Preventing Obesity in Pregnancy Study
POPS
Weight gain during pregnancy
25%-40% of women gain more weight than they should during pregnancy
These women have a higher risk of gestational diabetes large baby delivery complications Preeclampsia stillbirth obesity in later life (mother and child)
POPS Study Does regular weighing, monitoring and feedback by
community midwives prevent women from gaining excessive weight during pregnancy?
Preventing obesity in pregnancy study (POPS)
pilot trial and interviews – is it feasible?
phase III RCT – is it effective?
How much weight should women gain during pregnancy?
The Institute of Medicine (USA) made recommendations based on pre pregnancy BMI
Developed weight chart that calculates ideal weight for women through pregnancy
Healthy BMI pre pregnancy
Overweight BMI pre pregnancy
Obese BMI pre pregnancy
1st trimester 1-3 kg (total) 1-3 kg (total) 0.5-2.0 kg (total)
2nd trimester 0.5 kg p/w 0.3 kg p/w 0.2 kg p/w
3rd trimester 0.5 kg p/w 0.3 kg p/w 0.2 kg p/w
Total gain 11.5-16 kg 7-15 kg 5-9 kg
(Institute of Medicine guidelines 2009)
POPS Pilot RCT 76 pregnant women receiving
midwife led care (low risk pregnancy)
Randomised usual care or usual care plus the intervention
Intervention – 8 community midwives Weighed women and plotted weight on
personalised weight chart
Set a maximum weight limit
Encouraged women to weigh themselves each week & record it
Gave brief feedback on progress
Encouraged women to eat healthy diet & participate in regular physical activity
All women weighed at start and end of pregnancy
Insert chart
What did we find? Was it useful? Was it feasible for midwives?
WOMEN
Women very keen to take part (91%)
Women wanted their weight monitored
Made them think about what they were eating
Those who were weighed & monitored Less women gained excessive
weight
Did more physical activity
Less anxious and depressed
MIDWIVES
Easily implemented into antenatal care
Took 1-2 minutes to do
Gave them an opportunity to raise the topic of weight
Felt weight was an important part of the public health agenda for midwives
Hardest part was setting the maximum weight limits /targets
Pilot study
POPS2 - Is the intervention effective?
Four hospitals/sites Birmingham Women’s Hospital
Russells Hall Hospital, Dudley
John Radcliffe Hospital, Oxford
South Warwickshire Hospital
657 women and 103 community midwives
Inclusion and exclusion Singleton pregnancy with a BMI ≥18.5 kg/m2 Planned to receive community midwife led care or shared care
where it is anticipated any consultant appointments will be in addition to community midwife appointments
Study overview Women given participant information leaflet by community midwife or sent by post prior to dating scan
Research team approach eligible women after scan, takes consent ; randomises to
Usual care Usual care plus intervention
Provide intervention at each antenatal appointmenta. Weigh womenb. Plot weight & give feedbackc. Set maximum weight limit & record itd. Give advice on healthy eating & encourage regular physical activitye. Encourage women to weigh themselves between appointments
Midwife weighs women at 38 weeks of pregnancy
Example: woman who gained the right amount of weight throughout pregnancy
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Setting maximum weight limits
We know some women will not follow the recommendations & stay in the zone
Some women will put on too much weight or perhaps not gain enough
What is the best way of keeping women in the zone? Set a maximum weight limit for each subsequent appointment -
gives women a focus
The limit needs to take account of whether women are already on target, gaining too much weight or not enough weight
Women ALWAYS set a limit for weight gain – NEVER weight loss
Encourage women to monitor their own weight....
Women encouraged to weigh themselves each week – why?
Women who don't have scales given home scales
Midwives record on the chart they have reminded women to weigh themselves and check their own weight against their chart
Advice about healthy lifestyle?
Educational and motivational messages – why?
Healthy eating
Physical activity
CONVEY WHY THEY ARE IMPORTANT
POPS 2: Basic recruitment data
Total
Recruited 657Age (yrs)- mean 29.0 yrs% White ethnicity 72.8Location Birmingham 484 Dudley 106 Oxford 49 Warwick 18BMI category at booking Healthy weight 322 Overweight 210 Obese 125
Questions?