Title: Delivery of a habit-based intervention '10 Top Tips for a Healthy Weight' to overweight or obese pregnant women on the Island of Ireland: a feasibility study exploring integration into existing antenatal care pathways.
Funder: Health and Social Care Research and Development Division (HSC R&D) of Public Health Agency, Northern Ireland

Abstract: One in two pregnant women are considered overweight (OW) or obese (OB) at ‘booking’ (~12 weeks gestation). OW/OB at the outset of pregnancy is associated with serious adverse health consequences for mother and baby, with evidence illustrating a linear relationship between increasing BMI and risk of developing conditions such as pre-eclampsia, gestational hypertension, induction of labour and emergency caesarean section. OW/OB women are at risk of excessive gestational weight gain (GWG), a predictor of long-term obesity, cardiovascular disease, and type 2 diabetes; with OB expectant mothers costing the NHS 37% more than their healthy weight counterparts. Pregnant women with a BMI between 25.0 and 39.9kg/m2 at booking represent the largest proportion of the pregnancy population (>48%), placing them at an increased risk for adverse outcomes (compared to those with a BMI under 25), yet scalable GWG interventions are lacking. Systematic reviews indicate that GWG interventions to date are intensive, requiring high motivation and commitment from participants; and if, or where available, they often target only highest ‘risk’ women (booking BMI≥40kg/m2). Healthcare staff report feeling ill-equipped to tackle pregnancy weight-management, despite women seeking this information. Thus identifying evidence-based, accessible weight-management services for OW/OB pregnant women is an urgent healthcare priority. For sustainability, interventions need to consider the potential for integration into existing antenatal care pathways in a cost-effective manner. One intervention approach that may be effective and scalable is ‘Ten Top Tips for a Healthy Weight’ (10TT); a leaflet-based intervention which uses habit formation theory to facilitate lifestyle behaviour change. In a large-scale primary care randomised controlled trial (RCT), 10TT was explained by healthcare staff (15-20 minutes), with no further clinical contact, and was shown to be effective for long-term self-management of weight in obese adults. This healthcare trial will test the feasibility and acceptability of delivering a refined version of 10TT to pregnant women with a BMI 25.0-39.9kg/m2 during routine antenatal care across four geographical locations in Northern Ireland (NI) and Republic of Ireland (ROI). Part of the feasibility work will explore when, where and by who the intervention should be delivered in the different jurisdictions in NI/ROI border counties - working within existing care pathways - focusing on community-based settings to best meet women’s needs. This call affords a unique and valuable opportunity to explore embedding a novel intervention into four differing antenatal care pathways in NI and ROI border counties and will highlight interoperability capacity and offer extensive opportunities for knowledge-transfer alongside building research capacity. There will be two research phases: 1) Refine existing intervention, training and delivery methods and finalise detail of RCT. 2) Feasibility RCT assessing the acceptability of delivering 10TT as part of ‘community-based’ care within existing antenatal pathways in NI/ROI, address interoperability questions and trial outcome measures that would be used in a full trial. We envisage this feasibility study leading to a definitive trial to test if ‘10TT’ can encourage the adoption of healthy diet and activity behaviours throughout pregnancy (and into the postpartum period), by preventing excess GWG and reducing adverse outcomes.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH;CARDIOVASCULAR;METABOLIC AND ENDOCRINE