The role of lifestyle interventions in high risk pregnancies
Less than half of women enter pregnancy with a weight within a health range making it the most common obstetric risk factor. Women living with overweight and obesity during pregnancy as well as women who put on too much weight during pregnancy are at increased risk of poor pregnancy, birth and neonatal outcomes. The risk is further pronounced in women entering pregnancy with existing chronic conditions such as diabetes and hypertension who are additionally living with a lifelong risk of cardiovascular disease.
Part of our Helping Patients Manage their Own Conditions research theme
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.
How we are involving patients and the public
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.
How we are planning to implement the research outputs
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.
Project end date
- To collate the evidence of antenatal lifestyle interventions in women at high risk of cardiovascular disease and evaluate the effect of these interventions on gestational weight and blood pressure.
- To identify the type, frequency and combination of behaviour change techniques used within antenatal lifestyle interventions.
- To develop a national overview of weight management during pregnancy guidelines across NHS Trusts in England.
- To identify discrepancies and agreement between recommendations of clinical care for weight management during pregnancy and consider the underlying evidence base for these recommendations.
- Understanding the effect of antenatal lifestyle interventions in women experiencing high risk pregnancies and the identification of behaviour change techniques will support the development of interventions to support better care.
- A better understanding of weight management care guidelines in England. This will provide an overview of current practice and identify where there are inconsistencies or a lack of evidence supporting the recommendations. Understanding current practice will support the implementation of new interventions that can be effectively embedded within existing care pathways.
- Women experiencing a high risk pregnancy are the centre of this work. This research project hopes to further the existing evidence base relating to lifestyle interventions in pregnancy that can lead to enhanced antenatal care and ultimately improve maternal and neonatal outcomes for these women.