the intervention group than the control group, particularly for support and intervention self-efficacy (mean 71·4 [SD 17·1] vs 58·4 [20·1]). Self-efficacy was higher after the intervention than before the intervention for all outcomes among intervention midwives: weight-communication (mean 76·3 [SD 16·7] vs 67·2 [21·1]), risk-communication (79·4 [16·4] vs 68·6 [14·9]), diet, nutrition, and physical activity (76·4 [16·0] vs 49·3 [16·5]), weight management (72·1 [18·3] vs 48·3 [19·8]), referrals and signposting (63·3 [26·0] vs 47·9 [17·3]), and consistently higher than controls. INTERPRETATION Results support the theoretical models used to develop GLOWING: low self-efficacy is a core implementation barrier. Results suggest GLOWING successfully targets self-efficacy, potentially with positive implications for guideline implementation. A strength of this work is the rigorous evidence-based theoretical approach to intervention development, largely absent in maternity-based research. A limitation is that this is a pilot trial. A definitive trial is required to determine effectiveness. FUNDING National Institute for Health Research Postdoctoral Fellowship (reference PDF-2011-04-034).
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Catherine McParlin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Falko F Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Heslehurst N, Evans EH, Rodriguez ACI, Nagpal TS, Visram S. Newspaper media framing of maternal obesity in the UK: a review and framework synthesis. Lancet 2022; 400 Suppl 1:S48. [PMID: 36929993 DOI: 10.1016/s0140-6736(22)02258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND News media is powerful at framing health, shaping public perceptions and demand for policy. The effects of news media include perpetuating obesity discrimination, which threatens public health. Two-thirds of pregnant women report experiencing bodyweight-related stigma. The aim of this review was to explore the portrayal of maternal obesity in UK newspaper outlets. METHODS NexisUni was searched for newspaper articles published between Jan 1, 2010, and May 31, 2021, reporting content on obesity during pregnancy. Articles were screened against inclusion criteria. Integrated quantitative and qualitative analytics supported a novel framework synthesis to characterise the content of the articles. FINDINGS 442 articles were included: 261 (59%) published in tabloids and 181 (41%) in broadsheets. We identified three overarching themes: blame; responsibility; and burden of women with obesity. Subthemes were health outcomes (primarily of the infants); impact on the UK National Health Service (NHS); causes of and solutions for obesity; and calls for action. Women were blamed for their bodyweight, pregnancy risks, and NHS care requirements. Solutions were framed as the woman's responsibility to reduce her own and future generations' bodyweight, prevent adverse pregnancy outcomes, and alleviate the burden on the NHS. The burden of maternal obesity was consistently placed on women, as a burden on individuals (ie, themselves, their children, and health professionals), society, and the NHS. Patterns in language framed the so-called problem and scale of maternal obesity, emphasised risk and danger, and were alarmist, aggressive, and violent. Articles platformed purported experts' voices, such as professional organisations representatives, rather than women's lived experiences. The article narratives were underpinned by oversimplifications of obesity development, weight management, and causal pathways to health outcomes. INTERPRETATION UK newspapers negatively frame and oversimplify maternal obesity. Exposure to blaming and alarmist messaging could increase women's guilt and internalised weight bias, which can harm maternal and child physical and mental health during this life phase. The newspaper media should instead be harnessed to destigmatise maternal obesity, promote maternal wellbeing, and improve public health. The interdisciplinary, multinational research team and novel, rigorous methods are strengths of this review. A limitation is the focus on article texts but not on accompanying images. FUNDING None.
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | | | | | - Taniya S Nagpal
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Shelina Visram
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Bell Z, Scott S, Visram S, Rankin J, Bambra C, Heslehurst N. Experiences and perceptions of nutritional health and wellbeing amongst food insecure women in Europe: A qualitative meta-ethnography. Soc Sci Med 2022; 311:115313. [PMID: 36087388 DOI: 10.1016/j.socscimed.2022.115313] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Abstract
Since the 2008 global financial crisis, there has been a rise in the number of people experiencing food insecurity. Particularly vulnerable are mothers with young children, pregnant women, and lone parents (the majority of whom are women). This systematic review and meta-ethnography of qualitative studies focused on women's experiences of food insecurity and how it affects their nutritional health and wellbeing. Six electronic databases (Medline, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), were searched from January 1, 2008-July 10, 2021, and supplemented by searches of grey literature databases, relevant websites, examination of reference lists and citation searches. We adhered to PRISMA and eMERGe guidelines to improve the completeness and clarity of meta-ethnographic reporting. Methodological quality of the studies was assessed using the Critical Appraisal Skills Programme qualitative checklist. We identified 11,589 unique records; we included 23 publications reporting data from 22 unique studies involving 647 women. Data were synthesised according to Noblit & Hare's seven phases of meta-ethnography. We identified two key themes - accessing sufficient food and embodying food insecurity - comprising seven sub-themes. Our meta-ethnography provides a progressive 'storyline' of women's experiences of food insecurity. This includes the ways in which women attempt to access sufficient food, are unable to meet their nutritional needs, and the ways in which this is embedded into their everyday lives and embodied in unhealthful physical, social, and mental nutritional health and wellbeing impacts. Our review emphasises that food insecurity directly and tangibly impacts women's nutritional health and wellbeing. It concludes that there needs to be greater recognition of the psychosocial impact of food insecurity on vulnerable women in addition to its impact on their nutritional health and wellbeing.
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Affiliation(s)
- Zoë Bell
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK.
| | - Steph Scott
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
| | - Shelina Visram
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
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24
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Nguyen G, Hayes L, Ngongalah L, Bigirumurame T, Gaudet L, Odeniyi A, Flynn A, Crowe L, Skidmore B, Simon A, Smith V, Heslehurst N. Association between maternal adiposity measures and infant health outcomes: A systematic review and meta-analysis. Obes Rev 2022; 23:e13491. [PMID: 35801513 PMCID: PMC9539955 DOI: 10.1111/obr.13491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/04/2022]
Abstract
Maternal obesity increases risks of adverse fetal and infant outcomes. Guidelines use body mass index to diagnose maternal obesity. Evidence suggests body fat distribution might better predict individual risk, but there is a lack of robust evidence during pregnancy. We explored associations between maternal adiposity and infant health. Searches included six databases, references, citations, and contacting authors. Screening and quality assessment were carried out by two authors independently. Random effects meta-analysis and narrative synthesis were conducted. We included 34 studies (n = 40,143 pregnancies). Meta-analysis showed a significant association between maternal fat-free mass and birthweight (average effect [AE] 18.07 g, 95%CI 12.75, 23.38) but not fat mass (AE 8.76 g, 95%CI -4.84, 22.36). Women with macrosomic infants had higher waist circumference than controls (mean difference 4.93 cm, 95% confidence interval [CI] 1.05, 8.82). There was no significant association between subcutaneous fat and large for gestational age (odds ratio 1.06 95% CI 0.91, 1.25). Waist-to-hip ratio, neck circumference, skinfolds, and visceral fat were significantly associated with several infant outcomes including small for gestational age, preterm delivery, neonatal morbidity, and mortality, although meta-analysis was not possible for these variables. Our findings suggest that some measures of maternal adiposity may be useful for risk prediction of infant outcomes. Individual participant data meta-analysis could overcome some limitations in our ability to pool published data.
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Affiliation(s)
- Giang Nguyen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lem Ngongalah
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Laura Gaudet
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Adefisayo Odeniyi
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Angela Flynn
- Department of Nutritional Sciences, King's College London, London, UK
| | - Lisa Crowe
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Alexandre Simon
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Vikki Smith
- Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Corfe BM, Smith T, Heslehurst N, Nightingale JM, Kenneally S, Williams S, Moore JB. Long overdue: undergraduate nutrition education for medical students. Br J Nutr 2022; 129:1-2. [PMID: 35950314 PMCID: PMC9991831 DOI: 10.1017/s0007114522001647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Bernard M. Corfe
- The Nutrition Society, LondonW6 7NJ, UK
- Population Health Sciences Institute, Human Nutrition Research Centre, Faculty of Medical Sciences, Newcastle University, NewcastleNE2 4HH, UK
| | - Trevor Smith
- British Association for Parenteral and Enteral Nutrition, Seven Elms, WorcestershireB96 6HB, UK
- University Hospital Southampton NHS Foundation Trust, SouthamptonSO16 6YD, UK
| | - Nicola Heslehurst
- Association for the Study of Obesity, Knowle, West MidlandsB93 OLL, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, NewcastleNE2 4AX, UK
| | - Jeremy M. Nightingale
- Royal College of Physicians, LondonNW1 4LE, UK
- London North West University Healthcare NHS Trust, St Marks Hospital, HarrowHA1 3UJ, UK
| | - Sue Kenneally
- Royal College of General Practitioners, LondonNW1 2FB, UK
- Aneurin Bevan University Health Board, Lodge Road, Caerleon, NewportNP18 3XQ, UK
| | - Simon Williams
- Association for the Study of Obesity, Knowle, West MidlandsB93 OLL, UK
- University of Wales Trinity Saint David, CarmarthenSA31 3EP, UK
| | - J. Bernadette Moore
- The Nutrition Society, LondonW6 7NJ, UK
- School of Food Sciences and Nutrition, University of Leeds, Leeds, WY LS2 9JT, UK
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Heslehurst N, Ngongalah L, Bigirumurame T, Nguyen G, Odeniyi A, Flynn A, Smith V, Crowe L, Skidmore B, Gaudet L, Simon A, Hayes L. Association between maternal adiposity measures and adverse maternal outcomes of pregnancy: Systematic review and meta-analysis. Obes Rev 2022; 23:e13449. [PMID: 35467075 PMCID: PMC9285432 DOI: 10.1111/obr.13449] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 12/23/2022]
Abstract
Maternal obesity increases pregnancy-related risks. Women with a body mass index (BMI) ≥ 30 kg/m2 are considered to be at risk and should receive additional care, although approximately half will have uncomplicated pregnancies. This systematic review aimed to identify early pregnancy measures of adiposity associated with adverse maternal health outcomes. Searches included six databases, reference lists, citations, and contacting authors. Screening and quality assessment were carried out by two authors independently. Random effects meta-analysis and narrative synthesis were conducted. Seventy studies were included with a pooled sample of 89,588 women. Meta-analysis showed significantly increased odds of gestational diabetes mellitus (GDM) with higher waist circumference (WC) categories (1.40, 95% confidence interval [CI] 1.04, 1.88) and per unit increase in WC (1.31, 95% CI 1.03, 1.67). Women with GDM had higher WC than controls (mean difference [MD] 6.18 cm, 95% CI 3.92, 8.44). WC was significantly associated with hypertensive disorders, delivery-related outcomes, metabolic syndrome, and composite pregnancy outcomes. Waist to hip ratio was significantly associated with GDM, hypertensive disorders, and delivery-related outcomes. Fat mass, neck circumference, skinfolds, and visceral fat were significantly associated with adverse outcomes, although limited data were available. Our findings identify the need to explore how useful adiposity measures are at predicting risk in pregnancy, compared with BMI, to direct care to women with the greatest need.
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lem Ngongalah
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Giang Nguyen
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Adefisayo Odeniyi
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Angela Flynn
- Department of Nutritional Sciences, King's College London, London, UK
| | - Vikki Smith
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Lisa Crowe
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Laura Gaudet
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | | | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Nagpal TS, Souza SCS, Moffat M, Hayes L, Nuyts T, Liu RH, Bogaerts A, Dervis S, Piccinini-Vallis H, Adamo KB, Heslehurst N. Does prepregnancy weight change have an effect on subsequent pregnancy health outcomes? A systematic review and meta-analysis. Obes Rev 2022; 23:e13324. [PMID: 34694053 DOI: 10.1111/obr.13324] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022]
Abstract
International guidelines recommend women with an overweight or obese body mass index (BMI) aim to reduce their body weight prior to conception to minimize the risk of adverse perinatal outcomes. Recent systematic reviews have demonstrated that interpregnancy weight gain increases women's risk of developing adverse pregnancy outcomes in their subsequent pregnancy. Interpregnancy weight change studies exclude nulliparous women. This systematic review and meta-analysis was conducted following MOOSE guidelines and summarizes the evidence of the impact of preconception and interpregnancy weight change on perinatal outcomes for women regardless of parity. Sixty one studies met the inclusion criteria for this review and reported 34 different outcomes. We identified a significantly increased risk of gestational diabetes (OR 1.88, 95% CI 1.66, 2.14, I2 = 87.8%), hypertensive disorders (OR 1.46 95% CI 1.12, 1.91, I2 = 94.9%), preeclampsia (OR 1.92 95% CI 1.55, 2.37, I2 = 93.6%), and large-for-gestational-age (OR 1.36, 95% CI 1.25, 1.49, I2 = 92.2%) with preconception and interpregnancy weight gain. Interpregnancy weight loss only was significantly associated with increased risk for small-for-gestational-age (OR 1.29 95% CI 1.11, 1.50, I2 = 89.9%) and preterm birth (OR 1.06 95% CI 1.00, 1.13, I2 = 22.4%). Our findings illustrate the need for effective preconception and interpregnancy weight management support to improve pregnancy outcomes in subsequent pregnancies.
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Affiliation(s)
- Taniya S Nagpal
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Sara C S Souza
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Louise Hayes
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Tinne Nuyts
- Department of Development and Regeneration, Research Unit Woman and Child, KU Leuven, Leuven, Belgium
| | - Rebecca H Liu
- Institute for Health System Solutions & Virtual Care, Women's College Hospital, Toronto, Canada
| | - Annick Bogaerts
- Department of Development and Regeneration, Research Unit Woman and Child, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Antwerp, Belgium.,Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sheila Dervis
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Helena Piccinini-Vallis
- Faculty of Medicine, Departments of Family Medicine and Obstetrics and Gynecology, Dalhousie University, Halifax, Canada
| | - Kristi B Adamo
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
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Brown H, Jesurasa A, Bambra C, Rankin J, McNaughton A, Heslehurst N. Assessing the relationship between adverse pregnancy outcomes and area-level deprivation in Wales 2014-2019: a national population-based cross-sectional study. BMJ Open 2021; 11:e052330. [PMID: 34789495 PMCID: PMC8601077 DOI: 10.1136/bmjopen-2021-052330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the relationship between deciles of area-level deprivation and seven adverse pregnancy outcomes in Wales. DESIGN Cross-sectional analysis. SETTING 64 699 live births in Wales from 31 March 2014 to 16 September 2019. PRIMARY OUTCOME VARIABLE We examined each of the following seven adverse pregnancy outcomes: (1) small for gestational age (SGA); (2) large for gestational age; (3) preterm birth; (4) third-degree or fourth-degree perineal tear; (5) major postpartum haemorrhage (MPPH); (6) a lower Apgar score at 5 min and (7) emergency caesarean section. RESULTS There was no significant association between increasing aggregate measures of area-level deprivation and the adverse pregnancy outcomes we studied. Women living in an area with greater access to services are more likely to have a baby that is SGA (1.27, 95% CI 1.11 to 1.49), have a greater likelihood of a perineal tear (1.74, 95% CI 1.15 to 2.61), are significantly less likely to have MPPH (0.79, 95% CI 0.64 to 0.96), have a baby with an Apgar score of 0.26 higher (95% CI 0.22 to 0.29) and are significantly less likely to have an emergency caesarean section (0.81, 95% CI 0.73 to 0.88). Women living in areas with higher employment (0.26, 95% CI 0.19 to 0.36) and better health (0.26, 95% CI 0.19 to 0.35) were less likely to experience perineal tear. CONCLUSIONS There was no clear social-spatial gradient in area-level deprivation and adverse pregnancy outcomes. We found a stronger association for individual-level behavioural risk factors than area-level factors. These findings support the benefits that accessible and holistic person-centred care may bring through addressing individual behavioural risk factors. There is a need for improved data completeness and further individual-level data on risk factors such as employment and income to better understand the role which may be played by population-level policies and their pathways to affecting outcomes.
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Affiliation(s)
- Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Clare Bambra
- Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Bell Z, Scott S, Visram S, Rankin J, Bambra C, Heslehurst N. Food insecurity and the nutritional health and well-being of women and children in high-income countries: protocol for a qualitative systematic review. BMJ Open 2021; 11:e048180. [PMID: 34446488 PMCID: PMC8395272 DOI: 10.1136/bmjopen-2020-048180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Since the global financial crises of 2008, there has been a rise in the number of people experiencing food insecurity. The COVID-19 pandemic has exacerbated this. Many more are unable to afford or access food of sufficient quality and quantity to enable good health and well-being. Particularly vulnerable are mothers with young children, pregnant women and lone parents (the majority of whom are women). This review aims to understand experiences of food insecurity and how it affects women and children's nutritional health and well-being, focusing on experiences explicitly related to nutrition. Findings will help guide health policy and practice to support food-insecure women and children from high-income countries. METHODS AND ANALYSIS A systematic review and meta-ethnography exploring (1) food-insecure women's own accounts of their nutritional health and (2) food-insecure household's accounts of their children's nutritional health. Six major databases (MEDLINE, Scopus, Web of Science, EMBASE, CINAHL and ASSIA), grey literature databases and relevant stakeholder websites will be searched from 1 January 2008 to 30 March 2021. Reference list and citation searches will supplement electronic database searches. Outcomes of interest are accounts of nutrition and nutritional health, including diet, food practices, infant feeding practices and physical and mental health. The review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines, but as this is a meta-ethnography it will adhere to eMERGe Reporting Guidance for synthesis and writing findings of the final report. Critical Appraisal Skills Programme qualitative checklist will assess the quality of studies. A meta-ethnographic analysis will be conducted for all included studies. ETHICS AND DISSEMINATION As a qualitative systematic review, without primary data collection, ethical approval will not be required. Findings will be submitted for peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42020214159.
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Affiliation(s)
- Zoe Bell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Steph Scott
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Shelina Visram
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Coomar D, Hazlehurst JM, Austin F, Foster C, Hitman GA, Heslehurst N, Iliodromiti S, Betran AP, Moss N, Poston L, Nirantharakumar K, Roberts T, Simpson SA, Teede HJ, Riley R, Allotey J, Thangaratinam S. Diet and physical activity in pregnancy to prevent gestational diabetes: a protocol for an individual participant data (IPD) meta-analysis on the differential effects of interventions with economic evaluation. BMJ Open 2021; 11:e048119. [PMID: 34117047 PMCID: PMC8202105 DOI: 10.1136/bmjopen-2020-048119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Mothers with gestational diabetes mellitus (GDM) are at increased risk of pregnancy-related complications and developing type 2 diabetes after delivery. Diet and physical activity-based interventions may prevent GDM, but variations in populations, interventions and outcomes in primary trials have limited the translation of available evidence into practice. We plan to undertake an individual participant data (IPD) meta-analysis of randomised trials to assess the differential effects and cost-effectiveness of diet and physical activity-based interventions in preventing GDM and its complications. METHODS The International Weight Management in Pregnancy Collaborative Network database is a living repository of IPD from randomised trials on diet and physical activity in pregnancy identified through a systematic literature search. We shall update our existing search on MEDLINE, Embase, BIOSIS, LILACS, Pascal, Science Citation Index, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database without language restriction to identify relevant trials until March 2021. Primary researchers will be invited to join the Network and share their IPD. Trials including women with GDM at baseline will be excluded. We shall perform a one and two stage random-effect meta-analysis for each intervention type (all interventions, diet-based, physical activity-based and mixed approach) to obtain summary intervention effects on GDM with 95% CIs and summary treatment-covariate interactions. Heterogeneity will be summarised using I2 and tau2 statistics with 95% prediction intervals. Publication and availability bias will be assessed by examining small study effects. Study quality of included trials will be assessed by the Cochrane Risk of Bias tool, and the Grading of Recommendations, Assessment, Development and Evaluations approach will be used to grade the evidence in the results. A model-based economic analysis will be carried out to assess the cost-effectiveness of interventions to prevent GDM and its complications compared with usual care. ETHICS AND DISSEMINATION Ethics approval is not required. The study is registered on the International Prospective Register of Systematic Reviews (CRD42020212884). Results will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Dyuti Coomar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan M Hazlehurst
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Frances Austin
- Maternity Dietetic Service, Women's Health Division, Barts Health NHS Trust, Antenatal Clinic, Royal London Hospital and Newham University Hospital, London, UK
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Graham A Hitman
- Centre for Genomic Medicine and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stamatina Iliodromiti
- Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Ngawai Moss
- Katie's Team Patient and Public Involvement Advisory Group, Queen Mary University of London, London, UK
| | - Lucilla Poston
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Sharon A Simpson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, School of Public Health, Monash University, Melbourne, Victoria, Australia
| | - Richard Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Keele, UK
| | - John Allotey
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Pragmatic Clinical Trials Unit, Institute of Population Health Sciences, Barts and the London, School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Heslehurst N, Flynn AC, Ngongalah L, McParlin C, Dalrymple KV, Best KE, Rankin J, McColl E. Diet, Physical Activity and Gestational Weight Gain Patterns among Pregnant Women Living with Obesity in the North East of England: The GLOWING Pilot Trial. Nutrients 2021; 13:1981. [PMID: 34207613 PMCID: PMC8227571 DOI: 10.3390/nu13061981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 02/04/2023] Open
Abstract
Maternal diet, physical activity (PA) behaviours, and gestational weight gain (GWG) are important for optimum health of women and their babies. This secondary analysis of the GLOWING pilot cluster trial explored these among women living with obesity in high deprivation. Pregnant women completed food frequency, PA and psychosocial questionnaires. Weights were retrieved from medical records and measured during routine appointments with midwives. Descriptive and regression analyses were stratified by obesity class. A total of 163 women were recruited; 54.0% had class 1 obesity, 25.8% class 2, 20.2% class 3, and 76.1% lived in the two most deprived quintiles. Women had suboptimal dietary intake, particularly for oily fish, fruit and vegetables. PA was predominantly light intensity, from household, care and occupational activities. Most women gained weight outside of Institute of Medicine (IOM) guideline recommendations (87.8%); women in class 3 obesity were most likely to have inadequate GWG below IOM recommendations (58.3%, p < 0.01) and reduced odds of excessive GWG compared with class 1 (AOR 0.13, 95% 0.04-0.45). Deprived women with obesity have a double inequality as both increase pregnancy risks. This population requires support to meet guideline recommendations for diet, PA and GWG. Further research exploring obesity classes would inform policies and care to achieve the best pregnancy outcomes.
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Affiliation(s)
- Nicola Heslehurst
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (L.N.); (J.R.); (E.M.)
| | - Angela C. Flynn
- Department of Women and Children’s Health, Kings College London, Strand, London WC2R 2LS, UK; (A.C.F.); (K.V.D.)
| | - Lem Ngongalah
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (L.N.); (J.R.); (E.M.)
| | - Catherine McParlin
- Faculty of Health and Life Sciences, Northumbria University, Sutherland Building, Newcastle upon Tyne NE1 8ST, UK;
| | - Kathryn V. Dalrymple
- Department of Women and Children’s Health, Kings College London, Strand, London WC2R 2LS, UK; (A.C.F.); (K.V.D.)
| | - Kate E. Best
- Leeds Institute of Health Sciences, University of Leeds, Woodhouse, Leeds LS2 9JT, UK;
| | - Judith Rankin
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (L.N.); (J.R.); (E.M.)
| | - Elaine McColl
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (L.N.); (J.R.); (E.M.)
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Akhter Z, Heslehurst N, Ceulemans D, Rankin J, Ackroyd R, Devlieger R. Pregnancy after Bariatric Surgery: A Nested Case-Control Study of Risk Factors for Small for Gestational Age Babies in AURORA. Nutrients 2021; 13:nu13051699. [PMID: 34067722 PMCID: PMC8156275 DOI: 10.3390/nu13051699] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/14/2022] Open
Abstract
Bariatric surgery prior to pregnancy is a significant risk factor for small for gestational age (SGA) babies. This case-control study investigated differences between mothers delivering an SGA baby following bariatric surgery, compared to those delivering an appropriate for gestational age (AGA) baby. Out of 129 babies born to mothers in the AURORA cohort study, 25 were SGA (<10th percentile) and 97 were AGA (10th-90th percentile). Higher gestational weight gain (GWG) was significantly associated with decreased odds of SGA (aOR per kg 0.92, 95% CI 0.85-0.99). According to the Institute of Medicine GWG guidelines, 44% of SGA mothers had 'inadequate' GWG compared to 17% of AGA mothers. Nearly half of the mothers had 'excessive' GWG yet still gave birth to an SGA or AGA baby. Mothers of SGA babies lost more weight following bariatric surgery (45.6 ± 14.4 kg vs. 39.0 ± 17.9 kg). Women who reported receiving nutritional advice following bariatric surgery were significantly less likely to have an SGA baby (aOR 0.15, 95% CI 0.0.4-0.55). Women with a history of bariatric surgery should be provided with specialized support before and during pregnancy to encourage adequate nutritional intake and weight gain to support healthy fetal growth.
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Affiliation(s)
- Zainab Akhter
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (N.H.); (J.R.)
- Correspondence:
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (N.H.); (J.R.)
| | - Dries Ceulemans
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium; (D.C.); (R.D.)
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (N.H.); (J.R.)
| | - Roger Ackroyd
- Department of Surgery, Sheffield Teaching Hospitals, Sheffield S10 2JF, UK;
| | - Roland Devlieger
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, 3000 Leuven, Belgium; (D.C.); (R.D.)
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Thomson K, Moffat M, Arisa O, Jesurasa A, Richmond C, Odeniyi A, Bambra C, Rankin J, Brown H, Bishop J, Wing S, McNaughton A, Heslehurst N. Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis. BMJ Open 2021; 11:e042753. [PMID: 33722867 PMCID: PMC7959237 DOI: 10.1136/bmjopen-2020-042753] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed. STUDY SELECTION CRITERIA Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland. RESULTS Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I298.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I297.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I298.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I270.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I299.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes. CONCLUSIONS This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019140893.
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Affiliation(s)
- Katie Thomson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Oluwatomi Arisa
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Catherine Richmond
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Adefisayo Odeniyi
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Heather Brown
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Julie Bishop
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Susan Wing
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Amy McNaughton
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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Insan N, Slack E, Heslehurst N, Rankin J. Antenatal depression and anxiety and early pregnancy BMI among White British and South Asian women: retrospective analysis of data from the Born in Bradford cohort. BMC Pregnancy Childbirth 2020; 20:502. [PMID: 32873239 PMCID: PMC7466782 DOI: 10.1186/s12884-020-03097-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maternal obesity has severe physical impacts such as increased chances of pre-eclampsia and gestational diabetes. However, mental health impacts are given less attention within antenatal care. Evidence suggests that women with obesity carry increased risk of maternal depression and anxiety, however, this association is not well researched amongst South Asian women in the UK who are vulnerable to both. The aim of this study was to investigate the association between antenatal depression and anxiety and early pregnancy BMI, within and between White British and South Asian women, using data from the Born in Bradford cohort. METHODS Depression and anxiety were assessed using the General Health Questionnaire (GHQ); a GHQ score of > 0 for the depression subscale and > 6 for anxiety. Mother's BMI was stratified into six World Health Organisation BMI categories (underweight, recommended, overweight or obese class 1-3). To determine associations, univariate and multivariate logistic regression models (adjusting for maternal age, education, deprivation and smoking) were used. RESULTS There were 7824 women included (3514 White British and 4310 South Asian). South Asian women were more likely to have depression than White British (43.3% vs 36.1% p < 0.0001) and less likely to have anxiety (45.3% vs 48.4% p < 0.01). There were no significant associations between BMI and depression or anxiety in South Asian women. White British women with an overweight BMI had higher odds of anxiety compared with women with a recommended BMI (Adjusted Odds Ratio 1.25, 95% Confidence Interval 1.05-1.47). No significant associations were observed for other BMI categories. Smoking was a risk factor for antenatal depression (AOR 1.32, 95% CI 1.12-1.56; AOR 2.08, 95% CI 1.49-2.91) and anxiety (AOR 1.34, 95% CI 1.14-1.57; (AOR 2.87, 95% CI 2.02-4.07) in both White British and South Asian women, respectively. CONCLUSIONS Although South Asian women have a higher prevalence of depression than White women in this cohort, the known associations between maternal obesity and anxiety do not appear to be present. More studies are needed using validated depression tools for South Asian pregnant women. Mental health screening during antenatal care is important for South Asian women, with factors such as smoking considered.
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Affiliation(s)
- Nafisa Insan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Emma Slack
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
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Heslehurst N, Hayes L, Jones D, Newham J, Olajide J, McLeman L, McParlin C, de Brun C, Azevedo L. The effectiveness of smoking cessation, alcohol reduction, diet and physical activity interventions in changing behaviours during pregnancy: A systematic review of systematic reviews. PLoS One 2020; 15:e0232774. [PMID: 32469872 PMCID: PMC7259673 DOI: 10.1371/journal.pone.0232774] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pregnancy is a teachable moment for behaviour change. Multiple guidelines target pregnant women for behavioural intervention. This systematic review of systematic reviews reports the effectiveness of interventions delivered during pregnancy on changing women's behaviour across multiple behavioural domains. METHODS Fourteen databases were searched for systematic reviews published from 2008, reporting interventions delivered during pregnancy targeting smoking, alcohol, diet or physical activity as outcomes. Data on behaviour change related to these behaviours are reported here. Quality was assessed using the JBI critical appraisal tool for umbrella reviews. Consistency in intervention effectiveness and gaps in the evidence-base are described. RESULTS Searches identified 24,388 results; 109 were systematic reviews of behaviour change interventions delivered in pregnancy, and 36 reported behavioural outcomes. All smoking and alcohol reviews identified reported maternal behaviours as outcomes (n = 16 and 4 respectively), whereas only 16 out of 89 diet and/or physical activity reviews reported these behaviours. Most reviews were high quality (67%) and interventions were predominantly set in high-income countries. Overall, there was consistent evidence for improving healthy diet behaviours related to increasing fruit and vegetable consumption and decreasing carbohydrate intake, and fairly consistent evidence for increase in some measures of physical activity (METs and VO2 max) and for reductions in fat intake and smoking during pregnancy. There was a lack of consistent evidence across reviews reporting energy, protein, fibre, or micronutrient intakes; smoking cessation, abstinence or relapse; any alcohol behaviours. CONCLUSIONS The most consistent review evidence is for interventions improving dietary behaviours during pregnancy compared with other behaviours, although the majority of diet reviews prioritised reporting health-related outcomes over behavioural outcomes. Heterogeneity between reported behaviour outcomes limits ability to pool data in meta-analysis and more consistent reporting is needed. Limited data are available for alcohol interventions in pregnancy or interventions in low- or middle-income-countries, which are priority areas for future research.
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Affiliation(s)
- Nicola Heslehurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Durham, United Kingdom
| | - Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Fuse, The Centre for Translational Research in Public Health, Durham, United Kingdom
| | - Daniel Jones
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - James Newham
- School of Life Course Sciences, King’s College London, London, United Kingdom
| | - Joan Olajide
- Fuse, The Centre for Translational Research in Public Health, Durham, United Kingdom
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Louise McLeman
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine McParlin
- Fuse, The Centre for Translational Research in Public Health, Durham, United Kingdom
- Department of Nursing Midwifery and Health, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Caroline de Brun
- School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom
| | - Liane Azevedo
- Fuse, The Centre for Translational Research in Public Health, Durham, United Kingdom
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
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Slack E, Best KE, Rankin J, Heslehurst N. Maternal obesity classes, preterm and post-term birth: a retrospective analysis of 479,864 births in England. BMC Pregnancy Childbirth 2019; 19:434. [PMID: 31752763 PMCID: PMC6873733 DOI: 10.1186/s12884-019-2585-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preterm (< 37 weeks gestation) and post-term birth (≥42 weeks gestation) are associated with increased morbidity and mortality for mother and infant. Obesity (body mass index (BMI) ≥30 kg/m2) is increasing in women of reproductive age. Maternal obesity has been associated with adverse pregnancy outcomes including preterm and post-term birth. However, the effect sizes vary according to the subgroups of both maternal BMI and gestational age considered. The aim of this retrospective analysis was to determine the association between maternal obesity classes and gestational age at delivery. METHODS A secondary data analysis of 13 maternity units in England with information on 479,864 singleton live births between 1990 and 2007. BMI categories were: underweight (< 18.5 kg/m2), recommended weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2) and obesity classes I (30.0-34.9 kg/m2), II (35.0-39.9 kg/m2), IIIa (40-49.9 kg/m2) and IIIb (≥50 kg/m2). Gestational age at delivery categories were: Gestational age at delivery (weeks): extreme preterm (20-27), very preterm (28-31), moderately preterm (32-36), early term (37, 38), full term (39-40), late term (41) and post-term (≥42). The adjusted odds of births in each gestational age category (compared to full-term birth), according to maternal BMI categories were estimated using multinomial logistic regression. Missing data were estimated using multiple imputation with chained equations. RESULTS There was a J-shaped association between the absolute risk of extreme, very and moderate preterm birth and BMI category, with the greatest effect size for extreme preterm. The absolute risk of post-term birth increased monotonically as BMI category increased. The largest effect sizes were observed for class IIIb obesity and extreme preterm birth (adjusted OR 2.80, 95% CI 1.31-5.98). CONCLUSION Women with class IIIb obesity have the greatest risks for inadequate gestational age. Combining obesity classes does not accurately represent risks for many women as it overestimates the risk of all preterm and post-term categories for women with class I obesity, and underestimates the risk for women in all other obesity classes.
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Affiliation(s)
- Emma Slack
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Kate E Best
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Nicola Heslehurst
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
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Shawe J, Ceulemans D, Akhter Z, Neff K, Hart K, Heslehurst N, Štotl I, Agrawal S, Steegers‐Theunissen R, Taheri S, Greenslade B, Rankin J, Huda B, Douek I, Galjaard S, Blumenfeld O, Robinson A, Whyte M, Mathews E, Devlieger R. Pregnancy after bariatric surgery: Consensus recommendations for periconception, antenatal and postnatal care. Obes Rev 2019; 20:1507-1522. [PMID: 31419378 PMCID: PMC6852078 DOI: 10.1111/obr.12927] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 02/06/2023]
Abstract
The objective of the study is to provide evidence-based guidance on nutritional management and optimal care for pregnancy after bariatric surgery. A consensus meeting of international and multidisciplinary experts was held to identify relevant research questions in relation to pregnancy after bariatric surgery. A systematic search of available literature was performed, and the ADAPTE protocol for guideline development followed. All available evidence was graded and further discussed during group meetings to formulate recommendations. Where evidence of sufficient quality was lacking, the group made consensus recommendations based on expert clinical experience. The main outcome measures are timing of pregnancy, contraceptive choice, nutritional advice and supplementation, clinical follow-up of pregnancy, and breastfeeding. We provide recommendations for periconception, antenatal, and postnatal care for women following surgery. These recommendations are summarized in a table and print-friendly format. Women of reproductive age with a history of bariatric surgery should receive specialized care regarding their reproductive health. Many recommendations are not supported by high-quality evidence and warrant further research. These areas are highlighted in the paper.
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Affiliation(s)
- Jill Shawe
- Faculty of Health & Human SciencesUniversity of PlymouthDevonUK
| | - Dries Ceulemans
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Zainab Akhter
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Karl Neff
- King's College Hospital NHS Foundation TrustLondonUK
| | - Kathryn Hart
- Department of Nutritional Science, Faculty of Health and MedicineUniversity of SurreyGuildfordUK
| | - Nicola Heslehurst
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Iztok Štotl
- Department of Endocrinology, Diabetes and Metabolic DiseasesUniversity Medical CentreLjubljanaSlovenia
| | - Sanjay Agrawal
- Department of Upper Gastrointestinal and Bariatric SurgeryHomerton University HospitalLondonUK
| | - Regine Steegers‐Theunissen
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal MedicineErasmus MCRotterdamthe Netherlands
| | - Shahrad Taheri
- Weill Cornell Medicine in QatarQatar Foundation, Education CityDohaQatar
| | | | - Judith Rankin
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Bobby Huda
- Department of Diabetes and Metabolism, St. Bartholomew's Hospital and The Royal London HospitalBarts Health NHS TrustLondonUK
| | | | - Sander Galjaard
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal MedicineErasmus MCRotterdamthe Netherlands
| | - Orit Blumenfeld
- Israel Centre for Disease ControlMinistry of HealthJerusalemIsrael
| | - Ann Robinson
- Faculty of Health and Medical SciencesUniversity of SurreyGuildfordUK
| | - Martin Whyte
- Department of Clinical and Experimental MedicineUniversity of SurreyGuildfordUK
| | - Elaine Mathews
- St. Richard's Hospital Bariatric Surgery Service, ChichesterWestern Sussex NHS Foundation TrustChichesterUK
| | - Roland Devlieger
- Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Obstetrics and GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
- Department of Obstetrics, Gynaecology and ReproductionSt‐Augustinus Hospital WilrijkWilrijkBelgium
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Heslehurst N, Vieira R, Akhter Z, Bailey H, Slack E, Ngongalah L, Pemu A, Rankin J. The association between maternal body mass index and child obesity: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002817. [PMID: 31185012 PMCID: PMC6559702 DOI: 10.1371/journal.pmed.1002817] [Citation(s) in RCA: 184] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/01/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is a global obesity crisis, particularly among women and disadvantaged populations. Early-life intervention to prevent childhood obesity is a priority for public health, global health, and clinical practice. Understanding the association between childhood obesity and maternal pre-pregnancy weight status would inform policy and practice by allowing one to estimate the potential for offspring health gain through channelling resources into intervention. This systematic review and meta-analysis aimed to examine the dose-response association between maternal body mass index (BMI) and childhood obesity in the offspring. METHODS AND FINDINGS Searches in MEDLINE, Child Development & Adolescent Studies, CINAHL, Embase, and PsycInfo were carried out in August 2017 and updated in March 2019. Supplementary searches included hand-searching reference lists, performing citation searching, and contacting authors. Two researchers carried out independent screening, data extraction, and quality assessment. Observational studies published in English and reporting associations between continuous and/or categorical maternal and child BMI or z-score were included. Categorical outcomes were child obesity (≥95th percentile, primary outcome), overweight/obesity (≥85th percentile), and overweight (85th to 95th percentile). Linear and nonlinear dose-response meta-analyses were conducted using random effects models. Studies that could not be included in meta-analyses were summarised narratively. Seventy-nine of 41,301 studies identified met the inclusion criteria (n = 59 cohorts). Meta-analyses of child obesity included 20 studies (n = 88,872); child overweight/obesity, 22 studies (n = 181,800); and overweight, 10 studies (n = 53,238). Associations were nonlinear and there were significantly increased odds of child obesity with maternal obesity (odds ratio [OR] 3.64, 95% CI 2.68-4.95) and maternal overweight (OR 1.89, 95% CI 1.62-2.19). Significantly increased odds were observed for child overweight/obesity (OR 2.69, 95% CI 2.10-3.46) and for child overweight (OR 1.80, 95% CI 1.25, 2.59) with maternal obesity. A limitation of this research is that the included studies did not always report the data in a format that enabled inclusion in this complex meta-analysis. CONCLUSIONS This research has identified a 264% increase in the odds of child obesity when mothers have obesity before conception. This study provides substantial evidence for the need to develop interventions that commence prior to conception, to support women of childbearing age with weight management in order to halt intergenerational obesity.
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Affiliation(s)
- Nicola Heslehurst
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
- * E-mail:
| | - Rute Vieira
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen,
United Kingdom
| | - Zainab Akhter
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Hayley Bailey
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Emma Slack
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Lem Ngongalah
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Augustina Pemu
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon
Tyne, United Kingdom
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Bell R, Hayes L, Pasecinic N, Heslehurst N. Implementation of national screening guidelines for gestational diabetes: A national survey of maternity units in England. Diabetes Res Clin Pract 2018; 146:58-66. [PMID: 30287228 DOI: 10.1016/j.diabres.2018.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/18/2018] [Accepted: 09/28/2018] [Indexed: 02/02/2023]
Abstract
AIMS To describe national implementation of gestational diabetes (GDM) risk-factor based screening guidelines, and barriers to implementation relating to maternal body mass index (BMI). METHODS National online survey of NHS Trusts offering maternity services in England. A questionnaire was emailed to clinical staff involved in care of pregnant women assessing compliance with NICE guidelines for risk-factor based screening, BMI thresholds for offering OGTT and barriers to offering OGTT to women with BMI ≥ 30 kg/m2. RESULTS Health professionals from 113 (84%) of NHS Trusts in England responded to the survey. Most Trusts (81%) offered OGTT at 26-28 weeks gestation to women with selected risk factors for GDM. However, almost 40% of Trusts were not fully compliant with NICE screening criteria for all risk factors, mainly due to not offering OGTT to women with previous GDM (25% of Trusts), BMI ≥ 30 kg/m2 or ethnic minority groups (22% of Trusts). The main barriers to compliance with the BMI threshold were lack of capacity, resource and funding given the high prevalence of maternal obesity. Forty one percent of Trusts used diagnostic thresholds for GDM which differed from NICE recommendations. CONCLUSIONS Additional resources are required for NHS Trusts to fully implement and sustain risk-factor screening, especially for women with previous GDM, BMI ≥ 30 kg/m2 and ethnic minority groups.
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Affiliation(s)
- Ruth Bell
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Louise Hayes
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Nicoleta Pasecinic
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom
| | - Nicola Heslehurst
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne NE2 4AX, United Kingdom.
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Watterson C, MacDonald-Wicks L, Collins C, Hutchesson M, Shrewsbury V, Vincze L, Heslehurst N, Follong B. Effectiveness of maternal dietary interventions for improving mother and infant health outcomes: an umbrella review protocol. JBI Database System Rev Implement Rep 2018; 16:1929-1938. [PMID: 30335039 DOI: 10.11124/jbisrir-2017-003653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this umbrella review is to determine the characteristics of dietary interventions delivered any time before, during or after pregnancy for women living in developed countries, identified in quantitative systematic reviews as effective for improving mother and infant health outcomes and feasible for translation into practice.Specifically, the review will address the following questions:For the purpose of this overview, dietary interventions encompass the broad scope of dietary manipulations, including the direct provision of food and/or nutrients to participants, nutrition education, nutrition counseling, nutrition care teams, or any combination of these four intervention types.Both a narrative and quantitative summary on the effect of maternal dietary interventions on maternal and infant health outcomes as compared with usual care will be provided. The quantitative summary of the maternal and infant outcomes will be supported by an appraisal of the certainty of evidence of the effects and the strength of the recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.
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Affiliation(s)
- Cheryl Watterson
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
| | - Lesley MacDonald-Wicks
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
- The University of Newcastle Centre for Evidence Based Healthcare Informing Research (CEBHIR): a Joanna Briggs Institute Centre of Excellence
| | - Clare Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
- The University of Newcastle Centre for Evidence Based Healthcare Informing Research (CEBHIR): a Joanna Briggs Institute Centre of Excellence
| | - Melinda Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Vanessa Shrewsbury
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
- The University of Newcastle Centre for Evidence Based Healthcare Informing Research (CEBHIR): a Joanna Briggs Institute Centre of Excellence
| | - Lisa Vincze
- School of Allied Health Sciences. Griffith University, Gold Coast, Australia
| | - Nicola Heslehurst
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Berit Follong
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia
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Akhter Z, Rankin J, Devlieger R, Ackroyd R, Heslehurst N. Outcomes of pregnancy after bariatric surgery: a systematic review of systematic reviews. Eur J Med Genet 2018. [DOI: 10.1016/j.ejmg.2018.06.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ngongalah L, Rankin J, Rapley T, Odeniyi A, Akhter Z, Heslehurst N. Dietary and Physical Activity Behaviours in African Migrant Women Living in High Income Countries: A Systematic Review and Framework Synthesis. Nutrients 2018; 10:nu10081017. [PMID: 30081522 PMCID: PMC6115772 DOI: 10.3390/nu10081017] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 11/16/2022] Open
Abstract
Dietary and physical activity behaviours during preconception and in pregnancy are important determinants of maternal and child health. This review synthesised the available evidence on dietary and physical activity behaviours in pregnant women and women of childbearing age women who have migrated from African countries to live in high income countries. Searches were conducted on Medline, Embase, PsycInfo, Pubmed, CINAHL, Scopus, Proquest, Web of Science, and the Cochrane library. Searches were restricted to studies conducted in high income countries and published in English. Data extraction and quality assessment were carried out in duplicate. Findings were synthesised using a framework approach, which included both a priori and emergent themes. Fourteen studies were identified; ten quantitative and four qualitative. Four studies included pregnant women. Data on nutrient intakes included macro- and micro-nutrients; and were suggestive of inadequacies in iron, folate, and calcium; and excessive sodium intakes. Dietary patterns were bicultural, including both Westernised and African dietary practices. Findings on physical activity behaviours were conflicting. Dietary and physical activity behaviours were influenced by post-migration environments, culture, religion, and food or physical activity-related beliefs and perceptions. Further studies are required to understand the influence of sociodemographic and other migration-related factors on behaviour changes after migration.
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Affiliation(s)
- Lem Ngongalah
- Institute of Heath & Society, Newcastle University, Newcastle-Upon-Tyne, Tyne and Wear NE2 4AX, UK.
| | - Judith Rankin
- Institute of Heath & Society, Newcastle University, Newcastle-Upon-Tyne, Tyne and Wear NE2 4AX, UK.
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle-Upon-Tyne, Tyne and Wear NE7 7XA, UK.
| | - Adefisayo Odeniyi
- Institute of Heath & Society, Newcastle University, Newcastle-Upon-Tyne, Tyne and Wear NE2 4AX, UK.
| | - Zainab Akhter
- Institute of Heath & Society, Newcastle University, Newcastle-Upon-Tyne, Tyne and Wear NE2 4AX, UK.
| | - Nicola Heslehurst
- Institute of Heath & Society, Newcastle University, Newcastle-Upon-Tyne, Tyne and Wear NE2 4AX, UK.
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Heslehurst N, Brown H, Pemu A, Coleman H, Rankin J. Perinatal health outcomes and care among asylum seekers and refugees: a systematic review of systematic reviews. BMC Med 2018; 16:89. [PMID: 29890984 PMCID: PMC5996508 DOI: 10.1186/s12916-018-1064-0] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Global migration is at an all-time high with implications for perinatal health. Migrant women, especially asylum seekers and refugees, represent a particularly vulnerable group. Understanding the impact on the perinatal health of women and offspring is an important prerequisite to improving care and outcomes. The aim of this systematic review was to summarise the current evidence base on perinatal health outcomes and care among women with asylum seeker or refugee status. METHODS Twelve electronic database, reference list and citation searches (1 January 2007-July 2017) were carried out between June and July 2017. Quantitative and qualitative systematic reviews, published in the English language, were included if they reported perinatal health outcomes or care and clearly stated that they included asylum seekers or refugees. Screening for eligibility, data extraction, quality appraisal and evidence synthesis were carried out in duplicate. The results were summarised narratively. RESULTS Among 3415 records screened, 29 systematic reviews met the inclusion criteria. Only one exclusively focussed on asylum seekers; the remaining reviews grouped asylum seekers and refugees with wider migrant populations. Perinatal outcomes were predominantly worse among migrant women, particularly mental health, maternal mortality, preterm birth and congenital anomalies. Access and use of care was obstructed by structural, organisational, social, personal and cultural barriers. Migrant women's experiences of care included negative communication, discrimination, poor relationships with health professionals, cultural clashes and negative experiences of clinical intervention. Additional data for asylum seekers and refugees demonstrated complex obstetric issues, sexual assault, offspring mortality, unwanted pregnancy, poverty, social isolation and experiences of racism, prejudice and stereotyping within perinatal healthcare. CONCLUSIONS This review identified adverse pregnancy outcomes among asylum seeker and refugee women, representing a double burden of inequality for one of the most globally vulnerable groups of women. Improvements in the provision of perinatal healthcare could reduce inequalities in adverse outcomes and improve women's experiences of care. Strategies to overcome barriers to accessing care require immediate attention. The systematic review evidence base is limited by combining heterogeneous migrant, asylum seeker and refugee populations, inconsistent use of definitions and limited data on some perinatal outcomes and risk factors. Future research needs to overcome these limitations to improve data quality and address inequalities. SYSTEMATIC REGISTRATION Systematic review registration number: PROSPERO CRD42017073315 .
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Affiliation(s)
- Nicola Heslehurst
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Heather Brown
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Augustina Pemu
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Hayley Coleman
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
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Stephenson J, Heslehurst N, Hall J, Schoenaker DAJM, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD. Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet 2018; 391:1830-1841. [PMID: 29673873 PMCID: PMC6075697 DOI: 10.1016/s0140-6736(18)30311-8] [Citation(s) in RCA: 592] [Impact Index Per Article: 98.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 12/03/2017] [Accepted: 01/31/2018] [Indexed: 12/15/2022]
Abstract
A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from low-income, middle-income, and high-income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high-income and low-income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Several studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little effect on maternal and newborn health outcomes. Comparatively few interventions have been made for preconception diet and lifestyle. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that it is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and actions at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable diseases. Alongside continued efforts to reduce smoking, alcohol consumption, and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly, health professionals should be alerted to ways of identifying women who are planning a pregnancy.
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Affiliation(s)
- Judith Stephenson
- Institute for Women's Health, University College London, London, UK.
| | - Nicola Heslehurst
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jennifer Hall
- Institute for Women's Health, University College London, London, UK
| | | | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Lucilla Poston
- Department of Women and Children's Health, King's College London, St Thomas' Hospital, London, UK
| | | | - Sarah R Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Kalyanaraman Kumaran
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore, Karnataka, India
| | - Chittaranjan S Yajnik
- Diabetes Unit, King Edward Memorial Hospital and Research Centre, Pune, Maharashtra, India
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, Southampton General Hospital, Southampton, UK
| | - Gita D Mishra
- School of Public Health, University of Queensland, Herston, QLD, Australia
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45
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Slack E, Rankin J, Jones D, Heslehurst N. Effects of maternal anthropometrics on pregnancy outcomes in South Asian women: a systematic review. Obes Rev 2018; 19:485-500. [PMID: 29349860 PMCID: PMC5969310 DOI: 10.1111/obr.12636] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/07/2017] [Accepted: 09/26/2017] [Indexed: 12/16/2022]
Abstract
AIM This systematic review investigates associations between maternal pre-pregnancy/early-pregnancy anthropometrics (e.g. weight and body fat), anthropometric change and pregnancy outcomes in South Asian and White women. METHODS Twelve electronic literature databases, reference lists and citations of all included studies were searched. Observational studies published in the English language were included. Descriptive synthesis was used to summarize the evidence base. RESULTS Twenty-two studies met the inclusion criteria (403,609 births [351,856 White and 51,753 South Asian]). Nine were prospective cohort studies, nine were retrospective cohort studies and two were cross-sectional studies. Results suggested that in South Asian women, maternal pre-pregnancy/early-pregnancy anthropometrics were associated with anthropometric change, birthweight, mode of delivery and gestational diabetes mellitus (GDM). Gestational anthropometric change was found to be associated with GDM. There was limited evidence to suggest that there may be associations between maternal pre-anthropometrics/early anthropometrics and hypertensive disorders, stillbirth, congenital anomalies, post-natal weight retention and post-natal impaired glucose tolerance. The evidence suggested a combined effect of pre-pregnancy/early-pregnancy anthropometrics and gestational anthropometric change on both GDM and post-natal weight retention. CONCLUSION The increased risk of adverse pregnancy outcomes in South Asian women should be considered in guidelines for weight management before and during pregnancy.
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Affiliation(s)
- E. Slack
- Institute of Health & SocietyNewcastle UniversityNewcastle upon TyneUK
| | - J. Rankin
- Institute of Health & SocietyNewcastle UniversityNewcastle upon TyneUK
| | - D. Jones
- Health and Social Care InstituteTeesside UniversityMiddlesbroughUK
| | - N. Heslehurst
- Institute of Health & SocietyNewcastle UniversityNewcastle upon TyneUK
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Heslehurst N, Rankin J, McParlin C, Sniehotta FF, Howel D, Rice S, McColl E. GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING): a pilot cluster randomised controlled trial of a guideline implementation intervention for the management of maternal obesity by midwives. Pilot Feasibility Stud 2018; 4:47. [PMID: 29456871 PMCID: PMC5807844 DOI: 10.1186/s40814-018-0241-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 01/24/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Weight management in pregnancy guidelines exist, although dissemination alone is an ineffective means of implementation. Midwives identify the need for support to overcome complex barriers to practice. An evaluation of an intervention to support midwives' guideline implementation would require a large-scale cluster randomised controlled trial. A pilot study is necessary to explore the feasibility of delivery and evaluation prior to a definitive trial. The GestationaL Obesity Weight management: Implementation of National Guidelines (GLOWING) trial aims to test whether it is feasible and acceptable to deliver a behaviour change intervention to support midwives' implementation of weight management guidelines. METHODS GLOWING is a multi-centre parallel group pilot cluster randomised controlled trial comparing the delivery of a behaviour change intervention for midwives versus usual practice. Four NHS Trusts (clusters) will be randomised to intervention and control arms, stratified by size of maternity services. The intervention uses social cognitive theory and consists of face-to-face midwifery training plus information resources for routine practice. The main outcomes are whether the intervention and trial procedures are feasible and acceptable to participants and the feasibility of recruitment and data collection for a definitive trial. Target recruitment involves all eligible midwives in the intervention arm recruited to receive the intervention, 30 midwives and pregnant women per arm for baseline and outcome questionnaire data collection and 20 midwives and women to provide qualitative data. All quantitative and qualitative analyses will be descriptive with the purpose of informing the development of the definitive trial. DISCUSSION This pilot study has been developed to support community midwives' implementation of guidelines. Community midwives have been selected as they usually carry out the booking appointment which includes measuring and discussing maternal body mass index. A cluster design is the gold standard in implementation research as there would be a high risk of contamination if randomisation was at individual midwife level: community midwives usually work in locality-based teams, interact on a daily basis, and share care of pregnant women. The results of the pilot trial will be used to further develop and refine GLOWING prior to a definitive trial to evaluate effectiveness and cost-effectiveness. TRIAL REGISTRATION ISRCTN46869894; retrospectively registered 25th May 2016.
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Affiliation(s)
- Nicola Heslehurst
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Catherine McParlin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Falko F. Sniehotta
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Stephen Rice
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Elaine McColl
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
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Barber C, Rankin J, Heslehurst N. Maternal body mass index and access to antenatal care: a retrospective analysis of 619,502 births in England. BMC Pregnancy Childbirth 2017; 17:290. [PMID: 28877677 PMCID: PMC5588551 DOI: 10.1186/s12884-017-1475-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/28/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Late access to antenatal care increases risks of adverse outcomes including maternal and perinatal mortality. There is evidence that BMI influences patient engagement with health services, such as cancer screening services and delayed access to treatment; this association has not been fully explored in the context of antenatal care. This study investigated the association between the stage of pregnancy women access antenatal care, BMI, and other socio-demographic factors. METHODS Retrospective analysis of routine hospital data from 34 NHS maternity units in England, UK, including 619,502 singleton births between 1989 and 2007. Analyses used logistic regression to investigate the association between maternal BMI categories and stage of pregnancy women accessed antenatal care. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were used to estimate associations, adjusting for maternal age, ethnic group, parity, Index of Multiple Deprivation score and employment status. The primary outcome was late access to antenatal care (>13+6 weeks). Secondary outcomes were trimester of access, and the association between late access and other socio-demographic variables. RESULTS Women with an overweight or obese BMI accessed antenatal care later than women with a recommended BMI (aOR 1.11, 95%CI 1.09-1.12; aOR 1.04, 95%CI 1.02-1.06 respectively), and underweight women accessed care earlier (aOR 0.77, 95%CI 0.74-0.81). Women with obesity were 42% more likely to access care in the third trimester compared with women with a recommended BMI. Additional significant socio-demographic associations with late access included women from minority ethnic groups, teenagers, unemployment and deprivation. The greatest association was observed among Black/Black British women accessing care in the third trimester (aOR 5.07, 95% CI 4.76, 5.40). CONCLUSIONS There are significant and complex socio-demographic inequalities associated with the stage of pregnancy women access maternity care, particularly for women with obesity accessing care very late in their pregnancy, and among BME groups, teenagers, deprived and unemployed women. These populations are at increased risk of adverse maternal and fetal outcomes and require support to address inequalities in access to antenatal care. Interventions to facilitate earlier access to care should address the complex and inter-related nature of these inequalities to improve pregnancy outcomes among high-risk groups.
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Affiliation(s)
- Charlotte Barber
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Nicola Heslehurst
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
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Heslehurst N, Dinsdale S, Brandon H, Johnston C, Summerbell C, Rankin J. Lived experiences of routine antenatal dietetic services among women with obesity: A qualitative phenomenological study. Midwifery 2017; 49:47-53. [DOI: 10.1016/j.midw.2016.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/11/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
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Heslehurst N, Vieira R, Hayes L, Crowe L, Jones D, Robalino S, Slack E, Rankin J. Maternal body mass index and post-term birth: a systematic review and meta-analysis. Obes Rev 2017; 18:293-308. [PMID: 28085991 PMCID: PMC5324665 DOI: 10.1111/obr.12489] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/27/2016] [Accepted: 11/14/2016] [Indexed: 01/28/2023]
Abstract
Post-term birth is a preventable cause of perinatal mortality and severe morbidity. This review examined the association between maternal body mass index (BMI) and post-term birth at ≥42 and ≥41 weeks' gestation. Five databases, reference lists and citations were searched from May to November 2015. Observational studies published in English since 1990 were included. Linear and nonlinear dose-response meta-analyses were conducted by using random effects models. Sensitivity analyses assessed robustness of the results. Meta-regression and sub-group meta-analyses explored heterogeneity. Obesity classes were defined as I (30.0-34.9 kg m-2 ), II (35.0-39.9 kg m-2 ) and III (≥40 kg m-2 ; IIIa 40.0-44.9 kg m-2 , IIIb ≥ 45.0 kg m-2 ). Searches identified 16,375 results, and 39 studies met the inclusion criteria (n = 4,143,700 births). A nonlinear association between maternal BMI and births ≥42 weeks was identified; odds ratios and 95% confidence intervals for obesity classes I-IIIb were 1.42 (1.27-1.58), 1.55 (1.37-1.75), 1.65 (1.44-1.87) and 1.75 (1.50-2.04) respectively. BMI was linearly associated with births ≥41 weeks: odds ratio is 1.13 (95% confidence interval 1.05-1.21) for each 5-unit increase in BMI. The strength of the association between BMI and post-term birth increases with increasing BMI. Odds are greatest for births ≥42 weeks among class III obesity. Targeted interventions to prevent the adverse outcomes associated with post-term birth should consider the difference in risk between obesity classes.
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Affiliation(s)
- N. Heslehurst
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - R. Vieira
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - L. Hayes
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - L. Crowe
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - D. Jones
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - S. Robalino
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - E. Slack
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
| | - J. Rankin
- Institute of Health and SocietyNewcastle UniversityNewcastle upon TyneUK
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Dinsdale S, Azevedo LB, Shucksmith J, Newham J, Ells LJ, Jones D, Heslehurst N. Effectiveness of weight management, smoking cessation and alcohol reduction interventions in changing behaviors during pregnancy. ACTA ACUST UNITED AC 2016; 14:29-47. [DOI: 10.11124/jbisrir-2016-003162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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