The time period before, during and after pregnancy represents a unique opportunity for interventions to cultivate sustained healthy lifestyle behaviors to improve the metabolic health of mothers and their offspring. However, the success of a lifestyle intervention is dependent on uptake and continued compliance. To identify enablers and barriers towards engagement with a lifestyle intervention, thematic analysis of 15 in-depth interviews with overweight or obese women in the preconception, pregnancy or postpartum periods was undertaken, using the integrated-Promoting Action on Research Implementation in Health Services framework as a guide to systematically chart factors influencing adoption of a novel lifestyle intervention. Barrier factors include time constraints, poor baseline knowledge, family culture, food accessibility, and lack of relevant data sources. Enabling factors were motivation to be healthy for themselves and their offspring, family and social support, a holistic delivery platform providing desired information delivered at appropriate times, regular feedback, goal setting, and nudges. From the findings of this study, we propose components of an idealized lifestyle intervention including (i) taking a holistic life-course approach to education, (ii) using mobile health platforms to reduce barriers, provide personalized feedback and promote goal-setting, and (iii) health nudges to cultivate sustained lifestyle habits.

The extent to which lifestyle practices at night influence sleep quality in pregnant women remains unknown. This study aimed to examine whether nocturnal behaviours were associated with poor sleep during pregnancy. We performed a cross-sectional analysis of a prospective cohort of pregnant women at 18–24 gestation weeks recruited from KK Women’s and Children’s Hospital, Singapore, between 2019 and 2021. Nocturnal behaviours were assessed with questionnaires, and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) with a global score ≥5 indicative of poor sleep quality. Modified Poisson regression and linear regression were used to examine the association between nocturnal behaviour and sleep quality. Of 299 women, 117 (39.1%) experienced poor sleep. In the covariate-adjusted analysis, poor sleep was observed in women with nocturnal eating (risk ratio 1.51; 95% confidence interval [CI] 1.12, 2.04) and nocturnal artificial light exposure (1.63; 1.24, 2.13). Similarly, nocturnal eating (β 0.68; 95% CI 0.03, 1.32) and light exposure (1.99; 1.04, 2.94) were associated with higher PSQI score. Nocturnal physical activity and screen viewing before bedtime were not associated with sleep quality. In conclusion, reducing nocturnal eating and light exposure at night could potentially improve sleep in pregnancy.

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The time period before, during and after pregnancy represents a unique opportunity for interventions to cultivate sustained healthy lifestyle behaviors to improve the metabolic health of mothers and their offspring. However, the success of a lifestyle intervention is dependent on uptake and continued compliance. To identify enablers and barriers towards engagement with a lifestyle intervention, thematic analysis of 15 in-depth interviews with overweight or obese women in the preconception, pregnancy or postpartum periods was undertaken, using the integrated–Promoting Action on Research Implementation in Health Services (i-PARIHS) framework as a guide to systematically chart factors influencing adoption of a novel lifestyle intervention. Barrier factors include time constraints, poor baseline knowledge, family culture, food accessibility, and lack of relevant data sources. Enabling factors were motivation to be healthy for themselves and their offspring, family and social support, a holistic delivery platform providing desired information delivered at appropriate times, regular feedback, goal setting, and nudges. From the findings of this study, we propose components of an idealized lifestyle intervention including (i) taking a holistic life-course approach to education, (ii) using mobile health platforms to reduce barriers, provide personalized feedback and promote goal-setting, and (iii) health nudges to cultivate sustained lifestyle habits.

Objectives Little is known about the extent to which lifestyle practices at night influence sleep quality in pregnant women who are susceptible to sleep disturbances. This study aimed to examine the association between nocturnal lifestyle behaviour and sleep quality of women during pregnancy. Methods This observational cross-sectional study recruited pregnant women between 18 and 24 weeks of gestation from KK Women's and Children's Hospital, Singapore. Nocturnal lifestyle behaviour was assessed by frequency of night eating after 8 pm, moderate-to-vigorous physical activity performance after 7 pm, screen viewing > 1 hour before bedtime and artificial light exposure with ≥ 10 lux between 2–4 am. Sleep quality was measured using the Pittsburgh Sleep Quality Index with global score > 5 indicative of poor sleep quality. Modified Poisson regression model tested the association between nocturnal lifestyle behaviour and sleep quality. Results Of 299 women, 117 (39.1%) exhibited poor sleep quality. In the covariate-adjusted analysis, an increased risk of poor sleep quality was observed in women with night eating (risk ratio 1.54; 95% confidence interval 1.15, 2.06) and light exposure at night (1.74; 1.34, 2.25). No associations were observed for night-time physical activity (0.84; 0.60, 1.17) and screen viewing before bedtime (1.10; 0.76, 1.60) with sleep quality. Conclusions More than one-third of pregnant women experienced poor sleep quality. Night eating and artificial light exposure at night were associated with poor sleep quality during pregnancy. Thus, reducing night eating and decreasing levels of exposure to light at night represent potential targets for healthy sleep interventions in pregnancy, in a bid to augment efforts to promote sleep quality among pregnant women. Funding Sources This study is supported by the Singapore Ministry of Health's National Medical Research Council under its Open Fund-Young Individual Research Grant.