Gestational Weight Gain in Primary Care

Study Overview
=================
Brief Summary
-----------------
Excess weight gain in pregnancy is linked to a number of adverse outcomes for mothers and their offspring, and in 2011, 59 % of women in Nova Scotia gained weight in excess of recommendations. A number of factors influence how much weight a woman gains, including lack of knowledge, age, the number of previous pregnancies she's had, smoking, ethnicity, income, and education. Although a clinician's advice also plays a role, simply giving advice does not necessarily translate into patient behaviour change. On the other hand, advice that is given through a patient-centred approach is significantly associated with increased patient acceptance of and adherence to recommendations, and increased intentions and attempts at behaviour change. In addition, this approach has been shown to decrease costs to the health care system. Patient-centredness can measured from the perspective of the clinician, an observer, or the patient. Research suggests that the patient's perspective of patient-centredness is the perspective most significantly associated with improved health outcomes. Clinicians avoid discussing weight-related matters for a number of reasons, including a lack of time and general discomfort in raising the subject. There are some tools that can address some of these barriers, and example being the 5As of Obesity Management. This tool is based on principles of behaviour change science and patient-centredness. Pilot data on the use of this tool showed a two-fold increase in the initiation of weight-related discussions between clinicians and their patients. Our team was instrumental in the development, dissemination and initial evaluation of this tool, and Dr. Piccinini-Vallis has recently led a national multidisciplinary endeavor to adapt it to pregnancy, which has resulted in the 5As of Healthy Pregnancy Weight Gain tool. It is now time to evaluate whether the use of this tool is acceptable to clinicians and whether its use translates into any patient outcomes.

Official Title
-----------------
Curbing Gestational Weight Gain in Primary Care: Using Technology Based on Behaviour Change Theory

Conditions
-----------------
Gestational Weight Gain

Intervention / Treatment
-----------------
* Behavioral: Use of 5As to discuss gestational weight gain
* Behavioral: Usual care


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Family physicians providing prenatal care Patients who are pregnant Exclusion Criteria: Multiple pregnancy Abnormal pregnancy Inability to read and inability to speak English

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 5As<br>Physicians' use of the 5As tool to discuss gestational weight gain with their pregnant patients | Behavioral: Use of 5As to discuss gestational weight gain<br> <br> * Other names: 5As of Healthy Pregnancy Weight Gain;|
| Active Comparator: Usual care<br>Usual care by physicians in addressing gestational weight gain with their pregnant patients | Behavioral: Usual care<br> <br> * Other names: Usual care by physicians in addressing gestational weight gain;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Guideline-concordance of women's total gestational weight gain | The congruence of total gestational weight gain with Institute of Medicine guidelines based on pre-pregnancy body mass index | 12 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Pregnancy, Gestational Weight Gain, Primary Care, Guidelines