Presentation: Dr Amanda Daley, Effectiveness of regular weighing and feedback by community midwives in preventing excessive gestational weight gain (POPS 2) – Theme 1 Maternity & Child Health

1. Preventing Obesity in
Pregnancy Study
POPS

2. Weight gain during pregnancy
 25%-40% of women gain more weight
than they should during pregnancy
 These women have a higher risk of
 gestational diabetes
 large baby
 delivery complications
 Preeclampsia
 stillbirth
 obesity in later life (mother and child)

3. POPS Study
 Does regular weighing, monitoring and feedback by community
midwives prevent women from gaining excessive weight during
pregnancy?
 Preventing obesity in pregnancy study (POPS)
 pilot trial and interviews – is it feasible?
 phase III RCT – is it effective?

4. How much weight should women
gain during pregnancy?
 The Institute of Medicine
(USA) made
recommendations based on
pre pregnancy BMI
 Developed weight chart that
calculates ideal weight for
women through pregnancy
Healthy
BMI pre
pregnancy
Overweight
BMI pre
pregnancy
Obese
BMI pre
pregnancy
1st trimester 1-3 kg (total) 1-3 kg (total) 0.5-2.0 kg (total)
2nd trimester 0.5 kg p/w 0.3 kg p/w 0.2 kg p/w
3rd trimester 0.5 kg p/w 0.3 kg p/w 0.2 kg p/w
Total gain 11.5-16 kg 7-15 kg 5-9 kg
(Institute of Medicine guidelines 2009)

5. POPS Pilot RCT
 76 pregnant women receiving midwife
led care (low risk pregnancy)
 Randomised usual care or usual care
plus the intervention
 Intervention – 8 community midwives
 Weighed women and plotted weight on
personalised weight chart
 Set a maximum weight limit
 Encouraged women to weigh themselves each
week & record it
 Gave brief feedback on progress
 Encouraged women to eat healthy diet &
participate in regular physical activity
 All women weighed at start and end of
pregnancy

6. Insert chart

7. What did we find? Was it useful? Was it feasible for midwives?
WOMEN
 Women very keen to take part
(91%)
 Women wanted their weight
monitored
 Made them think about what they
were eating
 Those who were weighed &
monitored
 Less women gained excessive weight
 Did more physical activity
 Less anxious and depressed
MIDWIVES
 Easily implemented into
antenatal care
 Took 1-2 minutes to do
 Gave them an opportunity to
raise the topic of weight
 Felt weight was an important
part of the public health agenda
for midwives
 Hardest part was setting the
maximum weight limits /targets
Pilot study

8. POPS2 - Is the intervention effective?
 Four hospitals/sites
 Birmingham Women’s Hospital
 Russells Hall Hospital, Dudley
 John Radcliffe Hospital, Oxford
 South Warwickshire Hospital
 657 women and 103 community midwives
 Inclusion and exclusion
 Singleton pregnancy with a BMI ≥18.5 kg/m2
 Planned to receive community midwife led care or shared care where it is
anticipated any consultant appointments will be in addition to community
midwife appointments

9. Study overview
Women given participant information leaflet by community midwife or sent by post prior to dating scan
Research team approach eligible women after scan, takes consent ; randomises to
Usual care Usual care plus intervention
Provide intervention at each antenatal appointment
a. Weigh women
b. Plot weight & give feedback
c. Set maximum weight limit & record it
d. Give advice on healthy eating & encourage
regular physical activity
e. Encourage women to weigh themselves
between appointments
Midwife weighs women at 38 weeks of pregnancy

10. Example: woman who gained the right amount of weight
throughout pregnancy
60
61.8
62.7
66.9
68.6
69.9
70.8
71.6
72.8
73.8
1st Jan ’12
11th April
9th May
11th July
1st August
22nd Aug
12th Sept
26th Sept
10th Oct
24th Oct
-
-
63.5
66.8
68.2
69.5
70.8
71.6
72.6
73.5

11. Setting maximum weight limits
 We know some women will not follow the recommendations & stay in the
zone
 Some women will put on too much weight or perhaps not gain enough
What is the best way of keeping women in the zone?
 Set a maximum weight limit for each subsequent appointment - gives
women a focus
 The limit needs to take account of whether women are already on target,
gaining too much weight or not enough weight
 Women ALWAYS set a limit for weight gain – NEVER weight loss

17. Encourage women to monitor their own weight....
 Women encouraged to weigh themselves each week – why?
 Women who don't have scales given home scales
 Midwives record on the chart they have reminded women to weigh
themselves and check their own weight against their chart

18. Advice about healthy lifestyle?
 Educational and motivational messages – why?
 Healthy eating
 Physical activity
 CONVEY WHY THEY ARE IMPORTANT

19. POPS 2:
Basic recruitment data
Total
Recruited 657
Age (yrs)- mean 29.0 yrs
% White ethnicity 72.8
Location
Birmingham 484
Dudley 106
Oxford 49
Warwick 18
BMI category at booking
Healthy weight 322
Overweight 210
Obese 125

20. Questions?