A cluster randomised trial to evaluate the effectiveness of a telephone based coaching program in reducing excessive gestational weight gain amongst pregnant women

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Excessive gestational weight gain (EGWG) or weight gain during pregnancy is associated with poor child and maternal health outcomes, including preeclampsia, gestational diabetes, complications with labour and delivery, and babies who are born either small or large for gestational age. There is also an increased likelihood of postpartum obesity in both mothers and their children, which in turn leads to an increased risk of chronic disease later in life. Estimates from one off studies indicate the prevalence of EGWG in Australia could lie between 38 and 67%. The NSW Get Healthy Service (GHS) is a telephone based coaching service available to all adults in NSW aged 18 years and over. The NSW Office of Preventive Health (OPH) and NSW Kids and Families have collaborated to develop a service enhancement or “module” for the GHS specifically aimed at supporting pregnant women to achieve appropriate gestational weight gain. An initial pilot phase for the module is proposed to assess effectiveness of the coaching program, through conduct of a randomised controlled trial. This RCT will compare the effectiveness of a telephone based coaching program versus provision of information alone in supporting pregnant women to achieve appropriate gestational weight gain and prevent postpartum weight retention. The hypothesis is that compared with participants who only receive information, pregnant women enrolled in the coaching program will be less likely to achieve excessive gestational weight, and be more likely to have returned to their prepregnancy weight 12 months after giving birth. A stratified cluster randomised design will be used, with stratification by prepregnancy BMI (normal and overweight/obese) and clustering by hospital. Four hospitals will be invited to participate, with two allocated to the control arm and two to the intervention arm. Pregnant women will be invited to participate in the trial on their first booking visit with a midwife, and allocated to an arm depending on the hospital they attend. Anthropometric (e.g. weight gain or retention) and behavioural (e.g. fruit and vegetable consumption) outcomes for each group will be compared at 36 weeks gestation and 12 months post birth. Additionally, qualitative feedback on the feasibility and acceptability of the module (information and coaching components) will be sought from participants and midwives.