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Educational intervention regarding diet and
physical activity for pregnant women: Changes
in knowledge and practices...

Article in BMC Pregnancy and Childbirth · July 2016
DOI: 10.1186/s12884-016-0957-1


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7 authors, including:

Monica Yuri Takito Vera Lúcia Pamplona Tonete
University of São Paulo São Paulo State University


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Santos.0/). Faculdade de Saúde Pública. 140 of these women were cared for by professionals in the intervention group. and 141 were cared for by professionals in the control group. Keywords: Attitudes and Practices in health. Results: The intervention improved the professionals’ knowledge regarding leisure-time walking (92 % increase in the score. During pregnancy. The increases in the knowledge scores for walking and healthy eating of the intervention and control groups were calculated and compared using Student’s t-test. 1 month prior to and 1 year after the beginning of the intervention. p < 0. did not. unless otherwise stated. doctors and nurses (n = 20) from traditional basic health units in Botucatu. The intervention group. 95 % CI = 1. Monica Yuri Takito4. The percentage of pregnant women in each group that received guidance was compared using the chi-square test and the Prevalence Ratio (PR). 95 % CI = 715.0/) applies to the data made available in this article. received 16 h of training comprising an introductory course and three workshops.Malta et al. Methods: A controlled.83) and healthy eating (PR = 1. São Paulo 11030160. doctors and nurses (n = 22) from the family health units in a medium-sized city of São Paulo State. São Paulo 01246-904. . and indicate if changes were made. This study aimed to evaluate the effect of a focused educational intervention on improving the knowledge and practices of health professionals concerning diet and physical activity during pregnancy. distribution. using an ad hoc self-report questionnaire. Av. The professionals’ knowledge was assessed at two time points. non-randomized study was performed to assess the effects of an educational intervention on the knowledge and practices of nurses and doctors who provide primary care to pregnant women. provide a link to the Creative Commons license. this influence can be even stronger because there is frequent contact between women and doctors/nurses at periodic antenatal visits. Aluísio J D Barros5. Arnaldo.34-2.001). To analyze the professionals’ practice. and the corresponding 95 % confidence intervals (CI) were calculated. Cristina Maria Garcia de Lima Parada3 and Maria Helena D’Aquino Benício1 Abstract Background: The knowledge and practices of health professionals have a recognized role in behaviors related to the health of their patients. Advice * Correspondence: mairamaltanutri@gmail. Maria Antonieta de Barros Leite Carvalhaes3. BMC Pregnancy and Childbirth (2016) 16:175 DOI 10. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons. and reproduction in any medium. The Creative Commons Public Domain Dedication waiver (http://creativecommons.65. Brazil. Universidade de São Paulo . When trained. Conclusion: It is possible to improve the knowledge and practices of health professionals through the proposed intervention aimed at primary health care teams providing antenatal care.1186/s12884-016-0957-1 RESEARCH ARTICLE Open Access Educational intervention regarding diet and physical activity for pregnant women: changes in knowledge and practices among health professionals Maíra Barreto Malta1. women in the second trimester of pregnancy were asked whether they received guidance on healthy eating and leisure-time walking. whereas the control group. Antenatal care. 160 ap 315 Ponta da 1 Departamento de Nutrição. The women who were cared for by the intervention group were more likely to receive guidance regarding leisure-time walking (PR = Vera Lucia Pamplona Tonete3. Dr. Brazil Full list of author information is available at the end of the article © 2016 The Author(s).2*.76. supported and motivated. São Paulo. provided you give appropriate credit to the original author(s) and the source.82-3. which permits unrestricted use.31) when compared to the control group. Brazil 2 Rua Egidio Martins. these professionals can act as health promoters.

who did not receive any intervention. Several fac. 6]. the primary care system [29]. Methods nevertheless. the present article with doctors and nurses during periodic antenatal visits. to evaluate the effect of a focused educational interven- tors might influence eating behaviors and physical activ. Traditional health care units in care professionals in developed countries rarely discuss Brazil are not geographically defined and do not include issues such as nutrition during pregnancy with their pa. non-randomized study targeting pregnant some researchers have emphasized that the guidance women cared for at primary health care facilities was provided by healthcare professionals increases physical conducted in the city of Botucatu. risk antenatal care within the public health network of . defined geographic area. São women cared for by obstetricians who discussed physical Paulo city. an introductory course and three workshops. 25].Malta et al. activity during antenatal visits [18]. Botucatu is a municipality A study conducted in the United States found that the located in the Brazilian state with the highest socioeco- desire to exercise during pregnancy was higher among nomic level. cesarean delivery sionals and to formulate strategies to include the active [10]. low supported initiatives aim to train healthcare profes- birth weight [7]. moreover. group initially consisted of 23 doctors and nurses who In antenatal care. Similarly. 4] are prevalent among developed in Brazil. a recent literature review showed that health. as suppliers of knowledge basis for later analysis of the effect of the intervention and support. might play a relevant role in the promotion on the target population. prematurity [8.000 families living in a well- addition. activity among pregnant women [17]. women maintain frequent contact collective health interventions [32]. A controlled. The con- these include lack of time and lack of incentives [20]. they consider their lack of training to Family Health Strategy can be found elsewhere [31]. it is 250 km from the state capital. nurses and four nancy and have limited knowledge regarding its benefits community health workers who together provide med- and recommendations for safe practice [21–23]. be a hindrance in this regard [16]. The intervention among pregnant women [19]. Similarly. erature review suggested that nutritional counseling ef- fectively increases adherence to healthy eating patterns. state of São Paulo. BMC Pregnancy and Childbirth (2016) 16:175 Page 2 of 9 Background Health promotion programs focused on physical activ- Behaviors such as maintaining a sedentary lifestyle [1. a study in 93 % of whom reside in the urban area [30]. among other reasons. 2] ity and healthy eating are increasingly encouraged and and unhealthy dietary habits [3. itional primary care units. programs are adults [27. including the guidance and support provided by professionals with regard to diet and physical activity healthcare professionals [13–15]. of behavioral changes [24. In ical care to approximately 1. gestational diabetes [11] and pregnancy-induced promotion of physical activity and healthy eating within hypertension [12]. 9]. these professionals. The Family Health Strategy vide care to pregnant women are not acquainted with introduced in Brazil in 1994 is based on a novel concept the current guidelines for physical activity during preg. tion on improving the knowledge and practices of health ity. community health workers.000 inhabitants. The intervention ommendations in these areas is one of the barriers that group comprised staff from nine family health units. and has approximately 130. Certain health ministry- lems are associated with excessive weight gain [5. eating among pregnant women. describes the evaluation of the intervention process as a Therefore. the same review showed that professionals Design do not routinely promote such practices [16]. assessed educational interventions aimed at training pro- ical activity during pregnancy on mother-child outcomes fessionals who provide antenatal care in Brazil to sys- is increasingly gaining the attention of researchers and tematically promote physical activity and guide healthy public health managers because. 28]. The present study aimed these factors are potentially modifiable [13]. and can be modified by educational intervention. there are some barriers that hinder participated in a 16-h intervention package that included the promotion of physical activity and healthy eating. These public health prob. However. of a health team including a doctor. Finland showed that physical activity counseling during The study compared the knowledge and practices of antenatal visits effectively sustained exercise levels two groups of healthcare professionals. trol group (n = 20) was composed of doctors and nurses Doctors’ and nurses’ lack of knowledge of current rec. Previous the intervention group included staff from eight trad- studies have indicated that many professionals who pro. Pregnant women become strongly motivated to change their behaviors when they Population and sample are made aware of the positive effects that healthy eating All of the doctors and nurses (n = 43) who provided low- and physical activity have on pregnancy outcomes [19. during pregnancy. Based on the methodological framework used to assess During pregnancy. Brazil from 2012 to 2014. the primary targets of such pregnant women worldwide. no study has The evidence indicating the influence of diet and phys. A recent systematic lit. 26]. More details concerning the tients.

as were the results of a qualitative study the participants during the workshop.e. none refused. a tutorial that explained The results of a previous cross-sectional study con. ioral change according to the Transtheoretical Model centage of women who received guidance on healthy [39]. how to complete the form and folders to distribute to cerning the physical activity of low-risk pregnant women the pregnant women that described the recommenda- who received care from primary care units in the same tions for leisure-time walking and healthy eating as well city were considered in the design of the educational as their benefits. described the stages of behav- 5 % significance level to detect differences in the per. tent of the intervention because these individuals are The intervention lasted 8 months and comprised an required to attend the monthly administrative and tech.Malta et al. leisure-time walking and program [34]. which prioritizes the Family Health Strategy [33]. appropriate weight gain during pregnancy in all their oped to improve doctors’ and nurses’ knowledge con.7 %. Of the 353 women in promote leisure-time walking and healthy eating as part the second trimester of pregnancy who were selected for of the antenatal care provided at the family health units. Throughout the course. regard to walking and nutrition. the nurses Intervention and doctors agreed that they would provide counseling In the context of the Continuing Health Education with regard to healthy eating. and healthy eating throughout pregnancy and provided To analyze the professionals’ practice. On this occasion. trially processed cookies (once per week at most). a form to guide the provision of advice with antenatal care. and 141 were cared for by the con. portions of vegetables (one raw and one cooked). two Brazil. unit with the entire staff. 37]. One woman allocated to the The workshops were conducted at each family health intervention group could not be located. The printed materials were delivered to intervention [2]. pregnant women were acknowledged the barriers to and facilitators of the ac- required to be enrolled in the low-risk antenatal care tive promotion of leisure-time walking and healthy eat- program of the Botucatu public healthcare network. BMC Pregnancy and Childbirth (2016) 16:175 Page 3 of 9 the urban area of Botucatu municipality were invited to that identified barriers to and facilitators of healthy eat- participate in this study. used a motivational interview to improve the pro- eating and leisure-time walking. moreover. introductory course and three workshops. Finally. the 18 years of age or older and have started antenatal care professionals designed the initial version of a plan to beginning at gestation week 13. . fessionals’ interactions with pregnant women [40] and To be included in the study. One of the partic. Materials were printed to support counseling. cluding a form to guide and record the assessment of ing and leisure-time walking as part of the provided weight gain. the intervention group was composed of 22 healthy eating during pregnancy prior to intervention participants. The first workshop (4 h) in- two in the intervention group and four in the control volved designing a plan for systematizing the promotion group) refused to participate. The choice to framework used to define the recommendations for walk- include only professionals from family health units in ing during pregnancy (i. and the control group was composed of 20 were also considered. International guidelines provided the technical/scientific Group allocation was not randomized. 38 of those allocated to the interven. Further- second trimester of pregnancy were interviewed. The introduc- nical/scientific meetings held by the municipality’s family tory eight-hour course recommended physical activity health unit primary care managers. at least have been possible to prevent the professionals from the 5 days per week). two por- In addition. an educational intervention was devel. group were not eligible. the present study.. tices regarding their patients’ physical activity and Therefore. and six (1. participants. The itional basic health units in the control group aimed to healthy eating guidelines were based on the Brazilian rec- align the study with the current primary care policy in ommendations for pregnant women [38]: three fruits. The sample size provided 95 % power and a and their determinants. ing and physical activity among pregnant women from ipants was excluded because he was disaffiliated from Botucatu [35]. women in the the scientific basis for this recommendation. in- pregnancy and to systematically promote healthy eat. women with regard to physical activity. it updated the recommendations for weight gain these women were cared for by professionals from the during pregnancy as well as the status of pregnant intervention group. 30–40 min of walking at mod- the intervention group and only professionals from trad. be ing during antenatal care. erate intensity five or more times per week) [36. they would record the actions cerning healthy eating and physical activity during taken. and restriction of soft drinks and indus- family health units from meeting and sharing the con. of leisure-time walking and healthy eating within the local antenatal care routine. 140 of more. the participants completed a questionnaire to tion group and 27 of those allocated to the control evaluate the course. consultations. healthy eating trol group. this choice acknowledged that it would not tions of beans (one at lunch and one at dinner. The professionals’ knowledge and prac- the municipal primary care staff during the study.

including a sum. the total score ranged placed in the common areas of the family health units. square test according to the nature of each variable. duration of work in leisure-time walking and healthy eating in their antenatal the current healthcare unit (in years). The following variables were used to evaluate the pro- rials were delivered on that occasion. The other five Statistical analyses questions assessed the professionals’ knowledge of the The data were entered twice at the time of collection dietary recommendations for pregnant women regarding using Microsoft Office Access. and course. the dataset was fruit. nificance level. duration and intensity in each trimester). the consistency be. and after the educational intervention (1 point was tate the professionals’ task in antenatal care visits by assigned for each correct answer to questions regarding providing visual and practical support for such recom. and offer ways to overcome them. and duration of care. fessionals’ knowledge and practices: knowledge score for mary form listing all of the selected healthy eating habits walking before and after the educational intervention (1 and the recommendations for walking during pregnancy point was assigned for each correct answer to the ques- and two banners containing a synthesis of the messages tions on recommended frequency. latu- present proposals for promoting implementation of sensu graduate program (yes. Nine questions assessed the and the actual practices at the family health unit (excel- professionals’ knowledge of the current recommendations lent. After checking the data the frequency of intake and recommended portions of for accuracy and correcting errors. or agree upon procedures. age (in years).05 as the statistical sig- gard to walking and healthy eating in the consultations.e. BMC Pregnancy and Childbirth (2016) 16:175 Page 4 of 9 The second and third workshops each involved two Demographics hours of activity. analyses. reevaluate the difficulties met more than 10 years). practices performed at the family health units as excel- vention on the women’s behaviors. The characteristics of the intervention and control fessionals were asked prior to the administration of the groups were compared using Student’s t-test or the chi- questionnaire whether they had been given such guid. 1 month before and one year after the introductory leisure-time walking during pregnancy (yes or no). as well as the consistency between the topics addressed question version was created. survey sample: group (intervention or control). soft mendations to pregnant women. whether vention and control groups was assessed at two time pregnant women received guidance with regard to points. The between-group differences in the scores ence in family health units. no). time and intensity of (healthy eating and walking during pregnancy) to be leisure-time walking per trimester. drink and cookie intake. knowledge score for healthy eating before The purpose of providing these materials was to facili.0. obtained prior to the educational intervention were . which was used to as- essed cookies. whether pregnant women received guidance with regard searchers with previous experience in assessing the know. sess the consistency of the data and to perform statistical To assess the inclusion of practical guidance with re. vegetables. the professionals The means and standard deviations (SD) of the profes- responded to an ad hoc questionnaire that assessed their sionals’ knowledge scores (walking and healthy eating). the frequencies of the profes- their second trimester. the difficulties that the professionals had met and profession (nurse or doctor). its recommended frequency. good. This information was collected sionals who rated the topics addressed in the introduc- after adding specific respond-at-home questions to the tory course and their consistency with the actual survey for future assessment of the effect of the inter. The questionnaire were the topics addressed (excellent. soft drinks and industrially proc. We adopted alpha <0.Malta et al. the total score ranged from 0 to 5). bean. To evaluate the introductory course. Re. The third workshop sought to reinforce knowledge. increase in the knowledge score for walking (score for walking after – score for walking before). ledge of healthcare professionals specifically designed the The variables used to assess the introductory course questionnaire for the present study. calculated. work in antenatal care (less than 5 years. eating after – score for healthy eating before). vegetable. from 0 to 9). were tween the topics addressed and their practical experi. For ance during the antenatal care visits performed during the intervention group. New support mate. the recommendations for fruit. increase in Data collection the knowledge score for healthy eating (score for healthy The knowledge of the professionals allocated to the inter. transferred to Stata version 13. to healthy eating during pregnancy (yes or no). for leisure-time walking (i.. adapted and retested until the final 14. lent. using an ad hoc self-report questionnaire. good or fair/poor). The purpose of the second workshop The following variables were used to characterize the was to evaluate the effects of the first workshop. the pregnant women cared for by the two groups of pro. beans. perception of the course content. 5–10 years. good or fair/poor) was pilot tested. before and after the educational intervention. or fair/poor were calculated. specialization course.

0). eating showed no significant difference between the groups (intervention = 0. nurses 3:22 (SD = 1. p = 0.7 %. whereas the average age of those in were positive in terms of improving the professionals’ the control group was 39. The knowledge scores of the intervention and control tion with regard to leisure-time walking and healthy groups after the educational intervention were 7. were cared for by professionals in the control group A significant between-group difference with regard to (leisure-time walking: I = 50.6 (SD the healthcare unit) showed significant between-group = 1.55. the intervention group were younger and had worked at There were no differences in the mean knowledge health care units for less time.7 % as good. The present study assessed an intervention undertaken natal care was approximately three times higher in the with primary care nurses and doctors seeking to improve control group than in the intervention group. were more doctors in the intervention group than in the control group (54 % vs.Malta et al. Because the knowledge 1. 40 %). The possible differences between doctors group (p = 0.0 (SD = 1. given that 79. a significant difference (p = 0. however.89).3 %).88)). The aver.1296). eating practices more frequently than those in the The professionals were satisfied with the topics ad. healthy profession was not found (p = 0.7) years in the intervention group and 8. however. The average mote walking and five healthy eating practices among age of the professionals in the intervention group was pregnant women at antenatal care visits. The corresponding 95 % confidence intervals (CI) were average increase in the knowledge score regarding healthy calculated.7) in the control group (p = 0. some differences between intervention consistent with the actual practices performed at family and control groups were expected.1). were found not to be confounders. scores for walking and for healthy eating were calculated The knowledge scores obtained prior to the educa- separately. 1.6 %.15).4 (SD = 1. All of the cated to the intervention or control groups in the participating professionals considered the topics to be present study. control = 0.0001).6 (SD = 1. In addition. the increases in the knowledge professionals). C = 33.2 (SD = 8. however.3 (SD = eating were evaluated using Student’s t-test.2547 (doctors 3. respectively.2 professionals in the intervention group provided guid- (SD = 8.9 (SD = 2. and healthy eating. for walking and 3. and the difference was assessed using the chi.3 % Given that the participants were not randomly allo- rated them as excellent and 20. group and in the control group were compared using The average knowledge score for leisure-time walking Student’s t-test. for healthy ceiving guidance with regard to leisure-time walking and eating (Fig. In addition. healthy eating from both groups of professionals was The average increase in the knowledge score regarding compared. BMC Pregnancy and Childbirth (2016) 16:175 Page 5 of 9 analyzed using Student’s t-test. The average know- differences.18). possible induction effect resulting from the completion p = 0. additional analysis of the initial ledge score for healthy eating was 3. Some variables (age.25 (SD = 0. The results 34. C = 19. those variables scores of doctors and nurses prior to educational inter.0) years.5) in the intervention group and 3. however. vention: leisure-time walking. dressed in the introductory course. (SD = 2. the 2. and nurses in knowledge prior to educational interven.889). duration of work at was 3. knowledge regarding the current recommendations for age duration of work in the current healthcare unit was leisure-time walking during pregnancy.63). the knowledge and motivation needed to actively pro- this difference was not significant (p = 0.9 The percentage of pregnant women who reported re. Thus. p = 0. The average increases in the intervention tional intervention did not differ between the groups.5 for the intervention group and 0.4 (SD = 10. control group.0) in the knowledge scores did not confirm them as potential intervention group and 3.6 (SD = 1. The professionals in health units. 1).63 (SD = of questionnaires by the participants prior to the . Discussion sionals with more than 10 years of experience in ante.1158 (doctors 4:25 One additional factor deserving of consideration is the (SD = 0:50). There were 20 professionals in the control group sionals in the intervention group than when they and 22 in the intervention group. walking was 3.8 (SD = 2. The number of profes. the following results were obtained by con- of the professionals in the two groups did not differ sidering doctors and nurses as a single group (health prior to the intervention.3 for the square test.2) in the control confounders.7) and 3. there eating: I = 58.97).9) years in the control group.2) years.0) and 3. the Prevalence Ratio (PR) and control group. respectively. These differences ance regarding leisure-time walking and the five healthy were significant (Table 1).1 %.15. nurses 3. Results Table 2 shows that women were more likely to re- All of the doctors and nurses who provided low-risk ceive guidance regarding leisure-time walking and antenatal care within the public health network of the healthy eating at an antenatal care visit during their urban area of Botucatu municipality participated in this second trimester when they were cared for by profes- study.

or both.4 (10. able procedures or actions.9) 0. Because increased know.2 (8.0) Specialization (course) 20 (90. and healthy eating during antenatal care visits was a tionnaire was not observed in the control group. avoided the errors that result from the use of self- The validity of the results is also supported by the reports. nificant encounters with their healthcare providers tion during consultations.003 N (%) N (%) Profession Doctors 12 (54.0) 0.0) 0.041 Duration of work in unit (years) 2.Malta et al.0) 39. Traditionally. provided by the professionals was evaluated because nant women. thereby leading them to seek information. the use of pregnant women en- procedure used to assess the between-group differ.0) intervention.5) 06 (30.0) 0.7) 8.889 Nurses 10 (45.2 (8.6) 08 (40. information bias [41]. In addition.151 5 to 10 09 (40. assessment of this practice the women likely only remembered and reported sig- is based on professionals’ reports or direct observa. the latter is considered a but forgot more superficial encounters [42].6) 08 (40.349 Duration of work in antenatal care (years) Less than 5 10 (45. vided guidance with regard to leisure-time walking ledge of the topics addressed based on the second ques. it may suitable third option because it avoided the need to be inferred that the results were due to the educational perform laborious and expensive observations and intervention. BMC Pregnancy and Childbirth (2016) 16:175 Page 6 of 9 Table 1 Professional characteristics of the study groups Characteristics Intervention (n = 22) Control (n = 20) Mean (SD) Mean (SD) P-value Age (years) 34. ables one to assume that the quality of the guidance ences regarding the actual guidance provided to preg.9) 17 (85. Fig. 1 Average knowledge scores for walking and healthy eating during pregnancy before and after educational intervention .4) 12 (60.9) 06 (30.2) 0. thereby resulting in gated topics. superior approach because individuals tend to over- enced the results of the second assessment by raising the estimate the frequency with which they perform desir- awareness of the professionals with regard to the investi.0) More than 10 03 (13. This action might have favorably influ.0 (1. The use of pregnant women to discuss the topics more frequently in their consultations assess the frequency with which professionals pro- with pregnant women.

Another study performed garding the healthy eating knowledge scores notwith. tions for physical activity during pregnancy. novelties should be walking at their antenatal care visits. leading to patient im- significantly increasing the percentage of women who provement. cational intervention. and so on). saving time. The lack of change re. the current recommendations for physical activity dur- ing guidance on healthy eating than those cared for by ing pregnancy [23]. the distribution of Researchers who investigate the process of healthcare printed materials was specifically tailored to facilitate the service innovation dissemination argue that the exposure selection of the most relevant guidance to be pro. engage for continuing health education action targeting this them and facilitate their work so that they would effect. In addition. duration.34–2. 8. This finding indicates Africa showed that a large majority (83 %) of the doctors the positive effect of the intervention. 48]. few of the professionals (doctors and have more knowledge of the dietary recommendations nurses.e. physical effort during pregnancy [47]. of individuals to new knowledge has little effect when vided at each consultation. nurses standing.76 (1. prior to the intervention. In addition to up.. . However. current evidence shows that exercise of appropriate fre- portantly.6 %) 47 (33. thereby somehow better (i. cause dietary assessments and the promotion of healthy This situation was favorably modified in the intervention eating have been included as part of antenatal care visits group.9 %) 1 Healthy eating Yes 82 (58. especially ing pregnancy is older and more extensive [43–45]. The results of a study conducted in Michigan. Im.4 %) 94 (66.31) <0. women who were cared for by professionals in (9. be. who responded were not familiar with the ACOG guide- dating their knowledge. ively promote healthy eating within their antenatal care The unfavorable scenario observed regarding the pro- routine. importantly. For this realization to helped improve the communication between the occur. those for leisure-time walking.3 %) 114 (80. BMC Pregnancy and Childbirth (2016) 16:175 Page 7 of 9 Table 2 Number and percentage of pregnant women who received guidance regarding leisure-time walking and healthy eating (the values shown are number (%)) Guidance received Intervention (n = 140) Control (n = 141) PR (95 % CI) p Leisure-time walking Yes 71 (50.65 (1. thereby making that result a reality.1 %) or community healthcare workers (3. were similar: 73 % of investigated obstetricians This hypothesis was confirmed by the results and might were not familiar with the guidelines of the American account for the lack of effect of the intervention on the College of Obstetricians and Gynecologists (ACOG) for healthy eating knowledge scores. the educational lines for exercise during pregnancy [46]. fessionals’ knowledge of physical activity during preg- The positive results regarding the inclusion of healthy nancy results in low encouragement of pregnant women eating and walking guidance in the consultations might to begin or maintain regular physical activity. the stages of behavioral change described in quency.7 %) 1 The professionals in both groups were expected to Importantly. USA. Together.Malta et al. increasing the professional’s or the service’s had an opportunity to discuss healthy eating and prestige. This sce- have resulted from better understanding of the change nario might be explained given that past recommenda- process associated with the health-related behaviors of tions indicated the possible negative effects of excessive the professionals and the improved communication be. subject is obvious. the tween the professionals and the pregnant women. in Brazil for more than 20 years [29]. Thus. exercise and pregnancy [21]. with no difference between them) in either group than of the physical activity recommendations during were acquainted with many of the current recommenda- pregnancy because the literature on healthy eating dur.83) <0. and intensity protects maternal and the Transtheoretical Model [39] and the motivational fetal health and is associated with favorable perinatal interviewing technique [40] were addressed in the edu. 36.82–3. new knowledge or practices must be perceived as professionals and their pregnant patients [42].1 %) 2.7 %) 27 (19. A survey study conducted in South professionals in the control group. outcomes [6. the need intervention aimed to motivate the professionals. in Brazil found that few physicians (7.9 %). or because of both.001 No 69 (49.001 No 58 (41.3 %) 1. compatible with the professional’s needs and values. the knowledge is not perceived as relevant to the health- cluded in the educational intervention might have care facility or the individual. Moreover. the elements in.6 %) knew the intervention group were more likely to report receiv.

1590/S0034-8910. Br Med J. Hillier M.jmwh.55(6):502–11. São Paulo 11030160. no. MABLC participated in the study conception and design. Womens Health.2014.1590/0102-311X00115112. along with the purpose of that request. São Paulo. performed the statistical 10. The women Paulo . Spitznagle T. interpreted the results. nurses and not receive suitable guidance. doi:10. those cared for by the professionals in the intervention group. Competing interests In summary. Brazil. study conception and design. Conclusions Author details 1 The current intervention was effective. 2012.USP.0b013e31825365f1.33(2):87–92. Rev Botucatu-UNESP. Faculdade de Medicina de Botucatu. São Paulo space for improving the intervention given that a large State University at Botucatu-SP (Universidade Estadual Paulista. Fazio ES. Boulvain M. and critically Myhre R. Rev Saude Publica. Nomura RMY. interpretation. the professionals from the Botucatu-SP Saude Publica. Faculdade de Saúde Pública. Funding 4.2013047004689. professionals’ knowledge regarding the dietary recom. McNulty B. 2014. J Midwifery performed the analysis. Simões VMF. the educational intervention used in this The authors declare that they have no competing interests. large prospective cohort study. contributed to the elaboration of the materials used in EI. Brazil. UNESP. 2011. 160 ap 315 Ponta da Praia. study promoted changes in the knowledge and practices of the professionals in the family health units. Hunt D. Martiniano AC. Neri C. Arnaldo. Brennan L. Dias MCG. Benício MHD. the School of Medicine. . Rev The authors are happy to share anonymized data related to this paper upon Bras Ginecol Obstet. São Paulo 01246-904. contributed to the study conception and design. Universidade de São knowledge score for leisure-time walking. et al.29(8):1583–94. Standard deviation Mental health and physical inactivity during pregnancy: a cross-sectional study nested in the BRISA cohort study. and it accom. Matern Child Health J. Confidence interval. doi:10. São Paulo. 5Departamento de Medicina Social. 2010.4(11):845–50. Rio Grande do Sul.43(6): interpreted the results. Rua Mal. How do women’s The São Paulo Research Foundation (Fundação de Amparo à Pesquisa do diets compare with the new Australian dietary guidelines? Public Health Estado de São Paulo. Barguer MK.012. Takito MY. 72032011000200006. 7. Carvalhaes MABL. Kayser B.pmrj. VLPT contributed to the educational intervention. doi:10. Pelotas 96020220. Mishara GD.1590/S0100- receiving a specific request. UPeSC).1249/ MBM participated in the study conception and design. intervention. Physical activity by pregnant women and administered the educational intervention. References Abbreviations 1. Takahasi EHM. 18618970 group exhibited significant increases with regard to the Botucatu. Benício MH. Maternal dietary patterns and preterm delivery: results from revised the manuscript. primary care network. and critically revised the manuscript. 2013. Batada A.211(4):401. doi:10. Brazil. coordinated data collection. 715. Professor Montenegro. Escola de Educação Física e Esporte. Prof. McAuliffe FM. Davenport MH. Domenjoz I.1016/j. Heneghan C.UNESP. prepared and applied the EI. Deodoro.348:g1446. Sengpiel V. 2015.017. Atividade física em gestantes assistidas na atenção primária à saúde. Prevalence ratio. Silva AAM. and doi:10. Dr. 2009. Consent for publication more. proportion of the women in the intervention group did 3989–2011) and the School of Public Health. doi: Acknowledgments 10. Fapesp) funded this study. Sopper MM.Malta et al. Am J Obstet Gynecol. São Paulo. 5. 4Departamento de Pedagogia do Movimento do Corpo Humano. interpretation. University of São Paulo-SP (USP. Faculdade de Medicina.ajog.07.03. Zugaib M.2012. 2013.18(2):218–25. 8152/2012) approved this study. 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