The impact of continuity of care on weight gain in obese pregnant women

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Obesity in pregnancy has increased to epidemic proportions in developed countries. It is associated with adverse outcomes for both mother and child. Maternal risks for hypertensive disorders, gestational diabetes, thrombo-embolism, haemorrhage, infections and death are increased in obese women and there are attendant risks and resourcing issues associated with obesity and childbirth. Compared to women who have a BMI between 20.1- 25, obese women are more likely to experience: increased rates of induction of labour and failed induction; anaesthetic difficulties; caesarean section; a stay in hospital of more than five days and obese women require specific equipment for accurate monitoring and safe maternity care. The risks of adverse outcomes for fetuses and neonates are also increased While there is limited evidence to support the effectiveness of dietary and physical activity lifestyle interventions in preventing excessive gestational weight gain, the American Institute of Medicine (IOM) published revised guidelines (2009) on how much weight a woman should gain during pregnancy and highlighted the importance of intervention in pregnancy to prevent both postpartum weight retention and childhood obesity. The American IOM recommends that pregnant women who are obese (BMI >/= 30 ) should gain 5 to 9 kg. Excessive gestational weight gain is defined as weight gain above this recommended guideline. Maternity reform at both Australian federal and state levels of government promote the benefits of continuity of care to women at low risk of complications and the expanded role of midwives working collaboratively in multidisciplinary teams. Continuity of care can be defined as care that is provided by the same clinician or small group of clinicians throughout pregnancy, birth and the postnatal period. Continuity of care can empower women and promotes participation in their care improve the sense of control women perceive, and improve satisfaction with care. However the impact of continuity of care as an intervention to improve outcomes for women who are obese has not been explored. The primary aim of this trial is to measure the impact of continuity of care in preventing excessive gestational weight gain in obese women. Following the calculation of their BMI at the booking in visit, women with a BMI>/=30 and meeting the additional selection criteria will be provided with written information about this project by the attending midwife or doctor (not members of the study group) and invited to participate. Women will be given time to answer questions and to provide written informed consent. Women agreeing to participate will be randomised to receive continuity of care (intervention) or routine care (control group). Women in both group will receive an information booklet on restricting gestation weight gain for women with a BMI>/= 30. A secondary aim of the study is to measure the impact of continuity of care on obese women receiving evidenced based care as defined by the 2010 guidelines for management of women with obesity in pregnancy developed by the Centre for Maternal and Child Enquires and the Royal College of Obstetricians and Gynaecologists. An audit of participants’ pregnancy records after birth will assess whether or not standards of care have been achieved. Information will also be obtained on participants’ demographics, previous pregnancies, medical problems, interventions for labour and birth, mode of birth and baby’s weight at birth. Another secondary aim is women’s satisfaction with care. Participants will complete two surveys, one at recruitment and another at 36 weeks gestation.