Implementation effectiveness of an antenatal lifestyle intervention to optimize gestational weight gain in women with obesity

IF 4.2 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Obesity Pub Date : 2024-12-10 DOI:10.1002/oby.24192

Rebecca F. Goldstein, Jacqueline A. Boyle, Shamil D. Cooray, Anju E. Joham, Alison L. Fitz-Gerald, Joanne Enticott, Cheryce L. Harrison, Helena J. Teede

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Abstract

Objective

The objective of this study was to evaluate a lifestyle intervention implemented into routine antenatal care to optimize gestational weight gain (GWG) and outcomes using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Methods

This study was an embedded pragmatic behavioral intervention delivered by a health coach and supported by a physician over five sessions for women with a prepregnancy BMI between 25 and 43 kg/m² who were <23 weeks' gestation in an Australian maternity service. Both intervention and standard care received routine antenatal care. The primary outcome was effectiveness in reducing excess GWG, and the secondary outcomes were reach, adoption, implementation, and maintenance and maternal and neonatal outcomes using the RE-AIM framework.

Results

For the “Reach” aspect, 90% of eligible women were included (N = 404; n = 202 intervention and n = 202 standard care). For the “Efficacy” aspect, there were no differences in proportion exceeding GWG recommendations or mean GWG between groups. Secondary analysis excluding women with gestational diabetes showed that a lower proportion of women in the intervention group had GWG above recommendations (β coefficient 0.51, 95% CI: 0.27 to 0.97; p = 0.04), with less GWG (β coefficient −1.93 kg, 95% CI: −3.63 to −0.24; p = 0.03). For the “Adoption” aspect, qualitative analysis of staff/participants demonstrated strong support for service. For the “Implementation” aspect, strong fidelity (implementation according to study plan) and staff/participant acceptability were observed. Finally, for the “Maintenance” aspect, the program has continued for 4 years with plans/funding for scale-up.

Conclusions

Lifestyle intervention did not alter the overall proportion with excess GWG or total GWG. Secondary analysis, excluding women with gestational diabetes mellitus, showed less GWG. This demonstrates implementation and maintenance of the intervention in routine antenatal care, generating new knowledge within the RE-AIM framework.

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产前生活方式干预优化肥胖妇女妊娠期体重增加的实施效果

目的：本研究的目的是评估在常规产前保健中实施的生活方式干预，以优化妊娠期体重增加（GWG）和结果，使用Reach、疗效、采用、实施和维持（RE-AIM）框架。方法：本研究是一项嵌入式实用行为干预，由一名健康教练在一名医生的支持下，对孕前体重指数在25至43 kg/m2之间的妇女进行了五次的干预，结果：在“达到”方面，90%的符合条件的妇女被纳入(N = 404；N = 202干预和N = 202标准治疗)。在“疗效”方面，两组间超过GWG推荐值的比例和平均GWG均无差异。排除妊娠期糖尿病妇女的二次分析显示，干预组妇女GWG高于推荐值的比例较低(β系数0.51,95% CI: 0.27 ~ 0.97；p = 0.04)， GWG较小(β系数-1.93 kg, 95% CI: -3.63 ~ -0.24；p = 0.03)。在“采用”方面，对工作人员/参与者的定性分析显示，他们非常支持服务。在“实施”方面，观察到较强的保真度（根据研究计划实施）和员工/参与者的可接受性。最后，在“维护”方面，该项目已经持续了4年，并计划/资助扩大规模。结论：生活方式干预并没有改变GWG过量或总GWG的总体比例。二次分析，排除妊娠期糖尿病的妇女，显示GWG更少。这表明在常规产前保健中实施和维持干预措施，在RE-AIM框架内产生新知识。

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来源期刊

Obesity 医学-内分泌学与代谢

CiteScore

11.70

自引率

1.40%

发文量

261

审稿时长

2-4 weeks

期刊介绍： Obesity is the official journal of The Obesity Society and is the premier source of information for increasing knowledge, fostering translational research from basic to population science, and promoting better treatment for people with obesity. Obesity publishes important peer-reviewed research and cutting-edge reviews, commentaries, and public health and medical developments.