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Title: The Healthy Eating and Lifestyle in Pregnancy cluster randomised controlled trial : a 24 months postpartum follow-up study : an evaluation of the effect of a weight management intervention for maternal obesity, on maternal and child outcomes at 24 months following birth
Author: Gallagher, Dunla
ISNI:       0000 0004 7652 3561
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2018
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Background: Obesity in pregnancy, and excessive gestational weight gain, are associated with short and long-term adverse health outcomes for mothers and their offspring, including childhood obesity. The Healthy Eating and Lifestyle in Pregnancy (HELP) cluster randomised controlled trial compared the effectiveness of a group-based weight management intervention, delivered during pregnancy and postpartum, with National Health Service routine maternity care. In total, 598 pregnant women, aged 18 years and over, with a BMI of ≥30 kg/m2, and between 12 and 20 weeks gestation, were recruited across 20 study centres in England and Wales, United Kingdom. The aim of the HELP trial was to improve health outcomes in these women with obesity. The present study followed up these women and their children at 24 months postpartum and aimed to assess longer-term maternal and child outcomes. It also aimed to explore the experiences of these women. Methods: A sequential mixed methods approach was used. The first, quantitative phase, examined the effectiveness of the HELP intervention on primary outcomes, maternal BMI and child BMI-for-age z-scores, and secondary outcomes, including weight, diet, and physical activity behaviours of mothers and children. Outcomes were analysed using multilevel linear, logistic and ordinal regression models. The second, qualitative phase, used telephone interviews to explore women's experiences. Thematic analysis was used to organise and interpret the interview data. Findings from the two approaches were triangulated for discussion. Results: The 24 months postpartum follow-up included 241 women and children, across 19 clusters. The analyses found no evidence of between groups differences in the primary outcomes, maternal BMI at 24 months postpartum (adjusted percentage difference: -0.01, 95% CI -0.04 to 0.02; ICC < 0.001; p= 0.664) and child BMI-for-age z-scores (adjusted difference in means: 0.24, 95% CI -0.17 to 0.64; ICC < 0.001; p=0.250), or the secondary outcomes. Subsequently, 18 of these women completed a telephone interview. Maternal attitudes towards their own and their child's weight and health behaviours, before, during and after pregnancy, were described in three themes: 1) pregnancy specific attitudes and behaviours; 2) wider weight control attitudes and experiences; and, 3) maternal perceptions and influences on children's weight, diet and activity. Discussion: The HELP intervention did not improve outcomes for women and their children at 24 months postpartum. Women have a strong desire to be healthy for their unborn babies during pregnancy. Non-judgmental support may help them adopt healthier behaviours to achieve short-term goals. However, more support would be needed to help women achieve better long-term outcomes. Women's lived experiences of obesity are complex, and it is important to incorporate their beliefs and motivations into interventions. Rather than viewing pregnancy as a short window of opportunity for initiating behaviour change, it should be used as a unique motivator which could give women a purpose for change over a longer term. Exploring options for intervening in the preconception period to address attitudes and weight loss before pregnancy, supporting women during pregnancy to be healthy for their babies, and building on this postpartum to help women shift their goals to weight loss, self-regulation of weight management, being a positive role model for their children and health-promoting feeding practices; may be more effective for improving maternal and child outcomes.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available