About this time last year I posted an account of our involvement in the evaluation of the Lincoln County Hospitals Trust Bumps and Beyond intervention. Well, that work was completed in the autumn and we have submitted a paper for publication, which I hope will be accepted soon.
The Bumps and Beyond intervention was designed by the Healthy Lifestyle Midwife lead for Lincolnshire Community Health Services. For our evaluation of a new clinical service we targeted recruitment at April 2012 to February 2013. All pregnant women attending clinics at Lincoln hospital (UK) with a BMI of ≥ 35 kg/m2 were invited to take part in the intervention, which was delivered on a one-to-one basis by either a midwife or healthy lifestyle advisor at hospital antenatal clinics or local community ‘health shops’. The full intervention comprised eight sessions, beginning when women were around 16 weeks pregnant and continuing every 2-4 weeks until week 36 of pregnancy. The intervention comprised an introduction and overview of lifestyle changes and the benefits of avoiding excessive weight gain during pregnancy along with general and pregnancy-specific nutrition guidance including food safety information, the Eatwell plate model and population-based dietary advice such as reducing intakes of fat, sugar and salt and increasing consumption of fruit, vegetables and fibre. These were accompanied by recommendations for the duration and intensity of appropriate physical activity during pregnancy and guidance on food labelling, shopping cooking and eating out. Advice was given on eating behaviour, the benefits of breastfeeding for weight loss/maintenance and guidance on the maintenance of healthy lifestyle changes beyond the intervention. All women who took part in the intervention kept a food diary to help identify and modify individual dietary patterns or behaviours and were also provided with a course booklet listing further sources of advice and information for pregnancy, healthy eating and weight management. The booklet was updated once during the course of the intervention following feedback from staff and participants.
Our evaluation focused on the impact of the intervention upon pregnancy weight gain and the complications associated with severe obesity during pregnancy. The results were dramatic with:
21% of women actually losing weight during pregnancy (with no adverse effect) and the average weight gain of the intervention group being within the healthy guidance range. Women who took part in the intervention gained nearly 5kg less than those who did not.
Pre-eclampsia and gestational hypertension were reduced by 90-95% in the intervention group.
Women undertaking the intervention 3 times more likely to breastfeed their babies.
The findings of the evaluation were fascinating and we now hope to conduct further work which will help us understand how and why the intervention was so effective. This understanding will be critical if the programme is to be exported to other centres.