Mighty Mums – a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity

Abstract

BackgroundObesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes.MethodsThe intervention was performed in a city in Sweden 2011–2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790).ResultsIn the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG < 7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (− 0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population.ConclusionPregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting.Trial registrationThe study has been registered at ClinicalTrials.gov, Identifier: NCT03147079. May 10 2017, retrospectively registered.

Steroid Hormones in Cord Blood Mediate the Association Between Maternal Prepregnancy BMI and Birth Weight

“…No steroid hormones were found to have a significant association with maternal pre‐BMI in the GWG ≤ IOM group. These results strengthen the need for recent interventions that have been conducted to reduce GWG .…”

Offering weight management support to pregnant women with high body mass index: A qualitative study with midwives

“…New care guidelines were implemented in January 2014 to improve the care for pregnant women with high body mass index. These guidelines followed on from the Mighty Mums intervention study described in detail by Haby et al [9,14]. The new guidelines for care of pregnant women with high body mass index included an offer of additional appointments to discuss eating and physical activity and to set goals regarding these behaviours, regular weighing at appointments to assess weight gain, referral to a dietician and exercise on prescription [15].…”

“…Further, some of the participants had taken part in the intervention Mighty Mums [9,14] and may therefore have felt more confident and equipped to discuss weight support with pregnant women with high body mass index compared to other midwives in other settings who had not had this training. It is also likely that the new care guidelines which enabled midwives to have more and longer appointments with women with high body mass index helped midwives provide appropriate support.…”

“…Other requirements include support from healthcare professionals, family and friends [6]. Midwives are well-placed to offer and deliver weight management support in pregnancy [7][8][9], including information on weight gain [10] and weight management services and support [11]. Weight management support includes counselling on physical activity behaviour, which midwives sometimes identify as challenging [12].…”

“…Interventions delivered by midwives have been found to successfully help women gain a healthy amount of weight in pregnancy [8,9]. Less, however, is known about how midwives support healthy eating and physical activity in pregnancy.…”