Delivering optimal weight gain guidance and support to pregnant women study

The intervention will be delivered during and as part of antenatal care. There will be one additional antenatal appointment and the duration of this appointment will be 30-45 minutes. There will be two further intervention sessions which can be either added to a usual antenatal appointment or be a separate appointment. Whether these two further intervention sessions are added to a usual antenatal appointment or are a separate appointment will depend on what is decided by the participant and her Lead Maternity Carer (LMC) midwife. These two further intervention sessions will each be about 15-30 minutes duration. The intervention appointments will take place at the place where the routine antenatal appointments occur, which is usually at the LMC midwife's practice rooms or the pregnant participant's home. The first intervention visit will take place before 15 weeks gestation and this will be after the first registration antenatal visit. The intervention will consist of the LMC midwife asking some contextual lifestyle questions (see protocol) such as are there any dietary restrictions such as nut free or lactose free, how many people are in the household, who mostly purchase the household food, who mostly cooks household meals. There are also eight questions about eating habits using a modified validated questionnaire (STC:Diet). The response to these questions guides which part of the participant's eating habits to focus on and prompts further detailed questions to enable a goal setting process. Three realistic achievable lifestyle goals will be determined by the participant and her LMC midwife followed by a discussion as to how these could be achieved. Appropriate written resources will be provided or recommended by the LMC midwife. The second intervention session will take place about 3-4 weeks after the first intervention appointment. The purpose of this second intervention session is to check on progress with achieving the lifestyle goals and revise or establish new goals as indicated, and to provide further guidance and support. The third intervention session will take place about 3-4 weeks after the second intervention session. The purpose of this third intervention session is the same as that for the second intervention visit. The participating LMC midwives will attend a 5-hour training programme. The overarching goal of the training programme is to update skills and knowledge to enable the delivery of the intervention to enable healthy weight gain in pregnancy. There will be 1-hour of required pre-reading and self-reflection prior to attending a 2-hour training session via zoom. The topics in this zoom session will include the background to the study, a summary of the importance of healthy gestational weight gain, the principles of good food choice, an explanation of the intervention tool, including a brief dietary assessment and goal setting. This will be followed by a further 2-hour in person session, which will include a brief recap of the the intervention tool (brief dietary assessment and goal setting), an explanation and demonstration of the study processes including informed consent, data collection and recording and clinical measurements, followed by three case studies. The two 2-hour sessions will be delivered by the two study co-principle investigators and two dietitians working in the study area. The training materials are study specific. It is intended that the training programme is delivered over a one month period, and that the the training programme is completed within 6-weeks of a participating LMC midwife enrolling her first pregnant participant into the study. Adherence to the intervention by participants will be monitored by LMC midwives through assessment of goal achievement. Setting and progress with goal achievement will be recorded as part of data collection. Information at each of the three intervention visits such as answers to the brief dietary assessment, recording of participant goals and completion of clinical measures will be recorded electronically and reviewed monthly as part of routine data downloads for data checking. An Assistant Research Fellow will also communicate with participating LMC midwives regularly to support them with their study participation and implementation of the intervention.