How to improve obstetrics outcomes in overweight and obese pregnant women?

We will discuss “Self-weighing and simple dietary advice for overweight and obese pregnant women to reduce obstetric complications without impact on quality of life: a randomised controlled trial” by McCarthy and co-workers from 24 February 2016 for 7 days.

*This paper is now FREE-TO-VIEW

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Start date: 24 February 2016 (the discussion will open for 7 days between 27 January to 3 February 2016)

First hosted discussion session(s) starts at: GMT 8pm (UK time) *** NOTE: new start time for #BlueJC in 2016

Host: @BlueJCHost

Platforms: Twitter, FacebookLinkedIn and Weibo

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published Journal Club guide)

Scenario

A nulliparous woman visits her obstetrician at 13+0 weeks. Her body mass index (BMI) is 35 kg/m2, but she has no other medical history. Her dating ultrasound scan was normal. Her obstetrician explained the risks of obesity on her pregnancy. She asks, “what can I do to minimise these risks?”.

Description of research

Participants Overweight or obese pregnant women at <20 weeks with a singleton pregnancy, without pre-existing diabetes
Intervention Simple dietary advice, written personalised weight gain targets, encouragement of regular self-weighing and discussions of weight gain with the obstetric care provider
Comparison Written personalised weight gain targets only
Outcomes Composite primary outcome including any of: gestational diabetes; pregnancy-induced hypertension and pre-eclampsia; mode of birth other than spontaneous vertex; post-partum haemorrhage; 3rd or 4th degree perineal tear; admission to adult intensive care/ high-dependence units, maternal death
Study design Randomised controlled trial (Trial registration number: NCT01001689)
Authors’ conclusion Randomised controlled trial (RCT; Trial registration number: ACTRN12611000881932)


Discussion Points

  • What are the risks of obesity in pregnancy for mothers and babies?
  • How would you manage the woman in the scenario, compared to women with normal weight?
  • What are the strengths and weaknesses of this RCT?
  • How do the demographics of the study participants compare to women in your practice (see Table 1)?
  • Analysis of covariance (ANCOVA) was used to analyse the difference in gestational weight gain. What is ANCOVA and was its use appropriate?
  • Are the outcomes of women who were overweight different from those who were obese (see supplementary figure S2 and S4)?
  • How did the authors assess the impact of missing data (18%) in this study (see supplementary figure S3)?
  • How does this RCT enhance your practice, in view of the existing evidence (see suggested reading)?

Suggested reading

  • Critical Appraisal Skill Programme (CASP). CASP checklist for Randomised Controlled Trials (http://www.casp-uk.net/).
  • Thangaratinam S, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012 May 16;344:e2088.
  • Brownfoot FC, Davey MA, Kornman L. Routine weighing to reduce excessive antenatal weight gain: A randomised controlled trial. BJOG. 2016.
  • Sagedal LR, Øverby NC, Bere E, Torstveit MK, Lohne-Seiler H, Småstuen M, Hillesund ER, Henriksen T, Vistad I. Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial. BJOG. 2016.

 

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