Using health promotion to reduce the burden of obesity before and in pregnancy
Project title: Generating and translating knowledge in health promotion and lifestyle improvement prior to and during pregnancy to reduce the burden of maternal obesity
Start date: March 2018
Estimated end date: June 2022
What is the issue?
Two-thirds of Australian adults are overweight or obese. Women in their reproductive years are leading this trend, gaining more weight yearly than older women and progressing more rapidly to obesity than men. Over half of women in Australia and other developed countries enter pregnancy overweight or obese. A higher body mass index (BMI) prior to pregnancy increases the risk of complications during pregnancy including gestational diabetes mellitus, pre-eclampsia, caesarean section, and large-for-gestational-age (LGA) infants.
There is a clear imperative to reduce obesity, yet treating established obesity is intensive, costly, largely ineffective and unsustainable at a population level. This leading team has developed effective lifestyle interventions for reproductive aged women and pregnancy, however, to date, no country has implemented such interventions and scaled them as a systems level- and policy-level evidence-based strategies targeting women pre-conception and pregnancy to prevent obesity.
How is the project addressing the issue?
The aim of this project is to create, capture and deliver health promotion, lifestyle improvement and obesity prevention strategically targeting women during pre-conception and pregnancy, to improve the health of women and the next generation.
Taking a systems implementation approach, the project team will engage with stakeholders, generate and translate new knowledge in implementation of effective interventions and strategies at scale.
Relevance of the project for policy and practice
The delivery of effective interventions and tool kits will support women through pre-conception and pregnancy to live active and healthy lives.
This is the first project, nationally or internationally, to take such a systems approach in the maternal obesity space, and it will have flow on effects on childhood obesity. If we tackle obesity prevention from before conception, through pregnancy and into the postpartum, we will build effective and population level support for women and help prevent childhood obesity.
What are the expected outcomes?
The project will implement low cost, translatable and scalable solutions to reduce the burden of maternal and childhood obesity including:
- Designing an innovative and engaging pre-conception health promotion program targeting reproductive aged women
- Developing evidence-based resources and an implementation strategy ready for translation and scale of pre-conception health promotion programs
- Mapping current practice, scope implementation enablers and barriers in pregnancy
- Co-designing implementation strategies and resources for integration of lifestyle interventions into routine antenatal care
- Identifying gaps in the training of medical doctors and nurses/midwives to support lifestyle modification pre-conception and in pregnancy
- Co-designing an accessible, low-cost, capacity building intervention to up-skill health professionals to support lifestyle modification and deliver pre-conception and antenatal lifestyle interventions effectively.
Professor Helena Teede, Monash University
Professor Helen Skouteris, Monash University
Associate Professor Jacqueline Boyle, Monash University
Tracy Taylor (Project Manager), Monash University
Josie Johnson, Monash University
Cheryce Harrison, Monash University
Briony Hill, Monash University
Cate Bailey, Monash University
Emily Gilbert, Monash University
Rebeccah Bartlett, Monash University
Heidi Bergmeier, Monash University
Grace Xie, Monash University
Ruth Walker, Monash University
Siew Lim, Monash University
Suzanne Willey, Monash University
Lisa Moran, Monash University
Susanne Baker, Monash University
Funding for this research has been provided from the Australian Government’s Medical Research Future Fund (MRFF). The MRFF provides funding to support health and medical research and innovation, with the objective of improving the health and wellbeing of Australians. MRFF funding has been provided to The Australian Prevention Partnership Centre under the MRFF Boosting Preventive Health Research Program. Further information on the MRFF is available at www.health.gov.au/mrff.
- We have co-developed the Health in Preconception, Pregnancy and Postpartum (HiPPP) Consumer and Community Involvement (CCI) framework with consumers (women with lived experience of weight/lifestyle issues in preconception, pregnancy and/or postpartum) and stakeholders (researchers and clinicians) to ensure that HiPPP research and translation initiatives are conducted in partnership with the people most affected by the research, rather than to or for them. Given that research shows that off-the-shelf frameworks offer little transferability the HiPPP CCI framework has been co-designed to address barriers that prevent consumers from participating in or partnering in the specific life stages of pre-conception, pregnancy and postpartum and create opportunities for meaningful involvement.
- In late 2019, we formed the HiPPP early and mid-career research collective. The collective identified two priority areas for us to focus our activities around:
- Relationships, partnerships and collaborations, including policy collaborations, consumer and community involvement and ensuring cultural relevance
- Implementation, including knowledge mobilisation.
- The International Diabetes Federation has invited Professor Helena Teede and the HiPPP Global Alliance to join the Federation of International Gynaecology and Obstetrics (FIGO). FIGO has member societies in 132 countries and aims to develop and translate guidelines and optimise maternal nutrition around health in preconception, pregnancy and postpartum internationally.
- We have been working as a team to develop six ‘Healthy Lifestyle’ modules that will be embedded into the undergraduate midwifery curriculum at Monash University in 2020 and beyond. These modules are based on two foundation topics: Healthy lifestyles for a healthy pregnancy and Australia’s Pregnancy Care (2018) guidelines. Content related to evidence-based lifestyle recommendations for preconception, pregnancy and complicated pregnancies progresses throughout the course, focusing on physical activity, nutrition and weight. Students will learn how to support women to adopt healthy lifestyles before and during pregnancy using SMART goals, assessing readiness to change and modifying goals. The final module aims to promote midwifery leadership in this important area of preventive care.
- The project team developed and disseminated an intervention mapping roadmap for an online portal for the promotion of healthy lifestyles and weight gain prevention for reproductive-age women. Work on the portal is underway and taking place at the University of Tasmania.
- Hill B, Shrewsbury V, Bergmeier H, Iriving M, Martin J, Bailey C, et al. Maternal obesity prevention: The Health in Preconception, Pregnancy, and Postpartum Early- and Mid-Career Researcher Collective. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2021. doi: 10.1111/ajo.13316
- Goldstein RF, Walker RE, Teede HJ, Harrison CL, Boyle JA. The Healthy Pregnancy Service to Optimise Excess Gestational Weight Gain for Women with Obesity: A qualitative study of health professionals’ perspectives. Journal of Clinical Medicine. 2020;9(12):4073. doi: 10.3390/jcm9124073
- Bailey C, Skouteris H, Morris H, O’Donnell R, Hill B, Ademi Z. Economic evaluation methods used in home-visiting interventions: A systematic search and review. Health & Social Care in the Community. 2021. doi:10.1111/hsc.13349
- Yazdizadeh B, Walker R, Skouteris H, Olander EK, Hill B. Interventions improving health professionals’ practice for addressing patients’ weight management behaviours: Systematic review of reviews. Health Promotion International. 2021;36(1):165-77. doi:10.1093/heapro/daaa039
- Goldstein RF, Boyle JA, Lo C, Teede HJ, Harrison CL. Facilitators and barriers to behaviour change within a lifestyle program for women with obesity to prevent excess gestational weight gain: a mixed methods evaluation. BMC Pregnancy and Childbirth. 2021;21(1):569. doi:10.1186/s12884-021-04034-7
- Martin JC, Awoke MA, Misso ML, Moran LJ, Harrison CL. Preventing weight gain in adults: A systematic review and meta-analysis of randomized controlled trials. Obesity Reviews. 2021;22(10):e13280. doi: 10.1111/obr.13280
- Bahri Khomami M, Walker R, Kilpatrick M, de Jersey S, Skouteris H, Moran LJ. The role of midwives and obstetrical nurses in the promotion of healthy lifestyle during pregnancy. Therapeutic Advances in Reproductive Health. 2021;15. doi:10.1177/26334941211031866
- Hill B, Bergmeier H, Incollingo Rodriguez AC, Barlow FK, Chung A, Ramachandran D, Savaglio M, Skouteris H. Weight stigma and obesity-related policies: A systematic review of the state of the literature. Obesity Reviews. 2021. doi:10.1111/obr.13333
- Hill B, Skouteris H, Boyle J, Bailey C, Walker R, et al. Health in preconception, pregnancy and postpartum global alliance: International network pregnancy priorities for the prevention of maternal obesity and related pregnancy and long-term complications. J Clin Med. Special issue: Health in preconception, pregnancy and postpartum. 2020;9(822). doi: 10.3390/jcm9030822
- Cooray SD, Wijeyaratne LA, Soldatos G, Allotey J, Boyle J A, et al. The unrealised potential for predicting pregnancy complications in women with gestational diabetes: A systematic review and critical appraisal. Int J Environ Res Public Health. 2020;17(9):3048. doi: 10.3390/ijerph17093048
- Walker R, Drakeley S, Juice C, Sidduri N, Bickmore T, et al. Assessing the potential of a virtual patient advocate to provide preconception care and health advice to women living in Australia. J Dev Orig Health Dis. 2020;1-9. doi:10.1017 /S2040174420000264 Published online ahead of print, 2020 Apr 20.
- Lim S, Hill B, Teede HJ, Moran LJ, O’Reilly S. An evaluation of the impact of lifestyle interventions on body weight in postpartum women: A systematic review and meta-analysis. Obes Rev. 2020;21:(4):e12990. doi: 10.1111 /obr.12990.
- Bergmeier H, Hill B, Haycraft E, Blewitt C, Lim S, et al. Maternal body dissatisfaction in pregnancy, postpartum and early parenting: An overlooked factor implicated in maternal and childhood obesity risk. Appetite. 2020;147:104525.
- Bailey C, Skouteris H, Harrison CL, Boyle J, Bartlett R, Hill B, Thangaratinam S, Teede H, Ademi Z. Cost effectiveness of antenatal lifestyle interventions for preventing gestational diabetes and hypertensive disease in pregnancy. PharmacoEconomics-Open. 2020 Feb 5:1–2. doi: 10.1007/s41669-020-00197-9
- Hill B, Hall J, Skouteris H, Currie S. Defining preconception: Exploring the concept of a preconception population. BMC Pregnancy Childb. 2020;20(1):280. doi: 10.1186/s12884-020-02973-1
- Fernando M, Ellery SJ, Marquina C, Lim S, Naderpoor N, et al. Vitamin D-binding protein in pregnancy and reproductive health. Nutrients. 2020;12(5):E1489. doi: 10.3390/nu 12051489
- Walker R, Drakeley S, Boyle J. Preconception women’s views of promoting preconception women’s health in Australia. Health Promotion Journal of Australia. 2020 Aug 11. doi: :10.1002/hpja.402
- Walker R, Kandel P, Hill B, Hills S, Dunbar J, Skouteris H. Practice nurses and providing preconception care to women in Australia: a qualitative study. Australian Journal of Primary Health. 2020 Sep 8. doi:10.1071/PY20072
- Walker R, Morris H, Lang S, Hampton K, Boyle J, Skouteris H. Co-designing preconception and pregnancy care for healthy maternal lifestyles and obesity prevention. Women and Birth. 2020 Sep 1;33(5):473-8. doi: 10.1016/j.wombi.2019.11.005
- Kothe K, Bailey C, Weiner C, Nagle C, Nowson C, Hill B, McPhie S, Savaglio M, Skouteris H. An Investigation of Australian Midwifery Curricula for Obesity Management And Health Behaviour Change Training, Nurse Education in Practice, 2019; 36, 54-57
- O’Brien EC, Segurado R, Geraghty AA, Alberdi G, Rogozinska E, Astrup A, et al. Impact of maternal education on response to lifestyle interventions to reduce gestational weight gain: individual participant data meta-analysis. International Weight Management in Pregnancy (i-WIP) Collaborative Group. August 2019. BMJ Open. August 2019;9(8):e025620. doi: 10.1136/bmjopen-2018-025620
- Tay CT, Teede HJ, Hill B, Loxton D, Joham, AE. Increased prevalence of eating disorders, low self-esteem and psychological distress in women with polycystic ovary syndrome: a community-based cohort study. Fertility and Sterility. August 2019;112(2):353–61. doi: 10.1016/j.fertnstert.2019.03.027
- Bennett C, Walker R, Blumfield M, Gwini S, Ma J. Wang F, Wan Y, Truby H. Attenuation of maternal weight gain impacts infant birthweight: systematic review and meta-analysis. Journal of Developmental Origins of Health and Disease. August 2019;10(4):387–405. doi: 10.1017/S2040174418000879
- Lim S, Liang X, Hill B, Teede H, Moran LJ, O’Reilly S. A systematic review and meta‐analysis of intervention characteristic in postpartum weight management using the TIDieR framework: A summary of evidence to inform implementation. Obesity Reviews. 2019;20(7):1045–56. doi: 10.1017/S2040174418000879
- Khan NN, Boyle JA, Lang AY, Harrison CL. Preconception health attitudes and behaviours of women: A qualitative investigation. Nutrients. 2019;11(7):1490. doi: 10.3390/nu11071490
- Hill B, Kothe EJ, Currie S, Danby M, Lang AY, et al. A systematic mapping review of the associations between pregnancy intentions and health-related lifestyle behaviours or psychological wellbeing. Preventive Medicine Reports. June 2019;14. doi: 10.1016/j.pmedr.2019.100869
- Hill B, Hayden M, McPhie S, Bailey C, Skouteris H. Preconception and antenatal knowledge and beliefs about gestational weight gain. ANZJOG, 2019;1–7. doi: 10.1111/ajo.12942
- Hill B, Skouteris H, Teede HJ, Bailey C, Baxter JB, et al. Health in preconception, pregnancy and postpartum global alliance: International network preconception research priorities for the prevention of maternal obesity and related pregnancy and long-term complications. J. Clin. Med. 2019:8;2119. Doi:10.3390/jcm8122119
- Walker R, Ollander EK, Willey S, Hill B, Skouteris H. Weight management across pregnancy and postpartum care: The need for interprofessional education and collaboration. 2019;41:102651. Nurse Educ Pract. doi: 10.3389/fendo.2019.00163
- Lim SS, Tan A, Madden S, Hill B. Health professionals’ and postpartum women’s perspectives on digital health interventions for lifestyle management in the postpartum period: A systematic review of qualitative studies. 2019;10:163. Front Endocrinol. doi: 10.3389/fendo.2019.00767
- Nkrumah I, North M, Kothe E, Chai TL, Pirotta S, Lim S, Hill B. The relationship between pregnancy intentions and diet or physical activity behaviours in the preconception and antenatal periods: A systematic review and meta-analysis. 2019. doi:10.1111/jmwh.13112
- Kothe E, Lamb M, Bruce L, McPhie S, Klas A, Hill B, Skouteris H. Student midwives’ intention to deliver weight management interventions: A theory of planned behaviour & self-determination theory approach. Nurse Education Today. December 2018:71;10–16 (online publication).
- Teede H. International behavioural trials network conference. Plenary on stakeholders engagement in research using healthy lifestyle as an exemplar, Montreal, Canada, 2020.
- Teede H and Skouteris H. The Collective for Action on Obesity, national leadership group meetings, 2020.
- Lim S. Wheelers Hill Library, Monash City Council Community Talk, August 2019, Wheelers Hill, Vic Australia. Invited speaker – Polycystic Ovary Syndrome (PCOS) Information Session
- Walker R. Department of General Practice, Monash University Research Seminar, July 2019, Melbourne, Australia. Invited speaker – Maternal nutrition: A double-dose of prevention.
- Hill B, Ling B, Skouteris H, Bruce L, Moran L, Teede H, Mishra G. Australasian Society of Lifestyle Medicine Conference, June 2019, Auckland, New Zealand. Poster – Lifestyle and psychological characteristics of women with pregnancy intentions.
- Hill B, Ling B, Skouteris H, Bruce L, Moran L, Teede H, Mishra G. Australasian Society of Lifestyle Medicine Conference, June 2019. Auckland, New Zealand. Oral presentation and poster – Associations between future parenthood aspirations and lifestyle and psychological characteristics in women.
- Skouteris H. Capacity in building healthcare improvement. 16th Healthcare Executive Management Development Programme. Mysuru, India. 2-9 February 2019.
- Bergmeier H. Maternal body image during pregnancy, postpartum and early parenting. Expert panel discussion, PANDA (Perinatal Anxiety and Depression) Australia Professional Training. Richmond, Australia, 5 December 2018.
- Hill B, Moran LJ, Teede H, Skouteris H. Lifestyle intervention to prevent obesity during pregnancy: A view to the future. International Congress of Behavioral Medicine, Santiago, Chile. Oral in symposium, The impact of early environments on maternal and child obesity and overweight.
- Hill B, Kothe EJ, Currie S, Danby M, North M, Lang A, Bailey C, Moran LJ, Teede H, Skouteris H. Pregnancy intentions, health-related lifestyle behaviours, and psychological wellbeing: A systematic mapping review of the literature. International Congress of Behavioral Medicine. Santiago, Chile. November 2018.
- Skouteris H. Maternal body image across pregnancy, postpartum and early parenting, PANDA (Perinatal Anxiety & depression Australia), Victoria, Australia. November 2018.
- Skouteris H. Health in preconception and pregnancy: Prevention of maternal obesity, University of Thessaloniki, Greece. September 2018.
- Skouteris H. Health in preconception and pregnancy: An implementation science approach to reducing the burden of maternal obesity. Warwick University, UK, April 2018.
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