Oral Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2023

Implementing clinical guidelines for antenatal gestational weight gain care: using a novel best-worst scaling method to determine priority barriers (97624)

Eva J Farragher 1 2 3 , Laura Wall 3 4 5 , Olivia Wynne 2 3 , Jenna Hollis 1 2 3 , Luke Wolfenden 1 2 3 , John Attia 2 , Maralyn Foureur 3 6 , Karen Campbell 7 8 , Craig Pennell 2 9 10 , Francesco Paolucci 4 , Justine Daly 1 3 , Carly Mallise 1 , John Wiggers 1 2 3 , Melanie Kingsland 1 2 3
  1. HNELHD Population Health, NSW Health, Australia, Wallsend, NSW, Australia
  2. School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
  3. Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
  4. Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
  5. School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Newcastle, NSW, Australia
  6. HNE Nursing and Midwifery Research Centre, James Fletcher Campus, Newcastle, NSW, Australia
  7. NHMRC Centre for Research Excellence in the Early Prevention of Childhood Obesity (EPOCH), Canberra, ACT, Australia
  8. Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
  9. Maternity and Gynaecology , John Hunter Hospital, New Lambton Heights, NSW, Australia
  10. Centre for Precision Medicine in Perinatal Health, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia

Background: Globally, 70% of pregnant people gain weight outside the US Institute of Medicine gestational weight gain (GWG) guidelines [1], contributing to excessive global burden of illness [2,3]. Clinical care guidelines recommend antenatal care providers (ACPs) provide routine care for GWG, diet and physical activity (PA) [4-7]. Few people receive this care.

Purpose: A novel Best-Worst Scaling (BWS) survey was developed to scale the magnitude and relative importance of identified barriers to the ACP delivery of five key elements of guideline-recommended GWG care, in public maternity settings. Site and professional differences in barrier identification were investigated.

Methods:  Cross-sectional BWS surveys of ACPs from three health sectors were undertaken from December 2020 to November 2021. A research assistant recruited and assisted ACPs who had provided antenatal care within the past year in completing surveys. For each of five scenarios addressing key elements of GWG-related antenatal care (weighing at follow-up appointment; discussing GWG; discussing diet; discussing PA; offering referrals for behavioural support), ACPs selected which barriers were ‘most likely’ and ‘least likely’ to inhibit care. Different combinations of potential barriers were repeated four times. Barriers were ranked for each site and profession using frequency analysis and a counting approach.

Results: 134 ACPs completed surveys. Identified barriers included not considering GWG care high priority compared to other job components, lack of confidence providing care, forgetting to provide care elements, beliefs that pregnant people feel uncomfortable or judged during weighing and diet discussions, and beliefs that GWG care wouldn’t promote health in pregnant people. ACPs across sites and differing professions reported different barriers to implementing guideline GWG care within antenatal appointments.

Conclusion: BWS surveys revealed site and profession specific priorities. The outcomes provide a basis for developing targeted strategies to address the most influential barriers specific to implementing maternal GWG care.

  1. National Research Council (U.S.), Committee to Reexamine I.O.M. Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington (D.C.): The National Academies Press, 2009.
  2. Rogozińska E, Zamora J, Marlin N, et al. Gestational weight gain outside the Institute of Medicine recommendations and adverse pregnancy outcomes: analysis using individual participant data from randomised trials. BMC Pregnancy Childbirth 2019;19(1):322
  3. Kominiarek MA, Saade G, Mele L, et al. Association Between Gestational Weight Gain and Perinatal Outcomes. Obstet Gynecol 2018;132(4):875-81
  4. Australian Government, Department of Health. Clinical Practice Guidelines: Pregnancy Care - 2020 Edition. Canberra: Australian Government Department of Health, 2020
  5. Preconception Care in Public Health Agency of Canada. Family-Centred Maternity and Newborn Care: National Guidelines. Ottawa, Canada: Public Health Agency of Canada, 2017
  6. Health Information and Quality Authority. National Standards for Safer Better Maternity Services. Dublin, Ireland: Health Information and Quality Authority, 2016
  7. New Zealand Ministry of Health. New Zealand Maternity Standards. Wellington, New Zealand: N.Z. Ministry of Health, 2011