Reducing postpartum weight retention: a review of the implementation challenges of postpartum lifestyle interventions

Postpartum weight retention (PPWR) is a strong predictor of obesity in later life with long term health consequences in women. Suboptimal lifestyle behaviours (e.g., diet and physical activity) contribute to PPWR. Postpartum lifestyle interventions are known to be efficacious in reducing PPWR; however, there are challenges to their successful implementation. To inform implementation, this narrative review provides an overview of the factors that contribute to PPWR, the efficacy of existing postpartum lifestyle interventions and key determinants of effective implementation using the Consolidated Framework for Implementation Research (CFIR) across intervention characteristics, implementation process, individual characteristics and outer and inner setting. We then suggest strategies to improve the translation of evidence into large-scale interventions that deliver on health impact in postpartum women. We have identified gaps that need to be addressed to advance postpartum lifestyle research, including the involvement of postpartum women and community members as key stakeholders for optimal reach and engagement, more complete reporting of intervention characteristics to optimize translation of evidence into practice, capacity building of health professionals and guidelines for postpartum lifestyle management.Maureen Makama, Helen Skouteris, Lisa J. Moran and Siew Li

Support seeking in the postpartum period: content analysis of posts in web-based parenting discussion groups

Background: The transition from pregnancy to motherhood is a major developmental phase that can be challenging for both women and their families. For new mothers, the postpartum period is recognized as a critical period for increased risk of both physical and mental health concerns. For this reason, it is imperative that women receive accurate, evidence-based information during this time. Objective: This study aims to explore the conversations of new mothers on a web-based parenting forum to investigate what topics or concerns are being discussed. Methods: A leading Australian web-based support forum for women before and after birth was used to obtain a sample of posts from the mothers of infants aged 0-12 months. Quantitative data (word frequencies and sentiment analysis) and qualitative data (post content) were extracted from discussion threads and examined to determine sentiments and theoretical storylines. Results: In total, 260 posts were sampled. Infant care was the most prominent overarching topic discussed, with feeding and sleep being the most discussed subtopics. Discussions about maternal care were much less frequent but included questions about birth recovery, breastfeeding concerns, and interconception. A pattern of behavior emerged within the posts. This pattern resembled a cycle of learning across five phases: help seeking, solution ideation, testing and skill development, consolidation, and empowerment and improved mental well-being. A dynamic interplay was observed as mothers navigated new concerns or developmental changes. Conclusions: Engagement in web-based forums to seek help and support during the postpartum period was common, with infant health and well-being being the primary concerns for new mothers during this time. The identification of a maternal learning cycle within the forum underscores the contributory role of web-based communities in maternal peer social support, information seeking, and early parenting practices.Bonnie R Chivers, Rhonda M Garad, Lisa J Moran, Siew Lim, Cheryce L Harriso

Mobile apps for weight management: a review of the latest evidence to inform practice

Over the last decade, mobile technology has emerged as a potentially useful platform to facilitate weight management and tackle the current obesity epidemic. Clinicians are being more frequently asked to give advice about the usefulness of mobile apps and many individuals have already integrated apps into their attempts to manage weight. Hence, it is imperative for clinicians involved in weight management to be aware of the latest developments and knowledge about available mobile apps and their usefulness in this field. A number of newly published studies have demonstrated promising results of mobile-based interventions for weight management across different populations, but the extent of their effectiveness remains widely debated. This narrative literature review synthesizes the latest evidence, primarily from randomized controlled trials (RCTs), regarding the clinical use of mobile applications for weight management, as well as highlight key limitations associated with their use and directions for future research and practice. Overall, evidence suggests that mobile applications may be useful as low-intensity approaches or adjuncts to conventional weight management strategies. However, there is insufficient evidence to support their use as stand-alone intensive approaches to weight management. Further research is needed to clarify the extent of utility of these applications, as well as the measures required to maximize their potential both as stand-alone approaches and adjuncts to more intensive programs.Drishti P. Ghelani, Lisa J. Moran, Cameron Johnson, Aya Mousa and Negar Naderpoo

Diet quality in a weight gain prevention trial of reproductive aged women: a secondary analysis of a cluster randomized controlled trial

Reproductive-aged women are at high risk for obesity development. Limited research exploring weight gain prevention initiatives and associated modifiable risk factors, including diet quality exists. In a secondary analysis of a 12 month, cluster randomized controlled trial for weight gain prevention in reproductive-aged women, we evaluated change in diet quality, macronutrient and micronutrient intake, predictors of change and associations with weight change at follow-up. Forty-one rural towns in Victoria, Australia were randomized to a healthy lifestyle intervention (n = 21) or control (n = 20). Women aged 18⁻50, of any body mass index and without conditions known to affect weight, were recruited. Diet quality was assessed by the Dietary Guideline Index (DGI) and energy, macronutrient, and micronutrient intake as well as anthropometrics (weight; kg) were measured at baseline and 12 months. Results were adjusted for group (intervention/control), town cluster, and baseline values of interest. Of 409 women with matched data at baseline and follow-up, 220 women were included for final analysis after accounting for plausible energy intake. At 12 months, diet quality had improved by 6.2% following the intervention, compared to no change observed in the controls (p < 0.001). Significant association was found between a change in weight and a change in diet quality score over time β -0.66 (95%CI -1.2, -0.12) p = 0.02. The percentage of energy from protein (%) 0.009 (95%CI 0.002, 0.15) p = 0.01 and glycemic index -1.2 (95%CI -2.1, -0.24) p = 0.02 were also improved following the intervention, compared to the control group. Overall, a low-intensity lifestyle intervention effectively improves diet quality, with associated weight gain preventions, in women of reproductive age.Julie C. Martin, Lisa J. Moran, Helena J. Teede, Sanjeeva Ranasinha, Catherine B. Lombard and Cheryce L. Harriso

Postpartum diet quality: a cross-sectional analysis from the Australian Longitudinal Study on Women's Health

Reproductive-aged women are at high risk of developing obesity, and diet quality is a potential modifiable risk factor. There is limited research exploring diet quality and its association with time since childbirth. Using data from the Australian Longitudinal Study on Women's Health (ALSWH) survey 5 (2009) of women born between 1973-1978, who reported having previously given birth, we investigated the association between time since childbirth and diet quality, and differences in energy, macronutrients, micronutrient intake, and diet quality assessed by the dietary guideline index (DGI) in women stratified by time from last childbirth, early (0-6 months; n = 558) and late (7-12 months; n = 547), and all other women with children (>12 months post childbirth n = 3434). From this cohort, 8200 participants were eligible, of which 4539 participants completed a food frequency questionnaire (FFQ) and were included in this analysis. Overall, diet quality was higher in early and late postpartum women (mean DGI score 89.8 (SD 10.5) and mean DGI score 90.0 (SD 10.2), respectively) compared to all other women with children (>12 months post childbirth), mean DGI score 85.2 (SD 11.7), p 12 months), smoking compared with non-smoking and medium income level compared with no income was negatively associated with diet quality. A lower diet quality in women greater than 12 months post childbirth may be reflective of increased pressures, balancing childrearing and return to work responsibilities. This highlights the need to support women beyond the postpartum period to improve modifiable factors associated with weight gain, including diet quality, to optimize health and reduce chronic disease risk.Julie C. Martin, Anju E. Joham, Gita D. Mishra, Allison M. Hodge, Lisa J. Moran, and Cheryce L. Harriso

Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion

First published: 05 April 2022Polycystic ovary syndrome (PCOS) is associated with a higher risk for pregnancy and birth complications according to the specific features associated with PCOS. The features include obesity before and during pregnancy, hyperandrogenism, insulin resistance, infertility, cardiometabolic risk factors, and poor mental health. PCOS is not often recognized as a risk factor for poor pregnancy and birth outcomes in pregnancy care guidelines, while its associated features are. Pregnancy‐related risk profile should ideally be assessed for modifiable risk factors (e.g., lifestyle and weight management) at preconception in women with PCOS. Hyperglycaemia should be screened using a 75‐g oral glucose tolerance test at preconception or within the first 20 weeks of pregnancy if it has not been performed at preconception and should be repeated at 24–28 weeks of pregnancy. In the absence of evidence of benefit for strategies specific to women with PCOS, the international evidencebased guidelines for the assessment and management of PCOS recommend screening, optimizing, and monitoring risk profile in women with PCOS (at preconception, during and postpregnancy) consistent with the recommendations for the general population. Recommended factors include blood glucose, weight, blood pressure, smoking, alcohol, diet, exercise, sleep and mental health, emotional, and sexual health among women with PCOS. The guidelines recommend Metformin in addition to lifestyle for assisting with weight management and improving cardiometabolic risk factors, particularly in those with overweight or obesity. Letrozole is considered the first‐line pharmacological treatment for anovulatory infertility in PCOS. Individualized approach should be considered in the management of pregnancy in PCOS.Mahnaz Bahri Khomami, Helena J Teede, Anju E. Joham, Lisa J. Moran, Terhi T. Piltonen, Jacqueline A. Boyl

Lifestyle and psychological factors associated with pregnancy intentions: findings from a Longitudinal Cohort Study of Australian women

BACKGROUND:Preconception is a critical time for the establishment of healthy lifestyle behaviours and psychological well-being to reduce adverse maternal and offspring outcomes. This study aimed to explore relationships between preconception lifestyle and psychological factors and prospectively assessed short- (currently trying to conceive) and long-term (future parenthood aspirations) pregnancy intentions. METHODS:Data from Wave 3 (age 25-30 years; n = 7656) and Wave 5 (age 31-36 years; n = 4735) from the Australian Longitudinal Study of Women's Health were used. Pregnancy intentions and parenthood aspirations were evaluated. Logistic regressions explored cross-sectional associations between demographic, lifestyle and psychological factors and pregnancy intentions/parenthood aspirations. RESULTS:In multivariable models, parity and marital status were associated consistently with pregnancy intentions and parenthood aspirations. Few lifestyle behaviours and no psychological factors were associated with pregnancy intentions. Alcohol intake was the only behaviour associated with aspirations to have a first child. Aspirations for a second/subsequent child were associated negatively with physical activity, sitting time, diet quality, lower anxiety and higher stress. CONCLUSIONS:It appears that women are not changing their behaviours when they form a decision to try to conceive. Interventions are needed that address women's preconception needs, to optimise lifestyle and improve health outcomes for women and their families.Briony Hill, Mathew Ling, Gita Mishra, Lisa J. Moran, Helena J. Teede, Lauren Bruce and Helen Skouteri

Anti-Inflammatory Diets in Fertility: An Evidence Review

Infertility is a global health concern affecting 48 million couples and 186 million individuals worldwide. Infertility creates a significant economic and social burden for couples who wish to conceive and has been associated with suboptimal lifestyle factors, including poor diet and physical inactivity. Modifying preconception nutrition to better adhere with Food-Based Dietary Guidelines (FBDGs) is a non-invasive and potentially effective means for improving fertility outcomes. While several dietary patterns have been associated with fertility outcomes, the mechanistic links between diet and infertility remain unclear. A key mechanism outlined in the literature relates to the adverse effects of inflammation on fertility, potentially contributing to irregular menstrual cyclicity, implantation failure, and other negative reproductive sequelae. Therefore, dietary interventions which act to reduce inflammation may improve fertility outcomes. This review consistently shows that adherence to anti-inflammatory diets such as the Mediterranean diet (specifically, increased intake of monounsaturated and n-3 polyunsaturated fatty acids, flavonoids, and reduced intake of red and processed meat) improves fertility, assisted reproductive technology (ART) success, and sperm quality in men. Therefore, integration of anti-inflammatory dietary patterns as low-risk adjunctive fertility treatments may improve fertility partially or fully and reduce the need for prolonged or intensive pharmacological or surgical interventions.Simon Alesi, Anthony Villani, Evangeline Mantzioris, Wubet Worku Takele, Stephanie Cowan, Lisa J. Moran, and Aya Mous

Un nuevo Código de Corrección de Errores matricial con baja redundancia

Actualmente, y debido al continuo aumento en la escala de integración, la tasa de fallos en los sistemas de memoria de los computadores ha aumentado. Así, la probabilidad de que se produzcan Single Cell Upsets (SCUs) o Multiple Cell Upsets (MCUs) aumenta. Una solución común es el uso de Códigos de Corrección de Errores (ECCs). Sin embargo, cuando se utilizan ECCs en aplicaciones empotradas, se debe lograr un buen equilibrio entre la cobertura de errores, la redundancia introducida y la eficiencia en términos de área de silicio ocupada, potencia consumida y retardo de los circuitos de codificación y decodificación. En este sentido, existen diferentes propuestas para tolerar MCUs. Por ejemplo, los códigos matriciales utilizan códigos de Hamming y controles de paridad en un formato bidimensional para detectar y/o corregir MCUs. Sin embargo, estos códigos introducen una gran redundancia, lo que conlleva una sobrecarga excesiva con respecto al área, potencia consumida y retardo. En este trabajo presentamos un nuevo código matricial con una baja redundancia, que permite corregir diferentes patrones de MCUs y que no introduce una gran sobrecarga en los circuitos de codificación y decodificación

Disks, Tori, and Cocoons: Emission and Absorption Diagnostics of AGN Environments

One of the most important problems in the study of active galaxies is understanding the detailed geometry, physics, and evolution of the central engines and their environments. The leading models involve an accretion disk and torus structure around a central dense object, thought to be a supermassive black hole. Gas found in the environment of AGN is associated with different structures: molecular accretion disks, larger scale atomic tori, ionized and neutral "cocoons" in which the nuclear regions can be embedded. All of them can be studied at radio wavelengths by various means. Here, we summarize the work that has been done to date in the radio band to characterize these structures. Much has been learned about the central few parsecs of AGN in the last few decades with contemporary instruments but the picture remains incomplete. In order to be able to define a more accurate model of this region, significant advances in sensitivity, spectral and angular resolution, and bandpass stability are required. The necessary advances will only be provided by the Square Kilometer Array and we discuss the possibilities that these dramatic improvements will open for the study of the gas in the central region of AGN.Comment: To appear in "Science with the Square Kilometer Array," eds. C. Carilli and S. Rawlings, New Astronomy Reviews (Elsevier: Amsterdam); 17 pages, 7 figures (four of them in separate gif/tif files) The full paper with high resolution images can be downloaded from http://www.astron.nl/~morganti/Papers/AGNenvironment.ps.g