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- Lindqvist, Maria, 1975-
(författare)
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Experiences of counselling on physical activity during pregnancy Gestational diabetes mellitus : screening and pregnancy outcomes
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundOverweight and obesity are global health problems with several adverse health effects that threaten public health. In Sweden, almost four of ten pregnant women are overweight or obese, conditions that are associated with adverse pregnancy outcomes, including gestational diabetes mellitus (GDM), a metabolic disorder that complicates pregnancy. Globally, physical inactivity is the fourth leading risk factor for mortality. The recommendation for physical activity (i.e., ≥150 minutes/week) issued by the Professional Associations for Physical Activity and the Swedish National Board of Health and Welfare is in line with the recommendations by the WHO. Physical activity during pregnancy is generally safe and beneficial for both the pregnant woman and her fetus and can maintain or improve fitness and may further improve pregnancy outcomes. However, pregnant women tend to lower their physical activity when entering pregnancy. Midwives working in antenatal care (ANC) in Sweden play a prominent role in promoting a healthy lifestyle through counselling pregnant women on lifestyle, including physical activity during pregnancy. Individual counselling on physical activity encourages pregnant women to maintain their pre-pregnant leisure time physical activity throughout their pregnancy.AimsThis thesis has three main aims. First, this thesis investigated guidelines for screening of GDM, risk factors, and pregnancy outcomes in relation to GDM. Second, it investigated physical activity during pregnancy and pregnancy outcomes. Third, it explored midwives’ and pregnant women’s experiences with counselling that addressed physical activity during pregnancy.MethodsStudy I and III are cross-sectional studies using data from the Maternal Health Care Register and the Salut Register. A total of 184,183 pregnant women were included in Study I (2011-2012) and 3,868 in Study III (2011-2012). Several statistical analyses were used: two-independent samples t-test, Pearson’s Chi-Square test, and univariate and multivariate logistic regression analyses. Study II and IV are qualitative studies applying qualitative content analysis. Study II included 41 midwives who were interviewed in eight focus group discussions (FGD). Study IV included 14 pregnant women who participated in individual in-depth interviews.Main findingsThere was no consensus in Sweden regarding clinical guidelines for screening regimes or 2-hour cut-off value for diagnosis of GDM from 2011 through 2012. Four screening regimes were applied in Sweden during this time period: A) universal screening with a 2-hour cut-off value of 10.0 mmol/L; B) selective screening with a 2-hour cut-off value of
8.9 mmol/L; C) selective screening with a 2-hourcut-off value of 10.0 mmol/L; and D) selective screening with
a 2-hour cut-off value of 12.2 mmol/L. The highest prevalence of GDM was found where selective screening was applied with a 2-hour cut-off value of 8.9 mmol/L. Unemployment, low educational level, and non-Nordic origin were all risk factors for GDM, and a BMI ≥30 kg/m2 almost four-doubled the risk for GDM compared to pregnant women with BMI <30 kg/m2. Increasing OGTT-values were associated with increasing risk of adverse pregnancy outcomes (Paper I). Midwives in antenatal care perceived counselling as both challenging and as an opportunity to promote a healthy lifestyle for pregnant women. As the theme “An on-going individual adjustment” revealed, the midwives tried to adjust their counselling to each pregnant woman’s individual needs. Counselling pregnant women on physical activity was seen as complex and ambiguous with a risk of being rejected by the women if the advice was delivered too straightforward. Instead, the midwives were “tiptoeing” around the sensitive topics (Paper II). Almost half of pregnant women reported that they achieved the recommended level of physical activity duringpregnancy (i.e., ≥150 minutes/week). These pregnant women were characterized by lower BMI, higher educational level, and very good or good self-rated health (SRH) compared to the pregnant women who did not achieve the recommended level (Paper III). Pregnant women reported a desire for individual counselling on physical activity during pregnancy. The theme that emerged was “Longing for fulfilment of individual needs and expectations”, which reflected the wish that midwives’ counselling on physical activity should be based on pregnant women’s individual needs instead of merely providing general advice. Some participants reported receiving encouragement and support, but others believed they were provided insufficient counselling on physical activity and that the midwife had her own agenda focusing mostly on medical surveillance (Paper IV).ConclusionsNo consensus regarding clinical guidelines and diagnostic criterion for GDM existed in Sweden during 2011 to 2012. Obesity was a strong risk factor for development of GDM, and low socio-economic status and non-Nordic origin were also demonstrated as significant risk factors. Positively, almost half of the pregnant women reached the recommended level of physical activity during pregnancy. Participants fulfilling the recommendation were characterized by lower BMI, higher education, and very good or good self-rated health. Midwives strived to adjust and individualize their counselling on physical activity; however, some of the pregnant women could experience the counselling on physical activity being too general. Clearly, healthcare professionals should encourage fertile and pregnant women to be physically active, especially overweight and obese pregnant women who report low levels of physical activity, in order to improve overall health in this population.
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| 2. |
- Lundqvist, Anette, 1963-
(författare)
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Nutritional aspects of behaviour and biology during pregnancy and postpartum
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundA well-balanced nutritious diet is important for the pregnant woman and the growing fetus, as well as for their future health. Poor nutrition results from both over-consumption of energy-rich foods which can lead to a higher weight gain than is healthy and under-nutrition of essential nutrients. Food intake is regulated in complex biological systems by many factors, where steroid hormone is one factor involved.The overall aim of this thesis is to describe dietary intake, vitamin D levels, dietary information and dietary changes, and to study the relation between allopregnanolone and weight gain during pregnancy and postpartum.Methods Study I was a qualitative study with focus group interviews with 23 pregnant women. The text was analysed with content analysis. Study II was a quantitative cross-sectional study conducted in early pregnancy (n=209) with a reference group (n=206). Self-reported dietary data from a questionnaire was analysed using descriptive comparative statistics and a cluster analysis model (Partial Least Squares modelling). Study III had a quantitative longitudinal design. Vitamin D concentrations were analysed in 184 women, collected on five occasions during pregnancy and postpartum. Descriptive comparative statistics and a linear mixed model were used. Study IV was a quantitative longitudinal study with 60 women. Concentrations of allopregnanolone were analysed in gestational week 12 and 35. Descriptive and comparative statistics as well as Spearman’s correlation (rho) were used to describe the relationship between weight gain and allopregnanolone concentrations. Results The focus group interviews showed that women wanted to know more about different foods to reduce any risk for their child but the information about foods was partly up to themselves to find out. They expressedfeelingsof insecurityand guiltif they accidentallyate something“forbidden”. The recommendationswere followedas best as possiblealong withcommon sense todeal with dietchanges. The main themes were “Finding out by oneself”, “Getting professional advice when health problems occur”, “Being uncertain” and “Being responsible with a pinch of salt”. Some differences in the dietary patterns were found among the pregnant women compared to references, with less, vegetables (47 g/day), potatoes/rice/pasta (31 g/day), meat/fish (24 g/day) and intake of alcohol and tobacco/snuff but a higher intake of supplements. Bothpregnant women and referenceshad intakes offolatethrough diet45% (pregnant) and 22% (references) lower than current recommendations(500vs400g/day). Vitamin Dintake was34% lower than the recommendationsof 10mg/day. At least a third of the participants had insufficient plasma levels below 50 nmol/L of vitamin D. Season was a strong factor influencing the longitudinal pattern. Gestational week, season, total energy intake, dietary intake of vitamin D, and multivitamin supplementation over the previous 14 days were factors related to vitamin D levels. A correlation betweenallopregnanoloneconcentrations ingestationalweek 35and weight gainin weeks12–35was seen (p = 0.016). Therewas alsoa correlation betweenthe increase inallopregnanolone(weeks12–35) andweight gain(see above) (p = 0.028). ConclusionsDietary recommendations were described as contradictory and confusing and the dietary advice felt inadequate. The women faced their diet changes and sought information on their own but would have wished for more extensive advice from the midwife. The intake of vitamins essential for pregnancy was lower than recommended, which is also confirmed by low plasma levels of vitamin D in at least one third of the pregnant women. Vitamin D levels peaked in late pregnancy. Aside from gestational week and season which were related to plasma levels, intake from foods and supplements also affected the levels. Reasons for weight gain are complex and depend on many factors. Allopregnanolone is a factor that was seen to relate to the weight gain of the studied pregnant women.
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| 3. |
- Wennberg, Anna Lena, 1952-
(författare)
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Pregnant women and midwives are not in tune with each other about dietary counseling : studies in Swedish antenatal care
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background During pregnancy, a healthy diet is beneficial for the expecting mother and her fetus. Midwives in antenatal care have an ideal position for promoting a healthy diet and thereby help women to not only lower the risks of pregnancy complications and adverse birth outcomes, but improve maternal health. The overall aim of this thesis was to describe diet and dietary changes during pregnancy from the women’s and the midwives’ perspectives with a focus on dietary counseling. The thesis comprises four studies. The specific aims in the respective studies were to: I) Describe pregnant women’s attitudes to and experiences of dietary information and advice, as well as dietary management during pregnancy. II) Explore midwives’ strategies in challenging dietary counseling situations. III) Describe how midwives’ perceive their role and their significance in dietary counseling of pregnant women. IV) Describe women’s food habits during pregnancy and up to six months postpartum.Methods Studies I-III were qualitative. Study I included focus group interviews with 23 pregnant women. Study II included telephone interviews with 17 experienced midwives working in Swedish antenatal health care. Study III included the same 17 interviews from study II and supplemented them with four face-to-face-interviews. Qualitative content analysis was performed in all three studies. Study IV was a longitudinal study including a quantitative analysis of a questionnaire, which was given to women at five occasions during and after pregnancy. It concerned their food habits and it was answered by 163 women. The quantitative data was analyzed using comparative and descriptive statistics.Results The overall findings of the thesis were summarized as the main theme “Pregnant women and midwives are not in tune with each other about dietary counseling”. The main theme included the two themes ‘Pregnant women are concerned about risks for their child but fail to change to healthier dietary habits over time’, and ‘Midwives view themselves as authorities, though questioned ones’. In subthemes it was highlighted that pregnant women are well informed and interested in risk reduction for their child’s best and that they try to do their best to improve their diet during pregnancy. However, their diet did not reach levels of healthy eating recommendations and became even unhealthier after pregnancy. It was also highlighted that midwives experienced insufficient knowledge in dietary issues and related risks and that they had difficulties to give dietary support to pregnant women. Midwives were found to mainly focus on giving information and they lacked sufficient competence for challenging counseling.Conclusion Pregnant women, on the one hand, experience a lack of support from the midwives when dealing with dietary changes. The midwives, on the other hand, feel exposed and express a need for both further education in dietary issues and training in counseling. Women’s food habits during, but in particular after pregnancy need improvement, and dietary counseling could be more focused on healthy eating in a long-term perspective.
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