Date of Award

2021

Degree Name

PhD Nursing

Dissertation Committee

Dissertation Committee Mary Barger, PhD, MPH, CNM, FACNM Chairperson Ann M. Mayo, DNSc, RN, FAAN Committee Member Kathy Shadle James, DNSc, APRN, FAAN Committee Member

Keywords

pregnancy, Obesity, telehealth, nutrition, weight

Abstract

Purpose

The purpose of this feasibility study is to determine the magnitude of effect using a combination of weekly weights and an online registered dietician to control excessive gestational weight gain in pregnant women with obesity using a pilot randomized controlled trial.

Specific Aims

There are three specific aims. Aim 1: Describe the study population in terms of sociodemographic influences (e.g., ethnicity, age, weight, and height) and obstetrical influences (i.e., parity and pregnancy weight). Aim 2: Measure participant satisfaction with the study interventions of weekly weighing and online nutrition counselling. Aim 3: (a) Explore the differences in gestational weight gain from enrollment to 6 weeks later and at 28 weeks among pregnant women with obesity who were not given any special nutrition counseling or scale (historical controls) to those given scales and asked to weigh themselves weekly; (b) explore if there were any differences in gestational weight gain among the intervention group, between those who receive nutrition counseling and those who did not; (c) determine the effect size of the interventions for a future larger RCT.

Background

Approximately 1/3 of pregnancy complications are related to obesity (Ramachenderan et al., 2008). For example, the odds of developing gestational diabetes increases 7.7 times. For every 5-7 unit increase in maternal BMI the risk for preeclampsia doubles (Bautista-Castano et al., 2013), and the risk of having a cesarean delivery increases 2-3 times for women whose BMI is greater than 30 (Ovesen et al., 2011). Employing a Registered Dietician (RD) for weight management during pregnancy has demonstrated success, although the use of online dieticians remains untested (Vincze et al., 2019).

Methods

Pregnant women between 14-36 weeks gestation, with a BMI greater than 30 will be included in the study. Recruitment will occur remotely through the use of a recruitment flyer with a QR code. Participants will scan the QR, complete a survey for eligibility, and consent for the study online. Women will be randomly assigned to either the self weighing group or self-weighing and online nutritional counseling intervention group. Self-weighing will occur through the use of a preconfigured Bluetooth scale and data will be stored and retrieved through a secure data hub. Online nutritional counseling will occur through a secure telehealth platform, and occur for 30 minutes, once a week, for six weeks. For the control group, retrospective data will be extracted from an electronic medical record. Variables measured include gestational weight gain after six weeks, at 28 weeks, and 36 weeks gestation. Adherence to the intervention will be tracked.

Results

Those in the study group (n = 11) on average comprised of a group of multiethnic pregnant women in their late 20s early 30s with an average BMI of 33.5 (5.4), with an average gestation age at recruitment 16.5 weeks. The majority were married or cohabitating (n = 10), with a mix of some high-school (n = 2) to college education (n = 9), a mix of private (n = 4) and governmental insurance (n = 7), working (n = 7) and non-working (n = 4). Online nutritional counseling was accepted in this population using the virtual provider online satisfaction survey, Cronbach’s alpha of 0.55. There were no missed visits for those attending the nutritional counseling sessions. 82% (N = 9) of women adhered to self-weighing once a week. Overall gestational weight gain was less in the study group (mean weight gain 5.8 lbs., SD (5.9), than in the historical control group (Mean weight gain 6.6 lbs., SD (3.1)), The registered dietitian group had a mean weight gain of 4.1 lbs., SD (5.6) compared to 6.9 lbs., SD (5.6) in the self-weighing alone group. The Effect size was small with a Cohen’s D calculated at 0.17.

Significance:

It is feasible to provide online nutritional counseling to pregnant women with obesity while using remote weight monitoring to eliminate biases that occur with self-reporting. Further research is needed to determine the effect of this intervention within a larger sample size.

Comments

rmattson@sandiego.edu

Document Type

Dissertation: Open Access

Department

Nursing

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a CC BY License.

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