Preventing Obesity in Pregnancy Study

POPS

Weight gain during pregnancy

25%-40% of women gain more weight than they should during pregnancy

These women have a higher risk of gestational diabetes large baby delivery complications Preeclampsia stillbirth obesity in later life (mother and child)

POPS Study Does regular weighing, monitoring and feedback by

community midwives prevent women from gaining excessive weight during pregnancy?

Preventing obesity in pregnancy study (POPS)

pilot trial and interviews – is it feasible?

phase III RCT – is it effective?

How much weight should women gain during pregnancy?

The Institute of Medicine (USA) made recommendations based on pre pregnancy BMI

Developed weight chart that calculates ideal weight for women through pregnancy

Healthy BMI pre pregnancy

Overweight BMI pre pregnancy

Obese BMI pre pregnancy

1st trimester 1-3 kg (total) 1-3 kg (total) 0.5-2.0 kg (total)

2nd trimester 0.5 kg p/w 0.3 kg p/w 0.2 kg p/w

3rd trimester 0.5 kg p/w 0.3 kg p/w 0.2 kg p/w

Total gain 11.5-16 kg 7-15 kg 5-9 kg

(Institute of Medicine guidelines 2009)

POPS Pilot RCT 76 pregnant women receiving

midwife led care (low risk pregnancy)

Randomised usual care or usual care plus the intervention

Intervention – 8 community midwives Weighed women and plotted weight on

personalised weight chart

Set a maximum weight limit

Encouraged women to weigh themselves each week & record it

Gave brief feedback on progress

Encouraged women to eat healthy diet & participate in regular physical activity

All women weighed at start and end of pregnancy

Insert chart

What did we find? Was it useful? Was it feasible for midwives?

WOMEN

Women very keen to take part (91%)

Women wanted their weight monitored

Made them think about what they were eating

Those who were weighed & monitored Less women gained excessive

weight

Did more physical activity

Less anxious and depressed

MIDWIVES

Easily implemented into antenatal care

Took 1-2 minutes to do

Gave them an opportunity to raise the topic of weight

Felt weight was an important part of the public health agenda for midwives

Hardest part was setting the maximum weight limits /targets

Pilot study

POPS2 - Is the intervention effective?

Four hospitals/sites Birmingham Women’s Hospital

Russells Hall Hospital, Dudley

John Radcliffe Hospital, Oxford

South Warwickshire Hospital

657 women and 103 community midwives

Inclusion and exclusion Singleton pregnancy with a BMI ≥18.5 kg/m2 Planned to receive community midwife led care or shared care

where it is anticipated any consultant appointments will be in addition to community midwife appointments

Study overview Women given participant information leaflet by community midwife or sent by post prior to dating scan

Research team approach eligible women after scan, takes consent ; randomises to

Usual care Usual care plus intervention

Provide intervention at each antenatal appointmenta. Weigh womenb. Plot weight & give feedbackc. Set maximum weight limit & record itd. Give advice on healthy eating & encourage regular physical activitye. Encourage women to weigh themselves between appointments

Midwife weighs women at 38 weeks of pregnancy

Example: woman who gained the right amount of weight throughout pregnancy

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1st Jan ’1211th April9th May11th July1st August22nd Aug12th Sept26th Sept10th Oct24th Oct

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Setting maximum weight limits

We know some women will not follow the recommendations & stay in the zone

Some women will put on too much weight or perhaps not gain enough

What is the best way of keeping women in the zone? Set a maximum weight limit for each subsequent appointment -

gives women a focus

The limit needs to take account of whether women are already on target, gaining too much weight or not enough weight

Women ALWAYS set a limit for weight gain – NEVER weight loss

Encourage women to monitor their own weight....

Women encouraged to weigh themselves each week – why?

Women who don't have scales given home scales

Midwives record on the chart they have reminded women to weigh themselves and check their own weight against their chart

Advice about healthy lifestyle?

Educational and motivational messages – why?

Healthy eating

Physical activity

CONVEY WHY THEY ARE IMPORTANT

POPS 2: Basic recruitment data

  Total

Recruited 657Age (yrs)- mean 29.0 yrs% White ethnicity 72.8Location Birmingham 484 Dudley 106 Oxford 49 Warwick 18BMI category at booking Healthy weight 322 Overweight 210 Obese 125 

Questions?