Promoting Healthy Weights, Lifestyles and Nutrition During Pregnancy Through Innovative Counselling Methods

Study Objectives:

1. To examine the efficacy of a supportive prenatal counselling (intervention) vs. standard prenatal care (control) in promoting appropriate weight gain and dietary intake among pregnant women.
2. To describe pregnant women's and the RD's perceptions of the strengths, limitations, effectiveness and satisfaction with the supportive prenatal counselling (intervention) vs. standard care (control).

Study Design:

Seventy women < 20 weeks gestation will be recruited to participate in this randomized control trial. Interested women will be screened in person or by telephone by research staff to determine eligibility. During screening, participants will provide their self-reported height and pre-pregnancy weight. After eligibility is determined, the eligible participants will be stratified by pre-pregnancy body mass index (BMI). Block randomization will occur within each stratum to determine group assignment. Participants will be blinded to their group assignment, as all participants will follow the same study timeline and the visits will consist of the same procedures (completing questionnaires, measuring anthropometrics). During the visit, the control group will take part in routine prenatal care conversations with a Control RD, while the intervention group will receive conversations framed in a Healthy Conversations and 5As approach with the (different) RD. This is deemed as supportive prenatal counselling in our study. The investigators do not anticipate the participants would know the difference. At time of screening, the Baseline Visit will be scheduled with the respective RD. One RD will be responsible for participant contact and data collection from each group. Baseline and follow up appointments will take place at the Clinical Research Unit (CRU)/Human Nutrition Research Unit (HNRU), 2nd floor of the Li Ka Shing Centre for Health Research Innovation. All questionnaires used in this study will be online and available either in RedCap or through ASA24-CANADA-2014 (a specific dietary recall system). All participants will continue to receive prenatal care through their normal care providers, usually a Family Physician and/or Obstetrician/Gynecologist.

At the baseline visit, study staff will confirm participant eligibility, answer any questions, and review the "Information & Consent Form". Women will be asked to provide their healthcare number and permission to collect information from the Antenatal and Delivery and Birth records. For each group, the respective RD will guide participants in completing: the "Baseline Lifestyle Questionnaire" and a ASA24-Hr dietary recall. Each participant's weight and height will be measured. All participants will be provided with a package of general printed resources that contain relevant health information for pregnancy. After each visit and phone call, the RDs will record notes in the participant's study chart. At 28 and 34 weeks gestation, the respective RDs will call the participants to remind them to complete the dietary recalls and/or book the next clinic visit. For the intervention group, the RD will follow-up with goals previously set (if any). At approximately 30 weeks gestation, study visit 2 will occur to complete the "30 Week Lifestyle Questionnaire" for both the intervention and control groups. At 34 weeks, all participants will be sent the link in their email to complete the "34 Week Lifestyle Questionnaire" and the ASA-24 Hr recall. At approximately 4-6 weeks postpartum, all participants will receive a link to the "Postpartum Questionnaire". Participants in both groups will be asked if they would like to take part in a post-study focus group to discuss their perceptions of the strengths, limitations, effectiveness and satisfaction with the study. A separate focus group will be conducted for each arm of the study and will be facilitated by study staff that is not known to the participants. Participants who would like to meet with a RD for postpartum nutrition counselling will have the opportunity to schedule a session; no data collection will occur at this point.