Developing a community‐based maternal obesity intervention: a qualitative study of service providers’ views

Abstract

The aim of this study was to explore healthcare professionals' views on the development of multicomponent interventions for obese pregnant women. A cohort of 22 healthcare professionals was interviewed. The interview transcripts were analysed thematically. Three key themes were highlighted by the interviews: (1) the lack of existing services for obese pregnant women in south-east London; (2) the barriers and challenges that need to be overcome (e.g. ethnic and cultural) when considering the creation of a new service for obese women who are pregnant; (3) the possible components of a new intervention. The findings of this study will inform the design of a programme to combat maternal obesity.Keywords Obesity, overweight, pregnancy, programmes.Please cite this paper as: Oteng-Ntim E, Pheasant H, Khazaezadeh N, Mohidden A, Bewley S, Wong J, Oke B. Developing a community-based maternal obesity intervention: a qualitative study of service providers ' views. BJOG 2010;117:1651-1655. IntroductionObesity is a global epidemic and, if current trends continue, 50% of the UK female population is predicted to be obese by 2050.1 An escalating proportion of pregnant women are obese, 2 and obesity is associated with an increased rate of complications in mother and baby, e.g. maternal death, pre-eclampsia, gestational diabetes, stillbirth and neonatal death.2 Maternal obesity is also a major contributor to the development of childhood obesity. The national prevalence of maternal obesity is estimated to be 15%. However, the Confidential Enquiry into Maternal and Child Health (CEMACH) found that 27% of women who died between 2003 and 2005 were obese, and that 30% of mothers who had a stillbirth or neonatal death were obese, 3 suggesting that obesity is a contributor to poor outcome. In response to these findings, CEMACH provided recommendations for the management of maternal obesity, including the need for the development of national guidelines. The English Government has put in place a strategy to tackle obesity (Healthy Weight, Healthy Lives), recognising the challenge posed by obesity in pregnancy and making recommendations to mitigate its effect. At a local level, Primary Care Trusts (PCTs) are expected to commission or develop services that assist with the identification and treatment of pregnant obese women. However, recent systematic reviews on weight management in pregnancy have concluded that there is no evidence of the effectiveness of dietary 4 and/or physical activity interventions 5 in pregnancy. No published study could be found in the literature on providers' views of interventions to address obesity in pregnancy. The aim of this study was to gain an insight into the thoughts and views of healthcare providers managing obese pregnant women in order to help inform the development of an effective intervention. MethodsA total of 22 service providers was identified. Twelve were internal to the National Health Service (NHS), eight of which were clinical, and 10 were external, three of which were experienced in tackling mat...

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Maternal obesity support services: a qualitative study of the perspectives of women and midwives

“…Many women received no or inappropriate advice about weight gain, and half of overweight women were advised to gain more than recommended, despite established US guidelines [38]. Oteng-Ntim et al's UK service providers [28], like the women here, considered verbal advice offered to women on these topics was often inconsistent and unsupported by written information, a finding repeated elsewhere [39]. This is perhaps unsurprising, given the lack of UK guidance regarding appropriate weight gain in pregnancy [40].…”

“…Systematic reviews [26,27] conclude that insufficient evidence exists about the efficacy of dietary and physical activity interventions in pregnancy. Oteng-Ntim et al [28], who explored service providers' views regarding maternal obesity interventions, recommended that both service providers' and service users' perspectives should be sought when developing new services to ensure they are not only theoretically effective but also acceptable to those who will utilise them. Given the conflicting findings thus far, it is important to continue exploring and evaluating approaches to tackling maternal obesity and consider their acceptability to women and feasibility and cost-effectiveness in practice [28].…”

Talking about weight in pregnancy: An exploration of practitioners' and women's perceptions

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