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Prevention of Maternal Obesity: Lifestyle Health and Beyond

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (30 April 2021) | Viewed by 33307

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Special Issue Editors

Dr. Briony Hill

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Guest Editor

Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3168, Australia
Interests: maternal obesity; preconception; lifestyle; behavior change; gestational weight gain; obesity prevention; health promotion

Prof. Helen Skouteris

E-Mail Website
Guest Editor

School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3400, Australia
Interests: women's health; children's health; pregnancy; preconception; healthy living; implementation science; translation

Special Issue Information

Dear Colleagues,

Women of reproductive age gain more weight than older women and progress more rapidly to obesity than men. High preconception body mass index, excessive gestational weight gain, and postpartum weight retention are significant contributors to this rapid weight gain. Efforts targeting the preconception, pregnancy, and postpartum periods to improve lifestyles, wellbeing, and ameliorate weight gain during the reproductive years are essential to improving maternal and infant/child short- and long-term outcomes such as gestational diabetes mellitus, preeclampsia, caesarean section, large-for-gestational-age infants, child cognitive development, and higher offspring child, adolescent, and adult weight status. This Special Issue will focus on the latest evidence for maternal obesity prevention, including lifestyle health, psychosocial wellbeing, digital health, healthcare professional support, weight stigma, policy change, and guideline development. Research across the knowledge to action cycle is welcomed, including knowledge generation, evidence synthesis, intervention (co-)design, implementation research, and program evaluation.

Dr. Briony Hill
Prof. Helen Skouteris
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

maternal wellbeing
obesity prevention
preconception
pregnancy
postpartum
lifestyle
public health
weight gain prevention

Published Papers (9 papers)

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Research

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11 pages, 246 KiB

Open AccessArticle

The Use of Social Media for Preconception Information and Pregnancy Planning among Young Women

by Helen Skouteris and Melissa Savaglio

J. Clin. Med. 2021, 10(9), 1892; https://doi.org/10.3390/jcm10091892 - 27 Apr 2021

Cited by 14 | Viewed by 2860

Abstract

Young women of reproductive age (18–25 years) often seek and engage with health-related information via social media. However, the extent to which this population group seek preconception and pregnancy-related information has not been explored. Therefore, this study aimed to: (1) examine the proportion, type, and frequency of social media use to seek general health, preconception, and pregnancy-related information or advice among young women; and (2) explore the relationship between age, education status, relationship status, and planning a pregnancy on social media use for preconception and pregnancy-related health information. Ninety-one Australian women aged 18–25 years completed an online survey about their patterns and preferences of social media use for this information. Forty percent of women used social media for general health information (most often daily), 32% for preconception health advice (most commonly weekly), and 20% for pregnancy-related information (most often weekly), with Facebook the most frequently used platform. Planning a pregnancy within the next 5 years and younger age were associated with greater likelihood of using social media for such information. It is necessary that social media platforms are leveraged to disseminate preconception and pregnancy planning health advice, support, and education to provide better health promotion and preventive care to young women. Full article

(This article belongs to the Special Issue Prevention of Maternal Obesity: Lifestyle Health and Beyond)

13 pages, 243 KiB

Open AccessArticle

Healthcare Professionals’ Perspectives on the Cross-Sectoral Treatment Pathway for Women with Gestational Diabetes during and after Pregnancy—A Qualitative Study

by Anne Timm, Karoline Kragelund Nielsen, Ulla Christensen and Helle Terkildsen Maindal

J. Clin. Med. 2021, 10(4), 843; https://doi.org/10.3390/jcm10040843 - 18 Feb 2021

Cited by 14 | Viewed by 3294

Abstract

Gestational diabetes mellitus (GDM) increases the risk of adverse outcomes during and after pregnancy, including a long-term risk of type 2 diabetes. Women with GDM are treated by numerous healthcare professionals during pregnancy and describe a lack of preventive care after pregnancy. We aim to investigate healthcare professionals’ perspectives on the cross-sectoral treatment pathway for women with GDM—during and after pregnancy. A qualitative study was conducted using systematic text condensation. Nine healthcare professionals (two general practitioners, four midwives, two obstetricians and one diabetes nurse) were interviewed and eight health visitors participated in two focus group discussions., Three major themes emerged: (1) “professional identities”, which were identified across healthcare professionals and shaped care practices; (2) ”unclear guidelines on type 2 diabetes prevention after GDM”, which contributed to uncertainty about tasks and responsibilities during and after pregnancy; and (3) “cross-sectoral collaboration”, which relied heavily on knowledge transfers between hospitals, general practice and the local municipality. The findings implicate that clear, transparent guidelines for all sectors should be prioritized to strengthen cross-sectoral care to women with GDM during and after pregnancy. As a result, strong cross-sectoral care throughout the GDM care pathway may improve maternal health by supporting healthy behaviors, facilitate weight loss and reduce the risk of subsequent GDM and early onset diabetes. Full article

(This article belongs to the Special Issue Prevention of Maternal Obesity: Lifestyle Health and Beyond)

12 pages, 580 KiB

Open AccessArticle

Lifestyle and Psychological Factors of Women with Pregnancy Intentions Who Become Pregnant: Analysis of a Longitudinal Cohort of Australian Women

by Briony Hill, Mamaru A. Awoke, Heidi Bergmeier, Lisa J. Moran, Gita D. Mishra and Helen Skouteris

J. Clin. Med. 2021, 10(4), 725; https://doi.org/10.3390/jcm10040725 - 12 Feb 2021

Cited by 5 | Viewed by 2250

Abstract

Preconception lifestyle and psychological factors are associated with maternal and offspring outcomes. Both are important considerations for women planning pregnancy. The aim of this study was to explore associations between lifestyle/psychological factors and long-term pregnancy intentions in women who go on to become pregnant. Data from the cohort born 1973–1978 from the Australian Longitudinal Study of Women’s Health were utilised. Women were included if they had a new pregnancy occurring between Waves 3 and 5, resulting in 2203 women for analysis. Long-term pregnancy intentions (aspirations for children in 5–10 years), demographic, anthropometric, lifestyle (sedentary behaviour, physical activity, diet quality, smoking, alcohol use), and psychological factors (depression, anxiety, stress) were assessed at Wave 3. Multivariable logistic regression was employed to evaluate the associations between pregnancy intentions and lifestyle/psychological factors, adjusting for other explanatory variables. Younger age and being married were associated positively with pregnancy intentions, while living with obesity was associated negatively with pregnancy intentions. No lifestyle or psychological factors were significantly associated with pregnancy intentions. Our findings highlight potential opportunities to identify women who have longer-term pregnancy intentions during clinical care, offering a pivotal moment for preconception care relating to lifestyle health, psychological wellbeing, and family planning. Full article

(This article belongs to the Special Issue Prevention of Maternal Obesity: Lifestyle Health and Beyond)

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16 pages, 260 KiB

Open AccessArticle

The Healthy Pregnancy Service to Optimise Excess Gestational Weight Gain for Women with Obesity: A Qualitative Study of Health Professionals’ Perspectives

by Rebecca F. Goldstein, Ruth E. Walker, Helena J. Teede, Cheryce L. Harrison and Jacqueline A. Boyle

J. Clin. Med. 2020, 9(12), 4073; https://doi.org/10.3390/jcm9124073 - 17 Dec 2020

Cited by 8 | Viewed by 2130

Abstract

Maternal obesity is associated with health risks for women and their babies, exacerbated by excess gestational weight gain. We describe health professionals’ perspectives in the provision of a Healthy Pregnancy service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity. Semi-structured interviews were conducted with health professionals. Questions were based on the Theoretical Domains Framework (TDF) and deductive thematic analysis was performed. A total of 14 multidisciplinary staff were interviewed. Six themes were identified: 1. health professionals view themselves as part of a team; 2. health professionals reported having necessary skills; 3. experience generated confidence in discussing gestational weight gain; 4. gestational weight gain is considered of variable importance; 5. health professionals want women to be comfortable; 6. the environmental context and resources presented some barriers. Staff were supportive of the Healthy Pregnancy service and valued developing teamwork with staff and rapport with women. Most felt relatively comfortable discussing weight gain with women. Barriers included ability to navigate sensitive topics with women, limited awareness of the intervention among new staff, communication between teams, and waiting time for women. Barriers and enablers to the delivery of an integrated model of maternity care were identified. These findings should inform and improve implementation of service models integrating healthy lifestyle in the antenatal care of women with obesity. Full article

(This article belongs to the Special Issue Prevention of Maternal Obesity: Lifestyle Health and Beyond)

20 pages, 474 KiB

Open AccessArticle

Creating Healthy Change in the Preconception Period for Women with Overweight or Obesity: A Qualitative Study Using the Information–Motivation–Behavioural Skills Model

by Jodie Scott, Melissa Oxlad, Jodie Dodd, Claudia Szabo, Andrea Deussen and Deborah Turnbull

J. Clin. Med. 2020, 9(10), 3351; https://doi.org/10.3390/jcm9103351 - 19 Oct 2020

Cited by 14 | Viewed by 4825

Abstract

Worldwide, half of women begin a pregnancy with overweight or obesity, which increases the risk of pregnancy and birth complications and adversely affects the lifelong health of the offspring. In order for metabolic changes to influence the gestational environment, research suggests that weight loss should take place before conception. This study aimed to understand women’s emotional and social contexts, knowledge, motivations, skills and self-efficacy in making healthy change. Semi-structured interviews conducted with twenty-three women with overweight or obesity, informed by the Information–Motivation–Behavioural Skills (IMB) model, were analysed using reflexive thematic analysis. Information-related themes identified included poor health risk knowledge, healthy food decisions and health versus convenience. The Motivation themes comprised taking responsibility, flexible options, social expectations, interpersonal challenges and accountability. Behavioural Skills entailed themes such as the mental battle, time management, self-care and inspiration. An environmental factor was identified in affordability—limiting access to healthier alternatives. Women wanted simple, flexible options that considered family commitments, time and budgetary constraints. Unprompted, several mentioned the importance of psychological support in managing setbacks, stress and maintaining motivation. Strategies for enhancing self-efficacy and motivational support are required to enable longstanding health behaviour change. Findings will inform intervention mapping development of an eHealth solution for women preconception. Full article

(This article belongs to the Special Issue Prevention of Maternal Obesity: Lifestyle Health and Beyond)

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18 pages, 747 KiB

Open AccessArticle

Early Pregnancy Vitamin D Binding Protein Is Independently Associated with the Development of Gestational Diabetes: A Retrospective Cohort Study

by Melinda Fernando, Stacey J. Ellery, Deborah de Guingand, Clara Marquina, Siew Lim, Cheryce L. Harrison, Helena J. Teede, Negar Naderpoor and Aya Mousa

J. Clin. Med. 2020, 9(7), 2186; https://doi.org/10.3390/jcm9072186 - 10 Jul 2020

Cited by 4 | Viewed by 2284

Abstract

Background: Vitamin D-binding protein (VDBP) has been implicated in several adverse pregnancy outcomes either directly or indirectly via influencing the concentrations of biologically active vitamin D metabolites. However, human studies exploring these metabolites in pregnancy remain sparse. Here, we examine whether VDBP and total, free, and bioavailable 25-hydroxyvitamin D (25(OH)D) metabolites in early pregnancy are associated with subsequent adverse pregnancy outcomes. Methods: We conducted a retrospective analysis of 304 pregnant women in early pregnancy (<20 weeks gestation). The demographic characteristics, anthropometric data, and total 25(OH)D were measured and plasma or serum samples were collected and bio-banked. Using these samples, we measured VDBP (polyclonal ELISA) and albumin (automated colorimetry), and calculated free and bioavailable 25(OH)D using validated formulae. Pregnancy outcomes were derived from scanned medical records. Regression models were used to analyse the relationships between vitamin D metabolites in early pregnancy and subsequent pregnancy outcomes (gestational diabetes mellitus (GDM), pre-eclampsia, preterm birth), with adjustment for predetermined clinically relevant maternal factors including age, body mass index (BMI), and ethnicity. Results: Lower VDBP concentrations were associated with higher glucose levels and a greater likelihood of developing GDM at 26–28 weeks gestation (odds ratio [OR] (95% CI) = 0.98 (0.97,0.99), p = 0.015). This finding remained significant after adjustment for maternal covariates including age, BMI, and ethnicity (β = −0.003, p = 0.03). Lower total, free and bioavailable 25(OH)D, but not VDBP, were associated with a shorter length of gestation, but only the relationship with total 25(OH)D remained significant after adjustment for the above maternal covariates (β = 0.02, p = 0.006). Conclusions: This is the first study to examine VDBP, and total, free and bioavailable 25(OH)D in relation to pregnancy outcomes in a well characterised multi-ethnic cohort of pregnant women. Our findings show that VDBP and total 25(OH)D are associated with GDM and length of gestation, respectively; however, further investigations using large-scale prospective studies are needed to confirm our findings. Full article

(This article belongs to the Special Issue Prevention of Maternal Obesity: Lifestyle Health and Beyond)

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Review

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23 pages, 403 KiB

Open AccessReview

The Relationship of Diet and Physical Activity with Weight Gain and Weight Gain Prevention in Women of Reproductive Age

by Mamaru Ayenew Awoke, Helen Skouteris, Maureen Makama, Cheryce L. Harrison, Thomas Philip Wycherley and Lisa J. Moran

J. Clin. Med. 2021, 10(11), 2485; https://doi.org/10.3390/jcm10112485 - 4 Jun 2021

Cited by 4 | Viewed by 3531

Abstract

Reproductive-age women often see increased weight gain, which carries an increased risk of long-term overweight and obesity and adverse maternal and child health outcomes. Supporting women to achieve optimal weight through lifestyle modification (diet and physical activity) is of critical importance to reduce weight gain across key reproductive life-stages (preconception, pregnancy and postpartum). This review comprehensively summarizes the current state of knowledge on the contribution of diet and physical activity to weight gain and weight gain prevention in reproductive-aged women. Suboptimal diets including a higher proportion of discretionary choices or energy intake from fats, added sugars, sweets or processed foods are associated with higher weight gain, whereas increased consumption of core foods including fruits, vegetables and whole grains and engaging in regular physical activity are associated with reduced weight gain in reproductive age women. Diet and physical activity contributing to excessive gestational weight gain are well documented. However, there is limited research assessing diet and physical activity components associated with weight gain during the preconception and postpartum period. This review highlights the need for further research to identify key dietary and physical activity components targeting the critical windows of reproductive life-stages in women to best guide interventions to prevent weight gain. Full article

(This article belongs to the Special Issue Prevention of Maternal Obesity: Lifestyle Health and Beyond)

21 pages, 357 KiB

Open AccessReview

Reducing Postpartum Weight Retention: A Review of the Implementation Challenges of Postpartum Lifestyle Interventions

by Maureen Makama, Helen Skouteris, Lisa J. Moran and Siew Lim

J. Clin. Med. 2021, 10(9), 1891; https://doi.org/10.3390/jcm10091891 - 27 Apr 2021

Cited by 30 | Viewed by 4711

Abstract

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. Full article

(This article belongs to the Special Issue Prevention of Maternal Obesity: Lifestyle Health and Beyond)

14 pages, 998 KiB

Open AccessReview

The Role of Health Literacy in Postpartum Weight, Diet, and Physical Activity

by Rhonda Garad, Crystal McPhee, Tze Lin Chai, Lisa Moran, Sharleen O’Reilly and Siew Lim

J. Clin. Med. 2020, 9(8), 2463; https://doi.org/10.3390/jcm9082463 - 1 Aug 2020

Cited by 9 | Viewed by 6427

Abstract

Background: Postpartum weight retention is a significant contributor to obesity in women, adverse perinatal events in subsequent pregnancies, and chronic disease risk. Health literacy is known to impact health behaviors. The study aimed to identify the health literacy domains utilized in postpartum weight management interventions and to determine their impact on weight, diet and physical activity in postpartum women. Methods: We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases. We included random control trials of lifestyle intervention in postpartum women (within two years post-delivery) published up to 3 May 2019. Subgroup analyses were performed to determine the effect of health literacy domains on outcomes. Results: Out of 5000 studies, 33 studies (n = 3905) were included in the systematic review and meta-analysis. The health literacy domain self-care (skills and knowledge) was associated with a significant reduction in body weight (mean difference (MD) −2.46 kg; 95% confidence interval (CI) from −3.65 to −1.27) and increase in physical activity (standardized mean difference (SMD) 0.61; 95% CI 0.20 to 1.02). No other health literacy domain was associated with significant outcomes in weight, energy intake, or physical activity. Conclusions: Health literacy skills such as knowledge of self-care are effective in improving weight and in increasing physical activity in postpartum women. The efficacy of other health domains was not supported. Full article

(This article belongs to the Special Issue Prevention of Maternal Obesity: Lifestyle Health and Beyond)

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