Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.
The University of Queensland, Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, Brisbane, Australia.
BMC Health Serv Res. 2022 May 3;22(1):589. doi: 10.1186/s12913-022-08002-5.
Excess gestational weight gain (GWG) is associated with short-term perinatal complications and longer term cardiometabolic risks for mothers and their babies. Dietitian counselling and weight gain monitoring for women at risk of high pregnancy weight gain is recommended by clinical practice guidelines. However, face-to-face appointments, during a time with high appointment burden, can introduce barriers to engaging with care. Telephone counselling may offer a solution. The Living Well during Pregnancy (LWdP) program is a dietitian-delivered telephone coaching program implemented within routine antenatal care for women at risk of excess GWG. This program evaluation used a hybrid implementation-effectiveness design guided by the RE-AIM framework to report on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention.
The LWdP program evaluation compared data from women participating in the LWdP program with a historical comparison group (pregnant women receiving dietetic counselling for GWG in the 12 months prior to the study). The primary outcomes were described for the LWdP program. Between group comparisons were used to determine effectiveness of achieving appropriate GWG and pre and post intervention comparisons of LWdP participants was used to determine changes to dietary intake and physical activity.
The LWdP intervention group (n = 142) were compared with women in the historical comparison group (n = 49). Women in the LWdP intervention group attended 3.4 (95% CI 2.9-3.8) appointments compared with 1.9 (95% CI, 1.6-2.2) in the historical comparison group. GWG was similar between the two groups, including the proportion of women gaining weight above the Institute of Medicine recommendations (70% vs 73%, p = 0.69). Within group comparison showed that total diet quality, intake of fruit and vegetables and weekly physical activity were all significantly improved from baseline to follow-up for the women in LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p < 0.05).
The LWdP program resulted in more women accessing care and positive improvements in diet quality, intuitive eating behaviours and physical activity. It was as effective as face-to-face appointments for GWG, though more research is required to identify how to engage women earlier in pregnancy and reduce appointment burden.
过多的妊娠体重增加（GWG）与围产期短期并发症以及母婴长期的心脏代谢风险相关。临床实践指南建议对有高妊娠体重增加风险的妇女进行营养师咨询和体重增加监测。然而，在高预约负担期间进行面对面预约可能会给参与护理带来障碍。电话咨询可能是一种解决方案。“孕期健康生活（LWdP）”计划是一项由营养师提供的电话辅导计划，在常规产前护理中为有过多 GWG 风险的妇女实施。本计划评估采用了由 RE-AIM 框架指导的混合实施效果设计，以报告 LWdP 干预的主要结果（覆盖范围、采用、实施、维持）和次要结果（效果）。
LWdP 计划评估将参与 LWdP 计划的妇女的数据与历史对照组（研究前 12 个月接受 GWG 饮食咨询的孕妇）进行比较。描述了 LWdP 计划的主要结果。采用组间比较来确定实现适当 GWG 的效果，并对 LWdP 参与者进行干预前后的比较，以确定饮食摄入和身体活动的变化。
将 LWdP 干预组（n=142）与历史对照组（n=49）进行比较。LWdP 干预组妇女就诊 3.4 次（95%CI，2.9-3.8），而历史对照组妇女就诊 1.9 次（95%CI，1.6-2.2）。两组妇女 GWG 相似，包括体重增加超过医学研究所建议的比例（70%比 73%，p=0.69）。组内比较显示，LWdP 组妇女的总饮食质量、水果和蔬菜摄入量以及每周体力活动均从基线到随访显著改善，而随意性食物的消耗和久坐时间减少（均 p<0.05）。
LWdP 计划使更多的妇女获得了医疗服务，并在饮食质量、直觉饮食行为和体力活动方面取得了积极的改善。它在 GWG 方面与面对面预约一样有效，尽管需要进一步研究以确定如何在妊娠早期让更多的妇女参与，并减轻预约负担。
