BLOOM

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BLOOM

• Better Lifestyle and Obstetric Outcomes for
  Mothers
• Nutrition Dietetics
• Womens Newborn Health Service, Perth
• Anne.Rae_at_health.wa.gov.au

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Why a program for maternal obesity?

• Obstetric activity ? 30 over 2 years
• Increasing prevalence of maternal obesity
• Inconsistent recognition referral
• RCT of energy restriction in obese women with GDM
• Lower GWG associated with fewer obstetric
  complications
• Large GWG variation observed in WA Birth Cohort
• -2 kg to 45 kg (mean 16.5 kg)
• Opportunistic funding for 15 months

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BLOOM planning coordination
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Maternal obesity prevalence

• WA Birth Cohort (n 2834)
• 1989-1991 22.4 (91 of women with ht/wt data)
• WA Midwives Perinatal Database (STORK)
• KEMH 2006 (n 5512) 24.5 (BMI recorded in 74
  of women)
• KEMH 2007 (n 6048) 25.9 (BMI
  recorded in 88 of women)

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WNHS cohorts
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Increasing prevalence of maternal obesity
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BLOOM participants

• Gestational age at enrolment
• 24 weeks, 7 - 39 (median, range)
• Numbers
• 343 women enrolled
• 185 women delivered

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BMI categories _at_ enrolment
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A group for comparisons
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of women in each cohort by BMI
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BLOOM comparison
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Program content
Stepped interventions

• Patient chooses model
• Early appointment with dietitian
• Telephone consult and information mail out
• Personalized goal setting to improve diet
  activity
• Frequency of lifestyle counseling

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Resources

• 1 Starter package
• 3 review lifestyle packages
• Newsletters

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Dietary intervention

• 6900 7600 kJ meal plan (meets NRVs/RDIs)
• 3 meals 3 snacks
• 45 per cent energy as carbohydrates
• higher fibre lower GI
• 30 per cent energy as fat
• less saturated fat
• more LCPs

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Food choice concepts

• Plate model
• Portion control
• Reduced fat 10 per cent
• Low glycemic index
• Food exercise record

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Outcomes

• Gestational weight gain (median, range)
• 4.6 kg (-3.9 to 17kg)
• 46 achieved lt 5kg
• 55 achieved less than expected

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Outcomes
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Participant satisfaction survey

• 20 telephone surveys completed by independent
  surveyor.
• Domains
• Program components helpful, useful
• Changes in food exercise habits
• Motivation
• Recommend to a friend
• Other comments

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How helpful was the BLOOM program for you?
8 (7 - 9.5) median (IQ range) How
useful was Talking about food choices with the
dietitian? 8 (8 - 9.5) The meal plan showing
how much food to eat in a day? 10 (8 - 10) The
Newsletters? 9 (7 - 10) Setting goals for
better eating? 8 (7 - 9)
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Food habits

• Had breakfast used to miss breakfast meal
  planning
• Forced myself to eat meals to increase my
  metabolism
• Meal planning and being careful with carbohydrate
  intake
• Less carbohydrates more awareness of food groups
• Portion sizes
• Ate more fresh fruit and vegetables
• Ate wholegrain bread instead of white bread
  drank more water
• Ate less take aways and deep fried foods ate
  more fruit and vegetables
• Cut out fizzy drinks and drank water sometimes
  cordial
• Cut out sugar i.e. juice and fizzy drinks ate
  more vegetables

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Exercise habits

• More walking x 13
• with the dog and kids
• when I got bored or upset, instead of eating.
• every day.
• More swimming x 3
• Previously did no exercise at all x 2
• No change x 2
• Going to the gym after birth x 2

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Motivation to join

• Recommended, advised, suggested by doctor or
  midwife x 8
• Doctor advised I was at high risk of
  developing GDM if I did not watch my weight.

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Motivation to join

• Recommended, advised, suggested by doctor or
  midwife x 8
• Doctor advised I was at high risk of
  developing GDM If I did not watch my weight.
• For myself and babys health and wellbeing x 5
• Being overweight before the pregnancy and for
  the delivery of a healthy baby.

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Motivation to join

• Recommended, advised, suggested by doctor or
  midwife x 8
• Doctor advised I was at high risk of
  developing GDM if I did not watch my weight.
• For myself and babys health and wellbeing x 5
• Being overweight before the pregnancy and for
  the delivery of a healthy baby.
• Recognition of weight status, previous weight
  gains x 6
• After having first baby gained 20kg and was
  uncomfortable. Didnt want to go past
  100kg.
• Had not lost weight after my first
  pregnancy.

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Motivation to join

• Recommended, advised, suggested by doctor or
  midwife x 8
• Doctor advised I was at high risk of
  developing GDM if I did not watch my weight.
• For myself and babys health and wellbeing x 5
• Being overweight before the pregnancy and for
  the delivery of a healthy baby.
• Recognition of weight status, previous weight
  gains x 6
• After having first baby gained 20kg and was
  uncomfortable. Didnt want to go past
  100kg.
• Had not lost weight after my first
  pregnancy.
• To take opportunity to learn more about healthy
  eating x 4

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Recommendation

• All participants surveyed would recommend BLOOM
  to a friend.
• I would recommend BLOOM to a friend if it was
  more available to regional areas. Only heard
  about BLOOM because I was referred to KEMH.
• Should be available in more hospitals.

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17 of 20 respondents had other comments

• Program was very helpful, informative and
  knowing that everything can be eaten in
  moderation even ice-cream.
• Should be available in more Hospitals. I did not
  gain any weight during pregnancy and delivered a
  healthy 8lb 11oz baby. Ive continued on the
  program and am steadily losing weight. Now
  walking every day.
• Im amazed I lost weight. Ive lost 30kg and am
  continuing on the program.
• I am motivated to carry on with the program and
  have the meal plan on my fridge.

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other comments

• Program was good, great x 6
• Program was helpful x 8
• Support was helpful, appropriately delivered,
  appreciated x 3
• Helpful, informative, gave a lot of ideas x 2

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Next step

• Program V increased activity
• EBP V research
• Data management
• Cost
• Quality improvement
• Statewide

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Next step

• Program V increased activity
• EBP V research
• Data management
• Cost
• Quality improvement
• Statewide

• Interested participants
• Other health professionals participation is
  limited, eg brief intervention.
• Referral rate highest from sessional GPs

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Thanks to

• Dietitians for BLOOM
• Wendy Baker
• Linley Boulden
• Rosemary Torvaldsen
• Data from
• KEMH Perinatal database, STORK
• Western Australian Birth Cohort
• Data analysis
• Maureen Hutchinson
• Belynda Wheatland