The role of lifestyle interventions in high risk pregnancies

Supporting all women with weight management during pregnancy is important.

Many researchers have sought to establish the effectiveness of lifestyle interventions during pregnancy such as diet or physical activity programmes.

They have found that these interventions reduce excessive gestational weight gain and support health behaviours. It is less clear what effect these interventions have on clinical outcomes such as pre-eclampsia and gestational diabetes. It is now suggested that a targeted approach is needed instead of attempting to identify a one size fits all approach to weight management care. This is especially important for women who have existing health conditions such as diabetes and hypertension who are often excluded from these interventions but yet hold the most risk for poor outcomes.

Furthermore, in a non-pregnant hypertensive population, lifestyle interventions that support weight management have been shown to have favourable effects on blood pressure control. There are obvious physiological and psychological differences in the pregnant population that could alter this effect but the relationship between body weight and blood pressure through lifestyle changes during pregnancy needs to be further explored.

The active components within antenatal interventions such as the behaviour change techniques utilised are yet to be identified. This is essential in order to build a ‘toolkit’ of weight management care that can usefully inform policy and subsequently, practice.

This is especially relevant as women have reported differing care dependant on their health care provider and clinicians have reported unease and lack of knowledge about what and how to advise women about their weight.

The above highlights a lack of consensus regarding best practice which is essential for safe and effective care.

To do this we will conduct:

• A systematic review of antenatal lifestyle interventions in pregnant women at high risk of cardiovascular disease;
• A service evaluation of clinical guidelines for weight management during pregnancy at NHS Trusts in England; and
• Explore the use of a lifestyle self-management intervention in a high risk pregnant population.

Patient and public involvement is important to us. The research group works with the charity Action on pre-eclampsia (APEC) to support the involvement of clinicians and women and to help us disseminate findings.

Patient and public involvement will form part of any work to explore a lifestyle intervention.
We plan to work with a diverse group of women with a range of experiences to ensure that the interventions we develop are suitable for all women.

The findings from the systematic review and service evaluation will highlight gaps in the evidence and indicate the direction of research, both for the DPhil programme and the wider research field.

Dissemination will include submission to relevant journals and attendance and presentation at conferences.

Beyond the academic setting, informing charities, policy makers and important stakeholders of the findings will expose how the research outputs of this work may influence clinical practice, important for successful implementation of future work.