- Title
- Weight management during pregnancy and following childbirth
- Creator
- Vincze, Lisa Joanne
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2018
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Supporting women to achieve a healthy weight following childbirth has important implications for their life long weight trajectory, chronic disease risk and offspring health. To reduce postpartum weight retention, guidelines recommend women engage in a healthy lifestyle; however, few women achieve optimal levels of physical activity or appropriate nutrient intakes at this life-stage. The unique and complex barriers faced by women following childbirth (i.e. time constraints and need for childcare), make achievement of lifestyle recommendations challenging. Further, accessing professional support for weight management is difficult via traditional models of care. Given that previous interventions aimed at supporting healthy weight attainment after childbirth have had variable and/or modest success, there is a need to identify how weight management support at this important life-stage can be improved. Therefore, this thesis includes three distinct but complementary studies aiming to address the overarching research question, “How can women be better supported to achieve a healthy weight following childbirth.” Five specific research questions with three corresponding thesis aims were proposed to address this overarching question. Results are summarised by thesis aim below. Thesis Aim 1: To systematically review the characteristics and effectiveness of interventions that include a nutrition component aimed at improving gestational weight gain and/or postpartum weight retention. To investigate this aim, a comprehensive systematic review was conducted. In total, 39 studies were included. The review identified 20 studies conducted in pregnancy only (11 reported significantly reducing gestational weight gain), five studies commenced in pregnancy and continued through to the postpartum period (one reported significantly reducing gestational weight gain and postpartum weight retention) and 14 studies commenced after childbirth (nine reported significantly reducing postpartum weight retention). The review demonstrated that a large variety of approaches have been used to optimise weight management in pregnancy and following childbirth. Interventions varied in modality used to deliver the intervention, number of modalities included, intervention content, qualifications and experience of the interventionist, the BMI range of recruited women and gestation criteria for recruitment, and thus intervention length. Notably, intervention reporting lacked detail with only 11/38 studies reporting mode, duration and intensity information for all included intervention components. Thesis Aim 2: To explore weight loss methods used, motivations for weight change and factors perceived to influence healthy eating and physical activity for weight management following childbirth, and to evaluate differences in these variables by socio-demographic, weight status and pregnancy characteristics. Results from the cross-sectional survey of 874 women who were ≤5 years postpartum indicated that majority of women were dissatisfied at their current weight (68.1%). The most important reasons women wanted to change their weight were to improve their health, feel better about themselves/lift mood and improve their self-confidence. Three-quarters of women (75.8%) had used at least one weight loss method in the previous two years, however less than 5% of those reported visiting a health professional for weight loss support. Time constraints due to family commitments was the most common factor rated to have a major influence on both healthy eating (79.5%) and physical activity (86.7%). Importantly, weight loss methods used, motivations for weight change and factors influencing healthy eating and physical activity significantly differed by socio-demographic, weight status and pregnancy characteristics. Results from the survey indicate that interventions targeting weight management in this population group need to individually tailor advice to improve adherence and engagement with healthy lifestyle behaviours. Aim 3: To evaluate the implementation, acceptability and preliminary efficacy of a personally tailored nutrition and exercise program (VITAL change for mums) for postpartum women (3-12 months), delivered via video-consultations by an Accredited Practising Dietitian (APD) and an Accredited Exercise Physiologist (AEP). The implementation, acceptability and preliminary efficacy of VITAL change for mums was evaluated in 30 women (31.6±3.1years, BMI 29.0±4.0kg/m²) who were 3-12 months postpartum in a pre-post-test single-arm study. Following the 8-week intervention period where the participants received up to five real-time video-consultations (2x APD, 2x AEP & 1x optional APD/AEP), the 27 completers rated satisfaction (out of 5) with the video-consultations (4.4±0.9) and the online setting (4.5±0.8) highly. The participants also agreed that accessing an APD (4.4±0.8) and AEP (4.3±0.9) was easier using video-consultations than attending an in-person consultation. Eleven participants (11/27, 41%) reported a technical issue with at least one video-consultation. From baseline to 8-weeks significant improvements from intention-to-treat analysis were observed for waist circumference, skeletal muscle mass, fat mass, VO2, self-reported MET.min/week and percentage energy intake from energy-dense, nutrient-poor foods. Post-intervention telephone interviews with 21 completers (32.3±3.0 years, 28.1±3.8 kg/m²) provided insight into women’s perspectives of engaging with the APD and AEP in the online setting. Themes relating to the video-consultation experiences of the women included feeling that they did not differ from in-person consultations, they were convenient, and flexible options were appropriate, however there was a desire for increased contact frequency. The dietitian and exercise physiologist were perceived to increase the knowledge and confidence of participants to improve health behaviours. The approach to setting realistic and tailored goals was well received. The findings from VITAL change for mums are the first to demonstrate that tailored advice from a dietitian and exercise physiologist received via video-consultations is feasible and acceptable to postpartum women. Conclusion The findings from this research thesis have identified key areas for improving weight management in women following childbirth. Research gaps have been identified including lack of recruitment of women from all BMI groups, limited interventions commencing in pregnancy and continuing through to the postpartum period and poor intervention detail reporting. These areas require addressing to improve maternal weight management. Both researchers and health practitioners need to consider women’s individual motivations and barriers for weight change following childbirth based on their characteristics (i.e. pregnancy, BMI and sociodemographic characteristics), and tailor counselling, support and research interventions accordingly. VITAL change for mums identified that tailored nutrition and exercise care delivered by qualified health practitioners via online real-time video-consultations is feasible and acceptable to postpartum women and offers a viable alternative to in-person care. Overall, the results from this thesis have implications for pregnant and postpartum women and health practitioners, and key recommendations for future research into optimising maternal weight management are provided.
- Subject
- pregnancy; postpartum; weight management; nutrition; exercise; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1387915
- Identifier
- uon:32688
- Rights
- Copyright 2018 Lisa Joanne Vincze
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
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| View Details Download | ATTACHMENT01 | Thesis | 4 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 311 KB | Adobe Acrobat PDF | View Details Download |