Design of the New Life(style) study: a randomised controlled trial to optimise maternal weight development during pregnancy. [ISRCTN85313483]

BACKGROUND: Preventing excessive weight gain during pregnancy is potentially important in the prevention of overweight and obesity among women of childbearing age. However, few intervention studies aiming at weight management during pregnancy have been performed and most of these interventions were not as successful as expected. In this paper the design of the New Life(style) study is described as well as the content of the individually tailored intervention program, which focuses on controlling weight development during pregnancy. METHODS: The effectiveness of the New Life(style) intervention program versus usual care by midwives is evaluated in a randomised controlled trial. Women who expect their first child and visit one of the participating midwifery practices are included. The intervention is standardised in a protocol and executed by trained counsellors with the women who are randomised in the intervention group. During 5 sessions – at 18, 22, 30 and 36 weeks of pregnancy and at 8 weeks postpartum – individual weight gain is discussed in relation to weight gain guidelines for pregnant women of the American Institute of Medicine. Counsellors coach the women to maintain or optimise a healthy lifestyle, in a period of drastic physical and mental changes. Data is collected at 15, 25, 35 weeks of pregnancy and at 6, 26, and 52 weeks after delivery. Primary outcome measures are body weight, BMI, and skinfold thickness. Secondary outcome measures include physical activity, nutrition and blood levels of factors that are associated with energy homeostasis. DISCUSSION: Results of the current RCT will improve the knowledge of determinants of weight gain during pregnancy, weight retention after childbirth and of the effectiveness of the intervention program that is described. Caregivers and researchers in the field of health promotion are offered more insight in specific elements of the New Life(style) intervention program

Postabortion contraception use among women with and without a history of mental disorders: A Dutch prospective 5-year follow-up study

Background To provide optimal care, the Dutch national abortion care guidelines support immediate postabortion contraception counseling. As a consequence, uptake of contraception after abortion is supposed to be high. Surprisingly little is known about contraception continuation after abortion over time. Research has shown that women with a history of mental disorders (HMD) are at increased risk for repeat abortion, related to less (effective) contraception use. Objectives In the current study, we will investigate whether HMD predicts longterm contraception use after abortion, and explore whether decisional autonomy may in part explain this relationship. Method The study is based on the first and the third (last) wave of the Dutch Abortion and Mental Health Study (DAMHS), a five-year prospective cohort study of mental health among women who terminated an unwanted pregnancy (n=325). Data were collected using structured face-to-face interviews. Hypotheses were tested using regression models adjusting for SES, age, and desire to have a family. Preliminary results The proportion of women using no contraception at all was strikingly similar before abortion and 5 years after. Furthermore, LARC use had increased significantly in the five years after abortion, whereas oral contraceptives and condom use had decreased. Preabortion mental disorders did not predict long-term postabortion contraception use in general (age did), but it did predict the use of highly effective contraception (LARC) 5 years postabortion (pConclusion Contraception nonusers may continue their contraceptive nonuse in the five years postabortion, but other women using oral contraceptives or condoms preabortion may be more motivated to start using more effective contraception methods postabortion. Women with HMD might benefit from contraception counseling including LARC options, to ensure they make the choice that fits their needs

Postabortion contraception use among women with and without a history of mental disorders: A Dutch prospective 5-year follow-up study

Background To provide optimal care, the Dutch national abortion care guidelines support immediate postabortion contraception counseling. As a consequence, uptake of contraception after abortion is supposed to be high. Surprisingly little is known about contraception continuation after abortion over time. Research has shown that women with a history of mental disorders (HMD) are at increased risk for repeat abortion, related to less (effective) contraception use. Objectives In the current study, we will investigate whether HMD predicts longterm contraception use after abortion, and explore whether decisional autonomy may in part explain this relationship. Method The study is based on the first and the third (last) wave of the Dutch Abortion and Mental Health Study (DAMHS), a five-year prospective cohort study of mental health among women who terminated an unwanted pregnancy (n=325). Data were collected using structured face-to-face interviews. Hypotheses were tested using regression models adjusting for SES, age, and desire to have a family. Preliminary results The proportion of women using no contraception at all was strikingly similar before abortion and 5 years after. Furthermore, LARC use had increased significantly in the five years after abortion, whereas oral contraceptives and condom use had decreased. Preabortion mental disorders did not predict long-term postabortion contraception use in general (age did), but it did predict the use of highly effective contraception (LARC) 5 years postabortion (pConclusion Contraception nonusers may continue their contraceptive nonuse in the five years postabortion, but other women using oral contraceptives or condoms preabortion may be more motivated to start using more effective contraception methods postabortion. Women with HMD might benefit from contraception counseling including LARC options, to ensure they make the choice that fits their needs