Key result
The Living Well during Pregnancy tele-coaching program was as effective as face-to-face appointments, with 70% of tele-coaching participants and 73% of historical controls exceeding gestational weight gain recommendations.
Why the study?
Face-to-face appointments introduce barriers to engaging with recommended dietitian counseling for women at risk of excess gestational weight gain, making telephone counseling a potential solution.
Does a dietitian-delivered telephone coaching program improve gestational weight gain and dietary/physical activity behaviors in pregnant women at high risk of excessive gestational weight gain compared to usual face-to-face care?
Cohort (n=191)
No
Does a dietitian-delivered telephone coaching program improve gestational weight gain and dietary/physical activity behaviors in pregnant women at high risk of excessive gestational weight gain compared to usual face-to-face care?
Absolute Event Rate: 70% vs 73%
p-value: p=0.69
A dietitian-delivered telephone coaching program for pregnant women at risk of excess weight gain achieved similar gestational weight gain outcomes as face-to-face care while improving access and dietary behaviors.
Tele-coaching may offer a comparable option for gestational weight management; leaves open the need for randomized confirmation before practice change.
BackgroundExcess 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 reports on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention. MethodsThe 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. ResultsThe 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). 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 the LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p<0.05). ConclusionThe 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.
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Jersey et al. (2022) conducted a cohort in Excessive gestational weight gain (n=191). Living Well during Pregnancy (LWdP) tele-coaching program vs. Historical comparison group (face-to-face dietetic care) was evaluated on Proportion of women gaining weight above the Institute of Medicine (IOM) recommendations (p=0.69). The Living Well during Pregnancy tele-coaching program was as effective as face-to-face appointments, with 70% of tele-coaching participants and 73% of historical controls exceeding gestational weight gain recommendations.
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