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A theory driven, pragmatic trial implementing changes to routine antenatal care that supports recommended pregnancy weight gain

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posted on 21.06.2022, 06:35 authored by Susan de Jersey, Taylor Guthrie, Leonie Callaway, Jeanette Tyler, Karen New, Jan NicholsonJan Nicholson
BACKGROUND: Prevention of weight gain outside recommendations is a challenge for health services, with several barriers to best practice care identified. The aim of this pragmatic implementation study with a historical control was to examine the impact of implementing a service wide education program, and antenatal care pregnancy weight gain chart combined with brief advice on women's knowledge of recommended gestational weight gain (GWG), the advice received and actual GWG. METHODS: The PRECEDE PROCEED Model of Health Program planning guided intervention and evaluation targets and an implementation science approach facilitated service changes. Pregnant women < 22 weeks' gestation attending the antenatal clinic at a metropolitan birthing hospital in Australia were recruited pre (2010, n = 715) and post (2016, n = 478) implementation of service changes. Weight measurements and questionnaires were completed at recruitment and 36 weeks' gestation. Questionnaires assessed advice received from health professionals related to healthy eating, physical activity, GWG, and at recruitment only, pre-pregnancy weight and knowledge of GWG recommendations. RESULTS: Women who correctly reported their recommended GWG increased from 34% (pre) to 53% (post) (p < 0.001). Between pre and post implementation, the advice women received from midwives on recommended GWG was significantly improved at both recruitment- and 36-weeks' gestation. For normal weight women there was a reduction in GWG (14.2 ± 5.3 vs 13.3 ± 4.7 kg, p = 0.04) and clinically important reduction in excess GWG between pre and post implementation (31% vs 24%, p = 0.035) which remained significant after adjustment (AOR 0.53 [95%CI 0.29-0.96]) (p = 0.005). CONCLUSIONS: Service wide changes to routine antenatal care that address identified barriers to supporting recommended GWG are likely to improve the care and advice women receive and prevent excess GWG for normal weight women.

Funding

Dr de Jersey is supported by a Metro North Hospital and Health Service Clinician Research Fellowship.Project funding was provided by the Royal Brisbane and Women's Hospital (RBWH) Foundation for the New Beginnings Healthy Mothers and Babies Study; RBWH Research Advisory Committee and National Health and Medical Research Council (NHMRC) provided PhD Scholarship funding (SdeJ 1,017,169). TG was supported by a vacation research scholarship from Queensland University of Technology during 2015 that supported part of this work. Funding from the Advance Queensland Women's Academic Fund (Maternity Leave SdeJ) and a University of Queensland New Staff Research Start-up grant was used to support research assistant time for data collection, entry and analysis of the Healthy Pregnancy Healthy Baby study.

History

Publication Date

18/05/2022

Journal

BMC Pregnancy and Childbirth

Volume

22

Issue

1

Article Number

416

Pagination

11p.

Publisher

Springer Nature

ISSN

1471-2393

Rights Statement

© The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.