Implementing best practice weight management in antenatal care 

Queensland Health

Pregnant women who gain weight in accordance with guidelines have the lowest risk of pregnancy and birth-related complications. However, existing service processes and delivery of care does not always support women to adhere to best practice guidelines and achieve these outcomes. Even when good evidence is available to support maternal behavioural change, health professionals do not necessarily adopt it, or disseminate it to women.

This is a broader problem across healthcare delivery. Simply producing and disseminating guidelines does not always effect practice change. Evidence-practice gaps may continue to exist and to close this gap a systematic and theory-driven process (i.e. the implementation science methodology) is essential. This requires an assessment of influencing factors (barriers/enablers) and an implementation and evaluation plan that uses strategies to overcome and address barriers. The use of a framework to underpin the process is highly recommended.

This body of work applied implementation science methodologies in iterative improvement cycles across the Mater Mothers’ Hospitals (Brisbane) to design effective interventions to facilitate the delivery of best-practice care.

Research Team

A/Prof Shelley Wilkinson, Dr Michael Beckmann, Sally McCray, Elin Donaldson, Dr Helen Stapleton, 

Source of funding

Queensland Health-Health Research Fellowship 


Surveys, literature review and publications

Developed training and resources

  • Healthy Start to Pregnancy Initiative: This is an evidence based behaviour change workshop developed, trialled (RCT) and embedded as usual practice
  • Healthy nutrition booklet delivered by midwives at women’s first visit, which supports women to have a healthy diet in pregnancy
  • Online tools that women can access on the Mater Mothers website or watch in the antenatal clinics. It shows not only what to eat but how to eat, with practical tips and tricks.
  • One to one appointments in dietitian clinics plus groups showed a link between attendance and increase food and vegetable intake and guideline awareness
  • Support via mHealth (mobile health) text message program (txt4two)
  • Online, accessible training for staff
  • Scales for every room in the antenatal clinics

System changes and decision making tools:

  • Pregnancy weight tracker. It is a guide that allows pregnant women to track their weight and health professionals to guide conversations and referrals around healthy weight gain
  • Changes to electronic medical record to prompt weight recording           

This body of work has demonstrated successful longitudinal, hospital-wide, effective, stepped identification and targeting of barriers to guideline adherence with large and significant changes in health provider behaviour known to influence GWG.

The quality and relevance of this work was recognised with an invited blog post for the Biomedical Central journal website to accompany a published article, as well as Clinical Paper of the year award (MRI-UQ, 2019).

Knowledge Impact

This program has added to the knowledge base of the clinical care of pregnant women by:

  • demonstrating that interventions that include dietary advice, physical activity, supported by ongoing weight monitoring can prevent excessive GWG and can result in more women across all body mass index (BMI) categories achieving weight gain within correct ranges
  • Showing that this approach is highly efficacious when delivered by obstetricians and midwives and supported by dietitians in an antenatal setting
  • Showing the cumulative effect of interventions (recording, monitoring, advising and referring)
  • Showing that we need to map local solution to local setting – demonstrating that it was more effective to tweak how the system was working rather than rely on knowledge.  Reinforcing behaviour is a “stickier” solution than just education.

Health Impact

Clinical practice changes implemented through this program has led to:

  • increases in weight tracking compliance at  women's antenatal appointments (cohort data analysis in weight tracking compliance results : 4.2% baseline, 18.9% with scales and in service and 61.8% medical record prompts)
  • Proxy measures of this program’s interventions effectiveness demonstrated that:
    • There has been a significant increase in correct GWG from 23.2% to 38.6%
    • There has been a significant decrease in excessive GWG from 57.3% to 32.6%
  • Increase in measuring GWG has meant that there is a:
    • likelihood of catching if GWG gain is going above recommendations earlier
    • earlier referrals
    • decrease likelihood of gestational weight complications including adverse maternal and infant outcomes, including diabetes, preeclampsia, caesarean section, foetal macrosomia, admission to neonatal nursery, increased risk of postpartum weight retention, and risk of chronic disease for both mother and baby

Social Impact

Potential social impacts from this program include:

  • Community of Mater:  more respectful women focused program related to weight
  • Women feeling better and healthier – better self esteem
  • Knowledge of nutrition possibly taken to the family unit

Economic Impact

Potential economic outcomes from this program include:

  • introducing efficiency and effectiveness of care at Mater due to more timely referral and care as result of better clinical practice
  • management of weight in pregnancy decreases leads to less chronic disease which could lead to a decrease in burden on health system due to healthier citizens

Project members

HMNS Researcher