A review of literature was completed using CINHAL complete with the search terms “prenatal care” and “weight gain”. Results were restricted to publication date within the last ten years and journals of nursing or midwifery. 78 results were located and four relevant studies were further explored. The first study was conducted by Jewell, Avery, Barber and Simpson and assessed the feasibility of referring pregnant obese women to weekly sessions as part of the healthy eating and lifestyle in pregnancy (HELP) intervention (2014). While women did report negative feelings towards initial recruitment because they felt shamed about their weight, they also reported that the sessions gave them a sense of control on how to combat obesity during their pregnancy (Jewell et el., 2014). 85% of mothers attended at least three of the possible 33 sessions, and 65% attended at least 6 sessions (Jewell et al., 2014). In terms of weight change, 39 of the 148 mothers did lose weight during gestation, with no babies born small for gestational age (Jewell et al., 2014). Jewell et al. (2014) report that small sample size, lack of a control group, and a small number of participants in the focus group were all limitations of the study.
The second study was a quasi-experimental design by Haby, Glants, Hanas, and Premberg that investigated whether incorporating an intervention program as part of prenatal care visits could influence the gestational weight gain in obese pregnant women (2015). The intervention included personalized prescriptions for diet and exercise in addition to the opportunity to attend food group sessions or meetings with a dietician (Haby et al., 2015). Women were also given log books and pedometers or walking sticks to track their physical activity. Women in the intervention group were more likely to gain less than 7 kg during their pregnancy compared to the control group (Haby et al., 2015). Haby et al. (2015) reported lower weight gain per week in the intervention group, with significantly lower weights at the postnatal check-up compared to the controls. Haby et al. (2015) recognize that the lack of randomization was a limitation of the study, and selection bias may have occurred where women who agreed to participate were inherently more motivated than those who declined. The small sample size did not provide adequate power for any measure other than gestational weight gain.
The third study by Smith et al. (2014) tested the feasibility of a community-based prenatal care intervention (Smith et al., 2014). Twenty women were invited to attend an intervention session each week for ten weeks; the remaining women completed questionnaires and participated in focus groups (Smith et al., 2014). 79% of women attended at least one of the group sessions (Smith et al., 2014). The women preferred to use a food diary as opposed to pedometers or daily diaries, and they found goal setting in a group dynamic more favorable than when individualized (Smith et al., 2014). Limitations of this study are related to the design with no control group or randomization methods. In addition, only 35% of women reported their weight for the four to six week postpartum period, so there was not enough power to measure this variable.
The final study by Magriples et al. (2015) explored the effect of group prenatal care on weight gain during pregnancy and weight loss during the postpartum period while measuring the interaction of depression on the outcomes. The intervention consisted of ten 120 minute sessions with discussion, education and skills based on the guidelines from the American College of Obstetrics and Gynecology (Magriples et al., 2015). Magriples et al. (2015) showed a significant effect of the group prenatal care on weight loss that continued 12 months after the birth. However, if a woman had high baseline levels of depression or distress, she was more likely to gain weight compared to women with low initial levels. Magriples et al. (2015) admit that excluding 20% of the original sample served as a limitation for this study. Additionally, this study focuses on young pregnant women in an urban environment, so the results are not generalizable to older or rural populations.
The literature shows that prenatal care interventions can promote healthy weight gain during pregnancy and help women lose extra weight during the postpartum period. Women within the ideal range for BMI during and after pregnancy are at a lower risk for adverse health conditions and promote a healthier life for their children. The most successful interventions included a group aspect where women felt a sense of belonging and understanding. Therefore, a quality improvement initiative was created based on the Roy Adaptation Model. According to Polit and Beck (2017), this model acknowledges that several realms of influences shape the process of adaptation. To promote change in health behaviors, interventions must address the following systems: physiologic/physical, self-concept/group identity, role function, and interdependence (Polit & Beck, 2017). By identifying these main factors that promote or inhibit adaptability, health care professionals can tailor their interventions and treatment plans to better serve their patients. For this quality improvement project, a prenatal care intervention will be created where pregnant women will be given a questionnaire to identify the factors that influence weight gain in their lives, or more specifically factors that promote or inhibit their ability to adapt healthy weight management. The factors will fall under the systems addressed by the Roy Adaptation Model. Women will be placed into groups based on common factors where a nurse facilitates weekly discussions on strategies to combat these factors. Facilitator nurses will undergo training and receive paid compensation from the hospital in addition to their normal wage. To assess effectiveness, women will be weighed before the first session, at each session and will be asked to report their weight at three, six and twelve months postpartum.
Previous research identified that pregnant women benefited from prenatal care interventions to promote healthy weight gain during pregnancy. However, most studies were exploratory or initial efforts to gauge interest and feasibility. Results showed that group interaction and addressing multiple factors led to positive outcomes. Therefore, the quality improvement project based on the Roy Adaptation Model addresses various elements and includes a concrete plan for evaluation.
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