Maternal obesity support services: a qualitative study of the perspectives of women and midwives

Background - Twenty percent of pregnant women in the UK are obese (BMI ≥ 30 kg/m2), reflecting the growing public health challenge of obesity in the 21st century. Obesity increases the risk of adverse outcomes during pregnancy and birth and has significant cost implications for maternity services. Gestational weight management strategies are a high priority; however the evidence for effective, feasible and acceptable weight control interventions is limited and inconclusive. This qualitative study explored the experiences and perceptions of pregnant women and midwives regarding existing support for weight management in pregnancy and their ideas for service development. Methods - A purposive sample of 6 women and 7 midwives from Doncaster, UK, participated in two separate focus groups. Transcripts were analysed thematically. Results - Two overarching themes were identified, 'Explanations for obesity and weight management' and 'Best care for pregnant women'. 'Explanations' included a lack of knowledge about weight, diet and exercise during pregnancy; self-talk messages which excused overeating; difficulties maintaining motivation for a healthy lifestyle; the importance of social support; stigmatisation; and sensitivity surrounding communication about obesity between midwives and their clients. 'Best care' suggested that weight management required care which was consistent and continuous, supportive and non-judgemental, and which created opportunities for interaction and mutual support between obese pregnant women. Conclusions - Women need unambiguous advice regarding healthy lifestyles, diet and exercise in pregnancy to address a lack of knowledge and a tendency towards unhelpful self-talk messages. Midwives expressed difficulties in communicating with their clients about their weight, given awareness that obesity is a sensitive and potentially stigmatising issue. This indicates more could be done to educate and support them in their work with obese pregnant women. Motivation and social support were strong explanatory themes for obesity and weight management, suggesting that interventions should focus on motivational strategies and social support facilitation

Abordagem fisioterapêutica no pré-parto: proposta de protocolo e avaliação da dor Physiotherapeutic approach in the pre-partum: proposed protocol and evaluate pain

O objetivo deste estudo foi avaliar os efeitos da abordagem fisioterapêutica no pré-parto e propor um protocolo de intervenção baseado na escala visual analógica (EVA) de dor. Dez parturientes, na primeira fase do trabalho de parto, foram questionadas quanto à dor através da EVA e, com base nas respostas, foi proposto um protocolo, EVA 1-3: cinesioterapia, técnicas respiratórias, relaxamento e estímulo à deambulação; EVA 4-7: massoterapia, técnicas respiratórias, relaxamento e estímulo à deambulação; EVA 8-10: técnicas respiratórias, relaxamento e eletroestimulação nervosa transcutânea. Após as intervenções, as voluntárias foram questionadas novamente através da EVA. Os dados da EVA pré- e pós-intervenção foram submetidos ao teste t pareado, atingindo valor médio de 8,8 pré-intervenção e 8,2 pós-intervenção, sem diferença estatística. Os resultados obtidos por meio da análise quantitativa de dor demonstraram que não houve aumento da mesma até uma hora após a intervenção, fato considerado positivo, uma vez que em função da crescente dilatação é esperado um aumento da dor. O protocolo fisioterapêutico proposto mostrou ser de fácil aplicabilidade, podendo auxiliar o fisioterapeuta na escolha da conduta mais adequada à realidade da sala de pré-parto. A abordagem fisioterapêutica no pré-parto parece interferir positivamente sobre a dor e o desconforto materno no grupo estudado.<br>The aim of this study was to evaluate the effects of physical therapy approach in the antepartum and to propose an intervention protocol based on the visual analogue scale (VAS) of pain. Ten parturients in the first stage of labor were questioned about the pain by VAS. Based on the responses, we proposed a protocol VAS 1-3: kinesiotherapy, breathing techniques, relaxation and stimulation of walking; VAS 4-7: massage therapy, breathing techniques, relaxation and stimulation of walking; VAS 8-10: breathing techniques, relaxation and transcutaneous electrical stimulation. After the intervention, the volunteers were questioned again by VAS. The VAS data pre-and post-intervention were submitted to the paired t test, reaching an average value of 8.8 pre-intervention and 8.2 post-intervention, no statistical difference. The results obtained through quantitative analysis of pain showed no increase of the same until one hour after the intervention, which was considered positive, since due to the increasing expansion is expected to increase the pain. The proposed physical therapy protocol proved easy to apply. It can assist the therapist in choosing the most adequate to the reality of pre-delivery room. The physical therapy approach in the pre-partum seems to positively affect pain and maternal discomfort in the study group

The composition and stability of the vaginal microbiota of normal pregnant women is different from that of non-pregnant women

Abstract Background This study was undertaken to characterize the vaginal microbiota throughout normal human pregnancy using sequence-based techniques. We compared the vaginal microbial composition of non-pregnant patients with a group of pregnant women who delivered at term. Results A retrospective case–control longitudinal study was designed and included non-pregnant women (n = 32) and pregnant women who delivered at term (38 to 42 weeks) without complications (n = 22). Serial samples of vaginal fluid were collected from both non-pregnant and pregnant patients. A 16S rRNA gene sequence-based survey was conducted using pyrosequencing to characterize the structure and stability of the vaginal microbiota. Linear mixed effects models and generalized estimating equations were used to identify the phylotypes whose relative abundance was different between the two study groups. The vaginal microbiota of normal pregnant women was different from that of non-pregnant women (higher abundance of Lactobacillus vaginalis, L. crispatus, L. gasseri and L. jensenii and lower abundance of 22 other phylotypes in pregnant women). Bacterial community state type (CST) IV-B or CST IV-A characterized by high relative abundance of species of genus Atopobium as well as the presence of Prevotella, Sneathia, Gardnerella, Ruminococcaceae, Parvimonas, Mobiluncus and other taxa previously shown to be associated with bacterial vaginosis were less frequent in normal pregnancy. The stability of the vaginal microbiota of pregnant women was higher than that of non-pregnant women; however, during normal pregnancy, bacterial communities shift almost exclusively from one CST dominated by Lactobacillus spp. to another CST dominated by Lactobacillus spp. Conclusion We report the first longitudinal study of the vaginal microbiota in normal pregnancy. Differences in the composition and stability of the microbial community between pregnant and non-pregnant women were observed. Lactobacillus spp. were the predominant members of the microbial community in normal pregnancy. These results can serve as the basis to study the relationship between the vaginal microbiome and adverse pregnancy outcomes

Factorial and diagnostic validity of the beck depression inventory-II (BDI-II) in Croatian primary health care

The aim of this study was to examine the factorial and diagnostic validity of the Beck Depression Inventory-Second Edition (BDI-II) in Croatian primary health care. Data were collected using a medical outpatient sample (N = 314). Reliability measured by internal consistency proved to be high. While the Velicer MAP Test showed that extraction of only one factor is satisfactory, confirmatory factor analysis indicated the best fit for a 3-factor structure model consisting of cognitive, affective and somatic dimensions. Receiver operating characteristics (ROC) analysis demonstrated the BDI-II to have a satisfactory diagnostic validity in differentiating between healthy and depressed individuals in this setting. The area under the curve (AUC), sensitivity and specificity were high with an optimal cut-off score of 15/16. The implications of these findings are discussed regarding the use of the BDI-II as a screening instrument in primary health care settings