Short summary

The objective of this project is to develop an Information and Communication Technology intervention that can assist new mothers to control weight after childbirth. Postpartum weight loss should prevent inappropriate weight trajectory and associated health consequences of overweight and obesity in a subsequent pregnancy as well as long-term risks like Type 2 Dia- betes.

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Rationale

The number of obese citizens, including women of reproductive age, has increased signifi- cantly over the past decades in developed countries. Consequently, obesity has become a common lifestyle inflicted condition that among others has negative impacts on fertility and increases the risk of other lifestyle diseases.

Research shows that with a proper diet and exercise during pregnancy, the risk of developing Gestational Diabetes Mellitus (GDM) can be lowered, and subsequently also prevent possible side effects from GDM. It is well documented that high pre-pregnancy BMI, excessive weight gain during pregnancy and the development of GDM increases the risk of future diabetes. GDM is the most frequent occurring medical complications during pregnancy and it is pru- dent to attempt to prevent GDM through preventing overweight and obesity prior to a (se- cond) pregnancy.

In Europe, between two to six per cent of pregnant women develop Gestational Diabetes Mellitus (GDM), and the incidence is increasing globally. The most common risks related to GDM are later development of Type 2 Diabetes Mellitus (T2DM), complications related to birth and short and long-term health related issues for the offspring, such as higher risk of obesity and development of metabolic disease at an early stage in life. Obesity increases the risk of GDM 7-11 times compared women with normal weight and high gestational weight gain further increases this risk. Up to 60 per cent of women who have developed GDM are estimated to develop T2DM within seven years after their pregnancy.

More than 70 percent of pregnant women exceeds recommendations of weight gain during

pregnancy. A survey on BMI and pregnancy, carried out at Odense University Hospital from 2004 to 2012, also indicates an increase in overweight and obesity among pregnant women.

Studies further show the importance of regaining a normal BMI after a pregnancy, for both

woman and foetus in a later pregnancy.

Since it is difficult to treat obesity in the long run, it is important to prevent obesity rather than fight it. Therefore, this project seeks to prevent development and aggravation of obesity among women of childbearing age, who have just given birth to their first child, and thus re- duce the number of women who will experience complications in the subsequent pregnancy.

An ICT intervention with focus on healthy lifestyle may be a way to reach and help the target group. An efficient solution should be created and used in a way that ensures that it has a pos- itive effect on the individual user by taking human behaviour into consideration, or it will most likely fail. The utilisation of a nudging strategy can be a way to close the gap between people's own preferences and their behaviour. Nudging is a way to make it easy for people to make the right choice and is thus a way to change people's behaviour, and can be defined as: "any aspect of the choice architectures that alter people's behaviour in a predictable way without forbidding any options or significantly changing their economic incentives." An ethi- cal debate weather nudging can be seen as paternalism, and thus limit the chooser's autonomy or manipulate the chooser, does exist. However, nudging is being described as libertarian pa- ternalism, which is a way to replace more strict rules by influencing citizens' behaviour in a way that does not restrict or punish the individual. Behavioural economics and motivational theory are here relevant to take into account in this context. The theories have been used in different domains, but it is relatively new within healthcare.

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Description of the cohort

Focus groups and workshops: The cohort for the focus group and workshop is postpartum women in the Region of Southern Denmark. The women are recruited from Svendborg municipality, Odense University Hospital, and Morskrop.dk. Women may also be recruited from yoga classes and training for postpartum women. If a postpartum woman hears about the project through another group, and contact us, she will also be invited to take part in the study. A focus group will also be held with health professionals. They will be recruited from OUH and OUH's network. The health professionals will also be invited to take part in the workshops.

RCT: The cohort is postpartum women and will be recruited from the hospital or the municipality.

Data and biological material

We do not use biological material in the project.

We use focus groups and workshops in the first part of the project to examine barriers and needs related to a healthy lifestyle and weight control among postpartum women, and how to motivate these women to a healthier lifestyle and weight control.

In relation to the RCT study, we gather data through questionnaires and the birth-register.