Living well during pregnancy

Aim

To address existing barriers to care to develop and implement an evidence-based nutrition service into routine antenatal care for high-risk women.

Outcomoes

What our formative research demonstrated was that for a women with a higher body mass index, a low intensity intervention was unlikely to be enough to impact on outcomes.

Background

Gaining more weight than recommended and poor nutrition in pregnancy are key risk factors for the development of metabolic disease such as gestational diabetes mellitus (GDM), hypertension and obesity in mothers and future metabolic disease in offspring. Dietary counselling and weight monitoring are effective at improving nutritional intake and reducing weight gain above recommendations. However, women classified as being above a healthy weight before pregnancy experience greater barriers to achieving nutrition and weight gain recommendations, have a lower confidence to achieve health goals and require more intensive support.

Discussion

We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework to evaluate the program with our protocol and outcomes paper published.

Women with a pre-pregnancy BMI of 25 or over had stronger intentions to manage their GWG, however, they experienced greater barriers and lower confidence to overcome these barriers than women classified as a healthy weight.

Compared to pre-implementation we had a 105 increase in women eligible, that were referred to the program.

We used hospital costings data to evaluate the cost effectiveness of the program compared to standard care in preventing gestational diabetes. The Living Well program was dominant over routine care in reducing GDM and supports broad reach delivery of structured interventions during pregnancy to lower the short-term costs associated with GDM to the health system.

While the program demonstrated benefits to those who engaged, around half of those referred did not take up or complete the program. Those women were invited to tell us their experiences to inform the future development to meet the needs of more women. Nine women were interviewed and transcripts thematically analysed.

Lessons learnt

• activity pressures did not allow time for consumer co-design from the outset
• ongoing advocacy is needed to emphasise that this service is a high priority within an "acute care facility".
• staff turnover, training and willingness to work outside usual hours.
• funding for innovation and redesign

Further Reading

National Library of Medicine