ObjectiveTo assess maternal and neonatal outcomes associated with increasing body mass index (BMI) and interpregnancy BMI changes in an Australian obstetric population.MethodsA retrospective cohort study from 2008 to 2013 was undertaken. BMI for 14 875 women was categorised as follows: underweight (≤18 kg/m2); normal weight (19–24 kg/m2); overweight (25–29 kg/m2); obese class I (30–34 kg/m2); obese class II (35–39 kg/m2) and obese class III (40+ kg/m2). BMI categories and maternal, neonatal and birthing outcomes were examined using logistic regression. Interpregnancy change in BMI and the risk of adverse outcomes in the subsequent pregnancy were also examined.ResultsWithin this cohort, 751 (5.1%) women were underweight, 7431 (50.0%) had normal BMI, 3748 (25.1%) were overweight, 1598 (10.8%) were obese class I, 737 (5.0%) were obese class II and 592 (4.0%) were obese class III. In bivariate adjusted models, obese women were at an increased risk of caesarean section, gestational diabetes, hypertensive disorders of pregnancy and neonatal morbidities including macrosomia, large for gestational age (LGA), hypoglycaemia, low 5 min Apgar score and respiratory distress. Multiparous women who experienced an interpregnancy increase of ≥3 BMI units had a higher adjusted OR (AOR) (CI) of the following adverse outcomes in their subsequent pregnancy: low 5-min Apgar score 3.242 (1.557 to 7.118); gestational diabetes mellitus (GDM) 3.258 (1.129 to 10.665) and hypertensive disorders of pregnancy 3.922 (1.243 to 14.760). These women were more likely to give birth vaginally 2.030 (1.417 to 2.913). Conversely, women whose parity changed from 0 to 1 and who experienced an interpregnancy increase of ≥3 BMI units had a higher AOR (CI) of caesarean section in their second pregnancy 1.806 (1.139 to 2.862).ConclusionsWomen who are overweight or obese have a significantly increased risk of various adverse outcomes. Interpregnancy weight gain, regardless of parity and baseline BMI, also increases various adverse outcomes. Effective weight management strategies are needed.

BackgroundThe number of pregnant women with a body mass index (BMI) of 30kg/m2 or more is increasing, which has important implications for antenatal care. Various resource-intensive interventions have attempted to assist women in managing their weight gain during pregnancy with limited success. A mobile phone app has been proposed as a convenient and cost-effective alternative to face-to-face interventions.ObjectiveThis paper describes the process of developing and pilot testing the Eating4Two app, which aims to provide women with a simple gestational weight gain (GWG) calculator, general dietary information, and the motivation to achieve a healthy weight gain during pregnancy.MethodsThe project involved the development of app components, including a graphing function that allows the user to record their weight throughout the pregnancy and to receive real-time feedback on weight gain progress and general information on antenatal nutrition. Stakeholder consultation was used to inform development. The app was pilot tested with 10 pregnant women using a mixed method approach via an online survey, 2 focus groups, and 1 individual interview.ResultsThe Eating4Two app took 7 months to develop and evaluate. It involved several disciplines--including nutrition and dietetics, midwifery, public health, and information technology--at the University of Canberra. Participants found the Eating4Two app to be a motivational tool but would have liked scales or other markers on the graph that demonstrated exact weight gain. They also liked the nutrition information; however, many felt it should be formatted in a more user friendly way.ConclusionsThe Eating4Two app was viewed by participants in our study as an innovative support system to help motivate healthy behaviors during pregnancy and as a credible resource for accessing nutrition-focused information. The feedback provided by participants will assist with refining the current prototype for use in a clinical intervention trial.

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This study aimed to assess the relationship between early-pregnancy Body Mass Index (BMI), perinatal depression risk and maternal vitamin D status. Patients and Methods: A retrospective cohort study from 2013 to 2017 was undertaken involving 16,528 birth events in the Australian Capital Territory. Multivariate binary logistic regression was conducted using the forced entry method. Mediation of the association between maternal early-pregnancy BMI and perinatal depression risk by vitamin D status was also tested. Results: Adjusted logistic regression models found that high maternal early-pregnancy BMI was associated with increased risk of developing perinatal depression (AOR 1.421; 95% CI, 1.191, 1.696) as well as increased odds of being vitamin D deficient (AOR 1.950; 95% CI; 1.735, 2.191). In comparison to women with low perinatal depression risk, women with high perinatal depression risk had increased odds of being vitamin D deficient (AOR 1.321; 95% CI, 1.105, 1.579). Maternal early-pregnancy BMI was a weak significant predictor of perinatal depression risk after including vitamin D as a mediator, consistent with partial mediation, Path C: B=0.016 (95% CI 1.003, 1.030), p= 0.02. Path C´: B=0.014 (95% CI 1.001, 1.028), p= 0.04. Conclusion: In line with current Australian recommendations, women with high earlypregnancy BMI should be screened for both perinatal depression risk and vitamin D deficiency, with referral to relevant support services when indicated.

This research questions competency-based assessment practices based on discrete placement units and supports a constructivist-interpretivist programmatic approach where evidence across a whole course of study is considered by a panel of assessors.