By Sharon James, Jessica Moulton, Anisa Assifi, Jessica Botfield, Kirsten Black, Mark Hanson & Danielle Mazza
The potential impact of lifestyle risks such as smoking, unhealthy diet, unsafe alcohol consumption, and inadequate exercise, increases with the mother’s age and parity. While lifestyle risks are responsible for many chronic conditions, changing lifestyle behaviours during pregnancy can be too late to prevent some adverse pregnancy outcomes and risks to the child. To reduce these risks to both the mother and any subsequent pregnancy, the interconception period provides an opportunity to adopt changes in lifestyle behaviours. The interconception period refers to the time between pregnancies, when implementation of lifestyle changes may be challenging due to time restraints, employment and caring responsibilities to consider. Initiatives targeting lifestyle risk reduction activities during interconception need to consider these life stage demands to support engagement.
Our scoping review sought to understand these issues. Following the screening of 1734 results, 33 papers were included in the review. Interconception was most commonly identified through postpartum and/or preconception, rather than as a unique life stage. Most papers discussed lifestyle risk/s (n=30; 91%) during postpartum, rather than preferences of women during preconception. Women’s preferences for nutrition and/or physical activity engagement were the most commonly reported lifestyle risks in the included papers (82%; n=27), where the focus was largely on weight management and gestational diabetes mellitis or type 2 diabetes mellitis. None of the included papers discussed women’s perceptions of alcohol risk reduction during interconception.
Findings indicated the factors impacting women’s engagement in lifestyle risk reduction during interconception included;
- Informational needs. Person-centred communication and information were needed about lifestyle risk reduction benefits, chronic conditions and the risks of not changing lifestyle behaviours on mother and child. Practical advice was sought about issues such as meal planning as well as physical activity considerations.
- Managing competing priorities. Time and money impacted decisions around food access, choices and preparation as well as engagement in physical activity. The ability to prioritise lifestyle risk reduction alongside caring or family responsibilities, work and accessing health care was challenging.
- Physical and mental health. Postnatal recovery impacted the woman’s ability to engage in lifestyle risk reduction activities. Postpartum mental and physical health was considered to be worse than pre-pregnancy. While women recognised that there are mental health benefits of lifestyle risk reduction through improved energy, mood, stress and motivation, this was offset by perceived capabilities in initiating behaviour change due to fatigue, breastfeeding, stress and pelvic floor dysfunction.
- Self-perception and motivation. Changes in body shape following childbirth impacted women’s self-confidence and self-esteem. While returning to a pre-pregnancy body shape or looking healthier served as a motivator for lifestyle risk reduction, so too did family and social support, role modelling healthy behaviours, returning to work and setting goals. Women wanted to improve their health and prevent chronic conditions.
- Access to services and professional support. Access to transport for clinical support, physical activity or food impacted engagement in lifestyle risk reduction. Recommendations to address this focused on flexibility and access, such as a combination of home-based and face-to-face programs that consider family routines, involve children or have childcare available, are affordable and situated close to services such as medical practices. However, the availability of health professionals, health system fragmentation and communication techniques impacted women’s engagement in support for lifestyle risk reduction. The use of technology was considered a useful adjunct to this support.
- Family and peer networks. Access to peer and family support was needed to start and sustain lifestyle risk reduction activities. Family and partner support for lifestyle risk reduction removed the emotional burden of leaving the children with others so that risk reduction engagement could occur. However, environments that enabled women to make lifestyle risk improvements also occurred where, for example, these changes were made alongside domestic chore support or where behaviour change was undertaken with peers, partners or the family.
How can we better support women’s engagement in lifestyle risk reduction during interconception?
Our scoping review identified a range of challenges for women to engage in lifestyle risk reduction during interconception. Some strategies to overcome these might include:
- Supporting women better at home. Where there is little partner or family support, or, domestic and caring responsibilities occur alongside paid work in the home, traditional gender roles can fragment women’s opportunities for a healthy lifestyle. However, family and peer networks can create opportunities for lifestyle risk reduction through their involvement in behaviour change activities as well as through caring and domestic support.
- Making healthy lifestyles affordable and accessible. At a basic level, the social determinants of health such as income, health literacy and access to health care need to be addressed. This includes transport options, living wages, as well as the costs of childcare, healthcare, food and physical activity engagement. Other policy initiatives include curbing unplanned urbanisation on active transport and service accessibility as well as the aggressive marketing of tobacco, alcohol and unhealthy foods is also needed.
- Provide tailored and integrated lifestyle support. Whilst linked to the issue of affordability and accessibility, co-located and collaborative interconception services that includes, for example, diabetes education, contraception, and children’s healthcare would support interconception lifestyle risk reduction. This way, health professional support could occur across clinician groups opportunistically and in scheduled lifestyle risk reduction or chronic disease management consultations. Importantly, health professional communication about lifestyle risk reduction that is informed, person-centred and not stigmatising is valued by women.
- Improved employee wellbeing. For those who return to work following the birth of a child, there is opportunity to better support employees. Being active, for example, benefits job performance as well as physical and mental work abilities . Employers could provide enabling environments for lifestyle risk reduction through initiatives such as healthy food options and allocated time and financial incentives to attend places where physical activity engagement occurs.
Population-based lifestyle risk reduction engagement requires a multifaceted approach. The interconception period is no different. However, nuances to support women’s self-management during this life stage need to address the needs and challenges around issues including domestic support, childminding, ongoing person-centred clinical support, engagement costs and health literacy.
Read the research paper here.
About the Authors
Dr Sharon James is an experienced primary health care nurse and an Australian Primary Health Care Nurses Association Board Director. She currently works as a Research Fellow and Project Manager with Monash at the Department of General Practice on the Australian Contraception and Abortion Primary Care Practitioner Support (AusCAPPS) Network. Her other interests include women’s health, communication, preventive care, interconception health and nursing roles in primary health care.
Jessica Moulton is a PhD candidate at Monash University’s SPHERE Centre of Research Excellence and has over 5 years of experience in sexual and reproductive health research and service provision. Her PhD aims to co-design a nurse-led model of care to increase access to abortion and contraception in general practice.
Dr Anisa Assifi is a SPHERE CRE Research Fellow in the Department of General Practice, School of Public and Preventive Medicine at Monash University. She is a public health researcher, with an interest in sexual and reproductive health, with a particular focus on abortion access and adolescents. Anisa has worked in abortion research since 2014, starting at the World Health Organisation in Geneva. As part of SPHERE, Anisa is Project Manager of the Quality family planning services and referrals in community pharmacy: Expanding pharmacists’ scope of practice (ALLIANCE) trial and sexual and reproductive health research in the community pharmacy setting.
Dr Jessica Botfield is a Research Fellow with the SPHERE National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care at Monash University, and a Senior Research Officer at Family Planning NSW.
Professor Kirsten Black is an academic gynaecologist at the University of Sydney. She is a Fellow of the Royal Australian and New Zealand College of Obstetricians (RANZCOG) and chairs the college’s special interest group in Sexual and Reproductive Health. Kirsten has a PhD from the London School of Hygiene and Tropical Medicine, University of London and a Fellowship of the United Kingdom’s Faculty of Sexual and Reproductive Healthcare. Kirsten has been awarded over $10 million in research funding and has 150 peer reviewed publications. She practices clinically in the areas of contraception, abortion and preconception care and combines clinical work, research and teaching.
Mark Hanson is Emeritus Professor of Human Development and Health and BHF Professor at the University of Southampton, UK. He was a founder of the International DOHaD Society. He co-Chaired the FIGO Pregnancy and NCDs Committee and the Science and Evidence Working Group for the WHO Ending Childhood Obesity Commission. He chairs the Knowledge and Evidence Working Group of the Partnership for Maternal, Newborn and Child Health (hosted by WHO). His research concerns nutrition and health across the life-course, starting before conception. He pioneered LifeLab to promote health literacy in adolescents. He advocates developmental science to inform public health policy.
Professor Mazza is the Head of Department of General Practice at Monash University and the Director of the NHMRC-funded SPHERE Centre of Research Excellence in Women’s Sexual and Reproductive Health in Primary Care. Professor Mazza has held an impressive number of positions that reflect her leadership and prominence in her field and long-held commitment to advocacy for improved health outcomes for Australian women. Professor Mazza continues to work clinically as a GP and is a current board member of the South East Melbourne Primary Health Network. In addition, after serving for 11 years on the RACGP Expert Committee on Quality Care, she now serves on the RACGP’s Expert Committee on Research.