ORCID Profile
0000-0002-8990-9709
Current Organisations
University of Queensland
,
Metro North Hospital and Health Service
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Publisher: Elsevier BV
Date: 06-2023
Publisher: Wiley
Date: 10-07-2019
DOI: 10.1111/AJO.13032
Abstract: In 2014, updated screening and diagnostic criteria for gestational diabetes (GDM) were introduced across Australia. Many states including Queensland introduced clinical guidelines to include these changes and other recommendations for GDM management. While it is understood that GDM diagnosis has increased, it is unknown whether resources or service delivery have changed, or whether health services have implemented the guidelines. To understand the staff resourcing, models of care, level of guideline implementation and barriers and enablers to implementing the guideline across Queensland Health GDM services. A 22-item electronic survey containing multiple choice and open-ended questions was disseminated to healthcare professionals involved in GDM care across 14 Hospital and Health Services (HHS) in Queensland between August and October 2017. Fifty-three surveys were included for analysis. Between 2014 and 2016, Queensland GDM diagnosis increased by an average of 33%, yet only eight out of 14 HHS reported increases to staff resourcing. Full implementation of the GDM guideline was reported by 41% of metropolitan compared with 29% for regional and 25% for rural/remote services. Guideline recommendations were inconsistently delivered for physical activity advice, minimum schedule of dietetics appointments and psychosocial support. The most common barrier to guideline implementation was staff resourcing (85%), whereas enablers included staff/teamwork (42%), staff resourcing (21%), local protocols (21%) and staff education/knowledge (15%). Increased staff funding as well as an implementation science-driven process for guideline implementation is required to ensure that the increasing number of women with GDM can receive evidence-based care.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2022
DOI: 10.1186/S40337-022-00617-7
Abstract: The recently published Australia and New Zealand Academy of Eating Disorders (ANZAED) practice and training standards for dietitians providing eating disorder treatment recommended dietitians working in eating disorders (EDs) seek further clinical experience, training, and supervision to provide effective evidence-informed treatment. Access to dietetic clinical supervision is problematic, secondary to limited trained supervisors, location, cost, and lack of organizational support. Demand for clinical supervision increased with the 2022 introduction of ANZAED credentialing for eating disorder (ED) clinicians in Australia and addition of the Eating Disorder Management Plan to the Medicare Benefits Scheme. In 2018, QuEDS piloted a model of online peer group supervision with the goal of increasing service capacity to provide ED-specific clinical supervision to dietitians. Positive evaluation of the pilot led to the rollout of QuEDS Facilitated Peer Supervision (QuEDS FPS) program which was evaluated for utility and acceptability. By August 2021 five QuEDS FPS groups were established each with a maximum of 10 Queensland-based dietitians from public hospital, community, or private practice plus an additional Facilitator and Co-facilitator. A total of 76 participants enrolled in the program over the study period in addition to the 10 participants from the pilot program. Participant experience was evaluated with anonymous, voluntary surveys at baseline (59 responses), 6 months follow-up (37 responses), plus a one-off survey in August 2021 (50 responses). Pilot participant’s Baseline and Follow-up surveys were not included in this evaluation. Survey responses were positive across the four Kirkpatrick training evaluation domains of reaction, learning, behavior, and results. Respondents reported positive change to clinical practice (98%), including increased confidence to implement evidence-informed guidelines, and improved engagement with, and advocacy for, ED clients. Service capacity to provide supervision was increased by high participant to Facilitator ratios (10 participants to one Facilitator and one Co-facilitator) and recruitment of external Facilitators. Respondents indicated they would recommend QuEDS FPS to other dietitians and 96% planned to continue with the program. QuEDS FPS program increases capacity to provide supervision with demonstrated positive impacts on dietitians’ confidence and ability to deliver dietetic interventions in the ED arena and, by inference, the dietetic care of people with an ED.
Publisher: Springer Science and Business Media LLC
Date: 03-11-2020
DOI: 10.1186/S12884-020-03352-6
Abstract: There is strong evidence that women with gestational diabetes mellitus (GDM) who receive a minimum of three appointments with a dietitian may require medication less often. The aim of this study was to evaluate the impact of a dietitian-led model of care on clinical outcomes and to understand the utility of the integrated Promoting Action on Research Implementation in Health Services ( i -PARIHS) framework as a prospective tool for implementation. This was a pre-post intervention study measuring outcomes before-and-after changing a gestational diabetes (GDM) model of care and included women with GDM managed at a large, regional hospital in Queensland, Australia. The i -PARIHS framework was used to develop, implement and evaluate a dietitian-led model of care which increased dietetic input for women with GDM to a minimum of one initial education and two review appointments. The outcomes were adherence to the schedule of appointments, clinician perspective of the implementation process, pharmacotherapy use, gestational age at commencement of pharmacotherapy and birth weight. Pre- and post- comparisons of outcomes were made using t-tests and chi-squared tests. Adherence to the dietetic schedule of appointments was significantly increased from 29 to 82% ( p 0.001) but pharmacotherapy use also increased by 10% ( p = 0.10). There were significantly more women in the post-intervention group who were diagnosed with GDM prior to 24 weeks gestation, a strong independent predictor of pharmacotherapy use. Infant birthweight remained unchanged. The i -PARIHS framework was used as a diagnostic tool and checklist in the model of care development phase a facilitation tool during the implementation phase and during the evaluation phase was used as a reflection tool to identify how the i- PARIHS constructs and their interactions that may have impacted on clinical outcomes. The i -PARIHS framework was found to be useful in the development, implementation and evaluation of a dietitian-led model of care which saw almost 90% of women with GDM meet the minimum schedule of dietetic appointments.
Publisher: Springer Science and Business Media LLC
Date: 03-05-2022
DOI: 10.1186/S12913-022-08002-5
Abstract: Excess gestational weight gain (GWG) is associated with short-term perinatal complications and longer term cardiometabolic risks for mothers and their babies. Dietitian counselling and weight gain monitoring for women at risk of high pregnancy weight gain is recommended by clinical practice guidelines. However, face-to-face appointments, during a time with high appointment burden, can introduce barriers to engaging with care. Telephone counselling may offer a solution. The Living Well during Pregnancy (LWdP) program is a dietitian-delivered telephone coaching program implemented within routine antenatal care for women at risk of excess GWG. This program evaluation used a hybrid implementation-effectiveness design guided by the RE-AIM framework to report on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention. The LWdP program evaluation compared data from women participating in the LWdP program with a historical comparison group (pregnant women receiving dietetic counselling for GWG in the 12 months prior to the study). The primary outcomes were described for the LWdP program. Between group comparisons were used to determine effectiveness of achieving appropriate GWG and pre and post intervention comparisons of LWdP participants was used to determine changes to dietary intake and physical activity. The LWdP intervention group ( n = 142) were compared with women in the historical comparison group ( n = 49). Women in the LWdP intervention group attended 3.4 (95% CI 2.9–3.8) appointments compared with 1.9 (95% CI, 1.6–2.2) in the historical comparison group. GWG was similar between the two groups, including the proportion of women gaining weight above the Institute of Medicine recommendations (70% vs 73%, p = 0.69). Within group comparison showed that total diet quality, intake of fruit and vegetables and weekly physical activity were all significantly improved from baseline to follow-up for the women in LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p 0.05). The LWdP program resulted in more women accessing care and positive improvements in diet quality, intuitive eating behaviours and physical activity. It was as effective as face-to-face appointments for GWG, though more research is required to identify how to engage women earlier in pregnancy and reduce appointment burden.
Publisher: Wiley
Date: 21-09-2022
DOI: 10.1111/JHN.13082
Abstract: There is little known about nutrition intervention research involving consumer co‐design. The aim of this scoping review was to identify and synthesise the existing evidence on the current use and extent of consumer co‐design in nutrition interventions. This scoping review is in line with the methodological framework developed by Arksey and O'Malley and refined by the Joanna Briggs Institute using an adapted 2weekSR approach. We searched Medline, EMBASE, PsycInfo, CINAHL and Cochrane. Only studies that included consumers in the co‐design and met the ‘Collaborate’ or ‘Empower’ levels of the International Association of Public Participation's Public Participation Spectrum were included. Studies were synthesised according to two main concepts: (1) co‐design for (2) nutrition interventions. The initial search yielded 8157 articles, of which 19 studies were included (comprising 29 articles). The studies represented a range of intervention types and participants from seven countries. Sixteen studies were published in the past 5 years. Co‐design was most often used for intervention development, and only two studies reported a partnership with consumers across all stages of research. Overall, consumer involvement was not well documented. No preferred co‐design framework or approach was reported across the various studies. Consumer co‐design for nutrition interventions has become more frequent in recent years, but genuine partnerships with consumers across all stages of nutrition intervention research remain uncommon. There is an opportunity to improve the reporting of consumer involvement in co‐design and enable equal partnerships with consumers in nutrition research.
Publisher: Wiley
Date: 16-10-2023
DOI: 10.5694/MJA2.52129
Publisher: JMIR Publications Inc.
Date: 18-03-2021
DOI: 10.2196/27196
Abstract: Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI kg/m2 and gaining weight above recommendations at weeks’ gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. DERR1-10.2196/27196
Publisher: Wiley
Date: 12-08-2022
DOI: 10.1111/AJO.13601
Abstract: There is no international consensus for the screening and diagnosis of gestational diabetes mellitus (GDM). In March 2020, modified screening and diagnostic recommendations were rapidly implemented in Queensland, Australia, in response to the COVID‐19 pandemic. How clinicians perceived and used these changes can provide insights to support high‐quality clinical practice and provide lessons for future policy changes. The aim of this study was to understand clinicians' perceptions and use of COVID‐19 changes to GDM screening and diagnostic recommendations. Queensland healthcare professionals responsible for diagnosing or caring for women with GDM were recruited for semi‐structured telephone interviews. Data analysis of transcribed interviews used inductive reflexive thematic analysis. Seventeen interviews were conducted with the following participants: six midwives/nurses, three endocrinologists, two general practitioners, two general practitioners/obstetricians, two diabetes educators, one dietitian and one obstetrician. Three themes emerged: communication and implementation, perceptions and value of evidence and ersity in perceptions of GDM screening. Overall, clinicians welcomed the rapid changes during the initial uncertainty of the pandemic, but as COVID‐19 became less of a threat to the Queensland healthcare system, some questioned the underlying evidence base. In areas where GDM was more prevalent, clinicians more frequently worried about missed diagnoses, whereas others who felt that overdiagnosis had occurred in the past continued to support the changes. These findings highlight the challenges to changing policy when clinicians have erse (and often strongly held) views.
Publisher: Wiley
Date: 12-08-2022
DOI: 10.1111/AJO.13600
Abstract: Consumer perspectives are a cornerstone of value‐based healthcare. Screening and diagnosis of gestational diabetes mellitus (GDM) were among many of the rapid changes to health care recommended during the COVID‐19 pandemic. The changes provided a unique opportunity to add information about women's perspectives on the debate on GDM screening. The aim of this qualitative study was to explore women's perspectives and understanding of GDM screening and diagnosis comparing the modified COVID‐19 recommendations to standard GDM screening and diagnostic practices. Women who had experienced both the standard and modified GDM screening and diagnostic processes were recruited for telephone interviews. Data analysis used inductive reflexive thematic analysis. Online surveys were disseminated to any registrant not included in interviews to provide an opportunity for all interested participants to provide their perspective. Twenty‐nine telephone interviews were conducted and 19 survey responses were received. Seven themes were determined: (1) information provision from clinicians (2) acceptability of GDM screening (3) in idualisation of GDM screening methods (4) safety nets to avoid a missed diagnosis (5) informed decision making (6) women want information and evidence and (7) preferred GDM screening methods for the future. Overall, women preferred the modified GDM screening recommendations put in place due to the COVID‐19 pandemic. However, their preference was influenced by their prior screening experience and perception of personal risk profile. Women expressed a strong need for clear communication from health professionals and the opportunity to be active participants in decision making.
Publisher: Frontiers Media SA
Date: 17-02-2023
DOI: 10.3389/FRHS.2023.1103997
Abstract: Front-line health practitioners lack confidence in knowledge translation, yet they are often required to undertake projects to bridge the knowledge-practice gap. There are few initiatives focused on building the capacity of the health practitioner workforce to undertake knowledge translation, with most programs focusing on developing the skills of researchers. This paper reports the development and evaluation of a knowledge translation capacity building program for allied health practitioners located over geographically dispersed locations in Queensland, Australia. Allied Health Translating Research into Practice (AH-TRIP) was developed over five years with consideration of theory, research evidence and local needs assessment. AH-TRIP includes five components: training and education support and networks (including ch ions and mentoring) showcase and recognition TRIP projects and implementation evaluation. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation Maintenance) guided the evaluation plan, with this paper reporting on the reach (number, discipline, geographical location), adoption by health services, and participant satisfaction between 2019 and 2021. A total of 986 allied health practitioners participated in at least one component of AH-TRIP, with a quarter of participants located in regional areas of Queensland. Online training materials received an average of 944 unique page views each month. A total of 148 allied health practitioners have received mentoring to undertake their project, including a range of allied health disciplines and clinical areas. Very high satisfaction was reported by those receiving mentoring and attending the annual showcase event. Nine of sixteen public hospital and health service districts have adopted AH-TRIP. AH-TRIP is a low-cost knowledge translation capacity building initiative which can be delivered at scale to support allied health practitioners across geographically dispersed locations. Higher adoption in metropolitan areas suggests that further investment and targeted strategies are needed to reach health practitioners working in regional areas. Future evaluation should focus on exploring the impact on in idual participants and the health service.
Publisher: Georg Thieme Verlag KG
Date: 11-2020
Abstract: Gestational diabetes mellitus (GDM) is a common pregnancy disorder and the incidence is increasing worldwide. GDM is associated with adverse maternal outcomes which may be reduced with proper management. Lifestyle modification in the form of medical nutrition therapy and physical activity, as well as self-monitoring of blood glucose levels, is the cornerstone of GDM management. Inevitably, the search for the “ultimate” diet prescription has been ongoing. Identifying the amount and type of carbohydrate to maintain blood glucose levels below targets while balancing the nutritional requirements of pregnancy and achieving gestational weight gain within recommendations is challenging. Recent developments in the area of the gut microbiota and its impact on glycemic response add another layer of complexity to the success of medical nutrition therapy. This review critically explores the challenges to dietary prescription for GDM and why utopia may never be found.
Publisher: Wiley
Date: 22-10-2016
Publisher: Wiley
Date: 24-04-2017
Publisher: Wiley
Date: 13-11-2019
Abstract: To examine whether the nutritional quality of children's packaged food products available in Australian supermarkets improved between 2013 and 2016, and whether any change could be detected in product reformulation since the introduction of the Health Star Rating (HSR) labelling scheme. Packaged food products marketed towards children were purchased from three Australian supermarkets in July 2013 (for a previous study) and July 2016. Nutritional quality was assessed using the Food Standards Australian New Zealand Nutrient Profiling Scoring Criterion. Comparisons were made between the nutrient composition and formulation of products (a) available in 2013 and 2016 and (b) with and without HSR graphics. Of the 252 children's packaged products analysed, 53.6% were classified as 'less healthy'. HSR-labelled products had a significantly higher proportion classified as 'healthy' than those without the HSR (χ Despite the introduction of the HSR, more than half of children's packaged foods s led are 'less healthy'. However, early indications suggest that the HSR may stimulate healthier product reformulation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2020
DOI: 10.1097/AOG.0000000000003790
Abstract: To evaluate the effects of updated gestational diabetes mellitus (GDM) screening and diagnostic criteria on selected perinatal outcomes in Queensland, Australia. This was a pre–post comparison study using perinatal data the year before (2014) and after (2016) the screening and diagnostic criteria for GDM was changed in Queensland, Australia. In 2015, Queensland adopted the one-step screening and diagnostic criteria based on the International Association of the Diabetes and Pregnancy Study Groups' recommendations. The data from 62,517 women in 2014 and 61,600 women in 2016 who gave birth from 24 weeks of gestation were analyzed in three groups in each year: women with GDM women without diagnosed GDM and total population. The outcome measures were gestational hypertension, cesarean birth, gestational age at delivery, birth weight, preterm delivery, large-for-gestational age (LGA) neonates, small-for-gestational-age (SGA) neonates, neonatal hypoglycemia, and respiratory distress. The diagnosis of GDM increased from 8.7% (n=5,462) to 11.9% (n=7,317). After changing the diagnostic criteria, the changes to outcomes, odds ratios (OR), and adjusted odds ratios (aOR) (95% CI) for outcomes with statistically significant differences for the total population were: gestational hypertension 4.6% vs 5.0%, OR 1.09 (1.03–1.15), aOR 1.07 (1.02–1.13) preterm birth 7.6% vs 8.0%, OR 1.05 (1.01–1.09), aOR 1.06 (1.02–1.10) neonatal hypoglycemia 5.3% vs 6.8%, OR 1.31 (1.25–1.37), aOR 1.32 (1.25–1.38) and respiratory distress 6.2% vs 6.0%, OR 0.96 (0.91–1.00), aOR 0.94 (0.89–0.99). There was no change to cesarean births or LGA or SGA neonates for women with or without diagnosed GDM or the total population. Except for a very small decrease in respiratory distress, changing the diagnostic criteria has resulted in more GDM diagnoses with no observed changes to measured perinatal outcomes for women with and without diagnosed GDM.
Publisher: Wiley
Date: 18-04-2018
DOI: 10.1111/AJO.12816
Abstract: Gestational diabetes mellitus (GDM) is one of the most common pregnancy disorders however, if well managed, women with GDM experience similar pregnancy outcomes to those without. Currently, there is limited evidence on actual management practices across Australia or how multidisciplinary teams interact to optimise care. To examine the current screening, diagnostic, task and role perceptions and management practices, as reported by members of the GDM multidisciplinary team. A 64-item electronic survey containing multiple choice, Likert scale and open-ended questions was developed for this cross-sectional observational study and advertised through health professional organisations and Queensland Health facilities in May and June, 2017. The 183 survey respondents included 45 diabetes educators, 43 dietitians, 21 endocrinologists/diabetes specialists, 14 obstetricians and 21 midwives. Although almost 90% reported using updated diagnostic guidelines, less than two-thirds used GDM management guidelines. While 68% reported using the same blood glucose targets for GDM management, there was variation to what criteria prompted the commencement of medication to control blood glucose levels. There was a good consensus concerning the health professional responsible for tasks such as medical nutrition therapy, gestational weight gain and self-blood glucose monitoring education and ultrasound use. Other tasks appeared to be the role of almost any member of the GDM multidisciplinary team. The survey results indicate there is a need for consistent evidence on how to best manage GDM and that role identity, access to specialist knowledge and best practice need to be clearly defined within GDM models of care.
Publisher: MDPI AG
Date: 12-04-2023
DOI: 10.3390/NU15081860
Abstract: Living Well during Pregnancy (LWdP) is a telephone-based antenatal health behavior intervention that has been shown to improve healthy eating behaviors and physical activity levels during pregnancy. However, one-third of eligible, referred women did not engage with or dropped out of the service. This study aimed to explore the experiences and perceptions of women who were referred but did not attend or complete the LWdP program to inform service improvements and adaptations required for scale and spread and improve the delivery of patient-centered antenatal care. Semi-structured telephone interviews were conducted with women who attended ≤2 LWdP appointments after referral. The interviews were thematically analyzed and mapped to the Theoretical Domains Framework and Behavior Change Wheel/COM-B Model to identify the barriers and enablers of program attendance and determine evidence-based interventions needed to improve service engagement and patient-centered antenatal care. Three key themes were identified: (1) the program content not meeting women’s expectations and goals (2) the need for flexible, multimodal healthcare and (3) information sharing throughout antenatal care not meeting women’s information needs. Interventions to improve women’s engagement with LWdP and patient-centered antenatal care were categorized as (1) adaptations to LWdP, (2) training and support for program dietitians and antenatal healthcare professionals, and (3) increased promotion of positive health behaviors during pregnancy. Women require flexible and personalized delivery of the LWdP that is aligned with their in idual goals and expectations. The use of digital technology has the potential to provide flexible, on-demand access to and engagement with the LWdP program, healthcare professionals, and reliable health information. All healthcare professionals are vital to the promotion of positive health behaviors in pregnancy, with the ongoing training and support necessary to maintain clinician confidence and knowledge of healthy eating, physical activity, and weight gain during pregnancy.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.DIABRES.2022.109224
Abstract: To determine patient satisfaction, impact on maternal and neonatal outcomes and resource utilisation of a smartphone-based, remote blood glucose level (BGL) monitoring platform with software surveillance inwomen with gestational diabetes (GDM) compared with historical controls. This intervention study prospectively enrolled 98 women with GDM to the NET-Health smartphone-based application and compared them to 94 historical controls. The application allows automatic, real-time BGL upload to a central server for software monitoring, with automatic alerts generated for out-of-range results. Data recorded included demographics, outcomes and occasions of service (OOS). A validated satisfaction questionnaire was completed post-delivery. The groups had comparable baseline characteristics and no significant difference in maternal and neonatal outcomes. The NET-Health application intervention reduced resource utilisation, with 1.9 fewer OOS and 37 min less clinician time - equivalent to AUD$68 saved per woman (based on clinician time only) or AUD$23 after taking into account the cost of the application. Patient satisfaction was high. Use of this smartphone-based application with software surveillance in women with GDM has high patient satisfaction and no differences in maternal or neonatal outcomes despite reduced resource utilisation. It is the first to demonstrate a financial benefit. Larger studies are needed.
Publisher: Wiley
Date: 14-02-2023
DOI: 10.1111/JMWH.13477
Abstract: Current antenatal guidelines advocate for regular weighing of women during their pregnancy, with supportive conversations to assist healthy gestational weight gain (GWG). To facilitate overcoming weight monitoring barriers, a pregnancy weight gain chart (PWGC), coupled with brief intervention advice, was implemented in 2016 to guide provider and woman‐led routine weight monitoring. This study aimed to examine the extent to which the use of PWGCs and routine advice provision were normalized into routine antenatal care following enhanced implementation strategies and whether this led to a change in GWG. This pre‐post study included data from 2010 (preimplementation), 2016, and 2019 (postimplementation). A retrospective audit of health records and PWGCs was undertaken to assess adherence to chart use and evaluate GWG outcomes. A survey was sent to women in 2010 and repeated in 2019 to understand the advice women received from health care professionals. Compared with the preimplementation cohort (2010), more women achieved a healthy GWG in 2019 (42% vs 31%, P = .04). In 2019, having 3 or more weights recorded was associated with a reduction in excess GWG ( P = .028). More women reported receiving helpful advice about healthy GWG in 2019 compared with 2010, although minimal changes to advice received about nutrition and physical activity were observed. Enhanced implementation strategies and ongoing efforts to optimize supportive antenatal care practices are required to effect positive change in GWG. Further evaluation of the perspectives of pregnant women and counseling practices of health professionals is needed.
Publisher: JMIR Publications Inc.
Date: 17-01-2021
Abstract: espite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. his study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. etrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI & kg/m sup /sup and gaining weight above recommendations at & weeks’ gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. ata collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. his study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. ERR1-10.2196/27196
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.NUTRES.2021.12.004
Abstract: Healthy eating is identified as a priority in pregnancy. Vegetables are low-energy, nutrient-dense foods that support health. Needs of populations differ by demographics as such, there is a need to investigate vegetable intake in pregnant women of lower socioeconomic status (SES). The aim of this scoping review was (1) to describe vegetable intake during pregnancy in servings or grams and compare vegetable intake to recommendations and (2) to explore the relationship between vegetable intake during pregnancy and maternal SES characteristics. Using Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, studies were identified in a search of electronic databases (MEDLINE, Web of Science, Global Health, and Scopus) published up to July 2021. All observational studies assessing vegetable intake in pregnancy, written in English, and conducted in an energy-replete context worldwide were included for review. Forty-seven publications met inclusion criteria. Although vegetable intake of pregnant women varies across populations, vegetable intake falls below recommendations worldwide. Studies investigating older age (n =9), higher education (n =7), higher income (n =4), and vegetable intake consistently found a positive association, whereas a negative association with food insecurity (n =4) was identified. Other variables explored that may influence vegetable intake was limited and too fragmented to generalize. Inconsistencies and possible inaccuracies in reporting vegetable intake may be related to the considerable variation in tools used for assessing vegetable intake. In conclusion, low vegetable intake in pregnancy needs to be addressed, with a particular focus on women of lower SES because of greater vulnerability to low vegetable intake.
No related grants have been discovered for Nina J.L. Meloncelli.