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Improving Nutrition and Physical Activity Behaviours for the Prevention and Treatment of Obesity during Preconception, Pregnancy and Postpartum through Health System Settings

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutrition in Women".

Deadline for manuscript submissions: closed (5 December 2023) | Viewed by 16470

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Special Issue Editors

Dr. Jenna Hollis

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Guest Editor

1. School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
2. Hunter New England Population Health, Longworth Avenue, Wallsend, NSW 2287, Australia
3. Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
Interests: maternal and child health; nutrition and physical activity; behaviour change; obesity prevention; population health; implementation science; health professional communication skills

Dr. Michelle Kilpatrick

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Guest Editor

Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7005, Australia
Interests: maternal and child health; behaviour change; implementation science; translational research; health professional communication skills; nutrition and physical activity; obesity prevention

Dr. Susan J. De Jersey

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Guest Editor

1. Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Metro North Health, Brisbane, QLD 4029, Australia
2. Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4029, Australia
Interests: maternal and child health; nutrition and physical activity; implementation science; person-centred care; behaviour change; non-communicable disease prevention and population health; health professional communication skills

Special Issue Information

Dear Colleagues,

According to the World Health Organization, supporting people in reaching a healthy weight in preconception and pregnancy is one of the most important ways we can optimise health outcomes for women and babies. The mechanism by which maternal nutrition, physical activity and weight influence their child’s health and long-term risk of chronic disease is explained by the developmental origins of health and disease. Support provided by the health system and health care providers in the preconception, pregnancy and postpartum periods can be effective in improving behaviour and health outcomes for current and future pregnancies, and across a person’s life course.

This Special Issue focuses on improving nutrition and physical activity behaviours for the prevention and treatment of obesity during preconception, pregnancy and postpartum. This Special Issue specifically addresses maternal health behaviours, but research may also include paternal health behaviours.

The specific objective of this Issue is to summarise evidence supporting the implementation and knowledge translation of evidence-based care in health system settings. Health system settings may include a health service policy or re-orientation of services approach (e.g., models of health care) and/or health care providers such as general practitioners, obstetricians, midwives, Aboriginal health workers, dietitians, exercise physiologists, physiotherapists, family and child health nurses and population health practitioners.

This can include any research that informs intervention development, implementation, evaluation and scale-up in health system settings. Outcomes may include (but are not limited to) current levels of health care provision, current nutrition and physical activity behaviours and/or related health outcomes among preconception, pregnancy or postpartum populations; health system and health care provider barriers to delivering evidence-based guideline care; the effect of intervention on care provision, nutrition and physical activity behaviours and/or health outcomes (maternal or child); and intervention process evaluation outcomes and longer-term intervention effect sustainability.

We welcome the submission of a range of study designs, including systematic reviews, meta-analyses, observational studies, pre–post studies, and randomised and non-randomised controlled trials. Pilot and feasibility intervention studies are eligible for submission. Studies may collect quantitative and/or qualitative data.

We strongly encourage submissions that have embedded processes to inform cultural appropriateness and inclusion for First Nations peoples and culturally and linguistically diverse (CALD) populations.

We look forward to receiving your contributions.

Dr. Jenna Hollis
Dr. Michelle Kilpatrick
Dr. Susan J. De Jersey
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

nutrition/diet
physical activity
weight/obesity
pregnancy
preconception
postpartum/intrapartum
prevention
treatment
implementation
behaviour change

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Published Papers (7 papers)

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Research

14 pages, 263 KiB

Open AccessArticle

Evaluating Preconception Health and Behaviour Change in Australian Women Planning a Pregnancy: The OptimalMe Program, a Digital Healthy Lifestyle Intervention with Remotely Delivered Coaching

by Bonnie R. Brammall, Rhonda M. Garad, Helena J. Teede and Cheryce L. Harrison

Nutrients 2024, 16(1), 155; https://doi.org/10.3390/nu16010155 - 3 Jan 2024

Cited by 2 | Viewed by 2114

Abstract

OptimalMe is a digital healthy lifestyle intervention for women planning a pregnancy, with remotely delivered coaching. This follow-up study of Australian women, stratified by coaching delivery mode (phone vs. videoconferencing), assessed alignment to preconception care guidelines and self-reported behaviour change. Overall, 298 women enrolled with a mean (SD) age of 31.8 (4.3) years and mean BMI of 25.7 (6.1) kg/m². Suboptimal preconception behaviours were reported at baseline, including alcohol consumption (57.2%), infrequent weighing (37.2%) and incomplete cervical cancer screening (15.8%) and prenatal supplementation (38.5). At follow-up (4.5 months) (n = 217), a statistically significant shift towards desired behaviours was reported for alcohol consumption (z = −2.6045, p = 0.00932), preconception supplementation (z = −2.7288, p = 0.00634) and frequent weight monitoring (z = −5.2911, p < 0.00001). An insignificant shift towards adherence to cervical cancer screening (z = −1.8679, p = 0.06148) was observed, with a positive trend towards adherence. Results indicate that women who are actively planning a pregnancy require support to optimise health and lifestyle in preparation for pregnancy and general health and lifestyle improvement. Women demonstrated improvement in lifestyle behaviours and self-monitoring, indicating the uptake of low-intensity, non-prescriptive information provision. Supporting the provision of knowledge-enhancing tools and general healthy lifestyle information combines with skilled health coaching as an effective method for behaviour change and self-management. OptimalMe also shows significant improvements in rates of healthcare engagement, which suggests coaching-based digital health interventions may decrease women’s barriers for preconception care and improve engagement in clinical settings. Full article

(This article belongs to the Special Issue Improving Nutrition and Physical Activity Behaviours for the Prevention and Treatment of Obesity during Preconception, Pregnancy and Postpartum through Health System Settings)

18 pages, 469 KiB

Open AccessArticle

Enablers and Barriers Related to Preconception Physical Activity: Insights from Women of Reproductive Age Using Mixed Methods

by Pragya Kandel, Siew Lim, Michelle Dever, Prabhat Lamichhane, Helen Skouteris, Sinead Currie and Briony Hill

Nutrients 2023, 15(23), 4939; https://doi.org/10.3390/nu15234939 - 28 Nov 2023

Cited by 1 | Viewed by 1797

Abstract

Engaging in regular preconception physical activity (PA) is associated with benefits, including improved cardiovascular health and mental well-being. However, most women do not meet PA recommendations in the preconception period. This study aimed to investigate enablers and barriers related to PA in preconception women using a sequential mixed method design. An online survey was followed by Zoom interviews with women of reproductive age (aged 18–45 years). A weaving approach and the Capability Opportunity Motivation Behaviour (COM-B) model were used to integrate and present the data. Seven hundred and eighty-eight non-pregnant women from Australia, India, and the US completed the quantitative survey, and 13 Australian-based women participated in a qualitative interview. Physical activity levels were associated with having social support, a desire to improve body image, and becoming a healthier person. Women encountered barriers such as misconceptions about PA, competing priorities, financial constraints, and a lack of accessibility. Enablers for participation in PA included knowledge of its importance, a desire to be healthier, weight loss, social support, and having goals. The multifaceted and intricate nature of enablers and barriers for preconception PA lays the groundwork for developing tailored interventions and policies aimed at promoting preconception PA among women. Full article

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16 pages, 501 KiB

Open AccessArticle

Motivation for Behavior Change among Women with Recent Gestational Diabetes and Their Partners—A Qualitative Investigation among Participants in the Face-It Intervention

by Anne Timm, Karoline Kragelund Nielsen, Helle Mölsted Alvesson, Dorte Møller Jensen and Helle Terkildsen Maindal

Nutrients 2023, 15(18), 3906; https://doi.org/10.3390/nu15183906 - 7 Sep 2023

Cited by 2 | Viewed by 1519

Abstract

Promoting diet and physical activity is important for women with recent gestational diabetes mellitus (GDM) and their partners to reduce the risk of future type 2 diabetes (T2D). The study aimed to understand how motivation for changing diet and physical activity behaviors among women with recent GDM and their partners was experienced after participation in the Danish Face-it intervention. Fourteen couples’ interviews were conducted. Data analysis followed a reflexive thematic analysis. Guided by self-determination theory and interdependence theory, we identified four themes affecting couples’ motivation for health behavior change: (1) The need to feel understood after delivery; (2) adjusting health expectations; (3) individual and mutual preferences for health behaviors; and (4) the health threat of future T2D as a cue to action. We found that couples in general perceived the Face-it intervention as useful and motivating. Using couple interviews increased our understanding of how the women and partners influenced each other’s perspectives after a GDM-affected pregnancy and thus how targeting couples as opposed to women alone may motivate health behavior change. Full article

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17 pages, 307 KiB

Open AccessArticle

Barriers and Facilitators to Cardiovascular Disease Prevention Following Hypertensive Disorders of Pregnancy in Primary Care: Cross-Sectional Surveys

by Kaylee Slater, Rachael Taylor, Karen McLaughlin, Craig Pennell, Clare Collins and Melinda Hutchesson

Nutrients 2023, 15(17), 3817; https://doi.org/10.3390/nu15173817 - 31 Aug 2023

Cited by 1 | Viewed by 1561

Abstract

Women with a history of hypertensive disorders of pregnancy (HDP) have an increased risk of cardiovascular disease (CVD). Guidelines recommend that women diagnosed with HDP should be advised of their increased CVD risk, have regular blood pressure monitoring by their general practitioner (GP), and adopt healthy lifestyle behaviours. However, within Australia, the current practice in primary health care is unknown. The aim of this study was to describe current practices, barriers, and facilitators to the provision of CVD preventative services for women after HDP in the primary care setting and to identify potential strategies to support GPs in providing recommended care. Separate cross-sectional online surveys were undertaken with 35 GPs and 105 women with a history of HDP. Surveys included both closed- and open-ended questions. Closed-ended questions were analysed using basic descriptive statistics, and open-ended questions were themed and tallied. The survey of GPs revealed that GPs are more likely to assess traditional CVD risk markers than lifestyle risk factors or HDP history. GPs identified a lack of resources and skills as barriers to providing CVD preventative care post-HDP. The survey with women after HDP revealed that women with a history of HDP are more likely to be assessed for blood pressure than lifestyle CVD risk factors, and that the women’s barriers to obtaining care included difficulty obtaining an appointment and time required for attending appointments. Strategies to improve CVD preventative care were consistent between surveys, where 70% of GPs and 59% of women chose ‘increasing women’s awareness of increased CVD risk’ and 67% of GPs and 55% of women chose ‘improving communication between hospitals and primary care’ as their preferred strategies. While the findings suggest that women with a history of HDP are receiving advice consistent with guidelines for traditional CVD risk markers, such as blood pressure, they are less likely to receive CVD preventative care for lifestyle or female-specific CVD risk factors. Full article

15 pages, 302 KiB

Open AccessArticle

Use and Preferences of Health Apps among Women and Healthcare Professionals Regarding GDM Postpartum Care Related to Diet, Physical Activity, and Weight Management: A Cross-Sectional Survey

by Anna Roesler, Kaley Butten, Cobi Calyx, Elizabeth Holmes-Truscott and Pennie Taylor

Nutrients 2023, 15(15), 3304; https://doi.org/10.3390/nu15153304 - 25 Jul 2023

Cited by 3 | Viewed by 2200

Abstract

Gestational Diabetes Mellitus (GDM) is a common medical complication of pregnancy, which is associated with increased risk of future diabetes. mHealth (mobile health, in this paper applications abbreviated to apps) can facilitate health modifications to decrease future risks. This study aims to understand mHealth app use and preferences among women with past GDM and healthcare professionals (HCP) in Australia. An explorative cross-sectional online survey was disseminated via social media, a national diabetes registry, and professional networks. Descriptive analyses were conducted on valid responses (women with prior GDM: n = 1475; HCP: n = 75). One third (33%) of women with prior GDM have used health apps, and a further 80% of non-app users were open to using a health app if recommended by their HCP. Over half (53%) of HCPs supported health information delivery via mHealth, although only 14% had recommended a health app to women post-GDM, and lack of knowledge about mHealth apps was common. Health app users reported that they preferred tracking features, while non-users desired credible health and dietary information and plans. Expanding mHealth app use could facilitate healthy behaviours, but endorsement by HCPs is important to women and is still currently lacking. Full article

17 pages, 1020 KiB

Open AccessArticle

Improving Engagement in Antenatal Health Behavior Programs—Experiences of Women Who Did Not Attend a Healthy Lifestyle Telephone Coaching Program

by Jessica Fry, Shelley A. Wilkinson, Jane Willcox, Michaela Henny, Lisa McGuire, Taylor M. Guthrie, Nina Meloncelli and Susan de Jersey

Nutrients 2023, 15(8), 1860; https://doi.org/10.3390/nu15081860 - 12 Apr 2023

Cited by 1 | Viewed by 2383

Abstract

Living Well during Pregnancy (LWdP) is a telephone-based antenatal health behavior intervention that has been shown to improve healthy eating behaviors and physical activity levels during pregnancy. However, one-third of eligible, referred women did not engage with or dropped out of the service. This study aimed to explore the experiences and perceptions of women who were referred but did not attend or complete the LWdP program to inform service improvements and adaptations required for scale and spread and improve the delivery of patient-centered antenatal care. Semi-structured telephone interviews were conducted with women who attended ≤2 LWdP appointments after referral. The interviews were thematically analyzed and mapped to the Theoretical Domains Framework and Behavior Change Wheel/COM-B Model to identify the barriers and enablers of program attendance and determine evidence-based interventions needed to improve service engagement and patient-centered antenatal care. Three key themes were identified: (1) the program content not meeting women’s expectations and goals; (2) the need for flexible, multimodal healthcare; and (3) information sharing throughout antenatal care not meeting women’s information needs. Interventions to improve women’s engagement with LWdP and patient-centered antenatal care were categorized as (1) adaptations to LWdP, (2) training and support for program dietitians and antenatal healthcare professionals, and (3) increased promotion of positive health behaviors during pregnancy. Women require flexible and personalized delivery of the LWdP that is aligned with their individual goals and expectations. The use of digital technology has the potential to provide flexible, on-demand access to and engagement with the LWdP program, healthcare professionals, and reliable health information. All healthcare professionals are vital to the promotion of positive health behaviors in pregnancy, with the ongoing training and support necessary to maintain clinician confidence and knowledge of healthy eating, physical activity, and weight gain during pregnancy. Full article

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15 pages, 1395 KiB

Open AccessArticle

Evaluation of the Pragmatic Implementation of a Digital Health Intervention Promoting Healthy Nutrition, Physical Activity, and Gestational Weight Gain for Women Entering Pregnancy at a High Body Mass Index

by Shelley A. Wilkinson, Brianna Fjeldsoe and Jane C. Willcox

Nutrients 2023, 15(3), 588; https://doi.org/10.3390/nu15030588 - 22 Jan 2023

Cited by 2 | Viewed by 3082

Abstract

txt4two is a multi-modality intervention promoting healthy pregnancy nutrition, physical activity (PA), and gestational weight gain (GWG), which had been previously evaluated in a pilot randomized controlled trial (RCT). This study aimed to evaluate a pragmatic implementation of an adapted version of txt4two in a public tertiary hospital. Using a consecutive cohort design, txt4two was delivered to women with a pre-pregnancy BMI > 25 kg/m², between 10 + 0 to 17 + 6 weeks. Control and intervention cohorts (n = 150) were planned, with surveys and weight measures at baseline and 36 weeks. The txt4two cohort received a dietetic goal-setting appointment and program (SMS, website, and videos). The navigation of disparate hospital systems and the COVID-19 pandemic saw adaptation and adoption take two years. The intervention cohort (n = 35; 43% full data) demonstrated significant differences (mean (SD)), compared to the control cohort (n = 97; 45% full data) in vegetable intake (+0.9 (1.2) versus +0.1 (0.7), p = 0.03), fiber-diet quality index (+0.6 (0.8) versus 0.1 (0.5), p = 0.012), and total diet quality index (+0.7 (1.1) versus +0.2 (±0.6), p = 0.008), but not for PA or GWG. Most (85.7%) intervention participants found txt4two extremely or moderately useful, and 92.9% would recommend it. Embedding the program in a non-RCT context raised implementation challenges. Understanding the facilitators and barriers to adaptation and adoption will strengthen the evidence for the refinement of implementation plans. Full article

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Improving Nutrition and Physical Activity Behaviours for the Prevention and Treatment of Obesity during Preconception, Pregnancy and Postpartum through Health System Settings

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