Implementation of Antenatal Lifestyle Interventions Into Routine Care

Abstract

ImportanceLifestyle interventions in pregnancy optimize gestational weight gain and improve pregnancy outcomes, with implementation recommended by the US Preventive Services Task Force. Yet, implementation research taking these efficacy trials into pragmatic translation remains limited.ObjectiveTo evaluate success factors for implementing pregnancy lifestyle interventions into antenatal care settings in a meta-analysis, using the penetration, implementation, participation, and effectiveness (PIPE) impact metric.Data SourcesData from a previous systematic review that searched across 9 databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database, were obtained, in 2 stages, up to May 6, 2020.Study SelectionRandomized clinical trials reporting gestational weight gain in singleton pregnancies.Data Extraction and SynthesisThe association of penetration, implementation, and participation with effectiveness of antenatal lifestyle interventions in optimizing gestational weight gain was estimated using random-effects meta-analyses. The Cochrane risk of bias tool, version 1.0, was used to assess risk of bias.Main Outcomes and MeasuresPenetration (reach), implementation (fidelity), participation, and effectiveness of randomized clinical trials of lifestyle interventions in pregnancy.ResultsNinety-nine studies with 34 546 participants were included. Only 14 studies reported penetration of target populations. Overall, 38 studies (38.4%) had moderate fidelity, 25 (25.2%) had high fidelity, and 36 (36.4%) had unclear fidelity. Participation was reported in 84 studies (84.8%). Lifestyle interventions were associated with reducing gestational weight gain by 1.15 kg (95% CI, –1.40 to –0.91 kg).Conclusions and RelevanceThe findings of this systematic review and meta-analysis suggest that, despite the large body of evidence on efficacy of lifestyle interventions during pregnancy in optimizing gestational weight gain, little guidance is available to inform implementation of this evidence into practice. There is a need to better elucidate implementation outcomes in trial design alongside pragmatic implementation research to improve the health of women who are pregnant and the next generation.

Key Components of Antenatal Lifestyle Interventions to Optimize Gestational Weight Gain

“… 120 There was also a lack of understanding of reach and capacity for implementation of lifestyle interventions in pregnancy, as previously reported. 120 Included studies did not report against the TIDieR framework, so extraction of some components required subjective interpretation. In particular, there was limited information relating to gestational age at the completion of intervention or length of sessions (ie, minutes per hour), tailoring, adherence, or attrition rates, all of which limited our interpretative ability for the efficacy of these components in GWG reduction.…”

“…This study also has several limitations, including a moderate to high risk of bias across most studies as previously reported and a lack in reporting of quality assurance measures, such as adherence or fidelity . There was also a lack of understanding of reach and capacity for implementation of lifestyle interventions in pregnancy, as previously reported . Included studies did not report against the TIDieR framework, so extraction of some components required subjective interpretation.…”

“…Of 117 studies included in our systematic review, 99 studies reported GWG data and were included in this TIDieR meta-analysis (eFigure in Supplement 1), with general characteristics of studies previously reported . Of 34 546 pregnant individuals recruited, the mean (SD) baseline BMI ranged from 20.6 (2.5) to 38.6 (6.1) .…”

A Complex mHealth Coaching Intervention to Prevent Overweight, Obesity, and Diabetes in High-Risk Women in Antenatal Care: Protocol for a Hybrid Type 2 Effectiveness-Implementation Study

“…Current evidence, therefore, supports the efficacy of antenatal, postpartum, and interpregnancy health behavior change interventions in diet and physical activity during pregnancy and postpartum for improving maternal and child outcomes. Key evidence gaps include that studies typically focus on intervening during either the antenatal or postpartum period but not both and that studies tend to be short in duration (6 months is the average duration), which is known to be less effective at supporting sustained health behavior change [ 19 - 21 ]. Importantly, a large research translation gap exists around achieving adequate population penetration, participation, and implementation at scale with efficacious prevention interventions [ 19 , 20 , 22 , 23 ].…”

“…Key evidence gaps include that studies typically focus on intervening during either the antenatal or postpartum period but not both and that studies tend to be short in duration (6 months is the average duration), which is known to be less effective at supporting sustained health behavior change [ 19 - 21 ]. Importantly, a large research translation gap exists around achieving adequate population penetration, participation, and implementation at scale with efficacious prevention interventions [ 19 , 20 , 22 , 23 ]. Limited studies have explored intervention implementation aspects beyond highly controlled clinical trials [ 19 , 23 ].…”