1. The Health Roundtable Healthy Start to Pregnancy: the Personalised Pregnancy Weight Tracker Presenter: Dr Shelley Wilkinson, Dr Di Poad, Marlene Redelinghuys Hospital Code Name: Innovation Poster Session HRT1104b – Maternity Melbourne 10 th & 11 th March 2011

2. The Health Roundtable KEY PROBLEM  Complications exist with  high BMI pregnancies  excessive weight gain  35% of our women overweight/obese pre-pregnancy (see graphs)  ‘Diet quality’ deteriorates with increasing BMI  Low Nutrition & Dietetic staffing levels at our site  Knowledge of weight gain guidelines increases likelihood of correct weight gain, but no advice given

3. The Health Roundtable BMI range year

4. The Health Roundtable AIM OF THIS INNOVATION  To improve pregnant women’s nutrition knowledge and behaviours and to meet women’s nutrition-related needs by providing evidence-based nutrition education and advice, and appropriate and timely access to dietitians during pregnancy according to a self-management framework (The 5As): Assess/Advise/Agree/Assist/Arrange.

5. The Health Roundtable BASELINE DATA Our women had:  Poor access to and awareness of Dietetic service  Very poor knowledge of weight gain guidelines  Poor dietary behaviours  Excessive weight gain  50% of women with BMI > 25kg/m²  75% of women with BMI > 30kg/m²  100% of women with BMI > 40kg/m²  > 60% interested in nutrition education & support  50% when find out pregnant, 29.9% @ 1st ANC visit, 15.9% either

6. The Health Roundtable KEY CHANGES IMPLEMENTED  New Nutrition & Maternal Health Model of Care (MOC)  Evidence-based (EB) nutrition resource (given by midwives@1 st visit)  ‘Healthy Start to Pregnancy’ (Dietitian’s EB behaviour-change group)  1 hour, dietitian-facilitated workshop, delivery of evidence-based content, based on behaviour change theory  Integrated ‘healthy weight gain for a healthy pregnancy’ message through out service  Reinforced by ‘personalised pregnancy weight tracker’  With advice on “what to do when track outside the shading”  + Offer of phone or face to face reviews, esp. high BMI women Evidence-based nutrition booklet

7. The Health Roundtable Evidence based pregnancy weight tracker Weeks are along the bottom →→→ Weight goes up the side →→→ * * * * Write your pre-pregnancy weight at the bottom and then in the box above that write a weight that is one kilo higher until you’ve filled all the boxes Find your weeks of pregnancy, find your weight and put a cross where the lines meet * * Assess: Work out pre-pregnancy BMI Advise & agree: Discuss weight gain range for a healthy pregnancy Assist: Track (your) weight every week or so; if you track high or low, make diet and lifestyle changes according to the information in your booklet Arrange: If you continue to track high or low, contact the dietitian for an appointment

8. The Health Roundtable OUTCOMES SO FAR ‘Process’ evaluation of HSP: 200+ women attended so far  > 93.9% rated: ‘good’ or ‘very good’  Increased knowledge and understanding of:  Diet – 92.6% (agree/strongly agree)  Weight management – 74.2% (agree/strongly agree)  Gave practical advice (94.9%) and motivated to make changes (94.7%) to change diet (agree/strongly agree)  Many high BMI women attend HSP, but few who have been referred What women liked about the session:  Learning what a proper serve size was  Knowing what I need to eat and how to apply it to my own habits and preferences  I liked the opportunity to use the weight tracker  I was a bit worried coming to the group as I ’ m big and I was worried about what the dietitian would tell me to do — I ’ ve heard it all before but — the focus on healthy weight gain for pregnancy, whatever weight you start at and the weight tracker was really good.  The weight tracker was VERY helpful as my weight has been a main source of stress for me Currently evaluating impact outcomes in an RCT (n=360)

9. The Health Roundtable LESSONS LEARNT  Our healthy pregnancy nutrition booklet and program, with an integrated ‘healthy weight management’ message, delivered in early pregnancy is well received (and attended)  A separate weight management approach may be required to provide a higher level of support to some women  This should incorporate the evidence that numerous visits (or contacts) are usually required to support behaviour change  Funding of research to examine cost effectiveness of interventions to assist women would be useful