Abstract
Problem
A recognised gap exists between current and recommended practices in the provision
of lifestyle advice and weight management support for women across preconception and
pregnancy care.
Background
Preconception and pregnancy are critical stages for promoting healthy maternal lifestyles
and obesity prevention. Co-design is a novel approach with the potential to strengthen
existing models of care to facilitate the implementation of clinical practice guidelines
promoting preconception and pregnancy health, especially in relation to preconception
weight management and preventing excessive gestational weight gain.
Aim and methods
The aims of this discussion paper are to (i) define co-design in the context of preconception
and pregnancy care, (ii) outline key considerations when planning co-design initiatives
and (iii) describe co-design opportunities in preconception and pregnancy care for
promoting women’s health and obesity prevention.
Discussion
While several definitions of co-design exist, one critical element is the meaningful
involvement of all key stakeholders. In this discussion, we specifically identified
the involvement of women and expanding the role of practice nurses in primary care
may assist to overcome barriers to the provision of healthy lifestyle advice and support
for women during preconception. Co-designing pregnancy care will involve input from
women, nurses, midwives, obstetricians, allied health and administration and management
staff. Additional attention is required to co-design care for women considered most
at-risk.
Conclusion
There is potential to enhance current provision of preconception and pregnancy care
using co-design. Nursing and midwifery professions are active across both preconception
and pregnancy and therefore, they have an important role to play.
Keywords
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References
- Intervention strategies to improve nutrition and health behaviours before conception.Lancet. 2018; 391: 1853-1864
- Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health.Lancet. 2018; 391: 1830-1841
- Impact of updated Institute of Medicine guidelines on prepregnancy body mass index categorization, gestational weight gain recommendations, and needed counseling.J. Womens Health. 2011; 20: 837-844
- Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood.Int. J. Obes. 2010; 34: 67
- Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis.PLoS One. 2013; 8e61627
- Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth.Obes. Rev. 2013; 14: 792-805
- Preventive activities prior to pregnancy.2019 (. (Accessed 14 November 2019))
- Clinical Practice Guidelines Pregnancy Care 2018 Edition.2018 (. (Accessed 14 November 2019))
- Maternity care in Australia.1st ed. 2017 (. (Accessed 14 November 2019))
- Weight management before, during and after pregnancy.2010 (. (Accessed 13 November 2019))
- Comittee Opinion on Weight Gain During Pregnancy.2018 (. (Accessed 13 November 2019))
- Pregnancy: a “teachable moment” for weight control and obesity prevention.Am. J. Obstet. Gynecol. 2010; 202 (135.e1-.e8)
- The views of pre-and post-natal women and health professionals regarding gestational weight gain: an exploratory study.Sex. Reprod. Healthc. 2011; 2: 43-48
- ‘Not waving but drowning’: a study of the experiences and concerns of midwives and other health professionals caring for obese childbearing women.Midwifery. 2011; 27: 424-430
- Experience-based Co-design Toolkit.2019 (. (Accessed 14 November 2019))
- Co-creation and learning in health-care service development.J. Serv. Manag. 2012; 23: 328-343
- Pregnant women’s perceptions of gestational weight gain: a systematic review and meta-synthesis of qualitative research.Matern. Child Nutr. 2017; 13e12374
- Maternal nutrition and weight management in pregnancy: a nudge in the right direction.Nutr. Bull. 2018; 43: 69-78
- Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.Obes. Rev. 2015; 16: 319-326
- A qualitative study of the barriers and enablers to fertility-awareness education in general practice.J. Adv. Nurs. 2016; 72: 1541-1551
- Working with public contributors to improve the patient experience at the Manchester Clinical Research Facility: an evaluation of the Experience Based Design approach.Res. Involv. Engagem. 2017; 3: 10
- Improving mental health in pregnancy for refugee women: protocol for the implementation and evaluation of a screening program in Melbourne, Australia.JMIR Res. Protoc. 2019; 8e13271
- Implementing innovative evidence-based perinatal mental health screening for refugee women.Women Birth. 2018; 31 (S8-S)
- Improving the care pathway for women who request Caesarean section: an experience-based co-design study.BMC Pregnancy Childbirth. 2016; 16: 348
- A collaborative process for developing a weight management toolkit for general practitioners in Australia—an intervention development study using the Knowledge to Action framework.Pilot Feasibility Stud. 2016; 2: 20
- Experience-based co-design and healthcare improvement: realizing participatory design in the public sector.Des. J. 2015; 18: 227-248
- Patients and staff as codesigners of healthcare services.BMJ. 2015; 350 (g7714)https://doi.org/10.1136/bmj.g7714
- A design thinking framework for healthcare management and innovation.Healthcare. 2016; 4: 11-14
- An anthropologist walks into a bar.Harv. Bus. Rev. 2014; 92: 80-90
- Attenuating pregnancy weight gain—what works and why: a systematic review and meta-analysis.Nutrients. 2018; 10: 944
- Preconception management of women with obesity: a systematic review.Obes. Rev. 2019; 20: 510-526
- Targeting obstetric providers in interventions for obesity and gestational weight gain: a systematic review.PLoS One. 2018; 13e0205268
- A qualitative study of the experiences of women who are obese and pregnant in the UK.Midwifery. 2011; 27: 437-444
- A focus group study of women’s views and experiences of maternity care as delivered collaboratively by midwives and health visitors in England.BMC Pregnancy Childbirth. 2018; 18: 505https://doi.org/10.1186/s12884-018-2127-0
- Lost in knowledge translation: time for a map?.J. Contin. Educ. Health Prof. 2006; 26: 13-24
- Reaiming RE-AIM: using the model to plan, implement, and evaluate the effects of environmental change approaches to enhancing population health.Am. J. Public Health. 2010; 100: 2076-2084
- Preventing obesity across the preconception, pregnancy and postpartum cycle: implementing research into practice.Midwifery. 2017; 52: 64-70
- Barriers to the implementation of preconception care guidelines as perceived by general practitioners: a qualitative study.BMC Health Serv. Res. 2013; 13: 36
- Barriers and facilitators to the provision of preconception care by healthcare providers: a systematic review.Int. J. Nurs. Stud. 2018; 87: 113-130
- Nurse delivered lifestyle interventions in primary health care to treat chronic disease risk factors associated with obesity: a systematic review.Obes. Rev. 2012; 13: 1148-1171
- The global obesity pandemic: shaped by global drivers and local environments.Lancet. 2011; 378: 804-814
- Targeting the postpartum period to promote weight loss: a systematic review and meta-analysis.Nutr. Rev. 2018; 76: 639-654
- The comparative effectiveness of diabetes prevention strategies to reduce postpartum weight retention in women with gestational diabetes mellitus: the gestational diabetes’ effects on moms (GEM) cluster randomized controlled trial.Diabetes Care. 2016; 39: 65-74
- Mothers after Gestational Diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program.PLoS Med. 2016; 13e1002092
- A systematic review and meta-analysis of intervention characteristics in postpartum weight management using the TIDieR framework: a summary of evidence to inform implementation.Obes. Rev. 2019; 20: 1045-1056https://doi.org/10.1111/obr.12846
- Weight management across pregnancy and postpartum care: the need for interprofessional education and collaboration.Nurs. Educ. Pract. 2019; 41: 102651https://doi.org/10.1016/j.nepr.2019.102651
- Opportunities for primary and secondary prevention of excess gestational weight gain: general Practitioners’ perspectives.BMC Fam. Pract. 2011; 12: 124
- Weight gain in pregnancy: a survey of current practices in a teaching hospital.Aust. N. Z. J. Obstet. Gynaecol. 2012; 52: 208-210
- How effectively do midwives manage the care of obese pregnant women? A cross-sectional survey of Australian midwives.Women Birth. 2013; 26: 119-124
- Maternal gestational weight gain during pregnancy: prioritising the conversation.Aust. J. Primary Health. 2018; 24: 4-8
- Provision of maternity care.2019 (https://www1.health.gov.au/internet/publications/publishing.nsf/Content/pacd-maternityservicesplan-toc∼pacd-maternityservicesplan-chapter3#Models%20of%20care. (Accessed 13 November 2019))
- How can maternity services be developed to effectively address maternal obesity? A qualitative study.Midwifery. 2011; 27: e170-e177
- Obesity in pregnancy: a study of the impact of maternal obesity on NHS maternity services.BJOG. 2007; 114: 334-342
- Overweight and obesity in Australia.2018 (https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4364.0.55.001∼2017-18∼Main%20Features∼Overweight%20and%20obesity∼90. (Accessed 14 November 2019) (Accessed 18 June 2018).)
- Antenatal care in Australian general practice.Aust. Fam. Physician. 2016; 45: 538-541
- ‘Weighty issues’ in GP-led antenatal care: a qualitative study.BMC Fam. Pract. 2019; 20: 148
- Identifying evidence-practice gaps and strategies for improvement in Aboriginal and Torres Strait Islander maternal health care. (Research Article).PLoS One. 2018; 13e0192262
- Co-design and implementation research: challenges and solutions for ethics committees.BMC Med. Ethics. 2015; 16
Article info
Publication history
Published online: December 04, 2019
Accepted:
November 25,
2019
Received in revised form:
November 19,
2019
Received:
July 16,
2019
Identification
Copyright
© 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
