Engaging maternity services to address smoking, alcohol consumption and weight gain in pregnancy
Project title: Improving connection and engagement by maternity services in the prevention and better control of risk factors for chronic disease, including smoking, alcohol consumption and unhealthy weight gain in pregnancy
Start date: 1 January 2020
Estimated end date: 30 June 2022
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 is the project addressing the issue?
This project aims to identify the barriers to providing recommended care for smoking, alcohol consumption and weight gain in pregnancy in three different sites in Australia. We will then work with maternity services to improve the delivery of this care.
The sites are John Hunter Hospital, Newcastle, the Women’s and Children’s Hospital, Adelaide, and Launceston General Hospital in Tasmania.
The first step is to develop recommended models of care based on literature reviews. We will then use clinical records data and cross-sectional surveys of women who have recently attended antenatal services to identify to what extent this recommended care is being provided in each site.
Surveys with staff will identify the barriers and enablers to providing recommended care. We will map these against evidence-based practice change strategies, such as training or environmental restructuring, and behaviour change techniques, such as instructions on how to perform a behaviour and provision of prompts or cues.
We will develop a local implementation plan for each site and conduct if appropriate, a feasibility pilot of practice change strategies to support the provision of recommended preventive care for pregnant women.
Throughout the project, we will engage closely with obstetricians, midwives, dietitians, population health practitioners, health policy officers and pregnant women, who strongly support better care to address smoking, alcohol consumption and weight gain during pregnancy.
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 develop to change practice will align with existing care delivery and quality improvement processes at the local, state and national level. This means our findings will rapidly translate across jurisdictions.
This work will provide insights into how to integrate antenatal initiatives more broadly to prevent chronic disease.
Associate Professor Luke Wolfenden, University of Newcastle
Dr Melanie Kingsland, Hunter New England Population Health/ University of Newcastle
Heather Dunnachie, Women’s and Children’s Hospital, Adelaide, South Australia
Nadia Mastersson, Wellbeing SA, South Australia
Monique Reardon, Public Health Services, Tasmania
Janette Tonks, Tasmania Health Services – Launceston
Professor John Wiggers, Hunter New England Population Health/ University of Newcastle
This project is funded by the NHMRC, Australian Government Department of Health, ACT Health, Cancer Council Australia, NSW Ministry of Health, South Australian Department for Health and Wellbeing, Tasmanian Department of Health, and VicHealth.
- Best practice models of antenatal care addressing smoking, alcohol use, and gestational weight gain in pregnancy have been developed and finalised for John Hunter Hospital (NSW site).
- Telephone surveys commenced with pregnant women attending antenatal at John Hunter Hospital (NSW site) to assess their receipt of best practice antenatal care addressing smoking, alcohol use and gestational weight gain in pregnancy.
- Local project plans finalised and approved for John Hunter Hospital (NSW site) and Launceston General Hospital (Tasmania site).
- We have developed multidisciplinary project advisory groups for each maternity service site – John Hunter Hospital (Newcastle, NSW), Women’s and Children’s Hospital (Adelaide, SA) and Launceston General Hospital (Launceston, Tasmania), with representatives from practitioners and state and district level health promotion policy partners.
- We have developed and piloted data collection tools including telephone surveys with pregnant women and online surveys for maternity services staff.
- We have developed and drafted best practice models of antenatal care addressing smoking, alcohol use and gestational weight gain in pregnancy.
- Grady A, Barnes C, Wolfenden L, Lecathelinais C, Yoong SL. Barriers and enablers to adoption of digital health interventions to support the implementation of dietary guidelines in early childhood education and care: Cross-sectional study. J Med Internet Res. 2020;22(11):e22036. doi:10.2196/22036
The project has created a series of resources – Maternal Health Pathways – which are best practice models of antenatal care for clinicians. These were created for John Hunter Hospital (NSW site) and address gestational weight gain in pregnancy, alcohol consumption, and smoking cessation: