Reducing maternal obesity using telemonitoring

Telemonitoring NI > Health Professionals > Patient Stories > Clinical Case Studies > Reducing maternal obesity using telemonitoring

Pregnancy_case_study.PNGBackground

Maternal obesity can be extremely harmful to the health of mothers and babies, with increased risk of a range of conditions including hypertension, pre-eclampsia, caesarean section, birth injuries, post-partum haemorrhage and diabetes.

In 2014/15, almost half (49.3%) of all mothers in NI were considered pre-obese or obese at the time of booking, and obese pregnant women cost the NHS 37% more than their counterparts of a normal weight.

Methods

The Weigh to Healthy Pregnancy (WTHP) project was developed to address maternal obesity as part of the wider public health obesity agenda in Northern Ireland (NI). WTHP was initiated by the Public Health Agency (PHA), and the interdisciplinary service delivery commenced in all five NI Health and Social Care Trusts in 2013.

The objectives of the WTHP 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

A team of dietitians, midwives and physiotherapists were allocated to the project for specific hours of the working week, and received specialist training from PHA. 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.

These women then received a follow-up phone call from WTHP team and were invited to attend a consultation. Thereafter contact was maintained via a combination of face to face, telephone and small groups.

Participants also used the Telemonitoring NI service to monitor their weight. Women weighed themselves at home once a week at a time of their choosing on the weighing scales provided. This reading was then transmitted via Bluetooth to the mymedic home telemonitoring unit which in turn sent the data to the Telemonitoring NI monitoring centre. This information could then be accessed remotely by WTHP clinicians to monitor progress and inform ongoing care plans.

“Evidence from the evaluation was sufficient to confidently state that the intervention has the potential to impact positively on weight management for pregnant women with Body Mass Index of 40 or over.”

University of Ulster evaluation team

Results

WTHP data was evaluated by University of Ulster (UU) in 2013/14, using telemonitoring data, WTHP data, NIMATS data and qualitative feedback from the women participating and the WTHP teams.

During evaluation period, 306 women agreed to participate (representing 80% uptake to the programme). Of these, 217 (71%) completed the programme.

Average BMI when enrolled onto the programme = 43.95 Average Gestational Weight Gain (GWG) was 4.65kg, compared to Institute of Medicine (IOM) guidance for women with a BMI≥40 of 5-9kg.

Of the women taking part in the programme:

  • 53% were within IOM guidelines
  • 29% were below IOM guidelines
  • 18% were over IOM guidelines

At 6-8 weeks post-partum weight loss was 3.96kg compared to booking weight.

Results_of_GWG.PNG

Breastfeeding rates at 6 weeks post-partum were higher, with 23.8% of participants exclusively breastfeeding compared to 10.7% for those who did not participate in the WTHP programme.

“It keeps in the back of your mind to be conscious of what you’re eating and it wasn’t all about diet, it was about making me aware that I’m pregnant and I need to keep healthy.”

Mother taking part in the Weigh to Healthy Pregnancy programme

Long-term changes have also been seen as a result of the programme, with interviews undertaken one year after completing WTHP indicating positive lifestyle changes have been extended to include the wider family, including:

  • Participants reported changes in usual shopping habits and changes in attitude towards weight gain in pregnancy.
  • Self-monitoring with telehealth scales increased awareness of eating habits, making women more mindful and feeling a sense of control.
  • Majority of women felt that the programme did help them limit their GWG.

Anticipated Economic and Social Return

The results of the programme demonstrated:

  • Potential for significant reduction in maternity care and neonatal care costs
  • Future reduction in cost for chronic conditions (Maternal and Child)
  • Creating a ‘trickle down’ effect of positive health messages to women and their families.
  • Contributing to multiple public health priorities relevant to maternity, obesity and diabetes.
  • Increased uptake of breastfeeding for obese women.

The project has proven to be an effective intervention to manage health risks, resulting in significant positive health outcomes for mother and child.