Best Start - Weight Management During Pregnancy
Best Start - Weight Management During Pregnancy
The investigators know that being overweight during pregnancy increases the health risks to
 both mum and baby. There is good evidence that diet or exercise, or both, during pregnancy
 can reduce excessive weight gain. The Best Start study aims to test the theory that obese
 pregnant women with a Body Mass Index (BMI) of 30 or over who participate in a structured
 programme of nutrition and lifestyle advice (Foodwise in Pregnancy ™) will achieve the
 recommended weight gain during pregnancy of no less than 5kg and no more than 9.1kg.

 The investigators would like to find out if pregnant women with a BMI of 30 or over who
 receive the Best Start intervention are more likely to effectively manage weight gain during
 pregnancy. To achieve this, the investigators will undertake a trial that randomly puts
 participants into an experimental group, or a control group, which will compare those who
 receive the intervention to those who continue with routine antenatal care. The investigators
 are aiming to recruit around 500 women during the study period. 250 will receive the Best
 Start intervention, and 250 will continue with routine antenatal care.

 The investigators would also like to find out if women who gain the recommended weight during
 pregnancy have better outcomes, compared to women who gain more or less weight. To do this
 the investigators will look at the routine information collected during antenatal and
 postnatal care, for both mum and baby. To do this regardless of the group clients are
 randomised to, the investigators will ask for permission to look at the routine information
 within the participants maternity record. This information includes, weight gained during
 pregnancy, whether the baby is born early, the type of labour and delivery, and any
 complications during the pregnancy or delivery that may have resulted in the need for
 additional care for mum or baby.

 The results of the study will be prepared for publication in scientific journals, and for
 presentation at scientific conferences. All participants will be able to obtain a copy of the
 results once they have been published and any information that could identify participants
 will be removed.
The intervention will invite obese pregnant women with a BMI ≥30 to participate in a research
 study where participants may be offered a programme of nutrition and lifestyle advice, unless
 participants meet the exclusion criteria.

 The programme of nutrition and lifestyle advice will comprise a series of weekly 7 x 2 hour
 group sessions, which will be delivered in community venues by trained Healthy Lifestyle
 Support Workers (HLSWs) employed within the maternity service.

 The group sessions will follow the scripted "Foodwise in PregnancyTM" manual of nutrition
 information; practical cooking sessions; and information on low impact exercise e.g. walking.
 'Foodwise in PregnancyTM' has been developed by a group of NHS Dietitians and Midwives and is
 adapted from the existing Foodwise for Life programme. Pedometers will be provided at session
 three to raise participants awareness of the benefits of physical activity. The programme is
 participative in its approach to experiential learning.

 The group sessions will also promote breastfeeding (All Wales Maternity Strategy Key
 Performance Indicator/Measure) to assist healthy weight gain for babies, healthy weaning and
 the importance of play and physical activity. Delivery of the sessions will be quality
 assured by a specialist public health dietitian and public health midwife employed within Cwm
 Taf University Health Board.

 Because eligible women will initially be referred by a midwife, all midwives will be trained
 by a public health dietitian on the "Eating for 1, Healthy and Active for 2" Royal College of
 Midwives accredited compact training, to ensure a sensitive and effective conversation (using
 motivational interviewing techniques) that raises the issue of excess weight in pregnancy.
 The Healthy Lifestyle Support Workers, delivering the intervention, will also attend this
 training.
Inclusion Criteria:

 -  Pregnant women who at their early pregnancy dating scan (optimum time 12 weeks
 gestation, but with a tolerance of up to 16 full weeks gestation for women who book
 late) have a BMI of 30 or over and reside in Cwm Taf University Health Board area.

 -  Aged over 16.

 -  Capable of giving informed consent.

 -  Singleton and multiple pregnancies.

 Exclusion Criteria:

 -  Pregnant women who at their early pregnancy dating scan (optimum time 12 weeks
 gestation, but with a tolerance of up to 16 full weeks gestation for women who book
 late) have a BMI of less than 29.9 and reside in Cwm Taf University Health Board area.

 -  Aged under 16.

 -  Incapable of giving informed consent.

 -  Any women who have pre-existing diabetes, or develop gestational diabetes during their
 pregnancy.

 -  Any health condition that means the health professional looking after the patient
 feels would contra-indicate involvement in this programme (e.g. losing the ability to
 consent during the programme)