Promoting Healthy Weights, Lifestyles and Nutrition in Pregnancy

Promoting Healthy Weights, Lifestyles and Nutrition During Pregnancy Through Innovative Counselling Methods

Research has shown that a woman's lifestyle during pregnancy can predict the future health of a mother and her child. Improving the health of a mother during pregnancy can lead to the best health outcomes for mother and child in the short and long-term period. Currently there is a lack of understanding about how best to support women to achieve healthy weights during pregnancy. The aim of this study is to understand if additional lifestyle support, such as discussions about healthy eating and physical activity provided by a healthcare provider throughout pregnancy can help women achieve weights concordant with gestational recommendations.

The healthcare providers in this study will be Registered Dietitians (RD). The intervention RD will be trained in Healthy Conversations, a supportive method of communication that utilizes open-ended questions to support patient-centered behaviour change. This allows women to explore health issues, identify barriers and discover solutions for improving their own health. This supportive prenatal counselling will occur with the intervention group concurrently while completing lifestyle questionnaires with the study RD. During these conversations, health goals will be made and will be followed up at future visits. The control group will complete the lifestyle questionnaires with the control RD; they will not receive additional lifestyle support at these visits. Women will be randomized into one of the two study groups and will be blinded to their study allocation. All participants will complete two in person visits and two follow-up telephone calls. Data will be collected on diet, physical activity, gestational weight gain, delivery, and infant outcomes.

After this research is complete, the investigators hope to better understand the quantity and quality of additional support that may help women in Alberta achieve guideline concordant weight gain during pregnancy. If interventions can help women gain weight within the guidelines, pregnancy-related complications can be reduced. This information is also aimed at providing a better understanding of healthcare system requirements (i.e., type of providers and care model) in supporting women achieve healthy weights in pregnancy. The findings from this project have the potential to improve prenatal healthcare delivery across the province.

Study Overview

• Status: Completed
• Conditions: Pregnancy
• Intervention / Treatment: Behavioral: Supportive Lifestyle Counselling; Behavioral: Standard Lifestyle Counselling

Detailed Description

Study Objectives:

1. To examine the efficacy of a supportive prenatal counselling (intervention) vs. standard prenatal care (control) in promoting appropriate weight gain and dietary intake among pregnant women.
2. To describe pregnant women's and the RD's perceptions of the strengths, limitations, effectiveness and satisfaction with the supportive prenatal counselling (intervention) vs. standard care (control).

Study Design:

Seventy women < 20 weeks gestation will be recruited to participate in this randomized control trial. Interested women will be screened in person or by telephone by research staff to determine eligibility. During screening, participants will provide their self-reported height and pre-pregnancy weight. After eligibility is determined, the eligible participants will be stratified by pre-pregnancy body mass index (BMI). Block randomization will occur within each stratum to determine group assignment. Participants will be blinded to their group assignment, as all participants will follow the same study timeline and the visits will consist of the same procedures (completing questionnaires, measuring anthropometrics). During the visit, the control group will take part in routine prenatal care conversations with a Control RD, while the intervention group will receive conversations framed in a Healthy Conversations and 5As approach with the (different) RD. This is deemed as supportive prenatal counselling in our study. The investigators do not anticipate the participants would know the difference. At time of screening, the Baseline Visit will be scheduled with the respective RD. One RD will be responsible for participant contact and data collection from each group. Baseline and follow up appointments will take place at the Clinical Research Unit (CRU)/Human Nutrition Research Unit (HNRU), 2nd floor of the Li Ka Shing Centre for Health Research Innovation. All questionnaires used in this study will be online and available either in RedCap or through ASA24-CANADA-2014 (a specific dietary recall system). All participants will continue to receive prenatal care through their normal care providers, usually a Family Physician and/or Obstetrician/Gynecologist.

At the baseline visit, study staff will confirm participant eligibility, answer any questions, and review the "Information & Consent Form". Women will be asked to provide their healthcare number and permission to collect information from the Antenatal and Delivery and Birth records. For each group, the respective RD will guide participants in completing: the "Baseline Lifestyle Questionnaire" and a ASA24-Hr dietary recall. Each participant's weight and height will be measured. All participants will be provided with a package of general printed resources that contain relevant health information for pregnancy. After each visit and phone call, the RDs will record notes in the participant's study chart. At 28 and 34 weeks gestation, the respective RDs will call the participants to remind them to complete the dietary recalls and/or book the next clinic visit. For the intervention group, the RD will follow-up with goals previously set (if any). At approximately 30 weeks gestation, study visit 2 will occur to complete the "30 Week Lifestyle Questionnaire" for both the intervention and control groups. At 34 weeks, all participants will be sent the link in their email to complete the "34 Week Lifestyle Questionnaire" and the ASA-24 Hr recall. At approximately 4-6 weeks postpartum, all participants will receive a link to the "Postpartum Questionnaire". Participants in both groups will be asked if they would like to take part in a post-study focus group to discuss their perceptions of the strengths, limitations, effectiveness and satisfaction with the study. A separate focus group will be conducted for each arm of the study and will be facilitated by study staff that is not known to the participants. Participants who would like to meet with a RD for postpartum nutrition counselling will have the opportunity to schedule a session; no data collection will occur at this point.

For the intervention group (n=35), the process of completing the questionnaires and assessments will be framed using a Healthy Conversation approach. This includes the use of open-ended questions that enable participant-centered discussions on topics related to healthy weights, healthy eating, and other lifestyle factors in pregnancy. Discussion topics will be participant-centered, allowing the participant to guide the conversation. This type of exploratory counselling allows the participant to understand barriers they face and come up with solutions that will work within their life. These conversations will be reinforced at each in-person session and during each telephone follow-up. The intervention group can contact the study RD and ask questions via phone, email, video call and/or text message throughout pregnancy. The study team will record the quality and the quantity of all contacts with each participant.

For the control group (n=35), the RD will help participants complete the questionnaires and assessments (data collection only) without discussion of specific pregnancy-related topics. Questions directed at the RD will be answered within the scope of the RD's practice; however, not additional supportive prenatal counselling will be provided at these study visits. Participants in the control group will not receive any further follow-up other than the 2 study visits and 2 phone calls.

The investigators will also collect data from the 2 RDs throughout this study. The intervention RD will complete notes after each contact with participants. The mode of contact, total minutes, topic of discussion, goals made and amount of minutes a Healthy Conversation was held with the participants, will be noted. The RDs will ask a random sample of participants in each arm for permission to audio-record some of their visits to examine the fidelity and competency of the RD in delivering the intervention using Healthy Conversation Skills. Both RDs will record their perceptions of the strengths, limitations, and satisfaction with the study arm they administer to evaluate both protocols through their visit notes. Additionally, at the end of the study, the RDs will each complete a study reflection. These notes will be qualitatively analyzed.

• Study Type: Interventional
• Enrollment (Actual): 123
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Edmonton, Alberta, Canada, T6G 2E1
      • University of Alberta

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• Greater than or equal to 20 years of age
• Between 8-20 weeks gestation
• Singleton pregnancy
• Can read and speak English
• Has Internet and telephone access
• Can make the Baseline visit by 24 weeks gestation
• Willingness to provide pre-pregnancy weight and height
• Willingness to provide Alberta Healthcare Number (PHN)
• Willingness to be randomized
• Will be blinded to group allocation.

Exclusion Criteria:

• Smoker
• Incompetent cervix (previous or present diagnosis)
• Complete/total placenta previa
• Type I, Type II, Gestational Diabetes
• Hypothyroidism (low thyroid function)
• Hyperthyroidism (overactive thyroid)
• Present eating disorder
• Pregnancy-Induced Hypertension (PIH) with adverse features (ie: edema)
• Physical activity is contraindicated
• Currently receiving counselling from a Dietitian
• Currently participating in another lifestyle program
• Receiving prenatal care from a Midwife

Study Plan

How is the study designed?

Design Details

• Primary Purpose: PREVENTION
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: Supportive Lifestyle Counselling; Two supportive lifestyle counselling sessions with Registered Dietitian from study entry to 34 weeks.gestation.	Behavioral: Supportive Lifestyle Counselling; Each participant will meet with the intervention Registered Dietitian twice in pregnancy and have two follow-up phone calls. Participants in this group will have on-going, supportive discussions with the intervention Registered Dietitian about healthy lifestyles in pregnancy. Discussion topics with the intervention Registered Dietitian at each visit will be participant-centered, allowing the participant to guide the conversation. These conversations will be reinforced at every future contact made throughout pregnancy.; Behavioral: Standard Lifestyle Counselling; Each participant will meet in person with their respective Registered Dietitian twice in pregnancy and have two follow-up phone calls. At these visits, each participant will complete questionnaires and have anthropometric assessments (height/weight). From home, each participant will also complete online questionnaires at week 26, and week 34. Postpartum,each participant will complete an online questionnaire. Optional postpartum participation includes a focus group in the postpartum period and the option to meet with a Registered Dietitian postpartum.
ACTIVE_COMPARATOR: Standard Lifestyle Counselling; Two standard counselling sessions with Registered Dietitian from study entry to 34 weeks gestation	Behavioral: Standard Lifestyle Counselling; Each participant will meet in person with their respective Registered Dietitian twice in pregnancy and have two follow-up phone calls. At these visits, each participant will complete questionnaires and have anthropometric assessments (height/weight). From home, each participant will also complete online questionnaires at week 26, and week 34. Postpartum,each participant will complete an online questionnaire. Optional postpartum participation includes a focus group in the postpartum period and the option to meet with a Registered Dietitian postpartum.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Weight change from pre-pregnancy to end of pregnancy	difference between self-reported pre-pregnancy weight and highest weight in pregnancy	pre-pregnancy, study entry (8-24 weeks gestation), gestational week 30, delivery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Type of Labour	from prenatal/delivery record	Delivery
Mother's perceptions of quality of prenatal care	Quality of prenatal care Questionnaire (Sword, Heaman 2013)	1 month Postpartum
Rate of weight gain	calculated from weights recorded on prenatal record	From pre-pregnancy through delivery
Pregnancy Physical Activity Questionnaire (PPAQ)	A calculation is provided by the investigators whom created the PPAQ. Each activity is multiplied by an intensity to provide an average weekly energy expenditure.	Baseline, week 30 and week 34 gestation
Changes in dietary quality	Food and nutrient intake determined by 24 hour dietary recall	Baseline, week 30 and week 34 gestation
Augmentation used during delivery	from prenatal/delivery record (administration of oxytocin - yes/no)	Delivery
Type of Birth	from prenatal/delivery record	Delivery
Degree of Perineal Tearing	from prenatal/delivery record (degree of Perineal Tearing - nil, 1, 2, 3)	Delivery
Blood loss	from prenatal/delivery record	Delivery
Duration of Labour	from prenatal/delivery record	Delivery
Cord pH	from prenatal/delivery record	Delivery
Meconium Fluid	from prenatal/delivery record	Delivery
Breastfeeding initiation in hospital	from Delivery Record	Delivery
NICU Admission	from Delivery Record	Delivery
Infant sex	from Delivery Record	Delivery
Gestational age at birth	from Delivery Record	Delivery
Infant birth weight	from Delivery Record	Delivery
Infant birth weight percentile	from Delivery Record	Delivery
Infant birth length	from Delivery Record	Delivery
Infant birth length percentile	from Delivery Record	Delivery
APGAR Score	from Delivery Record	Delivery

Collaborators and Investigators

• Sponsor: University of Alberta
• Collaborators: Danone Institute International
• Investigators: Principal Investigator: Rhonda Bell, PhD, University of Alberta; Principal Investigator: Donna Manca, MD, University of Alberta

Publications and helpful links

General Publications

• Adam LM, Manca DP, Bell RC. Can Facebook Be Used for Research? Experiences Using Facebook to Recruit Pregnant Women for a Randomized Controlled Trial. J Med Internet Res. 2016 Sep 21;18(9):e250. doi: 10.2196/jmir.6404.

Helpful Links

• Study Website

Study record dates

Study Major Dates

• Study Start: July 1, 2015
• Primary Completion (ACTUAL): September 1, 2016
• Study Completion (ACTUAL): September 1, 2016

Study Registration Dates

• First Submitted: December 22, 2015
• First Submitted That Met QC Criteria: March 11, 2016
• First Posted (ESTIMATE): March 17, 2016

Study Record Updates

• Last Update Posted (ACTUAL): July 19, 2022
• Last Update Submitted That Met QC Criteria: July 13, 2022
• Last Verified: September 1, 2016

More Information

Terms related to this study

• Keywords: Pregnancy; Nutrition; Prenatal
• Other Study ID Numbers: Pro00054360

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO