title: The design of a community lifestyle programme to improve the physical and psychological well-being of pregnant women with a BMI of 30 kg/m2 or more.
abstract: BACKGROUND
  Obesity is a global public health issue. Having a BMI of 30 kg/m2 or more (classifying a person as obese) at the start of pregnancy is a significant risk factor for maternal and fetal morbidity. There is a dearth of evidence to inform suitable interventions to support pregnant women with a BMI of 30 kg/m2 or more. Here we describe a study protocol to test the feasibility of a variety of potential healthy lifestyle interventions for pregnant women with a BMI of 30 kg/m2 or more in a community based programme.
  
  
  METHODS
  Four hundred women will be approached to attend a 10-week community lifestyle programme. The programme will be provided as a supplement to standard antenatal care. The programme is multi-faceted, aimed at equipping participants with the skills and knowledge needed to adopt healthy behaviours. The social (cognitive) learning theory will be used as a tool to encourage behaviour change, the behaviour change techniques are underpinned by five theoretical components; self-efficacy, outcome expectancies, goal setting, feedback and positive reinforcement.The main outcomes are pregnancy weight gain and caesarean section rate. Other important outcomes include clinical outcomes (e.g., birth weight) and psychological outcomes (e.g., well-being). Secondary outcomes include women's experience of pregnancy and health care services, amount of physical activity, food intake and the suitability of the intervention components.A prospective study using quantitative and qualitative methods will inform the feasibility of implementing the community lifestyle programme with pregnant women with a BMI of 30 kg/m2 or more. Mixed methods of data collection will be used, including diaries, focus groups/interviews, pedometers, validated and specifically designed questionnaires, a programme register, weight gain during pregnancy and perinatal outcome data.
  
  
  CONCLUSIONS
  Findings from this current feasibility study will inform future interventions and NHS services and add to the evidence-base by providing information about the experiences of pregnant women with a BMI of 30 kg/m2 or more undertaking a community lifestyle programme. The study will lead on to a randomised control trial of a suitable intervention to improve the pregnancy outcomes of this target group.
authors.affiliation: The School of Nursing, Midwifery and Social Work, The University of Manchester, Oxford Road, Manchester, UK. debbie.smith-2@manchester.ac.uk
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Smith
authors.forename: Melissa
authors.initials: M
authors.lastname: Whitworth
authors.forename: Colin
authors.initials: C
authors.lastname: Sibley
authors.forename: Wendy
authors.initials: W
authors.lastname: Taylor
authors.forename: Jane
authors.initials: J
authors.lastname: Gething
authors.forename: Catherine
authors.initials: C
authors.lastname: Chmiel
authors.forename: Tina
authors.initials: T
authors.lastname: Lavender
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D015992:Body Mass Index; D002986:Clinical Trials as Topic; D004739:England; D005240:Feasibility Studies; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008019:Life Style; D008603:Mental Health; D009765:Obesity / Q000523:psychology* / Q000628:therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology* / Q000628:therapy*; D011446:Prospective Studies; D012107:Research Design