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Excessive weight gain during pregnancy is common in developed countries and increases the risk of complications during pregnancy, delivery and the postpartum period, which can affect both maternal and fetal outcome. Interventions to reduce excessive gestational weight gain have previously not been systematically evaluated using the Grading of Rec...
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Citations
... The MBMM + intervention also demonstrated high demand among pregnant women due to high attendance and completion of assessments. Many existing EGWG interventions focus on testing clinical interventions in healthcare settings only [42,[79][80][81]. However, a recent systematic overview found that women who participated in group prenatal care (provider-and facilitator-led) had improved attendance rates of prenatal visits [82]. ...
Background
Excessive gestational weight gain (EGWG), insufficient prenatal physical activity and sleep, and poor psychological wellbeing independently increase risks for adverse maternal and infant outcomes. A novel approach to mitigate these risks is utilizing peer support in a community-based prenatal intervention. This study assessed the feasibility (acceptability, demand, implementation, and practicality) of a remotely delivered prenatal physical activity intervention called My Baby, My Move + (MBMM +) that aims to increase prenatal physical activity, enhance mood and sleep hygiene, and reduce EGWG.
Methods
Participants were recruited through community organizations, local clinics, and social media platforms in the Fall of 2020 and Spring of 2021. Eligible pregnant women were randomized to either the MBMM + intervention or the control group. Each group met over Zoom for 16 sessions (twice weekly for 60 min over 8 weeks) to learn either behavioral change and wellbeing knowledge and skills (MBMM +) or knowledge and skills related to parenting (control group). Multiple methods of evaluation to better understand the feasibility of the intervention were conducted.
Results
A total of 49 women (25 MBMM + intervention, 24 control) completed both pre- and post-survey assessments and were included in the analyses. A subsample of 19 (39%) intervention participants completed a combination of semi-structured interviews/surveys to assess acceptability, demand, implementation, and practicality. Participants expressed positive feedback regarding acceptability (satisfaction and intent to continue use) and were extremely likely or likely to recommend the program to a friend (demand). Implementation metrics were assessed by observation and feedback forms completed by peer leaders and demonstrated high-quality control. Findings suggest that the intervention was practical due to remote sessions and cost-effectiveness.
Conclusion
The MBMM + intervention was deemed to be a feasible intervention with high acceptability, demand, implementation, and practicality. These findings can be used to inform the scalability of the intervention and implementation of a larger efficacy trial.
Trial registration
19–1366, initial date is on January 23, 2020.
... Nevertheless, in Canada, fewer than 20% of pregnant women adhere to this recommendation [4]. Moreover, approximately 50% of pregnant women in Canada gain more than the recommended weight during their pregnancy [5], a percentage similar to other developed countries [6]. Excessive GWG is associated with an increase incidence of maternal and neonatal complications [6,7]. ...
... Moreover, approximately 50% of pregnant women in Canada gain more than the recommended weight during their pregnancy [5], a percentage similar to other developed countries [6]. Excessive GWG is associated with an increase incidence of maternal and neonatal complications [6,7]. For the mother, excess GWG increases the risk of premature birth [8] and obesity [7], having a C-Sect. ...
Background
Physical activity (PA) during pregnancy is associated with healthy gestational weight gain (GWG) and a reduced risk of developing gestational diabetes (GD), gestational hypertension (GHT) and fetal macrosomia. However, in Canada, less than 20% of pregnant women meet PA recommendations. This study assessed associations between an intervention including PA education by prenatal nurses and a PA prescription delivered by physicians and fetal and maternal outcomes.
Methods
This is a quasi-experimental study. Two groups of women who received their prenatal care at the obstetrics clinic of a university hospital were created. In the first group, 394 pregnant women followed at the clinic received standard care. In the second group, 422 women followed at the clinic received standard care supplemented with education on the relevance of PA during pregnancy and a prescription for PA. Data for both study groups were obtained from the medical records of the mothers and their newborns. Logistic regressions were used to compare the odds of developing excessive GWG, GD, GHT, and fetal macrosomia between the two study groups.
Results
The addition of PA education and PA prescription to prenatal care was associated with 29% lower odds of developing excessive GWG (adjusted odds ratios (OR) 0.71, 95% confidence intervals (CI) 0.51–0.99), 73% lower odds of developing GHT (0.27, 0.14–0.53), 44% lower odds of fetal macrosomia (> 4 kg) (0.56, 0.34–0.93), and 40% lower odds of being large for gestational age (0.60, 0.36–0.99). The intervention was not associated with a difference in odds of developing GD (0.48, 0.12–1.94).
Conclusions
The inclusion of education and prescription of PA as part of routine prenatal care was associated with improvements in maternal and fetal health outcomes, including significantly lower odds of GWG, GHT and macrosomia.
... Another assessment of trials, primarily conducted in high-income nations, found that prenatal nutrition counseling decreased excessive gestational weight gain (13). ...
Background: Maternal malnutrition is widespread throughout the world, with Sub-Saharan Africa and Asia bearing the brunt of the burden. The objective this study was to evaluate the effect of intensive nutrition education and counseling on nutritional status during pregnancy.
Methods and Materials: The study was a one-year two-arm parallel design cluster randomized controlled trial conducted in East Shoa zone, Ethiopia from January 4, 2021, to February 28, 2022. A total of 374 were enrolled in the intervention (n = 185) and control (n = 189) groups. End-line data were collected from 163 women, from each intervention and control group. The intervention package provided was a three counseling sessions by trained midwives, a 3 page take-home brochures prepared in local languages distributed and 18 weekly serial short message texts were delivered. The women in the control group received routine nutrition education from the health facilities. After adjusting for potential confounders, a linear mixed-effects model was used to assess the intervention effect.
Results: After the intervention, the mean mid-upper arm circumference in the intervention group increased by 36% (23.08 Vs 23.44, p < 0.01). Similarly, the proportion of undernutrition in the intervention group was 11% (25% Vs 36%, p = 0.02) lower compared to the control arm. At the end of the trial, women in the intervention arm had significantly better nutritional status than women in the control group (β = 0.47, p < 0.01).
Conclusion: The finding showed that intensive nutrition education and counseling using the health belief model was effective in improving nutritional status and reducing under nutrition among pregnant women. As a result, nutrition education and counseling using HBM constructs, as well as regular reminder messages, should be provided to pregnant women as part of the routine antenatal care service.
... In observational studies, excessive GWG and pregravid obesity were associated with greater risk of adverse perinatal outcomes [4][5][6][7][8] and risk of infant macrosomia or large-forgestational age rises with maternal pregravid obesity and excessive GWG [9][10][11][12]. The experimental intervention in the Be Healthy in Pregnancy (BHIP) randomized controlled trial (RCT) [13] was grounded in a synthesis of existing systematic reviews of RCTs with varying intervention strategies that suggested the most convincing approach to achieve reduction in GWG was a combination of physical activity and individualized diet counselling, preferably in combination with weight monitoring [14][15][16]. ...
A randomized two-arm prospective superiority trial tested the efficacy of a novel structured and monitored nutrition (bi-weekly counselling for individualized energy and high dairy protein diet) and exercise program (walking goal of 10,000 steps/day) (intervention) compared to usual care (control) in pregnant women to achieve gestational weight gain (GWG) within current recommendations. Women recruited in communities in southern Ontario, Canada were randomized at 12–17 weeks gestation with stratification by site and pre-pregnancy BMI to intervention (n = 119) or control (n = 122). The primary outcome was the proportion of women who achieved GWG within the Institute of Medicine recommendations. Although the intervention compared to control group was more likely to achieve GWG within recommendations (OR = 1.51; 95% CI (0.81, 2.80)) and total GWG was lower by 1.45 kg (95% CI: (−11.9, 8.88)) neither reached statistical significance. The intervention group achieved significantly higher protein intake at 26–28 week (mean difference (MD); 15.0 g/day; 95% CI (8.1, 21.9)) and 36–38 week gestation (MD = 15.2 g/day; 95% CI (9.4, 21.1)) and higher healthy diet scores (22.5 ± 6.9 vs. 18.7 ± 8.5, p < 0.005) but step counts were similar averaging 6335 steps/day. Pregnancy and infant birth outcomes were similar between groups. While the structured and monitored nutrition with counselling improved diet quality and protein intake and may have benefited GWG, the exercise goal of 10,000 steps/day was unachievable. The results can inform future recommendations for diet and physical activity in pregnancy.
... Another review of studies, largely in high-income countries reported variations in effectiveness of different intervention methods on gestational weight gain. Authors concluded that the studies were few and the evidence was of insufficient quality to draw specific conclusions strong enough to make evidence-based recommendations in clinical antenatal care [11]. A later review shows that NEC significantly reduce the risk of anaemia in late pregnancy, increase birthweight and lower the risk of preterm delivery, but the effect on risk of low birthweight is not significant. ...
... The provision of nutrition advice by health professionals to pregnant women is limited, with lack of practitioner education being indicated as one of the obstacles to the provision of such advice [10,11]. Research has reported that nutrition education received by doctors is inadequate [13][14][15], however, midwives' nutrition education and services has received little attention. ...
Introduction:
A healthy and balanced diet is very important during pregnancy. By enhancing maternal nutritional status, healthcare providers can lower the risks of pregnancy complications and adverse birth outcomes.
Objectives:
To assess the pre-natal nutrition knowledge and services rendered by healthcare providers in antenatal clinics at Primary Health care Centres in Lagos, Nigeria.
Methodology:
This was a cross-sectional study carried out in June-September 2019. Self-administered questionnaires were used to collect data on nutritional knowledge from 391 nurses and midwives who provided pre-natal nutrition education. Direct observation with checklist was used to assess the nutrition education services at the ANC clinics and covered: adequacy of the venue, availability/use of nutrition education resources, education content and teaching strategies. EPi-Info version 3.5 was used for data analysis. Inferential statistics such as chi square and multiple logistic regression were used to determine associated factors and predictors of nutrition knowledge. The level of significance was set at 5% (p<0.05).
Results:
The mean age of respondents was 41.71±10.33years, all were females; 44.8% were Registered Nurses, 12.0% were Registered Midwives, and 23.8% had a B.Sc. in Nursing. Majority (81.3%) had taken a nutrition course in nursing training program, 62.1% as elective classes. Majority (81.1%) had good knowledge of prenatal nutrition. Respondents who were older (51-60years) (p<0.001), single (p<0.001) and Christian (p = 0.001) had significantly better knowledge. Nurses who had University degrees (p<0.001), of higher cadre (p<0.001), more years of practice (p<0.001) and involved in treating severely malnourished children (p = 0.013) were also significantly more knowledgeable. Respondents below 40 years (OR 0.104, CI 0.049-0.218) and those with 10 years or less of practice (OR 0.189, CI 0.092-0.387) had less odds of having good nutrition knowledge. Being single (OR 8.791, CI 3.125-24.731), and Christian (OR = 5.810, CI: 3.321-10.164) predict good nutrition knowledge. In 39% of the 41 PHCs observed, quality of nutrition education services was inadequate. Gaps were mainly in availability of certain nutrition education facilities/resources and teaching strategies.
Conclusion:
The majority of the respondents had good knowledge of pre-natal nutrition. Overall, however, nutrition education services provided by two-fifths of the facilities were inadequate. Interventions to improve prenatal nutrition knowledge of nurses/midwives should be focused more on those who are younger and have less work experience. All necessary equipment required for health service providers to execute their roles as nutrition counselors and educators should also be provided by the government.
... Non-pharmacological trials to prevent GDM, including multidimensional coaching, [56,57], intensive dietary counselling [59,60], and/or physical activity promotion [61], are few, frequently non-randomized, and have heterogeneous designs and outcomes [62,63]. The current evidence does not suggest an optimal prevention strategy [64,65]. ...
South Asians (i.e., people who originate from India, Pakistan, Sri Lanka, Nepal, and Bangladesh) have higher cardiovascular disease rates than other populations, and these differences persist in their offspring. Nutrition is a critical lifestyle-related factor that influences fetal development, and infant and child health in early life. In high-income countries such as Canada, nutrition-related health risks arise primarily from overnutrition, most strikingly for obesity and associated non-communicable diseases. Evidence for developmental programming during fetal life underscores the critical influence of maternal diet on fetal growth and development, backed by several birth cohort studies including the Pune Maternal Nutrition Study, the South Asian Birth Cohort Study, and the Born in Bradford Study. Gestational diabetes mellitus is a strong risk factor for type 2 diabetes, future atherosclerosis and cardiovascular disease in the mother and increases the risk of type 2 diabetes in her offspring. Non-pharmacological trials to prevent gestational diabetes are few, often not randomized, and are heterogeneous with respect to design, and outcomes have not converged upon a single optimal prevention strategy. The aim of this review is to provide an understanding of the current knowledge around perinatal nutrition and gestational diabetes among the high-risk South Asian population as well as summarize our research activities investigating the role of culturally-tailored nutrition advice to South Asian women living in high-income settings such as Canada. In this paper, we describe these qualitative and quantitative studies, both completed and underway. We conclude with a description of the design of a randomized trial of a culturally tailored personalized nutrition intervention to reduce gestational glycaemia in South Asian women living in Canada and its implications.
... Studienergebnisse zur perinatalen Programmierung weisen darauf hin, dass das Risiko für Übergewicht und chronische Erkrankungen des Kindes bereits während der Schwangerschaft durch den mütterlichen Lebensstil beeinflusst werden kann [5][6][7]. Darüber hinaus gilt die Schwangerschaft als günstige Phase für Lebensstilveränderungen, da in vielen Fällen besondere Motivation zur Verhaltensänderung besteht [8]. Die Strukturen der Schwangerschaftsvorsorge und Kinderuntersuchungen bieten auch deshalb großes Potenzial für Präventionsmaßnahmen, da neben der bereits angesprochenen günstigen Erreichbarkeit aller sozialen Gruppen, die Häufigkeit der Vorsorgetermine in dieser Lebensphase eine hohe Interventionsfrequenz ermöglicht. ...
Zusammenfassung
Einleitung
Übergewicht und Adipositas sind ein wichtiges Public Health Problem in Deutschland. Aufgrund der guten Erreichbarkeit von Patient*innen bietet das Setting der Arztpraxis ein hohes Potenzial für Prävention. Die bisher zurückhaltende Umsetzung von Präventions- und Gesundheitsförderungsmaßnahmen in Arztpraxen weist allerdings darauf hin, dass Hürden bei der Implementierung bestehen. Die vorliegende Studie beschäftigt sich daher damit, wie Interventionen zur Übergewichtsprävention gestaltet und implementiert werden sollten, damit sie als angemessen wahrgenommen werden und Leistungsbringer bereit sind, diese in ihrem Praxisalltag umzusetzen. Die Untersuchung wird exemplarisch anhand des Innovationsfondsprojektes „GeMuKi“ durchgeführt. Ziel ist es, eine Präventionsmaßnahme im Rahmen der Schwangerschafts- und Kindervorsorgeuntersuchungen zu implementieren.
Methoden
Es wurde eine Mixed-Methods Studie durchgeführt. Die Datenerhebung fand im Rahmen der GeMuKi-Fortbildung statt, die die Leistungserbringer zur Vorbereitung auf die Durchführung der Intervention absolvieren. Frauenärzt*innen, Kinder- und Jugendärzt*innen, Hebammen und Medizinische Fachangestellte füllten hierzu einen Fragebogen aus. Die Fragen betrafen die Implementierungsoutcomes „Angemessenheit“ und „Umsetzungsbereitschaft“. Über Freitextfelder konnten Angaben zu Umsetzbarkeit, erwarteten Erfolgsfaktoren und Hürden gegeben werden. Zudem wurden Beobachtungsprotokolle zu jeder Fortbildung angefertigt. Geschlossene Fragen wurden deskriptiv statistisch ausgewertet. Offene Fragen und Protokolle wurden anhand der inhaltlich strukturierenden qualitativen Inhaltsanalyse ausgewertet.
Ergebnisse
Es liegen Daten von 401 Leistungserbringern vor. Fast drei Viertel (73%) der Leistungserbringer gibt an, motiviert zu sein, die Präventionsmaßnahme umzusetzen. Gleichzeitig werden Bedenken hinsichtlich der organisatorischen Umsetzbarkeit im Praxisalltag geäußert. Dennoch erwarten 72%, dass sich ihre Beratung durch das Projekt verbessern wird.
Schlussfolgerung
Die befragten Leistungserbringer stehen der Umsetzung einer präventiven Lebensstilberatung im Praxisalltag positiv gegenüber. Durch die Erhebung von Faktoren, die die Implementierung beeinflussen, können identifizierte Hürden adressiert werden.
... A meta-analysis of randomized controlled trials of lifestyle interventions for pregnant women of normal BMI did not find an association with offspring macrosomia or LBW [40]. Study differences such as sample size, timing of the assessment of maternal diet quality/lifestyle during 3rd trimester [39] (which may be more relevant for offspring adiposity development than the first trimester when they were assessed in our study), population differences (only 3 of the 12 studies were in Europe) [41][42][43], and restriction to normal BMI range in other study [40], may partially explain the contradictory results of our study. An overall healthy maternal lifestyle during pregnancy was associated with favorable offspring outcomes including reduced risk of LBW and childhood overweight and obesity at age 5 and 9. Offspring of women who adhered to five healthy lifestyle factors (a high quality diet, normal body weight, moderate to vigorous PA, non to moderate intake of alcohol, and non-smoking) had lower risk of incident overweight and obesity than children of mothers who did not adhere to any of the healthy lifestyle factors. ...
Maternal adherence to healthy lifestyle behaviors during pregnancy has been associated with reduced risk of obesity in the offspring. Our objective is to examine associations between a composite healthy lifestyle score (HLS) in expectant mothers and adverse offspring birth outcomes and childhood obesity.
The Lifeways Study comprises 665 mother–child pairs. A composite HLS (scored 0–5) based on high dietary quality (top 40% of the Healthy Eating Index (HEI)-2015), moderate to vigorous physical activity (MVPA), healthy pre-pregnancy BMI (18.5–24.9 kg/m²), never smoker, and no/moderate alcohol intake was calculated. Birth outcomes were abstracted from hospital records. Offspring waist circumference (WC) and BMI was determined at age 5 and 9. Logistic regression tested HLS associations with offspring outcomes.
Offspring birth weight, length, and head circumference were positively associated with the maternal HLS (p < 0.001), whereas child BMI and incidence of overweight/obesity at age 5 and 9 were negatively associated (p < 0.05). In multivariable models, a lower maternal HLS was associated with increased risk of low birth weight (LBW) (P trend = 0.04) and lower likelihood of macrosomia (P trend = 0.03). Examined individually, poor maternal dietary quality, smoking, and alcohol intake were associated with higher risk of LBW (p < 0.04). Likelihood of macrosomia and combined overweight/obesity at age 5 and 9 years were greater among mothers with a pre-pregnancy BMI in the range with obesity (p < 0.04). Smoking during pregnancy was also linked to greater risk of childhood overweight/obesity (OR:1.91, 95% CI:1.01–3.61, p = 0.04 at age 5 and OR: 2.14, 95% CI:1.01–4.11, p = 0.03 at age 9).
Our findings suggest that maternal adherence to a healthy lifestyle during pregnancy, in particular having a good quality diet, not smoking, and no/low alcohol intake in combination with a healthy pre-pregnancy BMI, is associated with reduced risk of adverse offspring birth outcomes and childhood obesity.
... Some studies of nutritional interventions during pregnancy have demonstrated their efficacy in reducing GWG (10,11). These studies are usually designed as high-intensity interventions with small sample sizes, thus limiting their applicability in routine care (11,12). ...
... Some studies of nutritional interventions during pregnancy have demonstrated their efficacy in reducing GWG (10,11). These studies are usually designed as high-intensity interventions with small sample sizes, thus limiting their applicability in routine care (11,12). Further research is needed to confirm the effectiveness of high-coverage interventions on maternal and offspring outcomes and to assess the feasibility and ability of health care systems to deliver these interventions (11,13,14). ...
... These studies are usually designed as high-intensity interventions with small sample sizes, thus limiting their applicability in routine care (11,12). Further research is needed to confirm the effectiveness of high-coverage interventions on maternal and offspring outcomes and to assess the feasibility and ability of health care systems to deliver these interventions (11,13,14). ...
Background:
Some nutritional interventions have shown their efficacy in reducing gestational weight gain (GWG); however, their applicability in routine care is limited.
Objective:
We assessed the effectiveness of a low-intensity and high-coverage nutritional intervention on maternal and offspring outcomes; the intervention enhanced existing nutritional health care standards and practices at the primary health care level in Chile.
Methods:
This study was a cluster-randomized controlled trial of 12 primary health care centers (PHCCs) from Santiago, Chile. PHCCs were randomly allocated to either nutritional intervention [intervention group (IG), n = 5] or routine care [control group (CG), n = 7]. A total of 4631 pregnant women were recruited (IG, n = 2565; and CG, n = 2066). Primary outcomes were adequate GWG and glycemic control in mothers and birth weight, birth length, macrosomia, and large for gestational age in neonates. The intervention consisted of 4 key actions: training of health care professionals on nutritional recommendations, counseling of pregnant women on diet and physical activity recommendations, offering a physical activity program implemented in the participating PHCCs, and adequate referral to dietitians. Women randomly assigned to the CG received routine antenatal care.
Results:
At baseline, the mean age was 26.1 y; 45% of women were primipara and 24% were obese. No differences were found in the percentage of women achieving adequate GWG (IG: 30.3%, compared with CG: 31.3%; OR: 0.94; 95% CI: 0.81, 1.09), but women in the IG had lower GWG than those in the CG (11.3 compared with 11.9 kg; mean difference: -0.63 kg; 95% CI: -1.19, -0.08). Effects of the intervention were significantly higher in women with obesity at the begining of pregnancy (mean difference: -1.24 kg; 95% CI: -2.18, -0.30; P for interaction < 0.05). No differences were found between groups regarding maternal glycemic control or neonatal outcomes.
Conclusions:
Our findings demonstrate that a low-intensity, high-coverage intervention delivered through the Chilean public health care system under standard operating conditions reduces GWG and has the potential for successful scale-up. This trial was registered at clinicaltrials.gov as NCT01916603.
... Systematic reviews have shown that nonpharmacologic trials to encourage lifestyle changes during pregnancy, including multidimensional coaching (9,10), intensive dietary counselling (11,12) and/or physical activity (13), are rare, often not randomized and are heterogeneous with respect to design and outcomes (14,15). When analyzed together, however, the results are encouraging. ...
Objectives:
People of South Asian ancestry are the fastest growing non-Caucasian ethnic group in Canada and are at high risk for developing type 2 diabetes and coronary heart disease. Pregnant South Asian women have a 2-fold increased risk of developing gestational diabetes, which increases their risk of type 2 diabetes and coronary heart disease. The specific objectives of this study were to explore the perceptions of health behaviours (diet and physical activity) during pregnancy in the South Asian community.
Methods:
We used interpretive description to further understand the cultural and contextual factors that influence the knowledge, attitudes and practices of diet and physical activity of South Asian women of childbearing age and those who provide health care to this group.
Results:
Two major themes that emerged from the perspectives of 10 South Asian pregnant women included: (1) importance of considering an individual's locus of control; and (2) support (emotional and information exchange) from family, friends and health-care providers. Two major themes identified by the 11 health-care providers were: (1) cultural awareness in caring for South Asian women during pregnancy; and (2) clinic management, logistics and resources. A common theme for both South Asian pregnant women and health-care providers was the importance of considering the cultural landscape in relation to how knowledge is obtained, shared and valued.
Conclusion:
A better understanding of these cultural underpinnings may support the development of interventions tailored for pregnant South Asian women and their health-care providers.
