Healthy Weight Services in England before, during and after pregnancy: a mixed methods approach

Abstract

Background: Maternal overweight and obesity are associated with numerous adverse outcomes including higher rates of maternal and infant mortality and morbidity. Overweight and obesity before, during and after pregnancy are therefore a significant public health priority in England. This project explored and mapped healthy weight service availability at different stages of the childbearing cycle.Methods: A mixed methods approach included a questionnaire-based survey disseminated through Local Maternity Systems and semi-structured interviews or focus groups with providers and commissioners. Current maternal weight service provision was explored along with some of the barriers and facilitators for providing, delivering and accessing healthy weight services. Descriptive statistics were reported for quantitative data and content analysis was used for thematic reporting of qualitative data. Results: A total of 88 participants responded to the survey. All services were offered most frequently during pregnancy; with healthy eating and/or weight management services offered more often than physical activity services. Few services were targeted specifically at women with a raised body mass index. There was a high degree of inconsistency of service provision in different geographical areas. Several themes were identified from qualitative data including "equity and variation in service provision", "need for rigorous evaluation", "facilitators” to encourage better access or more effective service provision, including prioritisation, a change in focus and co-design of services, "barriers" encountered including financial and time obstacles, poor communication and insufficiently clear strategic national guidance and "the need for additional support”.Conclusions: There is a need to reduce geographical variation in services and the potential health inequalities that this may cause. Improving services for women with a raised body mass index as well as services which encourage physical activity require additional emphasis. There is a need for more robust evaluation of services to ensure they are fit for purpose. An urgent need for clear national guidance so that healthcare providers can more effectively assist mothers achieve a healthy weight gain was identified. Commissioners should consider implementing strategies to reduce the barriers of access identified such as childcare, transport, location and making services free at the point of use.

A meta‐review of systematic reviews of lifestyle interventions for reducing gestational weight gain in women with overweight or obesity

“…However, none of the other study characteristics investigated including gestation at which the intervention commenced, intensity of the intervention in terms of length of time, frequency, or duration of the intervention or the type of diet advised predicted the success of the lifestyle intervention 61 . This current lack of clarity regarding effective interventions during pregnancy appears to carry over into practice, with a recent study of providers and commissioners 62 highlighting provider's desire for clearer guidance on which to base their practice. This current overview illustrates how much our understanding of effective interventions still needs to advance.…”

Pre- and Post-Migration Influences on Weight Management Behaviours before and during Pregnancy: Perceptions of African Migrant Women in England

“…UK guidelines recommend that women need to be supported before conception and throughout pregnancy to have and maintain healthy dietary and PA behaviours, in order to improve their pregnancy outcomes and optimise the health of their children [ 12 ]. There are various guidelines and resources available to support the dietary and PA behaviours of pregnant women and women of child-bearing age in England, such as healthy eating guidelines provided by the NHS [ 13 ], weight management advice provided by midwives or health visitors [ 12 ], PA infographics for pregnant women and women of child-bearing age [ 14 ], and other weight management programmes such as aquanatal classes, park walks, and cooking programmes [ 15 ]. While several studies have explored women’s experiences and perceptions of weight management support in England [ 16 , 17 , 18 , 19 ], little is known about the experiences of women who have migrated to England from Africa (henceforth referred to as African migrant women).…”