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

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

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.

 

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

How to avoid excessive weight gain during pregnancy?

We will discuss “Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial” by Sagedal and co-workers from 27 January 2016 for 7 days.

*This paper is now FREE-TO-VIEW

We are now on LinkedIn too: http://linkd.in/1BVrpad (simply ask to join)!

Start date: 27 January 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 manuscript)

Scenario

A nulliparous woman visits with her midwife at 13 week of her pregnancy. Her body mass index is 23 kg/m2 and she is healthy. Her dating ultrasound scan was normal. She is concerned about weight gain during pregnancy because her sister became overweight during pregnancy and struggled to lose weight after birth. She asks, “what can I do to avoid gaining too much weight during my pregnancy?”.

Description of research

Participants Healthy, non-diabetic, nulliparous women, ≥18 years, body mass index ≥19 kg/m2, with a singleton pregnancy of ≤20 gestational-weeks.
Intervention Dietary counselling twice by telephone and access to twice-weekly exercise groups
Comparison Standard prenatal care
Outcomes Primary outcomes: maternal gestational weight gain (GWG), weight of the newborn, maternal fasting serum glucose level, incidence of operative delivery, maternal body composition

Secondary outcomes: proportion of newborns with weight ≥90th percentile, the proportion of women with elevated 2-hour glucose tolerance tests, measurement of hormones related to glucose metabolism, the incidence of delivery complications and postpartum weight retention

Study design Randomised controlled trial (Trial registration number: NCT01001689)
Authors’ conclusion Despite a modest but significant decrease in GWG, lifestyle intervention had no measurable effect on obstetrical or neonatal outcomes.


Discussion Points

  • Which additional factors you may consider when you counsel this woman?
  • Which interventions have been used to maintain maternal weight during pregnancy? Are they effective? (See suggested reading)
  • Critically appraise this randomised controlled trial (RCT) using the Critical Appraisal Skill Programme (CASP; http://www.casp-uk.net/) checklist.
  • Based on your assessment, what are the strengths and weaknesses of this RCT?
  • Which parameter was used in the power calculation of this RCT? How does it impact on the design of this study?
  • How do the demographics of the study participants compare to women you encounter in your usual practice?
  • In this study how do the measured outcomes differ between women who had normal BMI (<25 kg/m2), women who were overweight (20-25 kg/m2) and obese (>25 kg/m2)
  • How would you advice the woman in the scenario?

Suggested reading

  • Sagedal LR, Øverby NC, Lohne-Seiler H, Bere E, Torstveit MK, Henriksen T, Vistad I. Study protocol: fit for delivery – can a lifestyle intervention in pregnancy result in measurable health benefits for mothers and newborns? A randomized controlled trial. BMC Public Health. 2013 Feb 13;13:132.
  • 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.

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.

#BlueJC in 2015- ended on a high at #RCOGNTC

At the RCOG National Trainees’ Conference (#RCOGNTC) in December 2015, #BlueJC team had the opportunity to speak to doctors about engagement using social media. 

Social media- What’s in it for me?

Dr. Ann-Marie Cunningham, Primary Care Clinical Director at Aneurin Bevan University Health Board, has succinctly summarised the potential of social media for doctors using her wonderful infographic and slideshare slides.

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Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.