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Healthy Start to Pregnancy:the Personalised Pregnancy Weight Tracker
Presenter: Dr Shelley Wilkinson, Dr Di Poad, Marlene Redelinghuys
Hospital Code Name:
Innovation Poster SessionHRT1104b – MaternityMelbourne 10th & 11th March 2011
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KEY PROBLEM Complications exist with
high BMI pregnancies excessive weight gain
35% of our women overweight/obese pre-pregnancy (see graphs) ‘Diet quality’ deteriorates with increasing BMI Low Nutrition & Dietetic staffing levels at our site Knowledge of weight gain guidelines increases likelihood of
correct weight gain, but no advice givenBMI Trends
020
406080
100
120140
1 2 3 4 5 6 7 8 9 10
Years 2001 to 2010
Nu
mb
er o
f W
om
en
40-44.9
45-49.9
50 plus
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BMI range
year
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AIM OF THIS INNOVATION
To improve pregnant women’s nutrition
knowledge and behaviours and to meet women’s
nutrition-related needs by providing evidence-
based nutrition education and advice, and
appropriate and timely access to dietitians
during pregnancy according to a self-
management framework (The 5As): Assess/Advise/Agree/Assist/Arrange.
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BASELINE DATA
Our women had: Poor access to and awareness of Dietetic service Very poor knowledge of weight gain guidelines Poor dietary behaviours Excessive weight gain
50% of women with BMI > 25kg/m² 75% of women with BMI > 30kg/m² 100% of women with BMI > 40kg/m²
> 60% interested in nutrition education & support 50% when find out pregnant, 29.9% @ 1st ANC visit, 15.9% either
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KEY CHANGES IMPLEMENTED
New Nutrition & Maternal Health Model of Care (MOC)
Evidence-based (EB) nutrition resource (given by midwives@1st visit)
‘Healthy Start to Pregnancy’ (Dietitian’s EB behaviour-change group) 1 hour, dietitian-facilitated workshop, delivery of evidence-based content,
based on behaviour change theory
Integrated ‘healthy weight gain for a healthy pregnancy’ message through out service
Reinforced by ‘personalised pregnancy weight tracker’ With advice on “what to do when track outside the shading” + Offer of phone or face to face reviews, esp. high BMI women
Evidence-based nutrition booklet
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Evidence based pregnancy weight tracker
Weeks are along the bottom →→→
Wei
ght g
oes
up th
e si
de →
→→
****
Write your pre-pregnancy weight at the bottom and then in the box above
that write a weight that is one kilo higher until you’ve filled all the boxes
Find your weeks of pregnancy, find your weight and put a cross where the lines
meet
*
*
Assess: Work out pre-pregnancy BMI
Advise & agree: Discuss weight gain range for a healthy pregnancy
Assist: Track (your) weight every week or so; if you track high or low, make diet and lifestyle changes according to the information in your booklet
Arrange: If you continue to track high or low, contact the dietitian for an appointment
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OUTCOMES SO FAR‘Process’ evaluation of HSP: 200+ women attended so far
> 93.9% rated: ‘good’ or ‘very good’ Increased knowledge and understanding of:
Diet – 92.6% (agree/strongly agree) Weight management – 74.2% (agree/strongly agree)
Gave practical advice (94.9%) and motivated to make changes (94.7%) to change diet (agree/strongly agree)
Many high BMI women attend HSP, but few who have been referred
What women liked about the session: Learning what a proper serve size was Knowing what I need to eat and how to apply it to my own habits and preferences I liked the opportunity to use the weight tracker I was a bit worried coming to the group as I’m big and I was worried about what the dietitian
would tell me to do —I’ve heard it all before but— the focus on healthy weight gain for pregnancy, whatever weight you start at and the weight tracker was really good.
The weight tracker was VERY helpful as my weight has been a main source of stress for me
Currently evaluating impact outcomes in an RCT (n=360)
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LESSONS LEARNT Our healthy pregnancy nutrition booklet and
program, with an integrated ‘healthy weight management’ message, delivered in early pregnancy is well received (and attended)
A separate weight management approach may be required to provide a higher level of support to some women
This should incorporate the evidence that numerous visits (or contacts) are usually required to support behaviour change
Funding of research to examine cost effectiveness of interventions to assist women would be useful
