Bump Start: developing and piloting a healthy living group intervention for obese pregnant women
Pregnancy is a time when women may be particularly motivated to make healthy lifestyle changes, which is encouraging when maternal obesity remains such an important modifiable risk factor. However, offering the right ‘recipe’ of support can be challenging for midwives. They report lacking time and confidence for ongoing discussions about diet and physical activity in consultations, and a lack of local evidence-based supportive services to which they can refer interested women. This article reports the efforts of a team of midwives, health psychologists, dieticians and physiotherapists to use theory and evidence to develop and pilot a community-based programme to address this issue. Bump Start aims to encourage healthy lifestyle changes in overweight antenatal women in a health board in Scotland. It presents initial findings from the first pilot, highlighting particular factors that went well and challenges that presented themselves along the way, in the hope of sharing learning with other teams.
Maternal obesity (a body mass index (BMI) of 30kg/m2 or higher at the first antenatal consultation) is a key modifiable risk factor in pregnancy. The health problems linked to maternal BMI for both mother and baby are substantial and well-known to midwives (Catalano and Ehrenberg, 2006), but the UK prevalence of antenatal obesity in 2006 was 18.5% and this figure only seems to be increasing year-on-year (Heslehurst et al, 2010). Inevitably, this puts more pressure on squeezed health services, with health-care costs estimated to be 37% higher among obese women compared to those with a normal weight (Morgan et al, 2014).
In addition, finding the ‘right recipe’ of support and lifestyle advice can be somewhat challenging. In terms of reducing risk factors through healthy eating and physical activity, in one Australian nutrition study, only 7% and 13% of mothers reported consuming the recommended portions of vegetables and fruit, respectively, per day and, in total, 12% consumed more than two takeaways per week (Wen et al, 2010). In an analysis of population survey data, 60% of pregnant women reported engaging in no leisure time physical activity (Hesketh and Evenson, 2016).
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