1. Weigh to a Healthy Pregnancy - SHSCT Liz O’Connor (Dietitian) Ghillian Smyth & Catherine Morgan (Midwives) Sheelagh Thompson & Annette Kearney (Physiotherapists)

2. Overview Background and Strategic Context Aims and Objectives Material and methods Results Leadership and Engagement Conclusions Empowering Healthy Living

3. Background Obesity during pregnancy is associated with increased morbidity and mortality and multiple adverse maternal and perinatal outcomes for mother and child. Obese pregnant women cost the NHS 37% more than their counterparts of a normal weight. Up to 45% of women enter pregnancy overweight/obese in NI. At highest risk are pregnant women with BMI ≥ 40kg/m2. This accounts for 2% of pregnancies in NI. Empowering Healthy Living

4. Strategic context Empowering Healthy Living

5. Weight status in pregnancy, 2010/11- 2012/13 – N. Ireland BMI Category2012/13 Obese 1 (30 - 34.99 3,052 Obese II (35.00 - 39.99) 1,139 Obese III (>=40.00) 560 Empowering Healthy Living

6. Background WTHP project seeks to address maternal obesity as part of the wider Public health obesity agenda in NI. WTHP regional pilot initiated by PHA and designed in partnership with regional WTHP steering group which included significant PHA, HSCTs staff and QUB academia. Service delivery commenced in all five HSCTs in NI in 2013. Empowering Healthy Living

7. Aims and Objectives The objectives of the programme were to: Support individuals in adopting healthy eating behaviours during pregnancy. Encourage individuals to achieve appropriate levels of physical activity during pregnancy. Facilitate sustained lifestyle changes post-natally. Promote breastfeeding. Encourage optimal gestation weight gain and post- partum weight loss Empowering Healthy Living

8. NICE Public Health Guidance 27: Weight management before, during and after pregnancy Weight loss should be avoided during pregnancy Restrictive diets should be avoided Healthy eating and physical activity advice Women with a BMI above 30 to be referred to a dietitian. Empowering Healthy Living

9. Materials and Methods PHA provided specialist regional training to all WTHP team members. Women were identified for recruitment by their midwife at their first booking appointment or through the Northern Ireland Maternity System (NIMATs) and referred to local WTHP team. Followed up by phone call to patient from WTHP and invited to attend first consultation with the team. MDT Dietitian, Physiotherapist, Midwives. Empowering Healthy Living

10. Eligibility Criteria InclusionExclusion BMI>40 at bookingBMI<40 at booking Over 18 years oldUnder 18 years old Singleton pregnancyMultiple Pregnancy Willing to participateUnwilling to participate Previous SGA baby Severe psychiatric illness Eating disorder Maternal cardiac condition Empowering Healthy Living

11. The Weigh to a Healthy Pregnancy model 16-18 weeks dietitian goal setting/barriers Tele-health set-up Booking 10-12 weeks BMI >40 midwife invites eligible women 1 st group session partner, family physiotherapist, dietitian, midwife 24, 28, 32 weeks Texts/telephone support Midwife contact linked anaesthetic assessment Weigh Day 5 dietitian 6 weeks 2 nd group session partner, family physiotherapist, dietitian, midwife Empowering Healthy Living

12. IOM recommendations for weight gain in pregnancy depending BMI BMIDescriptionTotal Recommended Weight gain kgs <18Underweight12.5-18 18.5-24.9Healthy weight11.5-16 25- 29.9Overweight7.0-11.5 >30Obese5.0-9.0 Empowering Healthy Living

13. Components of programme Telehealth Tommy booklet Programme booklet

14. Remote Telemonitoring The participants used Remote Telemonitoring NI (RTNI) regional service. Used to monitor weekly weight readings Patient led – time and day of monitoring chosen by patient – self monitoring. Readings then access remotely by WTHP clinicians to inform ongoing care. Empowering Healthy Living

15. SHSCT Results 01/07/13-01/07/14DHHCAHTotal Women eligible (n)326597 Women consented (n)29 (91%)53 (82%)82 (85%) Weight gain: 5-9kg30%33%31.5% Weight gain: <5kg41%41%41% Weight gain: 9-10.5kg10%6%8% Weight gain: >10.5kg19%20%19.5% Empowering Healthy Living

16. SHSCT Results 01/07/13-01/07/14DHHCAHTotal Bottlefed62%75%68.5% Breastfed38%25%31.5% Normal delivery41%49%45% C. section59%51%55% Empowering Healthy Living

17. Contributing to Public Health Priorities WTHP contributes directly to the achievement of the objectives of: – Fitter Futures for All – Strategy of Maternal Care NI – NICE guidance relevant to adult, childhood and maternal obesity, maternal obesity and diabetes in pregnancy – AHP Strategy for NI

18. Contributing to Public Health Priorities Adopting a 'life course approach' with pregnancy identified as one of the critical points in the life course. Creating multidisciplinary interventions which address diet and physical activity. Empowering the clients to make the necessary lifestyle changes to manage their obesity. Addressing inequalities as all women with BMI≥40 within pilot criteria are offered WTHP across NI Creating a 'trickle down' effect of positive health messages to women’s families. Addressing the Early Years objective to give every child the best start in life - both in utero and post-natal Demonstrating an increased uptake of breastfeeding for obese women. Maximising resources, WTHP creates approximately 33% of RTNI referrals regionally, so contributing significantly to the HSCTs delivery targets for RTNI set by the PHA. Empowering Healthy Living

19. Leadership and Engagement PHA and QUB Health Intelligence PHA and regional steering group 5 Health and Social Care Trusts MDT, multi-AHP delivery – embed in services UU – evaluation RTNI private provider, trust Telehealth Managers, CCHSC. PPI –feedback from participants – future planning Empowering Healthy Living

20. Empowering Healthy Living Outcomes Improve Health for women and their families Improve mental health and wellbeing Women and their families are better informed about health matters in relation to healthy eating and exercise during pregnancy and beyond Empowering Healthy Living

21. Conclusions The UU team stated “evidence from evaluation was sufficient to confidently state that the intervention has the potential to impact positively on weight management for pregnant women with BMI≥40” (2015) The project is an effective intervention to manage health risks, resulting in significant positive health outcomes for mother and child. Empowering Healthy Living

22. Summary Outcomes associated with MDT approach, regular support as suited to patient and weekly weight monitoring Funding from PHA to continue at present Women need on-going encouragement to uptake and engage with WTHP programme Any questions. Empowering Healthy Living

23. References A Fitter Future for All;. Obesity Prevention Framework for Northern Ireland 2012-2022, DHSSPSNI, 2012 A maternity strategy for Northern Ireland 2012-2018, DHSSPSNI, 2012. Nice guidance PH27, NG3, CG189, CG43, PH47 Management of Women with Obesity in Pregnancy,CMACE/RCOG, 2010 AHP Strategy 2012 -2017 – Improving Health and Wellbeing through Positive Partnerships, DHSSPSNI, 2012. Empowering Healthy Living