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 2021

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.

Project lead

Professor Helena Teede, Monash University

Project team

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.

Publications

2020
2019
2018

Presentations

  • 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.