3 results
The predictors of interpregnancy change in body mass index
- Ciara Reynolds, Brendan Egan, Eimer O'Malley, Sharon Sheehan, Michael Turner
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E444
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Introduction
Pregnancy is a time when weight increases as part of a physiological process to aid fetal growth. However, when excess weight is gained during pregnancy, and retained thereafter, the risk of obesity in the future increases. Increasing BMI between pregnancies and maternal obesity are associated with several adverse pregnancy outcomes. Although the risks of increasing BMI on future pregnancies is well defined, the predictors of this weight gain are not. This study aimed to investigate the predictors of interpregnancy BMI change.
Materials and methodsThis study was conducted in one of Europe's largest maternity hospitals delivering approximately 8000 infants per annum. Women's sociodemographic and clinical data were self-reported at the first antenatal visit and computerised to an electronic recording system by trained midwives. Weight and height were measured at the first antenatal visits of both pregnancies, and body mass index was calculated. Data was extracted and analysed for women who delivered their first and second singleton infants between 2009–2018.
ResultsA total of 12,056 women delivered their first and second baby over the 10-year period. The mean interval between pregnancies was 32.3months (SD15.9) and the median BMI change was 0.6units (IQR1.3). From the first to the second pregnancy the rate of obesity increased from 11.6% to 16.0%. Between pregnancies 46.1% of women maintained their BMI (-1 to + 1units), 13.3% lost > 1 BMI unit(s), whereas 15.5% gained 1–2unit(s), 9.9% gained 2–3units and 12.0% gained > 3units. Overall, 5.8% became obese by the second pregnancy. On multinomial regression analysis, having a pregnancy interval of > 3years (aOR2.1, 95%CI 1.9–2.5, p < 0.001), artificial feeding after the first pregnancy (aOR1.8, 1.5–2.0, p < 0.001), postnatal depression after the first pregnancy (aOR1.6, 1.3–2.1, p < 0.001) and taking prescribed anxiolytics or antidepressants (aOR1.6, 1.1–2.5, p = 0.013) were predictors of gaining > 3 BMI units between pregnancies after adjusting for maternal occupation and age. The predictors of becoming obese in the second pregnancy also included a pregnancy interval of > 3years (aOR1.5, 1.2–1.8, p < 0.001), artificial feeding after the first pregnancy (aOR2.1, 1.8–2.6, p < 0.001), postnatal depression after the first pregnancy (aOR1.7, 1.2–2.3, p = 0.001) and taking prescribed anxiolytics or antidepressants (aOR1.8, 1.1–3.1, p = 0.016) following the same adjustments.
ConclusionLonger pregnancy interval, not breastfeeding and psychological health disorders are predictors of BMI increase between pregnancies and becoming obese in the second pregnancy. Interventions provided following women's first delivery should aim to promote breastfeeding, manage weight and improve mental health.
A preliminary qualitative study of general practitioners’ views on malnutrition management and oral nutritional supplementation prescription in the community
- Patricia Domínguez Castro, Sharon Kennelly, Barbara Clyne, Gerard Bury, Catriona Bradley, Karen Finnigan, Laura McCullagh, Michael Barry, Celine Murrin, Carla Perrotta, Katherine Loayza Villaroel, Ciara Reynolds, Eileen Gibney, Clare Corish
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E332
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Malnutrition, arising from a deficiency of energy and protein intake, occurs commonly among community-dwelling individuals. Oral nutritional supplements (ONS) are an effective method of managing malnutrition if prescribed for patients who are malnourished or at risk of malnutrition. However, previous research indicates that inappropriate prescribing of ONS occurs frequently in the community setting (30–70% prevalence). Moreover, it has been previously shown that the management of patients ‘at risk’ of malnutrition in the primary care/community setting in Ireland is sub-optimal, with low awareness of the condition and its management among non-dietetic health care professionals (HCPs). In Ireland, general practitioners (GPs) are the main prescribers of ONS in primary care. They are also on many occasions the first point of contact for individuals in the community who are malnourished or at risk of malnutrition. Therefore, exploring their experiences and perceptions can provide insight into the complexities of managing malnutrition and ONS prescribing in the community. The aim of this qualitative study was to explore GPs’ experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. Semi-structured interviews were conducted with nine GPs. The interview explored among others the following domains; Barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded interviews were transcribed and analysed using inductive thematic analysis. Three main themes were identified; i) Malnutrition a secondary concern, encapsulating the idea that malnutrition is not something that GPs screen for in isolation ii) Resources and support for managing malnutrition are needed in the community iii) Reluctance to prescribe ONS. GPs reported not screening for malnutrition, but viewed it as a consequence of other conditions and social factors. According to the GPs, they should not have sole responsibility for malnutrition management and more dietitians and trained community nurses would be desirable to support them to deal with malnutrition in the community. A preference to avoid supplementation and implement dietary changes first was expressed by GPs. As main prescribers, GPs thought that they should receive further independent trainingon the different ONS available in the market as currently they did not feel confident prescribing a range of them. Awareness of ONS cost and its misuse by certain patients were reported as reasons that made GPs reluctant to prescribe them, potentially leading to under prescribing.
A preliminary qualitative study of nurses’ and dietitians’ views on malnutrition management and oral nutritional supplementation prescription in the community
- Patricia Domínguez Castro, Sharon Kennelly, Celine Murrin, Catriona Bradley, Barbara Clyne, Gerard Bury, Karen Finnigan, Laura McCullagh, Michael Barry, Sarah Browne, Ciara Reynolds, Laura Bardon, Eileen Gibney, Clare Corish
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E108
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Protein-energy malnutrition, or undernutrition, arising from a deficiency of energy and protein intake, can occur in developed countries both in hospitalised patients and in the primary care/community setting. Oral nutritional supplements (ONS) are an effective method of managing malnutrition if prescribed for patients who are malnourished or at risk of malnutrition. Pooled data of older adults at risk of malnutrition indicate that ONS combined with dietary counselling is the most effective intervention. Previous Irish research has demonstrated that management of patients ‘at risk’ of malnutrition in the primary care/community setting is sub-optimal, with low awareness of the condition and its management among non-dietetic health care professionals. Therefore, the aim of this qualitative study is to explore community nurses’ and dietitians’ experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. Three focus groups were conducted with primary care dietitians (n = 17) and one focus group with community nurses (n = 5), one of the nurses had prescribing rights. The focus groups explored the following domains; the term malnutrition and patient population presenting as malnourished or at risk of malnutrition, barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded focus groups were transcribed and analysed using inductive thematic analysis. Both professional groups showed similar perspectives, and three preliminary main themes were identified; i) Malnutrition is a misunderstood term, ii) Delayed treatment of malnutrition, iii) Challenges with ONS prescription in the primary care/community setting. Both dietitians and community nurses agreed that the term malnutrition had negative connotations for patients and preferred not to use it with them. Dietitians identified the need for a multidisciplinary approach to manage patients at risk of malnutrition in the community, and community nurses agreed on their pivotal role identifying the risk of malnutrition and providing first line advice to clients. However, community nurses expressed the urgent need for training to provide first line advice to patients to improve their nutritional status to prevent malnutrition. Both groups also agreed on the need for access to more dietitians in the community, and suggested that giving dietitians prescribing rights would improve appropriate ONS prescribing. Community nurses identified a gap in their knowledge of the different ONS products, and the need to receive independent generic education on nutritional supplements.