Differing intensities of a midwife-led antenatal healthy lifestyle service on maternal and neonatal outcomes: A retrospective cohort study.

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  • Author(s): Fair FJ;Fair FJ; Soltani H; Soltani H
  • Source:
    Midwifery [Midwifery] 2024 Sep; Vol. 136, pp. 104078. Date of Electronic Publication: 2024 Jun 26.
  • Publication Type:
    Journal Article; Research Support, Non-U.S. Gov't
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Churchill Livingstone Country of Publication: Scotland NLM ID: 8510930 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-3099 (Electronic) Linking ISSN: 02666138 NLM ISO Abbreviation: Midwifery Subsets: MEDLINE
    • Publication Information:
      Original Publication: Edinburgh ; New York : Churchill Livingstone, 1985-
    • Subject Terms:
      Pregnancy Outcome*/epidemiology ; Prenatal Care*/methods ; Prenatal Care*/statistics & numerical data; Humans ; Female ; Pregnancy ; Retrospective Studies ; Adult ; Cohort Studies ; Healthy Lifestyle ; Body Mass Index ; Midwifery/methods ; Midwifery/statistics & numerical data ; Infant, Newborn ; Gestational Weight Gain
    • Abstract:
      Introduction: Maternal obesity and excessive gestational weight gain are associated with adverse maternal and neonatal outcomes. There is uncertainty over the most effective antenatal healthy lifestyle service, with little research determining the impact of different lifestyle intervention intensities on pregnancy outcomes.
      Method: This retrospective cohort study compared pregnancy and birth outcomes in women with a body mass index of 40 or above who were offered a low intensity midwife-led antenatal healthy lifestyle service (one visit) with women who were offered an enhanced service (three visits). The primary outcome was gestational weight gain.
      Results: There were no differences between the two healthy lifestyle service intensities (N = 682) in the primary outcome of mean gestational weight gain [adjusted mean difference (aMD) -1.1 kg (95 % CI -2.3 to 0.1)]. Women offered the enhanced service had lower odds of gaining weight in excess of Institute of Medicine recommendations [adjusted odds ratio (aOR) 0.63 (95 % CI 0.40-0.98)] with this reduction mainly evident in multiparous women. Multiparous women also gained less weight per week [aMD -0.06 kg/week (95 % CI -0.11 to -0.01)]. No overall beneficial effects were seen in maternal or neonatal outcomes measured such as birth weight [aMD 25 g (95 % CI -71 to 121)], vaginal birth [aOR 0.87 (95 % CI 0.64-1.19)] or gestational diabetes mellitus [aOR 1.42 (95 % CI 0.93-2.17)]. However, multiparous women receiving the enhanced service had reduced odds of small for gestational age [aOR 0.52 (95 % CI 0.31-0.87)]. This study was however underpowered to detect differences in some outcomes with low incidences.
      Discussion: Uncertainty remains over the best management of women with severe obesity regarding effective interventions in terms of intensity. It is suggested that further research needs to consider the different classes of obesity separately and have a particular focus on the needs of nulliparous women given the lack of effectiveness of this service among these women.
      Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
      (Copyright © 2024. Published by Elsevier Ltd.)
    • Contributed Indexing:
      Keywords: Gestational weight gain; Healthy lifestyle; Maternal obesity; Pregnancy outcome; Prenatal care; Weight management
    • Publication Date:
      Date Created: 20240711 Date Completed: 20240801 Latest Revision: 20241001
    • Publication Date:
      20241002
    • Accession Number:
      10.1016/j.midw.2024.104078
    • Accession Number:
      38991634