Feasibility of a controlled trial aiming to prevent excessive pregnancy-related weight gain in primary health care

<p>Abstract</p> <p>Background</p> <p>Excessive gestational weight gain and postpartum weight retention may predispose women to long-term overweight and other health problems. Intervention studies aiming at preventing excessive pregnancy-related weight gain are needed. The feasibility of implementing such a study protocol in primary health care setting was evaluated in this pilot study.</p> <p>Methods</p> <p>A non-randomized controlled trial was conducted in three intervention and three control maternity and child health clinics in primary health care in Finland. Altogether, 132 pregnant and 92 postpartum women and 23 public health nurses (PHN) participated in the study. The intervention consisted of individual counselling on physical activity and diet at five routine visits to a PHN and of an option for supervised group exercise until 37 weeks' gestation or ten months postpartum. The control clinics continued their usual care. The components of the feasibility evaluation were 1) recruitment and participation, 2) completion of data collection, 3) realization of the intervention and 4) the public health nurses' experiences.</p> <p>Results</p> <p>1) The recruitment rate was slower than expected and the recruitment period had to be prolonged from the initially planned three months to six months. The average participation rate of eligible women at study enrolment was 77% and the drop-out rate 15%. 2) In total, 99% of the data on weight, physical activity and diet and 96% of the blood samples were obtained. 3) In the intervention clinics, 98% of the counselling sessions were realized, their contents and average durations were as intended, 87% of participants regularly completed the weekly records for physical activity and diet, and the average participation percentage in the group exercise sessions was 45%. 4) The PHNs regarded the extra training as a major advantage and the high additional workload as a disadvantage of the study.</p> <p>Conclusion</p> <p>The study protocol was mostly feasible to implement, which encourages conducting large trials in comparable settings.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN21512277</p

Effect of dietary intervention on serum lignan levels in pregnant women - a controlled trial

<p>Abstract</p> <p>Background</p> <p>Mother's diet during pregnancy is important, since plant lignans and their metabolites, converted by the intestinal microflora to enterolignans, are proposed to possess multiple health benefits. Aim of our study was to investigate whether a dietary intervention affects lignan concentrations in the serum of pregnant women.</p> <p>Methods</p> <p>A controlled dietary intervention trial including 105 first-time pregnant women was conducted in three intervention and three control maternity health clinics. The intervention included individual counseling on diet and on physical activity, while the controls received conventional care. Blood samples were collected on gestation weeks 8-9 (baseline) and 36-37 (end of intervention). The serum levels of the plant lignans 7-hydroxymatairesinol, secoisolariciresinol, matairesinol, lariciresinol, cyclolariciresinol, and pinoresinol, and of the enterolignans 7-hydroxyenterolactone, enterodiol, and enterolactone, were measured using a validated method.</p> <p>Results</p> <p>The baseline levels of enterolactone, enterodiol and the sum of lignans were higher in the control group, whereas at the end of the trial their levels were higher in the intervention group. The adjusted mean differences between the baseline and end of the intervention for enterolactone and the total lignan intake were 1.6 ng/ml (p = 0.018, 95% CI 1.1-2.3) and 1.4 ng/mg (p = 0.08, 95% CI 1.0-1.9) higher in the intervention group than in the controls. Further adjustment for dietary components did not change these associations.</p> <p>Conclusion</p> <p>The dietary intervention was successful in increasing the intake of lignan-rich food products, the fiber consumption and consequently the plasma levels of lignans in pregnant women.</p> <p>Trial registration</p> <p><b>ISRCTN21512277, <url>http://www.isrctn.org</url></b></p

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

Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial

In a cluster-randomized trial, Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing gestational diabetes mellitus (GDM), but fail to find an effect on GDM

Opportunities for primary and secondary prevention of excess gestational weight gain: General Practitioners' perspectives

BackgroundThe impact of excess gestational weight gain (GWG) on maternal and child health outcomes is well documented. Understanding how health care providers view and manage GWG may assist with influencing healthy gestational weight outcomes. This study aimed to assess General Practitioner\u27s (GPs) perspectives regarding the management and assessment of GWG and to understand how GPs can be best supported to provide healthy GWG advice to pregnant women.MethodsDescriptive qualitative research methods utilising semi - structured interview questions to assess GPs perspectives and management of GWG. GPs participating in shared antenatal care in Geelong, Victoria and Sydney, New South Wales were invited to participate in semi - structured, individual interviews via telephone or in person. Interviews were digitally recorded and transcribed verbatim. Data was analysed utilising thematic analysis for common emerging themes.ResultsTwenty eight GPs participated, 14 from each state. Common themes emerged relating to awareness of the implications of excess GWG, advice regarding weight gain, regularity of gestational weighing by GPs, options for GPs to seek support to provide healthy lifestyle behaviour advice and barriers to engaging pregnant women about their weight. GPs perspectives concerning excess GWG were varied. They frequently acknowledged maternal and child health complications resulting from excess GWG yet weighing practices and GWG advice appeared to be inconsistent. The preferred support option to promote healthy weight was referral to allied health practitioners yet GPs noted that cost and limited access were barriers to achieving this.ConclusionsGPs were aware of the importance of healthy GWG yet routine weighing was not standard practice for diverse reasons. Management of GWG and perspectives of the issue varied widely. Time efficient and cost effective interventions may assist GPs in ensuring women are supported in achieving healthy GWG to provide optimal maternal and infant health outcomes.<br /

Erratum to: Study protocol: differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes: individual patient data (IPD) meta-analysis and health economic evaluation.

Erratum to: Study protocol: differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes: individual patient data (IPD) meta-analysis and health economic evaluatio

Одноколейные тракторно-ледяные дороги: учебное пособие для лесотехнических вузов

Книга содержит описание конструкций однополозных тракторных саней, расчет основных деталей саней, краткие технические условия проектирования одноколейных тракторно-ледяных дорог, правила постройки и эксплуатации ледяных дорог и основы организации тракторного хозяйства на базе одноколейных ледяных дорог. Книга предназначена в качестве учебного пособия для лесотехнических вузов, но может также служить практическим пособием и для высшего технического персонала лесозаготовительных предприятий Наркомлеса СССР.0|7|Предисловие [c. 7]0|8|Введение [c. 8]0|11|Возникновение и развитие конструкции однополозных саней [c. 11]1|11|Первые опыты [c. 11]1|12|Принцип работы одноколейной ледяной дороги и теоретические основания проектирования однополозных саней [c. 12]1|17|Конструкция первых однополозных саней [c. 17]1|17|Однополозные сани Востокостальлеса [c. 17]1|19|Одкополозные сани ЦНИИМЭ, модель Б [c. 19]1|21|Однополозные сани на базе поковок тракторных двухполозных саней модели Д [c. 21]1|22|Однополозные сани Я. И. Гинзбурга модели 1939 г. [c. 22]1|33|Однополозные сани ГЗЯ-2 [c. 33]1|39|Варианты соединения коника с полозом [c. 39]1|39|Модернизированные однополозные сани на базе поковок саней модели Свердлеса и Востокостальлеса [c. 39]1|44|Бескониковые однополозные сани конструкции СибНИИЛХЭ [c. 44]1|46|Буферно-прицепные устройства трактора конструкции УЛТИ, Сотринского мехлесопункта и Стройлеспроекта [c. 46]1|48|Автоматическая сцепка тракторных саней [c. 48]1|49|Рама для перевозки коротья на однополозных санях [c. 49]1|51|Расчет саней [c. 51]1|51|Расчет полоза [c. 51]1|58|О форме подрезов [c. 58]0|61|Постройка одноколейных ледяных дорог [c. 61]1|61|Условия применения, сырьевая база и порядок оформления строительства [c. 61]1|62|Технические условия проектирования одноколейных ледяных дорог [c. 62]1|72|Изыскания трасс одноколейных ледяных дорог [c. 72]1|73|Строительные работы на одноколейных ледяных дорогах [c. 73]1|85|Дорожные орудия для строительства одноколейных ледяных дорог [c. 85]1|91|Цистерны для поливки ледяной дороги [c. 91]1|91|Насосные станции [c. 91]0|95|Эксплуатация ледяных дорог [c. 95]1|95|Техническая характеристика тяговых машин [c. 95]1|107|Эксплуатация газогенераторных тракторов на лесовывозке по ледяным дорогам [c. 107]1|115|Правила вождения поездов [c. 115]1|117|Формирование состава и маневры [c. 117]1|117|Содержание и ремонт пути ледяной дороги [c. 117]1|119|Техника безопасности при вывозке леса по тракторным ледяным дорогам [c. 119]1|121|Основные правила по технике безопасности для тракторного лесотранспорта [c. 121]0|123|Приложения [c. 123]1|123|Детали однополозных саней ГЗЯ-1 [c. 123]1|136|Детали модернизированных однополозных саней на базе поковок саней Свердллеса [c. 136]1|141|Краткая техническая характеристика гусеничных тракторов Челябинского тракторного завода [c. 141]0|143|Оглавление [c. 143

Variations in reporting of outcomes in randomized trials on diet and physical activity in pregnancy: A systematic review

AIM: Trials on diet and physical activity in pregnancy report on various outcomes. We aimed to assess the variations in outcomes reported and their quality in trials on lifestyle interventions in pregnancy. METHODS: We searched major databases without language restrictions for randomized controlled trials on diet and physical activity-based interventions in pregnancy up to March 2015. Two independent reviewers undertook study selection and data extraction. We estimated the percentage of papers reporting 'critically important' and 'important' outcomes. We defined the quality of reporting as a proportion using a six-item questionnaire. Regression analysis was used to identify factors affecting this quality. RESULTS: Sixty-six randomized controlled trials were published in 78 papers (66 main, 12 secondary). Gestational diabetes (57.6%, 38/66), preterm birth (48.5%, 32/66) and cesarian section (60.6%, 40/66), were the commonly reported 'critically important' outcomes. Gestational weight gain (84.5%, 56/66) and birth weight (87.9%, 58/66) were reported in most papers, although not considered critically important. The median quality of reporting was 0.60 (interquartile range 0.25, 0.83) for a maximum score of one. Study and journal characteristics did not affect quality. CONCLUSION: Many studies on lifestyle interventions in pregnancy do not report critically important outcomes, highlighting the need for core outcome set development

Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: Individual participant data meta-Analysis

Objectives To identify if maternal educational attainment is a prognostic factor for gestational weight gain (GWG), and to determine the differential effects of lifestyle interventions (diet based, physical activity based or mixed approach) on GWG, stratified by educational attainment. Design Individual participant data meta-Analysis using the previously established International Weight Management in Pregnancy (i-WIP) Collaborative Group database (https://iwipgroup.wixsite.com/collaboration). Preferred Reporting Items for Systematic reviews and Meta-Analysis of Individual Participant Data Statement guidelines were followed. Data sources Major electronic databases, from inception to February 2017. Eligibility criteria Randomised controlled trials on diet and physical activity-based interventions in pregnancy. Maternal educational attainment was required for inclusion and was categorised as higher education ( 65tertiary) or lower education ( 64secondary). Risk of bias Cochrane risk of bias tool was used. Data synthesis Principle measures of effect were OR and regression coefficient. Results Of the 36 randomised controlled trials in the i-WIP database, 21 trials and 5183 pregnant women were included. Women with lower educational attainment had an increased risk of excessive (OR 1.182; 95% CI 1.008 to 1.385, p =0.039) and inadequate weight gain (OR 1.284; 95% CI 1.045 to 1.577, p =0.017). Among women with lower education, diet basedinterventions reduced risk of excessive weight gain (OR 0.515; 95% CI 0.339 to 0.785, p = 0.002) and inadequate weight gain (OR 0.504; 95% CI 0.288 to 0.884, p=0.017), and reduced kg/week gain (B-0.055; 95% CI-0.098 to-0.012, p=0.012). Mixed interventions reduced risk of excessive weight gain for women with lower education (OR 0.735; 95% CI 0.561 to 0.963, p=0.026). Among women with high education, diet based interventions reduced risk of excessive weight gain (OR 0.609; 95% CI 0.437 to 0.849, p=0.003), and mixed interventions reduced kg/week gain (B-0.053; 95% CI-0.069 to-0.037,p&lt;0.001). Physical activity based interventions did not impact GWG when stratified by education. Conclusions Pregnant women with lower education are at an increased risk of excessive and inadequate GWG. Diet based interventions seem the most appropriate choice for these women, and additional support through mixed interventions may also be beneficial