Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial

Poston, Lucilla; Bell, Ruth; Croker, Helen; Flynn, Angela C.; Godfrey, Keith M.; Goff, Louise; Hayes, Louise; Khazaezadeh, Nina; Nelson, Scott M.; Oteng‐Ntim, Eugene; Pasupathy, Dharmintra; Patel, Nashita; Robson, Stephen C.; Sandall, Jane; Sanders, Tom; Sattar, Naveed; Seed, Paul; Wardle, Jane; Whitworth, Melissa; Briley, Annette

doi:10.1016/s2213-8587(15)00227-2

Cited by 571 publications

(797 citation statements)

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“…Recent intervention trials have successfully increased physical activity levels among obese pregnant women (Dodd et al, 2014;Poston et al, 2015). However, similar to the women in this study, others have identified a lack of advice and support with physical activity in pregnancy, and a particular concern around safety (Weir et al, 2010;Sui and Dodd, 2013;Padmanabhan et al, 2015), while receiving physical activity advice from health professionals is a key enabler to supporting physical activity (Sui and Dodd, 2013).…”

Section: Resultsmentioning

confidence: 51%

Lived experiences of routine antenatal dietetic services among women with obesity: A qualitative phenomenological study

et al. 2017

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Objective: To understand the lived experiences and views of being referred to an antenatal dietetic service from the perspective of pregnant women with obesity.Design: A qualitative, interpretive approach using one-to-one in-depth interviews to explore the lived experience of pregnant women with obesity following referral to an antenatal dietetics service. Thematic content analysis was carried out by two researchers independently to develop data-driven themes.Setting: One NHS Trust maternity and dietetic services, North East England, UK Participants: Fifteen pregnant women with a booking body mass index ≥30kg/m 2 attending an obesity-specific antenatal dietetic service. All women were White, parity between 0-2, and BMI range 30-51kg/m 2 .Findings: Four themes were identified within this concept. 1) Women's overall experience of the service: experiences were predominately positive with only two negative cases identified.2) Process of referral: women placed importance on informative and in-person communication about the service, with health professionals, at the point of referral. 3) 2 Delivery of the service: dietitians were considered to be the experts and women wanted more frequent contact. 4) Content of the service: tailored advice enabled behaviour change, and women desired increased physical activity support and weight monitoring.Key conclusions: Women reported an overall positive experience and thought that dietitians were the expert health professionals to support them. Women in this study felt that tailoring advice specific to their personal circumstances helped them implement changes, and had a strong interest in the nutritional benefits for fetal development. Women considered weight monitoring to be a positive element of the service; however, further research is required given the limited and conflicting evidence-base.Implications for practice: It is important to incorporate women's experiences in the development and delivery of antenatal weight management services to facilitate personcentred care. Communication by health professionals at the point of referral is particularly important to provide accurate expectations of services and to reduce anxieties. Dietitians are considered to be appropriate experts to deliver these services, although they may need additional support to address women's physical activity needs in pregnancy.Keywords obesity, body mass index, dietetic, qualitative, experience, pregnancy IntroductionMaternal obesity (body mass index (BMI) ≥30kg/m 2 ) is increasing in prevalence internationally (Brynhildsen et al., 2006;Ray et al., 2007;Heslehurst et al., 2010;Fisher et al., 2013) and is associated with complex inequalities, including deprivation and ethnic minority groups (Heslehurst et al., 2010(Heslehurst et al., , 2012. There are significantly increased associations with adverse outcomes for women and babies including congenital anomalies, perinatal mortality, macrosomia, gestational diabetes, maternal infections and preterm birth (Heslehurst et al., 2008;Stothard et al., 2009;Tenn...

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Section: Resultsmentioning

confidence: 51%

Lived experiences of routine antenatal dietetic services among women with obesity: A qualitative phenomenological study

et al. 2017

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“…All aspects of the trial, including the analyses in the present study, were approved by the National Health Service Research Ethics Committee (UK Integrated Research Application System; reference 09/H0802/5) and all participants, including women aged 16 and 17 using Fraser guidelines, provided informed written consent [11].…”

Section: Methodsmentioning

confidence: 99%

Metabolic profiling of gestational diabetes in obese women during pregnancy

et al. 2017

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Aims/hypothesis Antenatal obesity and associated gestational diabetes (GDM) are increasing worldwide. While pre-existing insulin resistance is implicated in GDM in obese women, the responsible metabolic pathways remain poorly described. Our aim was to compare metabolic profiles in blood of obese pregnant women with and without GDM 10 weeks prior to and at the time of diagnosis by OGTT. Methods We investigated 646 women, of whom 198 developed GDM, in this prospective cohort study, a secondary analysis of UK Pregnancies Better Eating and Activity Trial (UPBEAT), a multicentre randomised controlled trial of a complex lifestyle intervention in obese pregnant women. Multivariate regression analyses adjusted for multiple testing, and accounting for appropriate confounders including study intervention, were performed to compare obese women with GDM with obese non-GDM women. We measured 163 analytes in serum, plasma or whole blood, including 147 from a targeted NMR metabolome, at time point 1 (mean gestational age 17 weeks 0 days) and time point 2 (mean gestational age 27 weeks 5 days, at time of OGTT) and compared them between groups. Results Multiple significant differences were observed in women who developed GDM compared with women without GDM (false discovery rate corrected p values <0.05). Most were evident prior to diagnosis. Women with GDM demonstrated raised lipids and lipoprotein constituents in VLDL subclasses, greater triacylglycerol enrichment across lipoprotein particles, higher branched-chain and aromatic amino acids and different fatty acid, ketone body, adipokine, liver and inflammatory marker profiles compared with those without GDM. Conclusions/interpretation Among obese pregnant women, differences in metabolic profile, including exaggerated dyslipidaemia, are evident at least 10 weeks prior to a diagnosis of GDM in the late second trimester.

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“…Second, interventions in most of the studies were implemented late, in the second or third trimester, which might not have allowed sufficient time for the intervention to be effective. The latter was true even for the relatively large-scale intervention studies published recently [28][29][30].…”

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confidence: 93%

Risk factors for gestational diabetes: is prevention possible?

2016

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Gestational diabetes mellitus (GDM), a common pregnancy complication, continues to be a significant public health and clinical problem. It carries significant short-term and long-term adverse health outcomes for both mother and offspring, which reinforces the significance of understanding risk factors, in particular modifiable factors, for GDM and of preventing the condition. Research in the past decade from observational studies has identified a few diet and lifestyle factors that are associated with GDM risk and demonstrated that time frames both before and during pregnancy may be relevant to the development of GDM. Findings from intervention studies on the effect of diet and lifestyle on the prevention of GDM have been largely controversial and inconsistent. Variations in study population, types of intervention, timing and duration of intervention and diagnostic criteria for GDM may all at least partly account for the large heterogeneity in the findings from these intervention studies. This review provides an overview of emerging diet, lifestyle, and other factors that may help to prevent GDM, and the challenges associated with prevention. It also discusses major methodological concerns about the available epidemiological studies on GDM risk factors. Findings from both observational and intervention studies are discussed.

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Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial

Abstract: National Institute for Health Research, Guys and St Thomas' Charity, Chief Scientist Office Scotland, Tommy's Charity.

Cited by 571 publications

References 25 publications

Lived experiences of routine antenatal dietetic services among women with obesity: A qualitative phenomenological study

Lived experiences of routine antenatal dietetic services among women with obesity: A qualitative phenomenological study

Metabolic profiling of gestational diabetes in obese women during pregnancy

Risk factors for gestational diabetes: is prevention possible?

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