Smith Debbie M, Taylor Wendy, Whitworth Melissa K, Roberts Stephen, Sibley Colin, Lavender Tina
The School of Psychological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester M13 9PL, UK.
Maternal & Fetal Health Research Centre, Institute of Human Development, The University of Manchester, Manchester Academic Health Science Centre, St Mary׳s Hospital, Manchester, Central Manchester University Hospitals NS Foundation Trust, UK.
Midwifery. 2015 Feb;31(2):280-7. doi: 10.1016/j.midw.2014.10.002. Epub 2014 Nov 4.
maternal obesity [body mass index (BMI)≥30kg/m(2)] is a cause for concern because of increasing rates and risk of associated complications. However, little is known about how to improve the health of women with a BMI≥30kg/m(2).
a 10-week antenatal lifestyle programme (The Lifestyle Course - TLC), underpinned by behaviour change theory, was developed in a programme of research which included a prospective, multicentred, feasibility phase (n=227). Participants had a BMI≥30kg/m(2) at the start of their pregnancy, planned to deliver in two areas of Greater Manchester and were aged 18 or over. The objectives were to (1) assess the feasibility of the intervention and (2) to pilot the trial processes and outcome measures.
(1) Trial intervention: only 22% of women in the feasibility phase had received gestational weight advice prior to the study. One or more TLC sessions were attended by 79% of women and 97% said they would recommend TLC to a friend due to the content suitability, perceived personal gains and extra care received. Changes to the TLC were suggested and implemented in the pilot phase. (2) Trial processes: recruitment rates (36%), retention rates (100%) and questionnaire completion rates up to one year (33%) were found. Daily general 'lifestyle' diaries and pedometers were not acceptable data collection tools (response rates of 32% and 16% respectively). However, specific food diaries were acceptable (response rates of 80-81%). The major challenge was the collection of maternal weight data at the follow-up points.
the antenatal intervention (TLC) designed for this programme of work appears to suit the needs of women with a BMI≥30kg/m(2). The need for an antenatal intervention is clear from this study and also highlights reflections on effective communication with pregnant women with a BMI≥30kg/m(2). Lessons learnt for designing a future trial include effective ways to communicate with pregnant women with a BMI≥30kg/m(2).
ISRCTN29860479.
孕妇肥胖（体重指数[BMI]≥30kg/m²）因发病率上升及相关并发症风险而令人担忧。然而，对于如何改善BMI≥30kg/m²女性的健康状况，人们知之甚少。
在一项研究计划中制定了一项为期10周的产前生活方式计划（生活方式课程 - TLC），该计划以行为改变理论为基础，其中包括一个前瞻性、多中心的可行性阶段（n = 227）。参与者在怀孕开始时BMI≥30kg/m²，计划在大曼彻斯特的两个地区分娩，年龄在18岁及以上。目标是（1）评估干预措施的可行性，以及（2）试行试验流程和结果测量方法。
（1）试验干预：在可行性阶段，只有22%的女性在研究前接受过孕期体重建议。79%的女性参加了一次或多次TLC课程，97%的女性表示由于内容适用性、个人收获感以及得到的额外关怀，她们会向朋友推荐TLC。在试点阶段，有人建议并实施了对TLC的修改。（2）试验流程：发现了招募率（36%）、保留率（100%）以及长达一年的问卷完成率（33%）。日常一般“生活方式”日记和计步器不是可接受的数据收集工具（回复率分别为32%和16%）。然而，特定食物日记是可接受的（回复率为80 - 81%）。主要挑战是在随访点收集孕妇体重数据。
为该工作计划设计的产前干预措施（TLC）似乎符合BMI≥30kg/m²女性的需求。从这项研究中可以清楚地看出产前干预的必要性，同时也凸显了对与BMI≥30kg/m²孕妇进行有效沟通的反思。为未来试验设计吸取的经验教训包括与BMI≥30kg/m²孕妇进行有效沟通的有效方法。
ISRCTN29860...
