References

Poston L, Bell R, Croker H Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol. 2015; 3:(10)767-77

Sandall J, Soltani H, Gates S, Shennan A, Devane D Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2015; 9

Bäckhed F, Roswall J, Peng Y Dynamics and stabilization of the human gut microbiome during the first year of life. Cell Host Microbe. 2015; 17:(5)690-703 https://doi.org/10.1016/j.chom.2015.04.004

Research roundup: November 2015

02 November 2015
3 min read
Volume 23 · Issue 11

Abstract

In this section, a range of brief synopses of recently published articles from around the world that may be of interest to midwives is presented. The aim of this roundup is to provide an overview, rather than a detailed summary, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided.

Obesity intervention does not prevent gestational diabetes

The UK Pregnancies Better Eating and Activity Trial (UPBEAT) was conducted in eight hospitals across the UK. Obese women (BMI ≥30 kg/m2) were recruited at 15–18+6 weeks gestation and randomised to standard antenatal care or the intervention group. The intervention was delivered through eight weekly health-trainer-led sessions. It included: achievable goal-setting; food and recipe recommendations based on reducing glycaemic load; and suggestions for physical activity.

There were 1555 women recruited to the study. It found no statistically significant difference between the two groups for the primary outcome of reduction in gestational diabetes, despite the intervention group showing improvements in some of the maternal secondary findings, including reduced dietary glycaemic load, gestational weight gain, maternal sum-of-skinfold thickness, and increased physical activity.

An ongoing follow-up aims to ascertain whether the changes recorded in diet, physical activity, and maternal anthropometric measures are sustained or extended, and whether they can benefit maternal and child health in the long term.

The secondary findings suggest this type of intervention could be used as an evidence-based method to encourage healthy diet and physical activity behaviours in obese women. Further research is needed in how to prevent gestational diabetes.

Benefits of midwife-led continuity models of care

This Cochrane systematic review concluded that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their experience than women who received other models of care.

A midwife-led continuity model of care was defined as: the midwife being the woman's lead professional, with one or more consultations with medical staff being routine practice. The review included 15 trials involving 17 674 women with low or increased risk of complication. Studies were from Australia, Canada, Ireland and the UK.

Benefits included a reduction in epidural rates; fewer episiotomies; fewer instrumental births; less preterm birth or fetal loss before 24 weeks; and less likelihood of losing the baby overall. Women were more likely to be cared for by a midwife they had met antenatally; had a higher chance of having a spontaneous vaginal birth; and reported higher rates of maternal satisfaction.

There were no differences for caesarean rate, fetal loss after 24 weeks, induction of labour, antenatal hospitalisation, ante-partum haemorrhage, augmentation/artificial oxytocin in labour, opiate analgesia, perineal laceration requiring suturing, postpartum haemorrhage, breastfeeding initiation, low birth weight, 5-minute Apgar score ≤7, neonatal convulsions, admission of infant to special care or neonatal intensive care or mean length of neonatal hospital stay.

These are positive findings to support midwifery-led care. There is a need for further investigation of the findings of fewer preterm births and fewer fetal deaths under 24 weeks in the midwife-led care group.

Investigating gut microbiome of mothers and infants

This Swedish study assessed the gut microbiome of mothers and their infants during the first year of life. It found that both mode of delivery and breastfeeding affect the infant gut microbiome.

The researcher took shotgun-sequenced stool samples from 98 women who had a normal, term pregnancy, and from their infants. Samples were collected in the first days after delivery and again at 4 months and 12 months. The mode of delivery strongly affected microbiome species in neonates. Compared to vaginally born infants, those born by caesarean had a microbiome that indicated that skin and oral microbes and bacteria from the surrounding environment during birth were the first to colonise the infants. Differences in the microbiome remained at 4 and 12 months.

The results highlighted the importance of breastfeeding in shaping the gut microbiome in the first year of life. The gut microbiota of children no longer breastfed was enriched by species belonging to Clostridia, that are prevalent in adults. In contrast, Bifidobacterium and Lactobacillus still dominated the gut microbiota of breastfed infants at 12 months of age. The results strongly suggest that cessation of breastfeeding, rather than the introduction of solid foods, is the major driver in the development of an adult microbiota.

This study adds to a rapidly developing area of research into the potential long-term effects that both the type of delivery and breastfeeding have on priming the gut microbiome, with possible effects on metabolic and immune health that are only just beginning to be understood.