DAPHNY: Diet and Activity for Pregnancy Hypertension
Research type
Research Study
Full title
Optimising lifestyle behaviours during high risk pregnancies: Mixed methods intervention development DAPHNY - Diet and Activity for Pregnancy Hypertension
IRAS ID
307929
Contact name
Lucy Goddard
Contact email
Sponsor organisation
University of Oxford, Research Governance, Ethics and Assurance
Duration of Study in the UK
2 years, 8 months, 30 days
Research summary
Research Summary
Background
It is important that pregnant women with long-term high blood pressure (chronic hypertension) are encouraged during pregnancy to adopt healthy eating patterns and good physical activity levels. These lifestyle behaviours have been shown to support appropriate weight gain during pregnancy and, in non-pregnant populations, have shown to support blood pressure management. Positive lifestyle behaviours thereby, have potential to improve health outcomes for both the mother and baby.Pregnant women with chronic hypertension may benefit the most from lifestyle support during pregnancy. However, there are only a few digital lifestyle interventions that have been designed or tested to support this important population.
Aims
We will work with pregnant women who have experience of chronic hypertension during pregnancy and their antenatal healthcare providers to answer the following research question: What is the optimum digital lifestyle intervention for pregnant women with chronic hypertension?Design and methods
Three workstreams will be performed including an online survey for women, focus groups with healthcare professionals, and interviews with women. We will gain valuable feedback from participants throughout each workstream to continuously modify and develop the digital intervention.Patient and Public Involvement (PPI)
Two PPI groups have taken place with pregnant women, or recently pregnant women, who have chronic hypertension. We discussed women’s thoughts and views on a digital lifestyle intervention. These discussions informed initial ideas, components and functions that will explored during the development of the intervention. We will continue to engage with two named PPI representatives as the project progresses.Dissemination
The research team will share the results of the work at conferences and with relevant charities, for example Action on Pre-eclampsia. The work will also be shared within maternity units and via online platforms including Twitter and Facebook groups which are accessed by women and healthcare professionals.Summary of Results
: People who enter pregnancy with long-term high blood pressure (chronic hypertension) may benefit the most from having a healthy lifestyle. Currently, we do not know the best way to support pregnant people with chronic hypertension to adopt healthy behaviours that may reduce blood pressure. The DAPHNY (Diet and Activity for Pregnancy Hypertension) study set out to work with healthcare professionals and women with experience of chronic hypertension during pregnancy to design, develop and optimise a digital lifestyle intervention.
Participants (healthcare professionals and pregnant, or recently pregnant women with chronic hypertension) were invited to take part in a survey, focus groups or an interview. 85 pregnant, or recently pregnant women completed the survey. This revealed high levels of knowledge, motivation and confidence around positive lifestyle changes for hypertension and to ensure a healthy pregnancy. However, some behaviours including fruit and vegetable intake and exercise levels did not meet recommendations. Less than half received advice about lifestyle behaviours in relation to their high blood pressure. This showed us that there was scope to support women during pregnancy to engage with these behaviours.
23 healthcare professionals and 21 women took part in focus groups or interviews. An evidence-based co-developed lifestyle App was developed after making many changes to the content and features, based on participant feedback. Participants were enthusiastic about the App, saying this would be beneficial to support the management of their high blood pressure but something like this didn’t currently exist. Participants used the App in different ways. The most accessed pages were entering a blood pressure reading and step count. Informational pages were accessed less often.
Lifestyle advice is not currently embedded in routine practice for the management of high blood pressure during pregnancy. Also, women’s lives are busy so taking up healthy behaviours can be challenging. These reasons make it difficult to introduce and promote the ongoing use of a lifestyle App. Connecting some of the information and features with existing self-monitoring blood pressure Apps along with ensuring the ongoing support from healthcare professionals may increase engagement with the App.
This study showed that lifestyle support is not part of hypertension management despite strong evidence that healthy dietary patterns and good levels of physical activity can reduce blood pressure. Though the App may be a step towards providing this support, significant changes to the intervention are needed which need further investigation to explore if these changes increase uptake and long-term use.
Thank you to all of the participants who took part in this study and the research and clinical staff who supported it’s uptake. Your contributions have been truly valuable. Thank you to the NIHR ARC studentship for funding this study.REC name
Wales REC 5
REC reference
22/WA/0130
Date of REC Opinion
17 May 2022
REC opinion
Further Information Favourable Opinion