Engaging maternity services to address smoking, alcohol consumption and weight gain in pregnancy

What is the issue?

Smoking, drinking alcohol and gaining too much weight during pregnancy can affect the long-term health of both mothers and children. Currently it is estimated that only 10% of pregnant women receive the recommended assessment, advice and referral they need to effectively address these risk factors.

There are system barriers preventing both individuals and organisations from providing recommended antenatal care. Research is needed to find an evidence-based way of changing practice, based on the local context, to ensure more women receive the care they need.

How did the project address the issue?

This project identified the main barriers to providing recommended care for smoking, alcohol consumption and weight gain in pregnancy in three different sites in Australia. The team worked with maternity services to improve the delivery of this care. The sites were John Hunter Hospital, Newcastle, the Women’s and Children’s Hospital, Adelaide, and Launceston General Hospital in Tasmania.

We developed recommended models of care based on literature reviews and then used clinical records and cross-sectional surveys of women who recently attended antenatal services to identify to what extent this recommended care was being provided at each site. Surveys with staff helped the team identify barriers and enablers to providing recommended care which were then mapped against evidence-based practice change strategies and behaviour change techniques. We developed a local implementation plan for each site to support the provision of recommended preventive care for pregnant women.

Throughout the project, we engaged closely with stakeholders who strongly support better care to address smoking, alcohol consumption and weight gain during pregnancy, including obstetricians, midwives, dietitians, population health practitioners, health policy officers, and pregnant women.

What is the relevance for practice?

Improving provision of antenatal care for smoking, alcohol consumption and weight gain in pregnancy will help to prevent avoidable morbidity – a key focus of health services across Australia. The models of care and strategies we developed to change practice align with existing care delivery and quality improvement processes at the local, state and national level. This means our findings can rapidly translate across jurisdictions. This work provides insights into how to integrate antenatal initiatives more broadly to prevent chronic disease.