一项以理论为导向、务实的试验，对常规产前保健进行了改变，以支持推荐的妊娠体重增加。
A theory driven, pragmatic trial implementing changes to routine antenatal care that supports recommended pregnancy weight gain.
机构信息
Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, QLD, 4029, Australia.
Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4029, Australia.
出版信息
BMC Pregnancy Childbirth. 2022 May 18;22(1):416. doi: 10.1186/s12884-022-04750-8.
BACKGROUND
Prevention of weight gain outside recommendations is a challenge for health services, with several barriers to best practice care identified. The aim of this pragmatic implementation study with a historical control was to examine the impact of implementing a service wide education program, and antenatal care pregnancy weight gain chart combined with brief advice on women's knowledge of recommended gestational weight gain (GWG), the advice received and actual GWG.
METHODS
The PRECEDE PROCEED Model of Health Program planning guided intervention and evaluation targets and an implementation science approach facilitated service changes. Pregnant women < 22 weeks' gestation attending the antenatal clinic at a metropolitan birthing hospital in Australia were recruited pre (2010, n = 715) and post (2016, n = 478) implementation of service changes. Weight measurements and questionnaires were completed at recruitment and 36 weeks' gestation. Questionnaires assessed advice received from health professionals related to healthy eating, physical activity, GWG, and at recruitment only, pre-pregnancy weight and knowledge of GWG recommendations.
RESULTS
Women who correctly reported their recommended GWG increased from 34% (pre) to 53% (post) (p < 0.001). Between pre and post implementation, the advice women received from midwives on recommended GWG was significantly improved at both recruitment- and 36-weeks' gestation. For normal weight women there was a reduction in GWG (14.2 ± 5.3 vs 13.3 ± 4.7 kg, p = 0.04) and clinically important reduction in excess GWG between pre and post implementation (31% vs 24%, p = 0.035) which remained significant after adjustment (AOR 0.53 [95%CI 0.29-0.96]) (p = 0.005).
CONCLUSIONS
Service wide changes to routine antenatal care that address identified barriers to supporting recommended GWG are likely to improve the care and advice women receive and prevent excess GWG for normal weight women.
背景
预防超出建议的体重增加是卫生服务的一个挑战，已确定了最佳实践护理的几个障碍。本实施性研究旨在检查实施一项全面服务的教育计划，以及产前保健妊娠体重增加图表结合对女性关于建议妊娠体重增加（GWG）的知识、所接受的建议和实际 GWG 的简要建议，对女性的影响。
方法
健康计划规划的 PRECEDE PROCEED 模型指导了干预和评估目标，实施科学方法促进了服务的改变。在澳大利亚一家大都市分娩医院的产前诊所，招募了妊娠 22 周以下的孕妇，分别在服务变化实施前（2010 年，n=715）和实施后（2016 年，n=478）进行了招募。在招募时和 36 周妊娠时完成了体重测量和问卷调查。问卷调查评估了健康专业人员提供的与健康饮食、身体活动、GWG 相关的建议，仅在招募时评估了孕前体重和 GWG 建议的知识。
结果
正确报告推荐 GWG 的女性比例从 34%（前）增加到 53%（后）（p<0.001）。在实施前后，孕妇在招募时和 36 周时从助产士那里获得的关于推荐 GWG 的建议明显改善。对于正常体重的女性，GWG 减少（14.2±5.3 比 13.3±4.7 kg，p=0.04），实施前后临床重要的多余 GWG 减少（31%比 24%，p=0.035），调整后仍然显著（AOR 0.53 [95%CI 0.29-0.96]）（p=0.005）。
结论
针对支持推荐 GWG 的障碍，对常规产前保健进行全面服务改变，可能会改善女性获得的护理和建议，并防止正常体重女性的 GWG 过多。
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