Article

Antenatal weight management: Diet, physical activity, and gestational weight gain in early pregnancy

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Abstract

Objective: to investigate women's physical activity levels, diet and gestational weight gain, and their experiences and motivations of behavior change. Design: analysis of cross-sectional data collected during a longitudinal, cohort study examining physiological, psychological, sociodemographic, and self-reported behavioural measures relating to bodyweight. Setting: women recruited from routine antenatal clinics at the Nottingham University Hospitals NHS Trust. Participants: 193 women ≤27 weeks gestation and aged 18 years or over. MEASUREMENTS & FINDINGS: measurements included weight and height, the Dietary Instrument for Nutrition Education (Brief Version), the International Physical Activity Questionnaire (Short Form), and open questions of perceptions of behaviour change. 50.3% (n=97) were overweight/obese, and women gained 0.26kg/wk (IQR 0.34kg/wk) since conception. The majority consumed low levels of fat (n=121; 63.4%), high levels of unsaturated fat (n=103; 53.9%), and used a dietary supplement (n=166; 86.5%). However, 41% (n=76) were inactive, 74.8% (n=143) did not consume high levels of fibre, and 90.0% (n=171) consumed less than 5 portions of fruit and vegetables a day. Body mass index category was not associated with diet, physical activity levels, or gestational weight gain. Themes generated from open-questions relating to behaviour change were: (1) Risk management, (2) Coping with symptoms, (3) Self-control, (4) Deviation from norm, (5) Nature knows best. Conclusions: early pregnancy is a period of significant and heterogeneous behaviour change, influenced by perceptions of risk and women's lived experience. Behaviour was influenced not only by perceptions of immediate risk to the fetus, but also by the women's lived experience of being pregnant. Implications for practice: There are exciting opportunities to constructively reframe health promotion advice relating to physical activity and diet in light of women's priorities. The need for individualized advice is highlighted, and women across all body mass index categories would benefit from improved diet and physical activity levels.

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... Letting pregnancy run its course (11/20 studies) Women referenced pregnancy as a 'free pass' to undertake indulgent behaviour and consume unhealthy foods ( Dinsdale et al., 2016 ;Keely et al., 2017 ;McMillan et al., 2018 ;Padmanabhan et al., 2015 ;Swift et al., 2017 ). Some women reported 'embracing' this temporary pause in healthy behaviour and feeling liberated with their attitude to weight. ...
... ( Dinsdale et al., 2016 ) Weight gain was seen by some as synonymous with pregnancy and necessary for the health of the baby. Therefore, less concern was shown to the implications of GWG and the consumption of less healthy foods ( McMillan et al., 2018 ;Padmanabhan et al., 2015 ;Swift et al., 2017 ;Weir et al., 2010 ). Whilst some women were untroubled by 'inevitable' weight gain and believed that GWG would disappear postnatally ( Heslehurst et al., 2013 ;Weir et al., 2010 ), others were anxious about this prospect and less able to relinquish control of their body ( Arden et al., 2014 ;Padmanabhan et al., 2015 ). ...
... Behavioural beliefs and attitudes, Control beliefs, Normative beliefs maintaining their regular activity levels and had a subsequent effect on weight management ( Draffin et al., 2016 ;Swift et al., 2017 ). Furthermore, consuming a healthy diet was compromised by nausea, heartburn and food cravings ( Arden et al., 2014 ;Bouga et al., 2018 ;Denison et al., 2015 ;Swift et al., 2017 ). ...
Article
Objectives: To understand UK women's experiences of antenatal dietary advice for risk of food borne illness and weight gain. Design: A systematic review and thematic synthesis of peer-reviewed qualitative studies. PubMed, MEDLINE, CINAHL and PMC databases were searched for articles published from January 2008 to June 2018. The search strategy combined terms for pregnancy with terms for body composition, weight change, food safety, nutrition, diet and qualitative terminology. Studies were eligible for inclusion if (1) they explored experiences of implementing advice received during pregnancy for nutrition, physical activity and/or weight gain, and (2) participants were women who had experienced maternity care in the UK. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool. Findings: Of 25,688 articles identified by the search strategy, 20 studies were identified that met the inclusion criteria. Five major themes were recognised: control, barriers to diet and exercise, motivators, relationship with weight, and information, with a further 12 subthemes. The majority of studies reported on weight gain (n = 10). Key conclusions: Evidence shows that UK antenatal dietary advice is currently inconsistent, vague and overwhelming despite pregnancy being an excellent time for lifestyle change. Women are primarily driven by the health of their baby and desire support to facilitate positive changes. Implications for practice: Findings outline a wishlist which highlights a desire for tailored information on preventing weight gain, dietary requirements, safe physical activity and a deprioritisation of food safety guidelines. This provision should be delivered by HCP. e.g. midwives, in a sensitive and supportive way to bridge the gap between women's needs and the current antenatal provision.
... Despite recognised public health guidelines encouraging PA during pregnancy, PA levels often decline during pregnancy, particularly during the second and third trimesters, and remain low until at least three months after birth [3], or completely cease [4]. A possible reason for this decline is that women are more likely to change the type of PA they engage in (i.e. ...
... switching to lower intensity activities which may not provide as many health benefits [3]). Women may also cease their PA as a result of their lived experiences of being pregnant and/or their perceptions of possible risk to the fetus [4]. ...
Article
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Background: Physical activity (PA) tends to decline during pregnancy, and remains low in the early postpartum period, despite the known physical and psychological benefits. This study aimed to explore: (1) women's experiences of PA during pregnancy and following birth; and (2) decision-making processes related to PA during this time. Methods: Semi-structured telephone interviews were conducted with 16 women who were either pregnant or had recently given birth. Interviews were transcribed verbatim and analysed using thematic analysis. Results: There were two over-arching themes: (1) ownership of body, which consisted of the sub-themes: others try to take ownership, important to maintain fitness into pregnancy and motherhood, expectations of PA, and pressure to conform; and (2) unknown territory, which consisted of the sub-themes: engaging in PA with caution, and unclear advice. Decision-making about PA during pregnancy was influenced by: pressure from others who felt responsible to protect the woman from coming to harm; pressure from social media to lose weight postpartum; participant's beliefs about the benefits of maintaining fitness and participants expectations of how active they thought they would be able to be during pregnancy. Participants felt that pregnancy was an 'unknown territory' in terms of the unfamiliar feelings in their body and the inability to continually monitor their baby for reassurance of baby's health. Advice received from midwives was often lacking, or not tailored to the individual. Advice from friends and family was often regarded as incorrect, but still caused doubt and fear of PA during pregnancy. Conclusions: These findings contribute to the understanding of women's experiences of PA during pregnancy and post-partum, and their decision-making processes about PA during pregnancy. Developing accurate and tailored advice as part of midwifery care, that considers the physical and psychological aspects of engaging in PA during pregnancy, will help to ensure that women are supported to make informed decisions about their PA behaviour.
... Quality nutrition and physical activity are paramount to ensure the well-being of both mother and child, as the fetal environment plays a pivotal role in the lifelong health status of a newborn [7][8][9]. In the United States, almost one-third of pregnancies begin with a mother who is classified as overweight or obese by body mass index (BMI) [10][11][12][13][14]. ...
Article
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The transition from pregnancy through early postpartum can be a particularly vulnerable time for women as they adjust to the changes of motherhood. This study aimed to provide a detailed account of additional health challenges that mothers are facing throughout motherhood during the pandemic. Data obtained can be utilized to create tailored interventions to aid women during their reproductive years. A sequential approach was utilized, collecting health-related information via survey and subsequent focus groups or interviews to further examine health experiences during pregnancy or postpartum. Fifty-seven participants completed the online survey, 73.5% were postpartum. The healthy eating index of the cohort was low, 50.5 ± 10.3%. Prior to pregnancy, 54.5% were classified as overweight/obese. Following pregnancy, 71.1% were classified as overweight or obese. Emergent qualitative themes from focus groups (n = 3) and interviews (n = 6) included (1) value and desire for healthy eating, (2) desire to make well-informed health-based decisions, and (3) role of social networks during pregnancy and postpartum. Pregnant/postpartum women desire to lead a healthy lifestyle but experience barriers to accomplishing intended goals. Upstream resources and policies that promote healthy living for pregnant/postpartum women can reduce chronic disease throughout the lifespan following childbirth.
... Having a healthy diet and being physically active during pregnancy can have benefits for the mother and her baby, including improved cardiorespiratory fitness, reduction in gestational diabetes and caesarean section [6][7][8][9]. However, physical activity levels tend to decline throughout the course of pregnancy and dietary quality is often suboptimal [10,11]. Poor maternal diet and physical activity behaviours can be associated with both pre-pregnancy obesity and excessive gestational weight gain, which further increases risks to mother and fetus (including gestational diabetes, pre-eclampsia, macrosomia, caesarean section and pre-term birth), and have implications for healthcare resources [12][13][14]. ...
Article
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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.
... However, they also referred to the normalisation of obesity in pregnant women (with direct reference to rates of obesity during pregnancy) and suggested that this, together with their high workload and lack of resources, explained the reasons why systematic advice was not part of standard antenatal care. Midwives and pregnant women, of all BMI categories, should be encouraged to access and implement the most up-to-date evidence base, and need to fully personalise healthy eating and weight management advice (NICE, 2016;Swift at al., 2017). Midwives are capable of engaging pregnant women in health behaviour change discussions (e.g. ...
Article
Midwives’ knowledge and experiences of providing weight management advice to pregnant women - Volume 76 Issue OCE3 - M.T. McCann, L.M. Newson, M.S. Charnley, J.S. Rooney, C. Burden, J.C. Abayomi
... Encouraging health promoting behaviour change is far from simple and there has been much interest recently in how clinicians and others in relevant positions go about offering lifestyle advice and whether there may be certain points in life (e.g. pregnancy and parenthood) that present 'teachable moments' (84) . Unless delivered in an appropriate way, a person's motivation to change often declines. ...
Article
Background Although lifespan is increasing, there is no evidence to suggest that older people are experiencing better health in their later years than previous generations. Nutrition, at all stages of life, plays an important role in determining health and wellbeing. Methods A roundtable meeting of UK experts on nutrition and ageing considered key aspects of the diet–ageing relationship and developed a consensus position on the main priorities for research and public health actions that are required to help people live healthier lives as they age. Results The group consensus highlighted the requirement for a life course approach, recognising the multifactorial nature of the impact of ageing. Environmental and lifestyle influences at any life stage are modified by genetic factors and early development. The response to the environment at each stage of life can determine the impact of lifestyle later on. There are no key factors that act in isolation to determine patterns of ageing and it is a combination of environmental and social factors that drives healthy or unhealthy ageing. Too little is known about how contemporary dietary patterns and sedentary lifestyles will impact upon healthy ageing in future generations and this is a priority for future research. Conclusions There is good evidence to support change to lifestyle (i.e. diet, nutrition and physical) activity in relation to maintaining or improving body composition, cognitive health and emotional intelligence, immune function and vascular health. Lifestyle change at any stage of life may extend healthy lifespan, although the impact of early changes appears to be greatest.
... Nevertheless, pregnancy often motivates women to change towards a healthy nutritional behavior [28,29]. However, women's capability to implement a healthy diet is determined not only by socioeconomic factors [30,31], but also by nutritional knowledge and familiarity with recommendations [32]. ...
Article
Full-text available
Pregnancy is a period in life in which women are willing to improve their lifestyle. Providing proper information for these women is crucial for their health and the health of their offspring. Clear information about weak points in their nutritional and weight gain knowledge is the first step for proper health care assistance. There are a few previous studies evaluating the nutritional and weight gain knowledge of pregnant women. In the few studies available, different approaches were taken and there was no wider discussion on the content of the questionnaires attempting to measure level of knowledge. The aim of this study, designed in a pilot fashion, was to test the adequacy of the questionnaire as a research instrument in a group of 139 pregnant Polish women. The developed instrument is a 33-item questionnaire comprising four domains: weight gain, importance of nutrients, quality and quantity of food intake. The results of this study indicate that the questionnaire is stable and internal consistency is acceptable (Cronbach’s alpha > 0.7) for dimensions with more than four items. For dimensions with less than four items, internal consistency was poor (Cronbach’s alpha < 0.7). The cumulative explained variance for domains weight gain, importance of nutrients, quantity and quality of food intake was 54.74%, 42.74%, 54.42% and 48.99% respectively. Results from validity, reliability and factor analysis indicate that the questionnaire is adequate for its purpose.
... Most interventions target lifestyle changes during pregnancy, e.g. managing excessive gestational weight gain by means of diet or physical activity ( Hill et al., 2016 ;Swift et al., 2017 ). Other common areas targeted by interventions are antenatal substance use e.g. ...
Article
Full-text available
Objectives: Behaviour change programmes (BCPs) for pregnant women are frequently implemented as part of health promotion initiatives. At present, little is known about the types of behaviour change programmes that are being implemented and whether these programmes are designed and delivered in accordance with the principles of high quality maternity care. In this scoping review, we provide an overview of existing interventions related to behaviour change in pregnancy with a particular emphasis on programmes that include empowerment components to promote autonomy and woman-led decision-making. Methods: A systematic search strategy was applied to check for relevant papers in August 2017 and again in October 2018. Results: Thirty studies met the criteria for inclusion. These studies addressed weight management, smoking cessation, general health education, nutrition, physical activity, alcohol consumption and dental health. The main approach was knowledge gain through education. More than half of the studies (n = 17) included three or more aspects of empowerment as part of the intervention. The main aspect used to foster women`s empowerment was skills and competencies. In nine studies midwives were involved, but not as programme leaders. Conclusions: Education for knowledge gain was found to be the prevailing approach in behaviour change programmes. Empowerment aspects were not a specific focus of the behaviour change programmes. This review draws attention to the need to design interventions that empower women, which may be beneficial through their live. As midwives provide maternal healthcare worldwide, they are well-suited to develop, manage, implement or assist in BCPs.
... Additionally, in their study, Swift et al. 53 pointed out that adequate nutritional care in prenatal care provides a window of opportunity for the development of improvements in the food standard, specifically benefiting the mother-child binomial. Furthermore, Claesson et al. 54 observed in their study that a prenatal follow-up in an appropriate gestational weight gain program seems to have a positive effect on the woman's weight in up to six years postpartum, preventing complications and future risks. ...
Article
Full-text available
This article aims to evaluate the associated factors with excessive weight gain in pregnant women from Maceió, the capital of Alagoas, Northeastern Brazil. Cross-sectional study with pregnant women attended in public health in the city of Maceió in 2014, of which socioeconomic, clinical (glycemia, capillary hemoglobin, and blood pressure measurement), dietary, and anthropometric data, including in the latter gestational weight gain, classified as insufficient, adequate and excessive according to the US Institute of Medicine, were collected. The combination of excessive weight gain with the independent variables was tested using the Poisson regression expressed by the Prevalence Ratio (PR) and a 95% confidence interval (CI95%). We studied 403 pregnant women with a mean age of 24.08 ± 6.01 years, with 19.9% of them displayed insufficient weight gain; 14.1% displayed adequate weight gain, and 66.0% displayed excessive weight gain, that was associated with maternal hyperglycemia (PR = 1.35; CI95% = 1.17 to 1.57; p < 0.001). Excessive weight gain is common among pregnant women evaluated with the association of this variable with maternal hyperglycemia.
... risk to the fetus, which provides an exciting "window of opportunity" for motivating healthy behaviors [26]. An observational study demonstrated that a healthy lifestyle, including physical activity, dietary patterns, smoking and stress, during early pregnancy was associated with substantially lower GDM risk after adjustment for maternal age, race, and parity [27]. ...
Article
Full-text available
BACKGROUND Women with normal fasting glucose (FPG) range (5.1 ≤FPG <6.09 mmol/L) in early pregnancy are at high risk of gestational diabetes mellitus (GDM). The aim of this study was to compare the effectiveness of routine antenatal care with a midwife-managed clinic service in the prevention of GDM in early pregnancy at a hospital in China. MATERIAL AND METHODS We designed a prospective observational clinical study among pregnancy women with normal fasting glucose (FPG) range (5.1 ≤FPG <6.09 mmol/L) in early pregnancy. Routine antenatal care was compared with a midwife-managed clinic service providing diet and exercise education before week 16. A 75-g OGTT was performed at weeks 24-28 for both groups. Results of OGTT and gestational weight gain were compared between the 2 groups. RESULTS Of the 592 eligible women, 296 women received the antenatal nursing clinic service and 296 were enrolled in a control group. Thirty-three women were lost to follow-up during the study, leaving 279 in the intervention group and 280 in the control group. Baseline demographic characteristics were similar between the 2 groups. GDM was diagnosed in 115 participants (41.2%) in the intervention group and 141 (50.4%) in the control group. Subgroup analysis showed a significantly lower rate of GDM in the intervention group among the No-IVF population (37.8% vs. 49.0%, P=0.01%). For pre-pregnancy BMI, significant differences were found in the incidence of GDM and maternal hypertension between the different groups, showing that the overweight group benefited most from the midwife-managed antenatal clinic service. CONCLUSIONS The midwife-managed clinic service was feasible and effective in the prevention of GDM.
... A review of the existing literature reveals that women identify many enablers to maintaining a healthy weight gain during pregnancy. Women identified pregnancy as an important time, and were motivated by the positive foetal and maternal health benefits associated with a healthy lifestyle [1,[16][17][18][19]. Women identified that they were more likely to maintain a healthy weight gain in pregnancy when they had a healthy lifestyle pre-pregnancy, had social support, access to pregnancy-specific exercise programmes, and practical supports such as access to childcare and transport [1,16,17,20]. ...
Article
Background: The amount of weight gained in pregnancy has the potential to impact the health of a woman and her baby in the short and long term. The existing literature demonstrates that women identify several barriers and enablers to maintain healthy weight gain in pregnancy. Understanding these barriers and enablers assists practitioners and maternity services to better support women to maintain healthy gestational weight gain. Aim: While the existing literature is largely focussed on women who are overweight or obese, this paper aims to explore the experiences of women from a range of pre-pregnancy body mass index (BMI) categories regarding their weight gain in pregnancy. Method: Fifteen women from the Australian Capital Territory participated in semi-structured interviews in the postpartum period to explore the barriers and enablers for healthy weight gain in pregnancy. Qualitative data were analysed using descriptive thematic analysis techniques. Findings: Women identified several barriers and enablers to maintain healthy weight gain in pregnancy. These included pregnancy-related physiological changes, personal and cultural attitudes and beliefs, availability of psychological support, social and community networks, attitudes and advice from their treating health professionals, and availability of education. Discussion: This study is consistent with existing literature in confirming that women experience a range of personal, social, and cultural factors that impact upon weight gain in pregnancy. Participants identified inconsistent education and advice regarding gestational weight gain. This has clinical implications for clinicians and maternity services for improvement in the education and support of pregnant women regarding weight gain in pregnancy.
... A 5-to 10-year follow-up of women after these interventions would provide useful information on the long-term effectiveness of such interventions. Point 3: Swift et al. (150) showed that "early pregnancy" is a period of significant and heterogeneous behavior change, which is prejudiced by women's lived experience and their perceptions of risk. As such, the time scale for pregnancy-based interventions needs to be established to maximize the advantages of an active pregnancy. ...
Article
Best-practice guidance and management of pregnant and postpartum elite athletes and women in arduous occupations is limited by the lack of high-quality evidence available within these populations. We have summarised the adaptations and implications of pregnancy and childbirth; proposed a novel integrative concept to address these changes; and made recommendations to progress research in this area.
... Numerous studies have highlighted the important role that social, and practical or environmental factors play in women's decision-making around their health during pregnancy (Harrison et al., 2018;Omidvar et al., 2018;O'Brien et al., 2017). Furthermore, physical pregnancy symptoms are commonly cited as a barrier to behaviour change, particularly in relation to dietary behaviour and physical activity (Foxcroft et al., 2011;Harrison et al., 2018;Swift et al., 2017). As such, and as these factors were also captured in the COM-B model, the addition of a construct reflecting nonpsychological factors may enhance the overall utility of the TM model within the context of pregnancy. ...
Article
Full-text available
Objectives Theoretical models have informed the understanding of pregnancy as a ‘teachable moment’ for health behaviour change. However, these models have not been developed specifically for, nor widely tested, in this population. Currently, no pregnancy-specific model of behaviour change exists, which is important given it is a unique yet common health event. This study aimed to assess the extent to which factors influencing antenatal behaviour change are accounted for by the COM-B model and Teachable Moments (TM) model and to identify which model is best used to understand behaviour change during pregnancy. Design Theoretical mapping exercise. Methods A deductive approach was adopted; nine sub-themes identified in a previous thematic synthesis of 92 studies were mapped to the constructs of the TM and COM-B models. The sub-themes reflected factors influencing antenatal health behaviour. Findings All sub-themes mapped to the COM-B model constructs, whereas the TM model failed to incorporate three sub-themes. Missed factors were non-psychological, including practical and environmental factors, social influences, and physical pregnancy symptoms. In contrast to the COM-B model, the TM model provided an enhanced conceptual understanding of pregnancy as a teachable moment for behaviour change, however, neither model accounted for the changeable salience of influencing factors throughout the pregnancy experience. Conclusions The TM and COM-B models are both limited when applied within the context of pregnancy. Nevertheless, both models offer valuable insight that should be drawn upon when developing a pregnancy-specific model of behaviour change.
... However, they also referred to the normalisation of obesity in pregnant women (with direct reference to rates of obesity during pregnancy) and suggested that this, together with their high workload and lack of resources, explained the reasons why systematic advice was not part of standard antenatal care. Midwives and pregnant women, of all BMI categories, should be encouraged to access and implement the most up-to-date evidence base and need to fully personalise healthy eating and weight management advice (NICE, 2016;Swift et al., 2017). Midwives are capable of engaging pregnant women in health behaviour change discussions (e.g., smoking cessation advice, Reardon & Grogan, 2016) and are aware of the health risks associated with obesity (and some aspects of a poor diet). ...
Article
Midwives are responsible for providing advice regarding the complex issues of healthy eating and weight management during pregnancy. This study utilised an inductive data-driven thematic approach in order to determine midwives' perceptions, knowledge, and experiences of providing healthy eating and weight management advice to pregnant women. Semistructured interviews with 17 midwives were transcribed verbatim and data subjected to thematic analysis. The findings offer insight into the challenges facing midwives in their role trying to promote healthy eating and appropriate weight management to pregnant women. Three core themes were identified: (a) “If they eat healthily it will bring their weight down”: Midwives Misunderstood; (b) “I don't think we are experienced enough”: Midwives Lack Resources and Expertise; and (c) “BMI of 32 wouldn't bother me”: Midwives Normalised Obesity. The midwives recognised the importance of providing healthy eating advice to pregnant women and the health risks associated with poor diet and obesity. However, they reported the normalisation of obesity in pregnant women and suggested that this, together with their high workload and lack of expertise, explained the reasons why systematic advice was not in standard antenatal care. In addition, the current lack of UK clinical guidance, and thus, possibly lack of clinical leadership are also preventing delivery of tailored advice. Implementation literature on understanding the barriers to optimal health care delivery and informing clinical practice through research evidence needs to be further investigated in this field. This study has recommendations for policy makers, commissioners, service providers, and midwives.
Article
The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre‐pregnancy body mass index that is greater than 25 kg/m2 are more likely than those with a body mass index in the ideal range (20‐24.99 kg/m2) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those which pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, but a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care. This article is protected by copyright. All rights reserved.
Article
Gaining weight above the Institute of Medicine recommended range contributes to the development of obesity, which increases risk for diseases. We evaluated the effectiveness of an educational program with the spouse's participation on the optimal gestational weight gain (GWG) in pregnancy. We conducted a randomized controlled trial on 128 nulliparous women attending Najmieh Hospital-Antenatal Clinic based in Tehran-Iran. Participants randomly allocated into two groups of interventions and one control group. In group A, the women received education with their spouse's participation. In group B, the women received education without the participation of the spouses. In the control group, women received only routine prenatal care. Data were analysed by the ANOVA and Chi-square coefficient. The mean of the total GWG in the groups A and B was significantly lower than the control group (13.50 ± 3.85, 13.55 ± 3.20 and 15.53 ± 4.20 kg, respectively, P > 0.05). The rate of optimal GWG in groups A and B was 1.97 and 1.77 times of the control group, respectively (P < 0.05). The percentage of non-optimal GWG significantly decreased (P < 0.05). Groups A and B were not significantly different indicating no effect of spousal presence.
Article
Inadequate gestational weight gain (GWG), which has reached almost two-thirds of Canadian pregnant women, is associated with several adverse effects both in the mother and her child. The aim of this review was to establish how psychosocial factors, diet and GWG are interrelated during pregnancy. More specifically, it aimed to evaluate how psychosocial factors can impact on diet and, thus, influence GWG. Studies published through May 2017 that examined factors related to GWG were included. Of 3268 non-duplicate titles and abstract, 77 articles underwent full-text review. Regarding dietary intakes, the majority of the included studies demonstrated that a higher caloric intake was associated with an elevated GWG. Also, a negative body image and attitude toward weight gain as well as a poor knowledge of GWG recommendations and inadequate prenatal care is associated with an increased GWG. Only few studies examined altogether the factors included and conclusions about how psychosocial factors can impact on diet and, thus, influence GWG cannot be drawn at this point. In the few studies that evaluated the interrelationships between psychosocial factors, diet and GWG, energy intake was not identified as a mediator of the association between psychosocial factors and GWG. This review highlights the scarcity of findings regarding psychosocial and dietary factors in relation to GWG and the need for high quality prospective cohort studies that will include all these factors to provide a better understanding of how they are interrelated to influence short- and long-term health.
Article
Purpose This study aimed to explore the psychological cognitive factors of weight management during pregnancy based on protective motivation theory (PMT). Design Cross-sectional study. Setting Participants were recruited at the Maternal and Child Health Hospital of Changzhou City, Jiangsu Province, China. Sample A sample of 533 pregnant women was enrolled in the study. Measures Measures was a self-design questionnaire, comprising of demographics, cognition of weight management during pregnancy, and weight management behavior during pregnancy. Analysis Structural equation modeling was used to examine the weight management’s cognitive factors, path relationships, and the influence of maternal characteristics. Results Self-efficacy cognition could promote gestational weight management behavior (b = .22, P < .001), but response cost cognition hindered gestational weight management (b = −.21, P < .001). Parity moderated pregnant women’s self-efficacy cognition (diff b = .24, P < .01), where the self-efficacy of nullipara promoted weight management behaviors, but the self-efficacy of multipara had no significant effect. Also, the response cost factors stably existed in primipara and multipara groups, with multipara, being positively affected by response efficacy ( b = .15, P < .05). Conclusion Findings highlight the need for psychological and cognitive interventions. Intervention strategies that focus on enabling women to correctly understand response cost and make an active response, improve self-efficacy cognition especially among primipara, and strengthening multipara’s response efficacy among pregnant are required.
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The current emphasis on obstetric risk management helps to frame gestational weight gain as problematic and encourages intervention by healthcare professionals. However pregnant women have reported confusion, distrust, and negative affect associated with antenatal weight management interactions. The MAGIC study (MAnaging weiGht In pregnanCy) sought to examine women?s self-reported experiences of usual-care antenatal weight management in early pregnancy, and consider these alongside weight monitoring behaviours and future expectations. 193 women (18yrs+) were recruited from routine antenatal clinics at the Nottingham University Hospital NHS Trust. Self-reported gestation was 10-27 weeks, with 41.5% (n=80) between 12-14 and 43.0% (n=83) between 20-22 weeks. At recruitment 50.3% of participants (n=97) could be classified as overweight or obese. 69.4% of highest weight women (?30kg/m2) did not report receiving advice about weight, although they were significantly more likely to compared to women with BMI<30kg/m2. The majority of women (regardless of BMI) did not express any barriers to being weighed and 40.8% reported weighing themselves at home. Women across the BMI categories expressed a desire for more engagement from healthcare professionals on the issue of bodyweight. Women are clearly not being served appropriately in the current situation which simultaneously problematizes and fails to offer constructive dialogue.
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Background The 2009 Institute of Medicine (IOM) gestational weight recommendations are tailored to women’s pre-pregnancy body mass index (BMI). Limited evidence exists on methods for estimating women’s pre-pregnancy BMI, particularly for women living in low and middle income countries. Using data from collected among Peruvian pregnant women, we compared the concordance between self-reported pre-pregnancy BMI with BMI measured at the earliest prenatal study visit. Methods Data were from the Pregnancy Outcomes Maternal and Infant Study (PrOMIS), a cohort of pregnant women at the Instituto Nacional Materno Perinatal (INMP) in Lima, Peru. 2605 women aged 18 to 49 years (mean ± SD gestational age = 10.9 ± 3.3 weeks) were included in the study. Self-reported pre-pregnancy weight and height and measured weight and height were collected at the first prenatal study contact. We assessed the concordance between measured and self-reported BMI; and, the agreement among indicators of nutritional status obtained using measured and self-reported BMI. Results On average, weight measured at the first prenatal study visit was 0.27 kg higher than self-reported pre-pregnancy weight (p < 0.05); and, measured height was 0.02 m lower than self-reported pre-pregnancy height (p < 0.001). Correspondingly, measured BMI was 0.71 kg/m2 higher than self-reported BMI (p < 0.001). Scatter and Bland-Altman plots indicated strong concordance between measured and self-reported BMI. The proportion of women in the normal BMI category tended to be higher when using self-reported BMI (59.6 %) than when using measured BMI (50.4 %). Conversely, the proportion of women in the overweight or obese BMI categories tended to be lower when using self-reported BMI (38.2 %) than when using measured BMI (47.7 %). Conclusion Self-reported pre-pregnancy BMI was strongly correlated with BMI measured at the first prenatal study contact. The findings potentially suggest that, in this context, there is minimal change between pre-pregnancy BMI and BMI measured at the first prenatal study contact; or, that women in this study just recalled their most recent measured anthropometrics (including values obtained during the index pregnancy but before enrollment in the PrOMIS study). Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0983-z) contains supplementary material, which is available to authorized users.
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Introduction: Physical inactivity likely contributes to fatigue and low energy during pregnancy but whether acute resistance exercise attenuates these symptoms is unknown. Methods: Twenty-six women performed six low-to-moderate intensity resistance exercises twice per week from weeks 23 to 35 of pregnancy and measurements were made before and after each workout using the Mental and Physical State Energy and Fatigue Scales. Results: Acute resistance exercise usually increased perceived physical and mental energy (92% to 96% of workouts, respectively). These increases did not differ significantly across the 24 exercise sessions for feelings of physical energy or mental energy, even after adjusting for variations in attendance (median = 22/24 workouts). Acute resistance exercise usually decreased perceived physical and mental fatigue (79% to 88% of workouts, respectively), and ANCOVA showed these decreases did not differ significantly across the 24 exercise sessions for feelings of physical fatigue or mental fatigue even after adjusting for variations in attendance. Discussion: The results suggest acute, low-to-moderate intensity muscle strengthening exercise during pregnancy is effective for transiently improving feelings of energy and fatigue.
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Behavioural interventions might improve clinical outcomes in pregnant women who are obese. We aimed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants. The UK Pregnancies Better Eating and Activity Trial (UPBEAT) is a randomised controlled trial done at antenatal clinics in eight hospitals in multi-ethnic, inner-city locations in the UK. We recruited pregnant women (15-18 weeks plus 6 days of gestation) older than 16 years who were obese (BMI ≥30 kg/m(2)). We randomly assigned participants to either a behavioural intervention or standard antenatal care with an internet-based, computer-generated, randomisation procedure, minimising by age, ethnic origin, centre, BMI, and parity. The intervention was delivered once a week through eight health trainer-led sessions. Primary outcomes were gestational diabetes (diagnosed with an oral glucose tolerance test and by criteria from the International Association of Diabetes in Pregnancy Study Groups) and large-for-gestational-age infants (≥90th customised birthweight centile). Analysis was by intention to treat. This trial is registered with Current Controlled Trials, ISCRTN89971375. Recruitment and pregnancy outcomes are complete but childhood follow-up is ongoing. Between March 31, 2009, and June 2, 2014, we assessed 8820 women for eligibility and recruited 1555, with a mean BMI of 36·3 kg/m(2) (SD 4·8). 772 were randomly assigned to standard antenatal care and 783 were allocated the behavioural intervention, of which 651 and 629 women, respectively, completed an oral glucose tolerance test. Gestational diabetes was reported in 172 (26%) women in the standard care group compared with 160 (25%) in the intervention group (risk ratio 0·96, 95% CI 0·79-1·16; p=0·68). 61 (8%) of 751 babies in the standard care group were large for gestational age compared with 71 (9%) of 761 in the intervention group (1·15, 0·83-1·59; p=0·40). Thus, the primary outcomes did not differ between groups, despite improvements in some maternal secondary outcomes in the intervention group, including reduced dietary glycaemic load, gestational weight gain, and maternal sum-of-skinfold thicknesses, and increased physical activity. Adverse events included neonatal death (two in the standard care group and three in the intervention group) and fetal death in utero (ten in the standard care group and six in the intervention group). No maternal deaths were reported. Incidence of miscarriage (2% in the standard care group vs 2% in the intervention group), major obstetric haemorrhage (1% vs 3%), and small-for-gestational-age infants (≤5th customised birthweight centile; 6% vs 5%) did not differ between groups. A behavioural intervention addressing diet and physical activity in women with obesity during pregnancy is not adequate to prevent gestational diabetes, or to reduce the incidence of large-for-gestational-age infants. National Institute for Health Research, Guys and St Thomas' Charity, Chief Scientist Office Scotland, Tommy's Charity. Copyright © 2015 Poston et al. Open Access article distributed under the terms of CC BY-NC-ND. Published by Elsevier Ltd.. All rights reserved.
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Excess gestational weight gain (GWG), which has reached epidemic proportions, is associated with adverse outcomes during pregnancy and postpartum obesity in women and children. Psychological variables represent potentially modifiable factors. Moreover, previous systematic reviews on GWG interventions have called for the need for a clearer understanding of psychological factors affecting GWG. Hence, a systematic review was conducted to summarize the relation between psychological factors and GWG. Eight databases were searched, and the guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality of the included studies was assessed using a modified Newcastle-Ottawa scale. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality. A total of 6198 titles and abstracts were reviewed of which 90 full text articles were retrieved. Thirty-five studies (25 cohort, eight cross-sectional and two case-control) met the inclusion criteria, assessing 26 different psychological constructs in affect, cognitions and personality. Negative affective states such as depression, anxiety and stress were not related to excess GWG. Among weight-related and dietary-related cognitions, risk factors for excess GWG included concern about weight gain, negative body image and attitude towards weight gain, inaccurate perceptions regarding weight, higher than recommended target weight gain, less knowledge about weight gain, higher levels of cognitive dietary restraint, and perceived barriers to healthy eating. Protective factors included an internal locus of control for weight gain, lower than recommended target weight gain and higher self-efficacy for healthy eating. Only one study examined the relation between personality and excess GWG. In this systematic review, a number of cognitive factors were identified that were associated with excess GWG. To address excess GWG, more high quality, adequately powered studies are required examining cognitions, motivation and personality factors.
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Background Pregnancy-related physical changes can have a significant impact on a woman’s body image. There is no synthesis of existing literature to describe the intricacies of women’s experiences of their body, and relevant clinical implications. Methods Four electronic databases were searched in February 2014 using predefined search terms. English-language, qualitative studies published between January 1992 and December 2013 exploring pregnancy and postpartum body image were included. Following quality appraisal, 17 papers were synthesised using the interpretive thematic synthesis approach within a social constructionist framework. Results Three themes were highlighted: “Public Event: ‘Fatness’ vs. Pregnancy”, “Control: Nature vs. Self”, and “Role: Woman vs. Mother”. Women perceived the pregnant body to be out of their control and as transgressing the socially constructed ideal, against which they tried to protect their body image satisfaction. Women perceived the physical manifestation of the mothering role as incongruent to their other roles as a wife or partner, or working woman. Body dissatisfaction dominated the postpartum period. Conclusions Women’s perception of their pregnancy body image is varied and depends on the strategies they use to protect against social constructions of female beauty. Women have unrealistic expectations for their postpartum body, highlighting this as an area where women need better support. Attending to women’s narratives about their pregnant body may identify at-risk women and provide an opportunity for health professionals to provide support to either address or accept body image dissatisfaction. Clinical communication training may enable health professionals to explore body image concerns with women and guide them in identifying ways of accepting or reducing any dissatisfaction.
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Background There has been a rapid increase in the publication of guidelines for managing obesity and weight gain during pregnancy over the past five years. Healthcare professionals have identified multiple barriers to this area of practice, including the need to improve their communication skills, beliefs that pregnant women will have negative reactions to weight-related discussions, and a lack of weight management knowledge. This systematic review aimed to identify: the effectiveness of interventions in changing healthcare professionals¿ practice relating to maternal obesity or weight management during pregnancy; and which behaviour change techniques and modes of intervention delivery have been used in interventions to date.FindingsThe search strategy included searching electronic databases, trial registers, and citation searching. Inclusion criteria were intervention studies targeted towards changing healthcare professionals¿ practice in relation to maternal obesity or weight management. The searches identified 3,608 studies. However, no eligible completed studies were identified. One registered Canadian randomised controlled trial was identified. The trial includes a training intervention for family physicians with the aim of supporting adherence to gestational weight gain guidelines. The trial had not yet commenced therefore no effectiveness data were available.Conclusions The current focus of maternal obesity and weight management research is targeted towards changing pregnant women¿s behaviours. These interventions do not address the multiple healthcare professionals¿ barriers to maternal obesity and weight management practice. Further research is required to identify the most effective approaches to support healthcare professionals to implement maternal obesity and weight management guidelines into practice.
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Background: Approximately 1 in 5 pregnant women in the United Kingdom are obese. In addition to being associated generally with poor health, obesity is known to be a contributing factor to pregnancy and birth complications and the retention of gestational weight can lead to long term obesity.This paper describes the protocol for a cluster randomised trial to evaluate whether a weight management intervention for obese pregnant women is effective in reducing women's Body Mass Index at 12 months following birth. Methods/design: The study is a cluster randomised controlled trial involving 20 maternity units across England and Wales. The units will be randomised, 10 to the intervention group and 10 to the control group. 570 pregnant women aged 18 years or over, with a Body Mass Index of +/=30 (kg/m2) and between 12 and 20 weeks gestation will be recruited. Women allocated to the control group will receive usual care and two leaflets giving advice on diet and physical activity. In addition to their usual care and the leaflets, women allocated to the intervention group will be offered to attend a weekly 1.5 hour weight management group, which combines expertise from Slimming World with clinical advice and supervision from National Health Service midwives, until 6 weeks postpartum.Participants will be followed up at 36 weeks gestation and at 6 weeks, 6 months and 12 months postpartum. Body Mass Index at 12 months postpartum is the primary outcome. Secondary outcomes include pregnancy weight gain, quality of life, mental health, waist-hip ratio, child weight centile, admission to neonatal unit, diet, physical activity levels, pregnancy and birth complications, social support, self-regulation and self-efficacy. A cost effectiveness analysis and process evaluation will also be conducted. Discussion: This study will evaluate the effectiveness of a theory-based intervention developed for obese pregnant women. If successful the intervention will equip women with the necessary knowledge and skills to enable them to make healthier choices for themselves and their unborn child. Trial registration: Current Controlled Trials: ISRCTN25260464 Date of registration: 16th April 2010.
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Background: In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. Methods: We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). Findings: Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. Interpretation: Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. Funding: Bill & Melinda Gates Foundation.
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To determine the effect of antenatal dietary and lifestyle interventions on health outcomes in overweight and obese pregnant women. Multicentre randomised trial. We utilised a central telephone randomisation server, with computer generated schedule, balanced variable blocks, and stratification for parity, body mass index (BMI) category, and hospital. Three public maternity hospitals across South Australia. 2212 women with a singleton pregnancy, between 10+0 and 20+0 weeks' gestation, and BMI ≥25. 1108 women were randomised to a comprehensive dietary and lifestyle intervention delivered by research staff; 1104 were randomised to standard care and received pregnancy care according to local guidelines, which did not include such information. Incidence of infants born large for gestational age (birth weight ≥90th centile for gestation and sex). Prespecified secondary outcomes included birth weight >4000 g, hypertension, pre-eclampsia, and gestational diabetes. Analyses used intention to treat principles. 2152 women and 2142 liveborn infants were included in the analyses. The risk of the infant being large for gestational age was not significantly different in the two groups (lifestyle advice 203/1075 (19%) v standard care 224/1067 (21%); adjusted relative risk 0.90, 95% confidence interval 0.77 to 1.07; P=0.24). Infants born to women after lifestyle advice were significantly less likely to have birth weight above 4000 g (lifestyle advice 164/1075 (15%) v standard care 201/1067 (19%); 0.82, 0.68 to 0.99; number needed to treat (NNT) 28, 15 to 263; P=0.04). There were no differences in maternal pregnancy and birth outcomes between the two treatment groups. For women who were overweight or obese, the antenatal lifestyle advice used in this study did not reduce the risk delivering a baby weighing above the 90th centile for gestational age and sex or improve maternal pregnancy and birth outcomes. Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).
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To review the peer-reviewed literature on relationships between intuitive eating and health indicators and suggest areas of inquiry for future research. We define the fundamental principles of intuitive eating as: (i) eating when hungry; (ii) stopping eating when no longer hungry/full; and (iii) no restrictions on types of food eaten unless for medical reasons. We include articles cited by PubMed, PsycInfo and Science Direct published in peer-reviewed journals or theses that include 'intuitive eating' or related concepts in the title or abstract and that test relationships between intuitive eating and physical or mental health indicators. We found twenty-six articles that met our criteria: seventeen cross-sectional survey studies and nine clinical studies, eight of which were randomised controlled trials. The cross-sectional surveys indicate that intuitive eating is negatively associated with BMI, positively associated with various psychological health indicators, and possibly positively associated with improved dietary intake and/or eating behaviours, but not associated with higher levels of physical activity. From the clinical studies, we conclude that the implementation of intuitive eating results in weight maintenance but perhaps not weight loss, improved psychological health, possibly improved physical health indicators other than BMI (e.g. blood pressure; cholesterol levels) and dietary intake and/or eating behaviours, but probably not higher levels of physical activity. Research on intuitive eating has increased in recent years. Extant research demonstrates substantial and consistent associations between intuitive eating and both lower BMI and better psychological health. Additional research can add to the breadth and depth of these findings. The article concludes with several suggestions for future research.
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Background: Cognitive processes such as attention and memory may influence food intake, but the degree to which they do is unclear. Objective: The objective was to examine whether such cognitive processes influence the amount of food eaten either immediately or in subsequent meals. Design: We systematically reviewed studies that examined experimentally the effect that manipulating memory, distraction, awareness, or attention has on food intake. We combined studies by using inverse variance meta-analysis, calculating the standardized mean difference (SMD) in food intake between experimental and control groups and assessing heterogeneity with the I(2) statistic. Results: Twenty-four studies were reviewed. Evidence indicated that eating when distracted produced a moderate increase in immediate intake (SMD: 0.39; 95% CI: 0.25, 0.53) but increased later intake to a greater extent (SMD: 0.76; 95% CI: 0.45, 1.07). The effect of distraction on immediate intake appeared to be independent of dietary restraint. Enhancing memory of food consumed reduced later intake (SMD: 0.40; 95% CI: 0.12, 0.68), but this effect may depend on the degree of the participants' tendencies toward disinhibited eating. Removing visual information about the amount of food eaten during a meal increased immediate intake (SMD: 0.48; 95% CI: 0.27, 0.68). Enhancing awareness of food being eaten may not affect immediate intake (SMD: 0.09; 95% CI: -0.42, 0.35). Conclusions: Evidence indicates that attentive eating is likely to influence food intake, and incorporation of attentive-eating principles into interventions provides a novel approach to aid weight loss and maintenance without the need for conscious calorie counting.
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Background Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims’ psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explores the presence of weight stigma from both patient and care provider perspectives. Methods Study One investigated associations between pre-pregnancy body mass index (BMI) and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity care providers, to investigate their perceptions of, and attitudes towards, providing care for pregnant patients of differing body sizes. Both studies used linear regression analyses. Results Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women. Pre-service maternity care providers perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal-weight pregnant women. Even care providers who reported few weight stigmatising attitudes responded less positively to overweight and obese pregnant women. Conclusions Overall, these results provide preliminary evidence that weight stigma is present in maternity care settings in Australia. They suggest a need for further research into the nature and consequences of weight stigma in maternity care, and for the inclusion of strategies to recognise and combat weight stigma in maternity care professionals’ training.
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Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.
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Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
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To estimate the energy requirements of pregnant and lactating women consistent with optimal pregnancy outcome and adequate milk production. Total energy cost of pregnancy was estimated using the factorial approach from pregnancy-induced increments in basal metabolic rate measured by respiratory calorimetry or from increments in total energy expenditure measured by the doubly labelled water method, plus energy deposition attributed to protein and fat accretion during pregnancy. Database on changes in basal metabolic rate and total energy expenditure during pregnancy, and increments in protein based on measurements of total body potassium, and fat derived from multi-compartment body composition models was compiled. Energy requirements during lactation were derived from rates of milk production, energy density of human milk, and energy mobilisation from tissues. Healthy pregnant and lactating women. The estimated total cost of pregnancy for women with a mean gestational weight gain of 12.0 kg, was 321 or 325 MJ, distributed as 375, 1200, 1950 kJ day(-1), for the first, second and third trimesters, respectively. For exclusive breastfeeding, the energy cost of lactation was 2.62 MJ day(-1) based on a mean milk production of 749 g day(-1), energy density of milk of 2.8 kJ g(-1), and energetic efficiency of 0.80. In well-nourished women, this may be subsidised by energy mobilisation from tissues on the order of 0.72 MJ day(-1), resulting in a net increment of 1.9 MJ day(-1) over non-pregnant, non-lactating energy requirements. Recommendations for energy intake of pregnant and lactating women should be updated based on recently available data.
Chapter
Human beings are a marvel of evolved complexity. Such systems can be difficult to enhance. When we manipulate complex evolved systems, which are poorly understood, our interventions often fail or backfire. It can appear as if there is a “wisdom of nature” which we ignore at our peril. Sometimes the belief in nature’s wisdom—and corresponding doubts about the prudence of tampering with nature, especially human nature—manifests as diffusely moral objections against enhancement. Such objections may be expressed as intuitions about the superiority of the natural or the troublesomeness of hubris or as an evaluative bias in favor of the status quo. This chapter explores the extent to which such prudence-derived anti-enhancement sentiments are justified. We develop a heuristic, inspired by the field of evolutionary medicine, for identifying promising human enhancement interventions. The heuristic incorporates the grains of truth contained in “nature knows best” attitudes while providing criteria for the special cases where we have reason to believe that it is feasible for us to improve on nature.
Article
Background: Obese pregnant women have an increased risk of antenatal, intra- and post-partum complications. At present, there is limited evidence to support specific nutritional management of obese women in pregnancy, and guidelines are infrequently translated into practice. Aims: To implement an individually tailored nutrition program for obese pregnant women to reduce the rates of Gestational Diabetes Mellitus (GDM), improve diet quality, achieve weight gain targets, limit gestational weight gain (GWG) and reduce complications for mother and child. Methods: A prospective dietary intervention study was conducted at a hospital in Melbourne, Australia, using a parallel control group from the Birthing Outcomes System (BOS) database. Obese pregnant women were included if they were ≤21 weeks gestation and aged ≥18 years. The intervention group received one face-to-face Dietitian-delivered consultation, with reviews conducted over the phone. Results: A total of 92 and 125 obese pregnant women were enrolled into the dietary intervention group and BOS control group, respectively. The diet quality of intervention participants improved, without significant differences in GWG across groups. In the control group, 19.3% of women developed GDM, compared to 6.5% in the diet group (P 0.013). However, after adjusting for ethnicity and BMI, the association between the diet group and GDM incidence was no longer significant. Conclusions: This study demonstrates that a behavioural nutrition intervention, individually tailored for obese pregnant women can improve diet quality. A larger randomised controlled trial targeted at obese pregnant women, with comparable groups at baseline, is required to observe the effects of dietary improvement on GDM incidence, and other maternal and neonatal outcomes.
Article
Exercise plays an important role in reducing the prevalence of gestational diabetes mellitus (GDM) in women with or without risk factors. GDM risk factors include obesity, family history of diabetes, high-risk ethnicity, increased maternal age, history of GDM, delivering a macrosomic infant, excessive gestational weight gain early in pregnancy (before glucose screening), sedentary behavior, low physical activity, and vitamin D deficiency. Most GDM patients can be managed with lifestyle modifications that include medical nutrition therapy and physical activity. When adherence is high and women are fully engaged in the exercise program, GDM can be effectively managed and prevented.
Article
Objectives: Diet influences the health of the foetus and the woman during pregnancy and later in life. It is therefore important to investigate pregnant women's food habits. The aim of this study was to describe women's food habits during pregnancy and up to six months post-partum. Study design: A Food Frequency Questionnaire (VIP-FFQ) was distributed to 163 pregnant women on five occasions during and after pregnancy. Data were analysed using Friedman's ANOVA and a Bonferroni post-hoc test. Main outcome measures: Food habits in relation to the National Food Agency's (NFA) food index. Results: The pregnant women's diets were inadequate according to the NFA food index. A tendency towards an even poorer diet after delivery was identified, something which was related to an increased intake of discretionary food, e.g. sweets, cakes, cookies, crisps, ice cream, and decreased intake of fruit and vegetable. The alcohol consumption was low throughout. Conclusions: The food habits during pregnancy were inadequate compared to recommendations and these habits became unhealthier after delivery. These suggest that dietary counselling needs to be more effective and continued into the lactating period. An increased focus should be given to healthy eating from the life course perspective, not just focus on effects on the foetus and pregnancy outcomes.
Article
Background: Fish and seafood are good sources of several nutrients that are important for foetal growth and development. Despite guidelines encouraging the eating of fish during pregnancy, research indicates that pregnant women may be limiting or avoiding these foods. Possible factors contributing to this include concerns regarding levels of mercury and other contaminants and pregnant women's purported heightened risk consciousness. The present study aimed to explore pregnant women's perceptions of consuming fish and seafood during pregnancy. Methods: Semi-structured telephone interviews were conducted with 15 pregnant women across all three trimesters in New South Wales, Australia. Questions focussed on exploring nutrition information received during pregnancy, dietary changes made during pregnancy and, more specifically, perceptions of fish and seafood, as well as views on information of fish and seafood commonly provided to pregnant women. Data were collected, then transcribed and analysed using an inductive coding process, guided by the qualitative theory grounded approach. Results: Multiple inter-related themes were found to shape pregnant women's perceptions related to fish and seafood consumption during pregnancy; namely, the understanding of fish and seafood as part of a healthy diet, external factors such as cost, individual preferences such as taste, and confidence in choosing and preparing fish. The context of a risk adverse society permeated these themes. Conclusions: The present study provides insight into the inter-related factors that influence pregnant women's consumption or avoidance of fish and seafood.
Article
Background: Midwives are increasingly expected to promote healthy behaviour to women and pregnancy is often regarded as a 'teachable moment' for health behaviour change. This view focuses on motivational aspects, when a richer analysis of behaviour change may be achieved by viewing the perinatal period through the lens of the Capability-Opportunity-Motivation Behaviour framework. This framework proposes that behaviour has three necessary determinants: capability, opportunity, and motivation. Aim: To outline a broader analysis of perinatal behaviour change than is afforded by the existing conceptualisation of the 'teachable moment' by using the Capability-Opportunity-Motivation Behaviour framework. Findings: Research suggests that the perinatal period can be viewed as a time in which capability, opportunity or motivation naturally change such that unhealthy behaviours are disrupted, and healthy behaviours may be adopted. Moving away from a sole focus on motivation, an analysis utilising the Capability-Opportunity-Motivation Behaviour framework suggests that changes in capability and opportunity may also offer opportune points for intervention, and that lack of capability or opportunity may act as barriers to behaviour change that might be expected based solely on changes in motivation. Moreover, the period spanning pregnancy and the postpartum could be seen as a series of opportune intervention moments, that is, personally meaningful episodes initiated by changes in capability, opportunity or motivation. Discussion: This analysis offers new avenues for research and practice, including identifying discrete events that may trigger shifts in capability, opportunity or motivation, and whether and how interventions might promote initiation and maintenance of perinatal health behaviours.
Article
Obesity is the UK's most prevalent antenatal comorbidity, and reducing rates of maternal obesity and risk management of complications in pregnancy and labour is a priority for the NHS. The emphasis on managing maternal obesity-related risks, rather than dealing with the causes of long-term obesity, is short-sighted and fails to consider the needs of the individual woman. This process of risk management is fuelled by the maternity services' costly litigation insurance that presents measures to manage obesity-related risks, leading to bureaucratic shaping of maternity services. This limits the choices for this group of women by standardising care rather than facilitating their individual needs. This article explores an alternative long-term strategy called Pregnancy Plus that facilitates the management of risk alongside supporting the needs of individual obese pregnant women, offering choice and equal access to maternity services while maintaining the safety of the women and their babies. Pregnancy Plus is an awardwinning multi-intervention health education and weight maintenance programme that has presented promising outcomes to date. It utilises a salutogenic approach to health education and care-planning for obese pregnant women and adopts the principles of the US Institute of Medicine guidelines for the maintenance of gestational weight-gain in obese women.
Article
The prevalence of excessive gestation weight gain, extended postpartum weight retention and pregravid obese women is increasing and is associated with numerous adverse health outcomes. To review the evidence from studies employing exercise-only interventions for weight management among pregnant and postpartum women. Ten databases were searched for randomised controlled trials conducted during pregnancy or within the 12 months following childbirth and published between 1990 and 2013. There were no restrictions to the type, frequency, duration or intensity of exercise intervention. Interventions not specifically designed to target weight were excluded. The outcomes were a change in body weight (kg) or body mass index (BMI; kg/m(2)). All data were continuous and were reported as weighted mean differences (WMD), with 95% CIs. Data were analysed with a fixed-effect model and heterogeneity was determined using the I(2) statistic. Five studies were included in this review. Exercise significantly reduced gestational weight gain (WMD=-2.22 kg, CI -3.14 to -1.3, p≤0.00001) and had no significant effect on postpartum weight loss (WMD=-1.74 kg, CI -3.59 to 0.10, p=0.06) or BMI during pregnancy (WMD=-2.8 kg/m(2), CI -5.60 to 0.00, p=0.05) or postpartum (WMD=-0.54 kg/m(2), CI -1.17 to 0.08, p=0.09). There is currently limited evidence to suggest that exercise can be used to limit maternal gestational weight gain. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Article
Background Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes. Although most guidance on pregnancy weight is focused on the prepregnancy period, pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health.Methods The hospital-based Bumps and Beyond intervention invited all pregnant women with a body mass index (BMI) >35 kg m−2 to take part in a programme of health education around diet and exercise, accompanied by one-to-one guidance and monitoring of dietary change. This service evaluation compares 89 women who completed at a programme of seven sessions with healthy lifestyle midwives and advisors (intervention) versus a group of 89 women who chose not to attend (non-intervention).ResultsMean (SD) weight gain in the intervention group [4.5 (4.6) kg] was less than in the non-intervention group [10.3 (4.4) kg] between antenatal booking and 36 weeks of gestation (< 0.001). This was associated with a 95% reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications. There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage (reduced by 55%). The impact of the intervention on gestational weight gain was greater in women with BMI >40 kg m−2 at booking. There were no adverse effects of the intervention, even though 21% of the intervention group lost weight during their pregnancy.Conclusions Intensive, personalised weight management intervention may be an effective strategy for the prevention of hypertensive disorders during pregnancy.
Article
Fear arousal is widely used in persuasive campaigns and behavioral change interventions. Yet, experimental evidence argues against the use of threatening health information. The authors reviewed the current state of empirical evidence on the effectiveness of fear appeals. Following a brief overview of the use of fear arousal in health education practice and the structure of effective fear appeals according to two main theoretical frameworks-protection motivation theory and the extended parallel process model-the findings of six meta-analytic studies in the effectiveness of fear appeals are summarized. It is concluded that coping information aimed at increasing perceptions of response effectiveness and especially self-efficacy is more important in promoting protective action than presenting threatening health information aimed at increasing risk perceptions and fear arousal. Alternative behavior change methods than fear appeals should be considered.
Article
Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty-five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included ‘knowledge’, ‘beliefs about consequences’ and ‘environmental context and resources’. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change.
Article
Smoking in pregnancy has many known risks both to the mother and her developing baby. Yet despite this knowledge, many women continue to smoke throughout pregnancy or relapse postnatally if they did manage to quit before the birth. This article highlights the importance of midwives working together with other professionals to provide smoking cessation support to women and their families. They can do this by providing information about the benefits of stopping smoking, referring to expert support and continually reassessing women's motivation to quit and progress in achieving QUIT status.
Article
The ongoing movement from institutional care to community-orientated care has gradually spread around the developed world. This shift in the philosophy of care has resulted in a reduction in the length of inpatient admissions and contributed to a decline in the number of inpatient beds. This literature review seeks to establish the suitability and relevance of solution-focused brief therapy (SFBT) to mental health nursing practice, with particular emphasis being given to acute inpatient settings. Databases searched for published material in English between 1980 and 2006 were: Cumulative Index of Nursing and Allied Health Literature; MEDLINE; Applied Social Sciences Index and Abstracts; Sociological abstracts; and social service abstracts. Search terms included: SFBT and solution-focused approaches. Only nine papers from the original 203 citations met the inclusion criteria and were thus reviewed. These papers indicated that SFBT constitutes an appropriate set of techniques for use in mental health nursing particularly where staff have relatively brief contact with patients. Preliminary data suggest that SFBT is congruent with the philosophical underpinning of contemporary mental health nursing. However, its clinical utility and effectiveness is not well established and methodologically rigorous studies are urgently needed to determine the appropriateness and effectiveness of such approach to nursing practice.
Article
Although much of the analysis conducted in qualitative research falls within the broad church of thematic analysis, the wide scope of qualitative enquiry presents the researcher with a number of choices regarding data analysis techniques. This review, the third in the series, provides an overview of a number of techniques and practical steps that can be taken to provide some structure and focus to the intellectual work of thematic analysis in nutrition and dietetics. Because appropriate research methods are crucial to ensure high-quality research, it also describes a process for choosing appropriate analytical methods that considers the extent to which they help answer the research question(s) and are compatible with the philosophical assumptions about ontology, epistemology and methodology that underpin the overall design of a study. Other reviews in this series provide a model for embarking on a qualitative research project in nutrition and dietetics, an overview of the principal techniques of data collection, sampling and quality assessment of this kind of research and some practical advice relevant to nutrition and dietetics, along with glossaries of key terms.
Article
Qualitative research is well placed to answer complex questions about food-related behaviour because it investigates how and why individuals act in certain ways. The field of qualitative health research is undoubtedly gaining momentum and, increasingly, there is a recognition that it should be a vital part of the decision-making processes that direct the development of health policy and practice. Much of the guidance available, however, is difficult to navigate for those new to 'qualitative research', and there is little discussion of qualitative research issues specifically in relation to nutrition and dietetics. This review, the first in a series, outlines the field of qualitative enquiry, its potential usefulness in nutrition and dietetics, and how to embark upon this type of research. Furthermore, it describes a process to guide high-quality qualitative research in this area that proceeds from the research question(s) and considers the key philosophical assumptions about ontology, epistemology and methodology that underpin the overall design of a study. Other reviews in this series provide an overview of the principal techniques of data collection and sampling, data analysis, and quality assessment of qualitative work, and provide some practical advice relevant to nutrition and dietetics, along with glossaries of key terms.
Article
Unlabelled: This study was designed to examine women's experiences of weight loss during the postpartum period. Understanding women's positive and negative experiences can assist health care providers to successfully intervene in helping women lose weight following pregnancy and avoid long-term weight gain and obesity development. Design: Phenomenology, according to Husserl's perspective. Setting: Private location of the women's choosing. Participants: Twenty-six women, who ranged in age from 25 to 35 years, and had given birth within the last 5 years, were interviewed regarding their experiences with postpartum weight loss. The majority of the sample was Caucasian. Interviews were transcribed and themes were identified from each of the interviews. Comparisons were made between interviews to identify common experiences between women. Data were analyzed according to the Giorgi method. The women in the study had a wide range of experiences. Themes that emerged from the interviews related to women's challenges with return to prepregnancy weight. These included: time and motivation issues, the need for support, and weight and other struggles. This study provides a look inside the lives of women faced with the reality of losing weight after childbirth. Losing weight after delivery is multi-faceted and influenced by many factors. Interventions to assist women with weight loss should target the challenges described in this paper. When effective strategies are developed, education can be done during pregnancy to prepare for the postpartum period. Ultimately, future research efforts can help us to eliminate pregnancy as a risk factor for obesity in women.
Article
Physical inactivity and its accompanying adverse sequelae (e.g., obesity and diabetes) are global health concerns. The single most commonly reported physical activity in public health surveys is walking (Centers for Disease Control and Prevention, 2000; Rafferty, Reeves, McGee, & Pivarnik, 2002). As evidence accumulates that walking is important for preventing weight gain (Levine et al., 2008) and reducing the risk of diabetes (Jeon, Lokken, Hu, & van Dam, 2007), there is increased need to capture this behavior in a valid and reliable manner. Although the disadvantages of a self-report methodology are well known (Sallis, & Saelens, 2000), it still represents the most feasible approach for conducting population-level surveillance across developed and developing countries. The International Physical Activity Questionnaire (IPAQ) was created and evaluated as a standardized instrument for this purpose. Although two versions of the IPAQwere designed and evaluated (short: nine items; and long: 31 items), the short form was recommended for population monitoring (Craig et al., 2003). However, it has not been recommended for intervention or research studies that require precise physical activity quantification to examine changes in physical activity at the individual level. IPAQ was also not intended to replace instruments that are more responsive to individual changes in activity level, such as objective measures. In addition to walking behaviors, IPAQ also assesses time spent in moderate- and vigorous-intensity activity as well as sitting behaviors, although the latter is not the focus of this analysis. Aggregated IPAQ data have been previously validated compared to accelerometers, and overall reliability was confirmed across 12 countries (Craig et al., 2003). Previous research showed criterion validity Spearman correlations with a median of 0.30 and test-retest reliability Spearman correlations clustered around 0.8 (Craig et al., 2003). The purpose of this study, however, was to reanalyze these data with respect to validity (again compared to an accelerometer) and test-retest reliability specifically for population monitoring of walking.
Article
Excessive gestational weight gain has been shown to relate to high-postpartum weight retention and the development of overweight and obesity later in life. Because many women are concerned about the health of their babies during pregnancy and are in frequent contact with their healthcare providers, pregnancy may be an especially powerful "teachable moment" for the promotion of healthy eating and physical activity behaviors among women. Initial research suggests that helping women gain the recommended amount during pregnancy through healthy eating and physical activity could make a major contribution to the prevention of postpartum weight retention. However, more randomized controlled trials with larger sample sizes are needed to identify the most effective and disseminable intervention. Providers have the potential to prevent high postpartum weight retention and future obesity by monitoring weight gain during pregnancy and giving appropriate advice about recommended amounts of gestational weight gain.
Article
Primary health care staff are involved increasingly in the provision of dietary advice for health promotion, often without adequate training in nutrition assessment or counselling. At present no brief diet assessment methods are available which have been validated for this purpose in the UK. We report on the accuracy of the Dietary Instrument for Nutrition Education (DINE) in classifying dietary fat and fibre intakes. This structured questionnaire can be administered and scored in under 10 minutes by primary care staff without specialized nutritional knowledge, and includes a dietary counselling component. The classification of fat and fibre intakes as low, medium or high by the DINE method was compared to that of a detailed 4-day diet record in a population of 206 factory workers. There was exact agreement of categorization for 53% of fat intakes and 52% of fibre intakes, and only 6% of fat intakes and 5% of fibre intakes were grossly misclassified (placed in a high category by one method and a low category by another). Pearson correlation coefficients between the two methods were 0.51 for fat, 0.46 for fibre and 0.43 for the polyunsaturated:saturated fat ratio. The DINE method is a brief and inexpensive tool for diet assessment in primary care health promotion programmes.
Article
Despite high rates of smoking among socioeconomically disadvantaged pregnant women, few tobacco cessation programs have been geared for this client group. This article describes newly developed strategies for addressing tobacco reduction with disadvantaged, high-risk prenatal clients enrolled in a community-based Pregnancy Outreach Program in a northern Canadian city. The new tobacco reduction strategies were based on "solution-focused" approaches to interviewing and counseling. Process evaluations conducted with program staff revealed that solution-focused approaches provided effective, client-centered, respectful ways of discussing tobacco reduction with disadvantaged clients. Solution-focused approaches also positively impacted clients' sense of self-efficacy regarding tobacco reduction. The benefits of using solution-focused approaches as an alternative approach to tobacco reduction with disadvantaged prenatal clients are discussed.
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