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Evidence review highlights effective interventions to boost health during pregnancy

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The most effective ways for midwives to support women to be healthy during pregnancy, based on the available evidence, have been drawn together in a new report by the research wing of the NHS.

The report, published by the National Institute for Health Research, details evidence-based interventions that can improve the health and wellbeing of pregnant women and their babies.

“There are a number of risk factors that can affect both mother and child”

Peter Davidson

The themed review – titled Better Beginnings: Health for Pregnancy – brings together 75 published or ongoing studies that are funded by the NIHR and cover health and wellbeing before, during and soon after pregnancy.

It includes maintaining a healthy diet and weight, breastfeeding and mental health, as well as smoking cessation, alcohol and recreational drug use, and domestic violence. It also shows how improving care for women from disadvantaged communities can improve the life chances of their children.

Key findings from the wide-ranging report include advice on the best ways to promote and target smoking cessation advice, dietary supplements and breastfeeding.

It noted that a review of pregnancy smoking cessation studies found high rates of relapse, with only 13% of women not smoking at delivery, and 43% of these smoking again six months later.

However, it highlighted that psychosocial interventions had been shown to enable women to stop smoking during pregnancy and reduced low birthweight and preterm births.

“The report supports midwives to fully understand the evidence that underlies our public health messages”

Cathy Warwick

In addition, the report said a review had confirmed folic acid supplements, taken before and during early pregnancy, reduced the risk of neural tube defects in the baby.

But it noted that women from disadvantaged groups were less likely to take folic acid or other supplements, suggesting they might need additional support.

Meanwhile, the report said dietary and lifestyle interventions for obese pregnant women reduced maternal weight gain and some risks for woman and baby.

However, it highlighted that giving non-diabetic obese pregnant women the diabetes drug metformin did not reduce risk of high birth weight.

Offering support with breastfeeding – from either professionals or peers – increased the length of time mothers breastfed for, said the NIHR report.

Peer support programmes for women on low incomes was particularly effective in helping them to start, it added.

The report noted that offering a doula – one-to-one support during pregnancy and for a short while after birth – improved care experiences and breastfeeding rates among disadvantaged women.

On mental health, the report said that psychological interventions delivered by health visitors reduced symptoms of postnatal depression in women at risk of developing it.

Another study suggested early treatment with antidepressants had clinical benefits for reducing postnatal depression as well, said the report.

Brief advocacy interventions, based on empowering women, may also improve short-term mental health and reduce domestic abuse in pregnancy.

Professor Cathy Warwick

Professor Cathy Warwick

Cathy Warwick

Dr Peter Davidson, director of the NIHR Dissemination Centre, which produced the report, said: “A healthy pregnancy helps a child to get the best possible start in life. But there are a number of risk factors that can affect both mother and child, from pre-conception, through pregnancy, and into early childhood.

“Research funded by the NIHR sheds light on how we can go about supporting parents to mitigate some of these risks,” he said. “It also highlights opportunities and mechanisms to improve health and wellbeing during this pivotal time.”

Cathy Warwick, chief executive of the Royal College of Midwives, said the college was “delighted” that the NIHR had published the themed review.

“The report supports midwives to fully understand the evidence that underlies our public health messages to women who are pregnant or planning a pregnancy,” she said.

“It is also important for midwives to understand the quality of research findings and where evidence needs strengthening,” she added.

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