Health in Preconception, Pregnancy, and Postpartum
Health in Preconception, Pregnancy, and Postpartum
The Health in Preconception, Pregnancy, and Postpartum (HiPPP) program of research is funded by the Medical Research Future Fund (MRFF) Boosting Prevention program, through The Australian Prevention Partnership Centre (TAPPC) – ‘BP2 Generating and translating knowledge in health promotion and lifestyle improvement prior to and during pregnancy to reduce the burden of maternal obesity’. The research is led by the HiPPP Collaborative, a multi-disciplinary national/international network led from the Monash Centre for Health Research and Implementation (MCHRI). Its primary aim is to improve lifestyle, improve health and prevent maternal obesity. This work is underpinned by partnership, research, capacity building and knowledge translation.
To enable women-centred and equitable healthcare that supports women in healthy lifestyles, optimising weight and health across the life-course: from pre-conception, through pregnancy and post-partum. This improves women’s own health, that of their children and has intergenerational impact.
What is woman-centred care?
Two-thirds of Australian adults are overweight or obese with reproductive-aged women leading this trend, gaining more weight yearly than older women and progressing more rapidly to obesity than men. Maternal obesity preconception contributes to decreased fertility, increased risks in pregnancy (e.g., gestational diabetes, pre-eclampsia and large for gestational age babies). It also impacts intergenerational health with double the risk of obesity and metabolic syndrome in children.
Gestational weight gain (GWG) above the internationally recommended US Institute of Medicine (IOM) guidelines increases risk independent of pre-pregnancy weight. For every kilogram of weight gain above IOM recommendations, there is increasing adverse maternal and foetal outcomes of ~10%, with subsequent child and childhood obesity increased three fold.
GWG above recommendations occurs in the majority of pregnancies globally.
50% Australian women and 57% Aboriginal and Torres Strait Islander women enter pregnancy overweight or obese.
Health system burden with obese (vs healthy weight) pregnancies is ~40% more costly.
- Preconception, women are a diverse, otherwise healthy population that are difficult to engage with little connectedness with the healthcare system
- There is no national or international preconception health promotion program
- 1 in 2 pregnancies are not planned
- Only 1 in 5 Australian women perceive they are obese
- GWG guidelines are limited or not implemented
- 3/4 midwives report inadequate training, time and resources to support healthy lifestyle behaviours
- No country has implemented systems practice- and policy-level evidence-based strategies targeting preconception and pregnancy life stages to prevent obesity
Strategic prioritised implementation research, translation, capacity building and collaboration is now crucial to drive evidence into practice, improve lifestyle, reduce the obesity epidemic and deliver health impact.
The Solution – The HiPPP Centre of Research Excellence
Now with thousands of women having gone through pregnancy lifestyle randomised controlled trials (RCTs), no more RCTs are needed.
Clear health promotion preconception priorities (maintain a healthy lifestyle and weight, reduce smoking/alcohol, take folate) await implementation, given the intergenerational effects of adverse lifestyle at conception.
Similarly, effective low-intensity and low-cost lifestyle interventions in pregnancy prevent excess GWG, promote healthy lifestyle and need implementation at scale.
Our HiPPP program of research address how to meaningfully implement multifaceted obesity prevention strategies at pace and scale, to deliver tangible public health impact.
This program of research was generated from the HiPPP Collaborative that we formed in 2013. HiPPP is a national network with the primary aim of improving lifestyle and preventing maternal obesity, underpinned by partnership, research, capacity building and knowledge translation. Multidisciplinary expertise includes stakeholders across community, government, private and public health services, workplaces, primary care, end-users and international collaborators.
HiPPP involves three interrelated themes:
- Preconception Health
- Pregnancy Health
- Upskilling of Health Professionals
The Policy Context
There is a clear imperative to reduce obesity, yet treating established obesity is intensive, costly, largely ineffective and unsustainable at a population level. The World Health Organisation, Institute of Medicine, Australian Medical Association (Obesity-2016-AMA-Position-Statement), and the National Health and Medical Research Council Obesity Translation Committee have unanimously called for targeted efforts to improve lifestyle preconception and during pregnancy to limit obesity and improve health.
Follow us on Twitter: @HiPPPMonash
|Professor Helena Teede||
Executive Director, Monash Partners Academic Health Sciences Centre|
Director, Monash Centre for Health Research and Implementation (MCHRI)
Endocrinologist, Diabetes and Endocrine Units, Monash Health
|Professor Helen Skouteris||Monash Warwick Alliance Joint Professor of Healthcare Improvement and Implementation Science, Monash University|
|Deputy Director, Monash Centre for Health Research and Implementation (MCHRI); obstetrician/gynaecologist at Monash Health|
|Professor Frada Burstein||Professor, Information Systems Discipline Leader (IT), Monash University|
|Tracy Taylor||Senior Project Manager and Finance Lead, Monash Centre for Health Research and Implementation (MCHRI)|