Healthy Eating and Lifestyle in Pregnancy

Obesity in pregnancy is linked to poorer outcomes for both mother and child. It is also linked to complications during the pregnancy and at birth such as increased risk of caesarean section or diabetes that develops during the pregnancy. Retaining weight gain following pregnancy can lead to longer term obesity. We have developed an intervention for obese pregnant women based around the Slimming World approach combined with input from midwives which targets diet and physical activity. A scientific evaluation is now needed to determine whether or not this is effective. We plan to do this by recruiting 20 antenatal units across the UK. We will train midwives from half the units in how to deliver the intervention. Women attending intervention units will attend groups run by ?Slimming World? and a midwife. These women will be encouraged to eat more healthily and increase their levels of exercise using a walking programme. Women attending control units will receive usual care and a leaflet giving advice on diet and exercise. The main outcome we will look at is the difference in Body Mass Index (BMI), 12 months from giving birth, between the women in intervention and control groups. We will also measure changes in diet and exercise levels, mental health, quality of life, child?s weight, self confidence, social support and self regulation. Pregnancy and birth outcomes will be assessed as well as the cost effectiveness of the intervention. Women will be followed up at the 36th week of pregnancy, then at 6 weeks, 6 months and one year after giving birth. Some of these women will be invited to take part in an interview which will ask them about their experiences of the intervention. This intervention could reduce complications during pregnancy and childbirth as well as influence women?s health behaviours in the longer term which could impact not only on the woman?s health but that of her family as well. If the study is successful we will develop a training package for midwives which could be rolled out across the UK. We will develop a study website which is accessible to everyone which will describe the study results. We will also offer to send all participants a summary of the results and we will look for creative ways to publicise the results via the media. We will use our links with Slimming World to publicise the results, including on their website.

Around 1 in 5 pregnant women in the UK are obese. Obesity is linked generally to poor health and also pregnancy complications. Retaining weight gain following pregnancy can lead to long-term obesity. There is evidence that excess maternal weight gain during pregnancy is associated with obesity in the child at 3 years and in adolescence, which suggests there is potential for influencing not only the mother?s lifestyle but the new child?s weight and the family?s health behaviour. Intervening with pregnant obese women and equipping them with the skills, knowledge and support necessary to manage their weight effectively during pregnancy and after childbirth is an important step in tackling overweight and obesity among women of child bearing age. This study is a cluster randomised controlled trial which will examine whether a weight management intervention for obese pregnant women, which targets physical activity and healthy eating, is effective in reducing women?s BMI at 12 months from giving birth and at what cost. Secondary outcomes include; pregnancy weight gain, quality of life, mental health, waist-hip ratio, child weight centile, admission to neonatal unit, diet, physical activity, pregnancy and birth complications, social support, self regulation and self efficacy. Twenty maternity units will be recruited and midwives will be trained in recruitment and the intervention. These units will be randomised, ten to the intervention group and ten to the control group. We will recruit women over 18 with a BMI of =30 between 12 and 20 weeks gestation, 570 women will be recruited allowing for a drop out of 30%. Those women attending the maternity units randomised to the intervention group will attend a weekly, 1.5 hour specialist weight management and physical activity support group run jointly by ?Slimming World? and midwives. At each session weight will be monitored and advice given regarding diet, lifestyle and pregnancy. Slimming World advice is similar to that advised for pregnancy and for breastfeeding mothers and offers a balanced unrestricted diet. Additional exercise recommendations will encourage graded, supervised increases in daily physical activity through a walking programme. Women attending control units will receive usual care and a leaflet giving advice on diet and physical activity. Women will be followed up at 36 weeks gestation, 6 weeks post birth, six months and one year after birth. Positive results are likely to lead to refinement and roll-out of the intervention.