Pregnancy & postpartum lifestyle, Across the lifespan - Prevention

Pregnancy & postpartum lifestyle

Dr Cheryce Harrison, Prof Helena Teede, A/Prof Lisa Moran

Our aim is to optimise the health of women, their infant and families through effective, sustainable and low-cost healthcare programs and initiatives, informed by the best available evidence.

Young, reproductive age women are a high-risk group for accelerated weight gain across adulthood, with related reproductive, metabolic and psychological complications.

Pregnancy presents a critical window for excessive weight gain and weight retention post-birth, driving future obesity development. During pregnancy approximately 50-60% of women gain above recommendations for gestational weight gain (GWG), increasing the risk of adverse outcomes, including miscarriage, preeclampsia, gestational diabetes, caesarean section and birth complications. Risks are independent of, yet exacerbated by, pre-existing obesity.

Broad reaching, accessible, low intensity and cost effective lifestyle interventions to promote healthy lifestyle behaviours and prevent escalating weight gain in young women in pregnancy, postpartum and beyond are vital and broadly prioritised. Underpinned by our effective weight gain prevention program, we work to design, implement, deliver and evaluate healthy lifestyle interventions that arrest and reverse the progressive increase in weight gain in young women.

Implementation & Impact

Our healthy lifestyle program demonstrates efficacy in trials of >6000 women to date. It is effective in differing populations (Culturally and Linguistically Diverse [CALD]) and across diverse settings (urban, rural, antenatal care, community), has received National recognition, is low-intensity, cost effective, optimises health behaviour and prevents weight gain, with greatest benefit in non-obese populations. The significance of this program is validated on individual patient data (IPD) meta-analysis with associated reduction in adverse outcomes. Grounded in social cognitive theory, HeLPher is a non-prescriptive, self-management lifestyle intervention. It is underpinned by individual health priority identification, goal setting, self-efficacy, problem solving, action planning and self-monitoring for sustained behaviour change. How it is delivered (face-to-face, remotely, individually or group), who delivers it, where it is delivered, its frequency (number of sessions) and resources (written or digital) can be flexible and contextually adapted.

A/Prof Emily Callander, Prof Helena Teede

Improving the outcomes of women and children during pregnancy. We are working
towards the creation of a national Maternity Learning Health System, that brings together
women as consumers of care, clinicians and academics to remove silos and enable change.
We are using the Learning Health System framework, innovate IT platforms, big data, and
novel analyses.

Nationally there are 300,000 pregnancies yearly. Efforts to reduce risks in pregnancy have
yielded great benefits, however we have now tipped the balance between managing risk and
causing harm, with only 30% of pregnancies having a spontaneous birth. Intervention rates,
harms and costs are rising dramatically year on year and action is vital.
The Pregnancy Group is currently working to bring the voices, priorities, guidance and
shared decision making with women as consumers of healthcare, to the forefront. This will
underpin a National Maternity Learning Health System. This evidence-based approach
unlocks the power of research evidence, health data through cutting edge, secure IT and data
technology, and best practice implementation approaches to rapidly transform care, in areas
that matter to women.
Our activities will be guided by women’s priorities. Leslie Arnott, a long-term maternity
consumer advisor has stated

“The current models of care are predominately non-evidence based, and designed to cater for the system and are not woman-centred”.

Our work is already unpinning the advocacy work of consumer groups, being used to
codesign state and national maternity policy. We will continue to place women’s priorities at
the centre of our Learning Health System work.

Implementation & Impact
With our partners reaching across 86% of Australian maternity care nationally, will deliver a
national Maternity Learning Health System, leveraging world leading innovation in health
data innovation, implementation research and translation, delivering priorities of women,
evidence, and healthcare improvement. This is in alignment with the National Women’s
Health Strategy 2020 – 2030, conducted with support of women’s consumer groups, and with
national partnership with Women’s Healthcare Australasia.

Current Projects: 
- Optimising use of Caesarean section
Caesarean section is one of the most common surgeries in Australia with rates
increasing from 17% in the early 2000s to above OECD-average at 36%, with rates
continuing to rise. Related harm is now evident and reducing caesarean section to
align with the World Health Organisation, would save $940 million in the public
system annually.

- Improving lifetime trajectories of children
Mode and timing of birth have lifelong
impacts on children. Preterm and early term birth, and caesarean section birth have
risk of neurodevelopmental delays, autism, ADHD, and a suite of other chronic health
conditions. By optimising timing of birth and use of caesarean section, we will
improve the lifetime trajectories of Australian children with substantive cost savings.

- Reducing costs of maternity care
Public maternity care costs rose by 48%, from $2.6 billion to $4.4 billion in six years between 2012 and 2018. Some of these costs are driven by preterm birth and caesarean use, and others by low efficiency. It is
estimated overall that 30% of care is unnecessary or of little value, and 10% can cause
harm. Through our Learning Health System model, delivery of high value across
quality, preferences and cost, is embedded into maternal health care delivery at policy
and service levels.