Opportunities to promote healthy maternal weight during and following pregnancy

 This thesis has identified opportunities for provision of support for women to attain a healthy weight and healthy diet and physical activity behaviours during and following pregnancy. A better understanding of strategies to promote optimal support to women during the postpartum period has been achieved

Energy deficiency, menstrual disturbances, and low bone mass : what do exercising Australian women know about the female athlete triad?

Purpose: Prevention of the female athlete triad is essential to protect female athletes&rsquo; health. The aim of this study was to investigate the knowledge, attitudes, and behaviors of regularly exercising adult women in Australia toward eating patterns, menstrual cycles, and bone health. Methods: A total of 191 female exercisers, age 18&ndash;40 yr, engaging in &ge;2 hr/wk of strenuous activity, completed a survey. After 11 surveys were excluded (due to incomplete answers), the 180 participants were categorized into lean-build sports (n = 82; running/ athletics, triathlon, swimming, cycling, dancing, rowing), non-lean-build sports (n = 94; basketball, netball, soccer, hockey, volleyball, tennis, trampoline, squash, Australian football), or gym/fitness activities (n = 4). Results: Mean (&plusmn; SD) training volume was 9.0 &plusmn; 5.5 hr/wk, with participants competing from local up to international level. Only 10% of respondents could name the 3 components of the female athlete triad. Regardless of reported history of stress fracture, 45% of the respondents did not think that amenorrhea (absence of menses for &ge;3 months) could affect bone health, and 22% of those involved in lean-build sports would do nothing if experiencing amenorrhea (vs. 3.2% in non-lean-build sports, p = .005). Lean-build sports, history of amenorrhea, and history of stress fracture were all significantly associated with not taking action in the presence of amenorrhea (all p &lt; .005). Conclusions: Few active Australian women are aware of the detrimental effects of menstrual dysfunction on bone health. Education programs are needed to prevent the female athlete triad and ensure that appropriate actions are taken by athletes when experiencing amenorrhea.<br /

Modifiable barriers to leisure-time physical activity during pregnancy: a qualitative study investigating first time mother\u27s views and experiences

BACKGROUND: Evidence suggests physical activity often declines during pregnancy, however explanations for the decline are not well understood. The aim of this study was to identify modifiable barriers to leisure-time physical activity among women who did not meet physical activity guidelines during pregnancy. METHODS: Analyses were based on data from 133 mothers (~3-months postpartum) who were recruited from the Melbourne InFANT Extend study (2012/2013). Women completed a self-report survey at baseline in which they reported their leisure-time physical activity levels during pregnancy as well provided an open-ended written response regarding the key barriers that they perceived prevented them from meeting the physical activity guidelines during their pregnancy. Thematic analyses were conducted to identify key themes. RESULTS: The qualitative data revealed six themes relating to the barriers of leisure-time physical activity during pregnancy. These included work-related factors (most commonly reported), tiredness, pregnancy-related symptoms, being active but not meeting the guidelines, lack of motivation, and a lack of knowledge of recommendations. CONCLUSION: Considering work-related barriers were suggested to be key factors to preventing women from meeting the physical activity guidelines during pregnancy, workplace interventions aimed at providing time management skills along with supporting physical activity programs for pregnant workers should be considered. Such interventions should also incorporate knowledge and education components, providing advice for undertaking leisure-time physical activity during pregnancy

Excess gestational weight gain : an exploration of midwives\u27 views and practice.

BackgroundExcess gestational weight gain (GWG) can affect the immediate and long term health outcomes of mother and infant. Understanding health providers\u27 views, attitudes and practices around GWG is crucial to assist in the development of practical, time efficient and cost effective ways of supporting health providers to promote healthy GWGs. This study aimed to explore midwives\u27 views, attitudes and approaches to the assessment, management and promotion of healthy GWG and to investigate their views on optimal interventions. MethodsMidwives working in antenatal care were recruited from one rural and one urban Australian maternity hospital employing purposive sampling strategies to assess a range of practice areas. Face-to-face interviews were conducted with 15 experienced midwives using an interview guide and all interviews were digitally recorded, transcribed verbatim and analysed thematically. ResultsMidwives interviewed exhibited a range of views, attitudes and practices related to GWG. Three dominant themes emerged. Overall GWG was given low priority for midwives working in the antenatal care service in both hospitals. In addition, the midwives were deeply concerned for the physical and psychological health of pregnant women and worried about perceived negative impacts of discussion about weight and related interventions with women. Finally, the midwives saw themselves as central in providing lifestyle behaviour education to pregnant women and identified opportunities for support to promote healthy GWG. ConclusionsThe findings indicate that planning and implementation of healthy GWG interventions are likely to be challenging because the factors impacting on midwives\u27 engagement in the GWG arena are varied and complex. This study provides insights for guideline and intervention development for the promotion of healthy GWG. <br /

Views of women and health professionals on mHealth lifestyle interventions in pregnancy: a qualitative investigation

BACKGROUND: Evidence suggests that women are failing to meet guidelines for nutrition, physical activity, and weight gain during pregnancy. Interventions to promote a healthy lifestyle in pregnancy demonstrate mixed results and many are time and resource intensive. mHealth-delivered interventions offer an opportunity to provide trusted source information in a timely and cost-effective manner. Studies regarding women\u27s and health professionals\u27 views of mHealth in antenatal care are limited. OBJECTIVE: This study aimed to explore women\u27s and health professionals\u27 views regarding mHealth information sources and interventions to assist women to eat well, be physically active, and gain healthy amounts of weight in pregnancy. METHODS: A descriptive qualitative research approach employed focus groups and in-depth interviews with 15 pregnant or postpartum women and 12 in-depth interviews with health professionals including two from each category: obstetricians, general practitioners, midwives, dietitians, physiotherapists, and community pharmacists. All interviews were transcribed verbatim and thematically analyzed. RESULTS: Women uniformly embraced the concept of mHealth information sources and interventions in antenatal care and saw them as central to information acquisition and ideally incorporated into future antenatal care processes. Health professionals exhibited varied views perceiving mHealth as an inevitable, often parallel, service rather than one integrated into the care model. Four key themes emerged: engagement, risk perception, responsibility, and functionality. Women saw their ability to access mHealth elements as a way to self-manage or control information acquisition that was unavailable in traditional care models and information sources. The emergence of technology was perceived by some health professionals to have shifted control of information from trusted sources, such as health professionals and health organizations, to nontrusted sources. Some health professionals were concerned about the medicolegal risks of mHealth (incorrect or harmful information and privacy concerns), while others acknowledged that mHealth was feasible if inherent risks were addressed. Across both groups, there was uncertainty as to who should be responsible for ensuring high-quality mHealth. The absence of a key pregnancy or women\u27s advocacy group, lack of health funds for technologies, and the perceived inability of maternity hospitals to embrace technology were seen to be key barriers to provision. Women consistently identified the functionality of mHealth as adding value to antenatal care models. For some health professionals, lack of familiarity with and fear of mHealth limited their engagement with and comprehension of the capacity of new technologies to support antenatal care. CONCLUSIONS: Women exhibited positive views regarding mHealth for the promotion of a healthy lifestyle in antenatal care. Conversely, health professionals expressed a much wider variation in attitudes and were more able to identify potential risks and barriers to development and implementation. This study contributes to the understanding of the opportunities and challenges in developing mHealth lifestyle interventions in antenatal care

The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

BackgroundChildren from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families.MethodsSearches of major electronic databases identified articles published from 1993&ndash;2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.ResultsThirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m2 to -0.54 kg/m2 for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3&ndash;5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery.ConclusionThere is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required

Fathers\u27 perspectives on the diets and physical activity behaviours of their young children

BackgroundChildren&rsquo;s learning about food and physical activity is considerable during their formative years, with parental influence pivotal. Research has focused predominantly on maternal influences with little known about the relationships between fathers&rsquo; and young children&rsquo;s dietary and physical activity behaviours. A greater understanding of paternal beliefs regarding young children&rsquo;s dietary and physical activity behaviours is important to inform the design and delivery of child-focussed health promotion interventions. This study aimed to describe fathers&rsquo; perceived roles in their children&rsquo;s eating and physical activity behaviours. It also sought to document fathers&rsquo; views regarding how they could be best supported to promote healthy eating and physical activity behaviours in their young children.MethodsIn depth, semi-structured interviews were conducted with twenty fathers living in socio-economically diverse areas of metropolitan Melbourne, Australia who had at least one child aged five years or less. All interviews were audio recorded, transcribed verbatim and thematically analysed.ResultsThematic analysis of the transcripts revealed eight broad themes about fathers&rsquo; beliefs, perceptions and attitudes towards the dietary and physical activity behaviours of their young children: (i) shared responsibility and consultation; (ii) family meal environment; (iii) parental role modelling; (iv) parental concerns around food; (v) food rewards; (vi) health education; (vii) limiting screen time; and (viii) parental knowledge. Analysis of themes according to paternal education/employment revealed no substantial differences in the views of fathers.ConclusionsThis exploratory study presents the views of a socio-economically diverse group of fathers regarding the dietary and physical activity behaviours of their young children and the insights into the underlying perceptions informing these views. The findings suggest that fathers believe healthy eating behaviours and being physically active are important for their young children. Fathers believe these behaviours can be promoted and supported in different ways including through the provision of appropriate meal and physical activity environments and parental role modelling of desired dietary and physical activity behaviours.<br /

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 /