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      Piloting a Telephone Based Health Coaching Program for Pregnant Women: A Mixed Methods Study

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          Abstract

          Abstract

          Objectives Get Healthy in Pregnancy (GHiP) is a telephone based lifestyle coaching service for pregnant women, in New South Wales, Australia. GHiP had two service options; a telephone-based health coaching program consisting of up to 10 calls and information only (including one call). This study sought to compare the outcomes of the two GHiP options, to determine the characteristics of women likely to use the service and to explore the feedback from women and health professionals. Methods A pragmatic stratified clustered randomised controlled trial was conducted. Two metro and three rural hospitals were randomised into health coaching or information only arms. Self-reported measures of height and weight and health behaviours (dietary and physical activity) were collected at baseline and 36 weeks gestation. Process evaluation included descriptive analysis of routine program data, and semi-structured interviews with participants and health professionals. Results Of 3736 women screened, 1589 (42.5%) were eligible to participate, and of those eligible, 923 (58.1%) were recruited. More women in the health coaching arm gained weight within the target range for their BMI at 36 weeks gestation (42.9%) compared with information only (31.9%). Women found GHiP to be useful and supportive and midwives and doctors said that it facilitated conversations about weight with pregnant women. Conclusions for Practice Telephone-based lifestyle programs integrated with routine clinical care show promise in helping pregnant women achieve healthy gestational weight gain, but in this case was not significantly different from one information telephone call. Strong positive feedback suggests that scaled-up service delivery would be well received.

          Trial Registration

          ACTRN12615000397516 (retrospectively registered).

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          The risk of adverse pregnancy outcomes in women who are overweight or obese

          Background The prevalence of obesity amongst women bearing children in Australia is rising and has important implications for obstetric care. The aim of this study was to assess the prevalence and impact of mothers being overweight and obese in early to mid-pregnancy on maternal, peripartum and neonatal outcomes. Methods A secondary analysis was performed on data collected from nulliparous women with a singleton pregnancy enrolled in the Australian Collaborative Trial of Supplements with antioxidants Vitamin C and Vitamin E to pregnant women for the prevention of pre-eclampsia (ACTS). Women were categorized into three groups according to their body mass index (BMI): normal (BMI 18.5-24.9 kg/m2); overweight (BMI 25-29.9 kg/m2) and; obese (BMI 30-34.9 kg/m2). Obstetric and perinatal outcomes were compared by univariate and multivariate analyses. Results Of the 1661 women included, 43% were overweight or obese. Obese women were at increased risk of pre-eclampsia (relative risk (RR) 2.99 [95% confidence intervals (CI) 1.88, 4.73], p < 0.0001) and gestational diabetes (RR 2.10 [95%CI 1.17, 3.79], p = 0.01) compared with women with a normal BMI. Obese and overweight women were more likely to be induced and require a caesarean section compared with women of normal BMI (induction - RR 1.33 [95%CI 1.13, 1.57], p = 0.001 and 1.78 [95%CI 1.51, 2.09], p < 0.0001, caesarean section - RR 1.42 [95%CI 1.18, 1.70], p = 0.0002 and 1.63 [95%CI 1.34, 1.99], p < 0.0001). Babies of women who were obese were more likely to be large for gestational age (LFGA) (RR 2.08 [95%CI 1.47, 2.93], p < 0.0001) and macrosomic (RR 4.54 [95%CI 2.01, 10.24], p = 0.0003) compared with those of women with a normal BMI. Conclusion The rate of overweight and obesity is increasing amongst the Australian obstetric population. Women who are overweight and obese have an increased risk of adverse pregnancy outcomes. In particular, obese women are at increased risk of gestational diabetes, pregnancy induced hypertension and pre-eclampsia. Effective preventative strategies are urgently needed. Trial Registration Current Controlled Trials ISRCTN00416244
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            Gestational weight gain and adverse neonatal outcome among term infants.

            To examine the relationship between gestational weight gain and adverse neonatal outcomes among infants born at term (37 weeks or more). This was a retrospective cohort study of 20,465 nondiabetic, term, singleton births. We performed univariable and multivariable analyses of the associations between gestational weight gain and neonatal outcomes. We categorized gestational weight gain by the Institute of Medicine guidelines as well as extremes of gestational weight gain (less than 7 kg and more than 18 kg). Gestational weight gain above the Institute of Medicine guidelines was more common than gestational weight gain below (43.3% compared with 20.1%). In multivariable analyses, gestational weight gain above guidelines was associated with a low 5-minute Apgar score (adjusted odds ratio [AOR] 1.33, 95% confidence interval [CI] 1.01-1.76), seizure (AOR 6.50, 95% CI 1.43-29.65), hypoglycemia (AOR 1.52, 95% CI 1.06-2.16), polycythemia (AOR 1.44, 95% CI 1.06-1.94), meconium aspiration syndrome (AOR 1.79, 95% CI 1.12-2.86), and large for gestational age (AOR 1.98, 95% CI 1.74-2.25) compared with women within weight gain guidelines. Gestational weight gain below guidelines was associated with decreased odds of neonatal intensive care unit admission (AOR 0.66, 95% CI 0.46-0.96) and increased odds of small for gestational age (SGA; AOR 1.66, 95% CI 1.44-1.92). Gestational weight gain less than 7 kg was associated with increased risk of seizure, hospital stay more than 5 days, and SGA. Gestational weight gain more than 18 kg was associated with assisted ventilation, seizure, hypoglycemia, polycythemia, meconium aspiration syndrome, and large for gestational age. Gestational weight gain above guidelines was common and associated with multiple adverse neonatal outcomes, whereas gestational weight gain below guidelines was only associated with SGA status. Public health efforts among similar populations should emphasize prevention of excessive gestational weight gain.
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              Effectiveness of Australia's Get Healthy Information and Coaching Service®: translational research with population wide impact.

              With increasing rates of non-communicable disease, there is a need for implementing population-wide, evidence-based interventions for improving behavioural risk factors. Telephone-based interventions provide one option. This study reports on the evaluation of the Australia's Get Healthy Information and Coaching Service®, to improve lifestyle behaviours, amongst a population-wide sample who completed the 6-month coaching programme. Using a pre-post design, New South Wales participants who completed telephone-based coaching between February 2009 and December 2011 were included. Outcomes comprised self-reported weight, waist circumference, height, physical activity and dietary behaviours. Matched pair analyses and multivariate modelling were performed to assess behavioural changes. Participants (n=1440) reported statistically significant improvements in weight (-3.9 kg (5.1)); waist circumference (-5.0 cm (6.0)); and Body Mass Index (-1.4 BMI units (1.8)); number of walking and moderate-vigorous physical activity sessions of ≥30 min per week; number of vigorous physical activity sessions of ≥20 min per week and servings of vegetables; fruit; take-away meals and sweetened drinks (all p<0.001). Improvements in weight, waist, moderate physical activity, fruit and vegetable and take-away meals consumption remained significant after adjusting for socio-demographic characteristics. These results support the effectiveness of replicating an evidence-based intervention in improving population risk factors for chronic disease. Copyright © 2012 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                (61) 2 8738 6545 , Chris.Rissel@health.nsw.gov.au
                khanal_santosh@hotmail.com
                Jane.raymond@health.nsw.gov.au
                vanessa.clements@health.nsw.gov.au
                Kit.leung@health.nsw.gov.au
                michael.nicholl@health.nsw.gov.au
                Journal
                Matern Child Health J
                Matern Child Health J
                Maternal and Child Health Journal
                Springer US (New York )
                1092-7875
                1573-6628
                12 February 2019
                12 February 2019
                2019
                : 23
                : 3
                : 307-315
                Affiliations
                [1 ]NSW Office of Preventive Health, Liverpool, NSW Australia
                [2 ]ISNI 0000 0001 0753 1056, GRID grid.416088.3, NSW Ministry of Health, ; North Sydney, NSW Australia
                [3 ]ISNI 0000 0004 0587 9093, GRID grid.412703.3, Department of Obstetrics and Gynaecology, Royal North Shore Hospital, ; St Leonards, NSW Australia
                Author information
                http://orcid.org/0000-0002-2156-8581
                Article
                2735
                10.1007/s10995-019-02735-2
                6394500
                30756280
                9e601961-fabb-47ff-930a-4e1688284369
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                © Springer Science+Business Media, LLC, part of Springer Nature 2019

                Obstetrics & Gynecology
                health promotion,health coaching,gestational weight gain,obesity,maternal obesity

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