Weight management in pregnancy

Key learning points: - Women who start pregnancy in an overweight or obese weight category have increased health risks - Irrespective of pre-pregnancy weight category, there are health risks associated with gaining too much weight in pregnancy for both mother and baby - There are currently no official weight gain guidelines for pregnancy in the UK, thus focus needs to be on supporting pregnant women to eat healthily and keep activ

What are we measuring and why? Using theory to guide perinatal research and measurement

Background: A theory is a set of ideas that attempt to explain phenomena and can provide guiding principles on which to base practice. Many theories from biological and social sciences are relevant to women’s health and wellbeing during pregnancy and after birth, yet theory is not commonly explicitly reported in perinatal research. Method: This paper outlines the importance of theory to perinatal research and provides a pragmatic overview of when and how to use theory in research. In particular, we consider (i) deciding when it is appropriate to use theory, (ii) choosing which theory to use and (iii) how to operationalise theory in research. We give examples that illustrate how four different theories have been used in perinatal research to increase understanding and inform the development of interventions. Conclusion: Even when it is not appropriate to use theory in our research, careful consideration of pertinent theories contributes to greater clarity of concepts and understanding of different explanations or perspectives on what we are studying. It also prompts us to consider where our research fits in terms of contribution to knowledge or the development and evaluation of treatments. However, it is important that a critical approach is taken so that theories continue to be developed. In this way we will systematically advance our understanding of general factors or processes that are relevant to perinatal health, as well as those factors that are unique to perinatal health

Obese women's reasons for not attending a weight management service during pregnancy

Evaluations of services targeting obese women's gestational weight gain often report low uptake. Thus it is important to elicit the reasons why obese pregnant women decline to participate in these services and to identify their barriers to participation. Sixteen obese pregnant and postnatal women were interviewed regarding their reasons for declining a group-based service targeting their gestational weight gain. All interviews were recorded, transcribed verbatim and analyzed thematically. Both pragmatic and motivational barriers were identified. The most common practical reasons for not attending the service were its inconvenient location and time, and feeling unable to attend due to work commitments. Pregnancy-specific barriers included decreased mobility and feeling unwell. Motivational barriers included lack of interest and not wanting to focus on one's weight in pregnancy. These findings highlight issues that need to be taken into consideration when designing group-based weight management services for this population

The Concurrent Acceptability of a Postnatal Walking Group: A Qualitative Study Using the Theoretical Framework of Acceptability.

Walking groups are often enjoyed by postnatal women, but little is known about what makes them an acceptable activity to this group. This study aimed to investigate the acceptability of a postnatal walking group using the Theoretical Framework of Acceptability (TFA). Seventeen postnatal women took part in a walk-along interview during a walking group session. Semi-structured interviews were based on the TFA and findings were analysed deductively onto the seven TFA components. Overall, the walking group was found to be acceptable. Benefits included meeting other mothers and walking in an accessible and convenient location. Women understood the group aim of supporting new mothers and thought it achieved this aim. Most women reported that attending the group was little effort, although for some the timing did not fit well with their baby's schedule. Participants stated that meeting other mothers and being physically active aligned with their value system. In conclusion, the acceptability of the walking group was found to be multifaceted, of which enjoyment was one part. These findings can be used when advertising other walking groups or physical activities for the postnatal population

Supporting women with postpartum anxiety: exploring views and experiences of specialist community public health nurses in the UK

Anxiety is common among postpartum women and can have adverse effects on mother's and child's somatic and psychological health if left untreated. In the UK, nurses or midwifes with a specialisation in community public health nursing, also called health visitors (HVs), work with families who have children younger than 5 years of age and are therefore in a key position to identify and support women with postpartum mental health issues. Until recently, postpartum mental health support provided by HVs mainly focused on identifying and managing depression, but the updated clinical guidance by the National Institute for Health and Care Excellence also includes guidance regarding screening and psychological interventions for perinatal anxiety. This study therefore aimed to explore HVs' experiences of supporting women with postpartum anxiety and their views on currently available care. Using a qualitative approach, in-depth semi-structured interviews were conducted with 13 HVs from the UK between May and October 2015. Participants were interviewed in person at their workplace or on the phone/Skype. Using thematic analysis, four main themes emerged: identification and screening issues; importance of training; service usage; and status of current service provision. Women with postpartum anxiety were commonly encountered by HVs in their clinical practice and described as often heavily using their or other related healthcare services, which puts additional strain on HVs' already heavy workload. Issues with identifying and screening for postpartum anxiety were raised and the current lack of perinatal mental health training for HVs was highlighted. In addition, HVs described a current lack of good perinatal mental health services in general and specifically for anxiety. The study highlights the need for HV perinatal mental health training in general and postpartum anxiety specifically, as well as better coverage of specialist mental health services and the need for development of interventions targeted at postpartum anxiety

Interest in web-based treatments for postpartum anxiety: an exploratory survey

Objective: This study aimed to explore women’s interest in web-based treatments for postpartum anxiety and determine the feasibility of reaching women with postpartum anxiety online. Background: Anxiety in the postpartum period is common and often untreated. One innovative approach of offering treatment during this period is through web-based self-help. Assessing women’s interest in new treatments, such as a web-based self-help, is an important step prior to development efforts. Methods: A cross-sectional online survey was created and promoted for 4 months via unpaid social media posts (Facebook and Twitter). To be eligible, women had to be over the age of 18, live in England, fluent in English, be within 12 months postpartum and self-report at least mild levels of anxiety. Results: A sample of 114 eligible women were recruited. The majority were Caucasian, well-educated, middle-class women. Seventy percent reported moderate or severe anxiety. Sixty-one percent of women expressed interest in web-based postpartum anxiety treatments. Women preferred treatment in a smartphone/tablet application format, presented in brief modules and supported by a therapist via email or chat/instant messaging. Conclusions: Based on the stated preferences of participating women it is recommended that postpartum anxiety web-based treatments include different forms of therapist support and use a flexibly accessible smartphone/tablet application format with content split into short sections. The findings also suggest that unpaid social media can be feasible in reaching women with postpartum anxiety, but additional efforts are needed to reach a more diverse population

Think Pink! a Pink Sticker Alert System for Women with Psychological Distress or Vulnerability During Pregnancy

The importance of good clinical communication to women during pregnancy and birth is clear. Poor communication in labour is associated with general dissatisfaction, more complaints and a range of perinatal mental health problems including posttraumatic stress disorder (PTSD) and postnatal depression. To communicate effectively, maternity staff needs information about which women are vulnerable and require extra support. To address this, we implemented and evaluated a pink sticker communication system to alert midwifery and obstetric staff to potential psychological difficulties experienced by some women. Evaluation showed this system was viewed positively by women and midwifery staff. Audit of referrals to the perinatal psychology service during this period suggests no woman with a pink sticker developed birth trauma as a direct result of perceived poor care. In addition, the proportion of referrals to perinatal psychology for birth trauma significantly reduced during this period

Accumulation of 125I-labelled thiouracil and propylthiouracil in murine melanotic melanomas.

We have shown that thioamides are incorporated as false precursors into melanin during its synthesis. To be clinically useful in the diagnosis or therapy of melanotic melanomas, they would have to be tagged with an appropriate isotope or possibly a cytotoxic moiety. 125I-Thiouracil (125I-TU) is here shown to be accumulated in the melanin of melanotic melanomas transplanted into mice in a similar way as is 14C-thiouracil (14C-TU). 125I-TU gives tumour/liver and tumour/muscle ratios up to 22 and 778 respectively, at 4 days after administration. 125I-TU is accumulated by melanoma cells in vitro more effectively than 14C-TU (125I-TU/14C-TU, 2.7), while the in vivo accumulation into melanomas is slightly lower for 125I-TU as compared to 14C-TU (125I-TU/14C-TU, 0.35). This appears to be due to a partial deiodination (less than 14% of the dose within 4 days) and probably a more rapid excretion of 125I-TU or its metabolite(s). The accumulation of radioactivity in the thyroid can essentially be eliminated by pretreatment with potassium iodide and/or thyroxine. 125I-Propylthiouracil is also accumulated in melanotic melanoma cells in vivo and in vitro, but at a lower level than in 125I-TU and 14C-TU

Promoting stair climbing: Stair-riser banners are better than posters... sometimes

Objective: Stair-riser banners are twice as effective as posters in encouraging stair climbing in shopping centres. This study tested the effectiveness of stair-riser banners in an English train station in 2006-2007. Method: The train station had a 39-step staircase and an adjacent escalator. Baseline observations (3.5 weeks) were followed by 10.5 weeks of a banner intervention supplemented with 3 weeks of a poster intervention. Both poster and banner featured the message ‘Stair climbing burns more calories per minute than jogging. Take the stairs’. Ascending escalator and stair users (N=36,239) were coded for gender. Results: Analyses, controlling for effects of gender and pedestrian traffic volume, revealed no significant change in stair climbing between baseline (40.6%) and the banner intervention (40.9%; p=0.98). Addition of the poster increased stair climbing (44.3%; OR= 1.36, 95% CIs 1.16-1.60, p< 0.001), with the effect reduced at higher pedestrian traffic volumes. Conclusion: While stair-riser banners had no effect, the poster intervention increased stair climbing. The high pedestrian volumes as the wave of disembarking passengers seek to leave the station would have obscured the visibility of the banner for many commuters. Thus stair-riser banners appear unsuitable point-of-choice prompts in stations where pedestrian traffic volume is high