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Physical activity throughout pregnancy has been shown to have health benefits for the pregnant person, including reductions in the risk of preeclampsia and gestational weight gain and improvements in blood pressure regulation. Despite the benefits, many pregnant women do not meet the guidelines for physical activity throughout pregnancy. Therefore, it is important to determine what influences women's activity levels during pregnancy. This systematic review of the qualitative literature aimed to determine pregnant and postpartum women's perceptions of barriers to and enablers of physical activity, specifically during pregnancy.MEDLINE, PsycINFO, CINAHL, and Embase were searched systematically to identify qualitative studies investigating pregnant or postpartum women's perceptions of barriers to and enablers of physical activity during pregnancy. Included studies were limited to populations of pregnant or postpartum women, the majority of whom were aged 18 to 40 years, and studies published from 1985 onward. Data quality was assessed using the Critical Appraisal Skills Programme Qualitative Studies Checklist. Data were extracted using NVivo software and subsequently mapped on the COM-B framework.Twenty-five qualitative studies were included in this systematic review. Sixteen themes were identified that mapped onto 6 components of the COM-B framework. Commonly reported barriers to physical activity during pregnancy included pregnancy symptoms, lack of knowledge of what constitutes safe activity, and the opinions of women's social circles. Commonly reported enablers of physical activity during pregnancy were social support and the experienced benefits, including physiologic, psychological, and social benefits.The results of this systematic review have clinical implications for perinatal care providers, as the overall benefits of physical activity during pregnancy have been well documented in previous studies. The authors recommend clinicians aim to explore pregnant women's perspectives on physical activity during pregnancy in order to be able to address their perceived barriers to and enablers of physical activity during pregnancy.

Objectives: Pregnant women prioritize the health of their pregnancy, and weight gain contributes to the pregnancy’s health. Women encounter different messages about gestational weight gain from various sources that can be confusing. This study aimed to increase our understanding of the processes influencing how women experience the gestational weight gain advice they receive. Methods: Grounded theory methodology was chosen. Women receiving prenatal care in a primary care setting were invited to participate in one-on-one interviews. Results: All fifteen participants had high educational attainment, fourteen were Caucasian, and five had an elevated pre-pregnancy body mass index. Six interconnected themes emerged from the data: (1) striving to have a healthy pregnancy; (2) experiencing influences; (3) feeling worried; (4) Managing ambiguity; (5) trusting a source of information; and (6) feeling relief. Conclusions for Practice: Physicians are perceived by pregnant women to be a source of trusted information about gestational weight gain and are therefore in a strategic position to help women achieve healthy weight gain during pregnancy.

BackgroundPatient-centred interventions to help patients with multimorbidity have had mixed results.AimTo assess the effectiveness of a provider-created, patient-centred, multi-provider case conference with follow-up, and understand under what circumstances it worked, and did not work.Design and settingMixed-methods design with a pragmatic randomised trial and qualitative study, involving nine urban primary care sites in Ontario, Canada.MethodPatients aged 18–80 years with ≥3 chronic conditions were referred to the Telemedicine IMPACT Plus intervention; a nurse and patient planned a multi-provider case conference during which a care plan could be created. The patients were randomised into an intervention or control group. Two subgroup analyses and a fidelity assessment were conducted, with the primary outcomes at 4 months being self-management and self-efficacy. Secondary outcomes were mental and physical health status, quality of life, and health behaviours. A thematic analysis explored the patients’ experiences of the intervention.ResultsA total of 86 patients in the intervention group and 77 in the control group showed no differences, except that the intervention improved mental health status in the subgroup with an annual income of ≥C$50 000 (β-coefficient 11.003, P = 0.006). More providers and follow-up hours were associated with poorer outcomes. Five themes were identified in the qualitative study: valuing the team, patients feeling supported, receiving a follow-up plan, being offered new and helpful additions to their treatment regimen, and experiencing positive outcomes.ConclusionOverall, the intervention showed improvements only for patients who had an annual income of ≥C$50 000, implying a need to address the costs of intervention components not covered by existing health policies. Findings suggest a need to optimise team composition by revising the number and type of providers according to patient preferences and to enhance the hours of nurse follow-up to better support the patient in carrying out the case conference’s recommendations.

POINTS CLES L’obesite est une maladie chronique complexe dans laquelle la graisse corporelle anormale ou excessive (adiposite) nuit a la sante, augmente le risque de complications medicales a long terme et reduit la duree de vie[1][1]. Les etudes epidemiologiques definissent l’obe

KEY POINTS Obesity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan.[1][1] Epidemiologic studies define obesity using the body mass index (BMI; weight/height2), which can stratify

Exclusive breastfeeding is the ideal source of nutrition for the first 6 months of life. Although skin-to-skin contact (SSC) has been shown to be associated with greater rates of exclusive breastfeeding, the results are heterogeneous. SSC involves placing a naked infant on its mother's bare chest immediately after birth. We examined the association between SSC immediately after birth and exclusive breastfeeding at 4 months.A retrospective cohort of healthy, term, singleton infants who were liveborn from 2008 to 2019 was constructed from the Nova Scotia Atlee Perinatal Database. Our main outcome was exclusive breastfeeding at 4 months, available for a subset of the cohort through linkage to a primary care database (n=256). Our secondary outcome was exclusive breastfeeding at hospital discharge, available for the broader cohort (n=56,459). Odds ratios (OR) for the association between SSC and exclusive breastfeeding at 4 months were estimated from logistic regression models.The odds of breastfeeding exclusively at 4 months were 4.14 (95% confidence interval (CI) 1.89-9.25) times greater among those who had SSC than among those who did not. The odds of breastfeeding exclusively at hospital discharge were 3.81 (95% CI 3.64-3.99) times greater among those who had SSC than among those who did not. The association between SSC and exclusive breastfeeding at hospital discharge was heterogeneous by birth year (OR 4.35, CI 4.07-4.65 in 2008-2011; OR 2.81, CI 2.57-3.07 in 2012-2015; OR 1.89, CI 1.63-2.10 in 2016-2019).Skin-to-skin contact appears to be associated with greater odds of exclusive breastfeeding at discharge and 4 months postpartum. Early SSC should continue to be supported for breastfeeding promotion.RéSUMé: OBJECTIFS: L’allaitement exclusif est la source de nutrition idéale pour les six premiers mois de la vie. Bien qu’il ait été démontré que le contact peau à peau (SSC) est associé à des taux plus élevés d’allaitement exclusif, les résultats sont hétérogènes. La SSC consiste à placer un enfant nu sur la poitrine nue de sa mère immédiatement après la naissance. Nous avons examiné l’association entre la SSC immédiatement après la naissance et l’allaitement exclusif à quatre mois. MéTHODES: Une cohorte rétrospective de nourrissons seuls à terme en bonne santé de 2008 à 2019 a été construite à partir de la Nova Scotia Atlee Perinatal Database. Notre critère de jugement principal était l’allaitement exclusif à quatre mois, disponible pour un sous-ensemble de la cohorte grâce à un couplage à une base de données de soins primaires (n = 256). Notre critère de jugement secondaire était l’allaitement exclusif à la sortie de l’hôpital, disponible pour la cohorte plus large (n = 56 459). Les rapports de cotes (OR) pour l’association entre la SSC et l’allaitement exclusif à quatre mois ont été estimés à partir de modèles de régression logistique. RéSULTATS: Les chances d’allaiter exclusivement à quatre mois étaient 4,14 (intervalle de confiance (IC) à 95 % 1,89-9,25) fois plus élevées chez celles qui avaient le SSC que chez celles qui n’en avaient pas. Les chances d’allaiter exclusivement à la sortie de l’hôpital étaient 3,81 (IC à 95 % 3,64 à 3,99) fois plus élevées chez celles qui avaient la SSC que chez celles qui n’en avaient pas. L’association entre la CSS et l’allaitement exclusif à la sortie de l’hôpital était hétérogène selon l’année de naissance (OR 4,35, IC 4,07-4,65 en 2008-2011; OR 2,81, IC 2,57-3,07 en 2012-2015; et OR 1,89, IC 1,63-2,10 en 2016-2019). CONCLUSION: Le contact peau à peau semble être associé à une plus grande probabilité d’allaitement exclusif à la sortie de l’hôpital et à quatre mois après l’accouchement. La SSC tôt avec les nouveau-nés doit continuer à être soutenue en tant qu’aspect des pratiques de promotion de l’allaitement.

Sleep problems during early development are common and associated with negative health outcomes. Earlier recognition of poor sleep health permits earlier intervention and improved outcomes. This retrospective cohort study aimed to identify the frequency with which primary care providers assessed sleep health when completing the Rourke Baby Record for infants and young children during routine well-baby visits from 2002 to 2019. Using 1180 electronic medical records from an academic family medicine teaching clinic, we identified the frequency with which primary care providers assessed sleep health at three time intervals in child development: 1 week to 1 month; 2 months to 6 months; and 9 months to 12-13 months. Sleep variables were night waking, healthy sleep habits, and safe sleep. The frequency of having any aspect of sleep addressed was 85.4%, 90.2% and 66.7% at the three respective time intervals. There were no differences in the frequency with which sleep was assessed based on birthweight or sex. Children born during 2002-2015 were approximately half as likely to be assessed for sleep compared with those born during 2016-2019 at the second and third time intervals. In the first and second time intervals, children who were not exclusively breastfed had their sleep assessed significantly less than children who were exclusively breastfed. To our knowledge this is the first study to explore the area of sleep discussions and breastfeeding status in primary care during routine well-baby visits. These results are clinically relevant for clinicians and parents, due to the known associations between sleep issues and sudden infant death syndrome, childhood injuries, and emotional dysregulation.

There is a lack of cost-effective and readily available access to evidence-based information to manage healthy behaviours for pregnant individuals. Mobile health (mHealth) tools offer a cost-effective, interactive, personalized option that can be delivered anywhere at a time most convenient for the user. This study protocol was primarily developed to i) assess the feasibility of the SmartMoms Canada intervention in supporting participants to achieve gestational weight gain (GWG) guidelines. The secondary objectives are to: ii) assess user experience with the app, measured by adherence to the program via app software metrics and frequency of use; iii) determine the impact of SmartMoms Canada app usage on the adoption of healthful behaviours related to nutrition, physical activity and sleep habits, improvements in health-related quality of life, pregnancy-related complications, and symptoms of depression, and iv) investigate the potential extended effects of the app on postpartum health-related outcomes.This is a feasibility trial. Pregnant individuals aged 18-40 years with pre-gravid body mass index between 18.5 and 39.9 kg/mSmartMoms Canada is the first bilingual Canadian-centric app designed for pregnant people. This mHealth intervention, with its ability to supply frequent interactions, provides pregnancy- related health knowledge to users, potentially leading to an improvement in pregnancy-related outcomes and behaviours, and, ultimately a reduction in the present economic burden related to in-person interventions.ISRCTN, ISRCTN16254958. Registered 20 December 2019, http://www.isrctn.com/ ISRCTN16254958.

Pregnant women prioritize the health of their pregnancy, and weight gain contributes to the pregnancy's health. Women encounter different messages about gestational weight gain from various sources that can be confusing. This study aimed to increase our understanding of the processes influencing how women experience the gestational weight gain advice they receive.Grounded theory methodology was chosen. Women receiving prenatal care in a primary care setting were invited to participate in one-on-one interviews.All fifteen participants had high educational attainment, fourteen were Caucasian, and five had an elevated pre-pregnancy body mass index. Six interconnected themes emerged from the data: (1) striving to have a healthy pregnancy; (2) experiencing influences; (3) feeling worried; (4) Managing ambiguity; (5) trusting a source of information; and (6) feeling relief.Physicians are perceived by pregnant women to be a source of trusted information about gestational weight gain and are therefore in a strategic position to help women achieve healthy weight gain during pregnancy.

International guidelines recommend women with an overweight or obese body mass index (BMI) aim to reduce their body weight prior to conception to minimize the risk of adverse perinatal outcomes. Recent systematic reviews have demonstrated that interpregnancy weight gain increases women's risk of developing adverse pregnancy outcomes in their subsequent pregnancy. Interpregnancy weight change studies exclude nulliparous women. This systematic review and meta-analysis was conducted following MOOSE guidelines and summarizes the evidence of the impact of preconception and interpregnancy weight change on perinatal outcomes for women regardless of parity. Sixty one studies met the inclusion criteria for this review and reported 34 different outcomes. We identified a significantly increased risk of gestational diabetes (OR 1.88, 95% CI 1.66, 2.14, I2 = 87.8%), hypertensive disorders (OR 1.46 95% CI 1.12, 1.91, I2 = 94.9%), preeclampsia (OR 1.92 95% CI 1.55, 2.37, I2 = 93.6%), and large-for-gestational-age (OR 1.36, 95% CI 1.25, 1.49, I2 = 92.2%) with preconception and interpregnancy weight gain. Interpregnancy weight loss only was significantly associated with increased risk for small-for-gestational-age (OR 1.29 95% CI 1.11, 1.50, I2 = 89.9%) and preterm birth (OR 1.06 95% CI 1.00, 1.13, I2 = 22.4%). Our findings illustrate the need for effective preconception and interpregnancy weight management support to improve pregnancy outcomes in subsequent pregnancies. ispartof: OBESITY REVIEWS vol:23 issue:1 ispartof: location:England status: published

Helena Piccinini-Vallis, Michael Vallis Department of Family Medicine, Dalhousie University, Halifax, NS, Canada Introduction: Excess gestational weight gain (GWG) is a risk factor for several adverse outcomes for mothers and their offspring. In Nova Scotia, Canada, approximately 60% of women experience excess GWG. Outside the pregnancy arena, a patient-centered approach has been shown to promote increased patient adherence to clinician recommendations, and increased intentions for, and attempts at, behavior change. The 5As of Healthy Pregnancy Weight Gain is a tool that assists clinicians to have patient-centered discussions about GWG. This feasibility trial examined the association between training in the use of this tool and women’s self-efficacy to manage GWG, readiness to adhere to GWG guidelines, perception of their clinicians’ patient-centeredness when discussing GWG, and guideline concordance of total GWG.Method: Participants were 11 family physicians who provide prenatal care and 24 of their patients who were pregnant. Physicians were randomly assigned to a single 60-minute training session in the use of the tool or usual care. Consenting patients completed measures of social support, stress, patient-perceived patient-centeredness, self-efficacy, and motivation. At the end of each woman’s pregnancy, data pertaining to guideline concordance of GWG were collected.Results: Comparison of patient participants with prenatal care providers in the trained and untrained groups showed no significant difference in patient-perceived physician patient-centeredness when discussing GWG, self-efficacy to manage GWG, readiness to adhere to GWG guidelines, or GWG congruence with the guidelines.Conclusion: This feasibility study required very little time commitment and entailed minimal disruption to clinicians’ practices. Nonetheless, it was very difficult to recruit clinicians for the study. Although recent theory-driven work showed that prenatal care providers have, overall, high perceived self-efficacy in discussing GWG with their patients, most studies have demonstrated that these providers do not often discuss GWG with their patients; so, there is clearly a mismatch in their perceived self-efficacy and what actually transpires. Keywords: weight gain in pregnancy, prenatal care providers, patient-centeredness, counseling

Objective The primary objective of this study was to explore the association between weight cycling in the 6 months prior to pregnancy and gestational weight gain concordance with the 2009 Institute of Medicine guidelines for weight gain in pregnancy. Methods This was a prospective cohort study. Participants were women aged 18 years or older with a singleton pregnancy who had a prenatal appointment between April 1 and August 31, 2019. Eligible women completed a questionnaire that assessed their pre-pregnancy attempts to lose weight, measured with a modified version of the Weight Cycling subscale within the Revised Restraint Scale. After delivery, participants’ last recorded gestational weight before delivery, and corresponding gestational ages were obtained from prenatal records. Results One hundred and ninety-five pregnant women consented to participate in the study (a 95.6% response rate). Of them, 5 were excluded; therefore, 190 participants were included in the analysis. One-third of participants had attempted to lose weight in the 6 months before pregnancy. Logistic regression showed that for every one-unit increase in Weight Cycling score, the odds of excess gestational weight gain increased by a factor of 1.32. Conclusion Women's pre-conceptual efforts to enter pregnancy at a lower BMI should be approached in a manner that avoids pre-pregnancy weight cycling.

Background: Behavioral science is now being integrated into diabetes self-management interventions. However, the challenge that presents itself is how to translate these knowledge resources during care so that primary care practitioners can use them to offer evidence-informed behavior change support and diabetes management recommendations to patients with diabetes. Objective: The aim of this study was to develop and evaluate a computerized decision support platform called “Diabetes Web-Centric Information and Support Environment” (DWISE) that assists primary care practitioners in applying standardized behavior change strategies and clinical practice guidelines–based recommendations to an individual patient and empower the patient with the skills and knowledge required to self-manage their diabetes through planned, personalized, and pervasive behavior change strategies. Methods: A health care knowledge management approach is used to implement DWISE so that it features the following functionalities: (1) assessment of primary care practitioners’ readiness to administer validated behavior change interventions to patients with diabetes; (2) educational support for primary care practitioners to help them offer behavior change interventions to patients; (3) access to evidence-based material, such as the Canadian Diabetes Association’s (CDA) clinical practice guidelines, to primary care practitioners; (4) development of personalized patient self-management programs to help patients with diabetes achieve healthy behaviors to meet CDA targets for managing type 2 diabetes; (5) educational support for patients to help them achieve behavior change; and (6) monitoring of the patients’ progress to assess their adherence to the behavior change program and motivating them to ensure compliance with their program. DWISE offers these functionalities through an interactive Web-based interface to primary care practitioners, whereas the patient’s self-management program and associated behavior interventions are delivered through a mobile patient diary via mobile phones and tablets. DWISE has been tested for its usability, functionality, usefulness, and acceptance through a series of qualitative studies. Results: For the primary care practitioner tool, most usability problems were associated with the navigation of the tool and the presentation, formatting, understandability, and suitability of the content. For the patient tool, most issues were related to the tool’s screen layout, design features, understandability of the content, clarity of the labels used, and navigation across the tool. Facilitators and barriers to DWISE use in a shared decision-making environment have also been identified. Conclusions: This work has provided a unique electronic health solution to translate complex health care knowledge in terms of easy-to-use, evidence-informed, point-of-care decision aids for primary care practitioners. Patients’ feedback is now being used to make necessary modification to DWISE.

We present Diabetes Web-Centric Information and Support Environment (D-WISE) that features: (a) Decision support tool to assist family physicians to administer Behavior Modification (BM) strategies to patients; and (b) Patient BM application that offers BM strategies and motivational interventions to engage patients. We take a knowledge management approach, using semantic web technologies, to model the social cognition theory constructs, Canadian diabetes guidelines and BM protocols used locally, in terms of a BM ontology that drives the BM decision support to physicians and BM strategy adherence monitoring and messaging to patients. We present the qualitative analysis of D-WISE usability by both physicians and patients.

Objective To develop and evaluate Diabetes Web-Centric Information and Support Environment (D-WISE) that offers 1) a computerized decision-support system to assist physicians to A) use the Canadian Diabetes Association clinical practice guidelines (CDA CPGs) to recommend evidence-informed interventions; B) offer a computerized readiness assessment strategy to help physicians administer behaviour-change strategies to help patients adhere to disease self-management programs; and 2) a patient-specific diabetes self-management application, accessible through smart mobile devices, that offers behaviour-change interventions to engage patients in self-management. Methods The above-mentioned objectives were pursued through a knowledge management approach that involved 1) Translation of paper-based CDA CPGs and behaviour-change models as computerized decision-support tools that will assist physicians to offer evidence-informed and personalized diabetes management and behaviour-change strategies; 2) Engagement of patients in their diabetes care by generating a diabetes self-management program that takes into account their preferences, challenges and needs; 3) Empowering patients to self-manage their condition by providing them with personalized educational and motivational messages through a mobile self-management application. The theoretical foundation of our research is grounded in behaviour-change models and healthcare knowledge management. We used 1) knowledge modelling to computerize the paper-based CDA CPGs and behaviour-change models, in particular, the behaviour-change strategy elements of A) readiness-to-change assessments; B) motivation-enhancement interventions categorized along the lines of patients' being ready, ambivalent or not ready; and C) self-efficacy enhancement. The CDA CPGs and the behaviour-change models are modelled and computerized in terms of A) a diabetes management ontology that serves as the knowledge resource for all the services offered by D-WISE; B) decision support services that use logic-based reasoning algorithms to utilize the knowledge encoded within the diabetes management ontology to assist physicians by recommending patient-specific diabetes-management interventions and behaviour-change strategies; C) a mobile diabetes self-management application to engage and educate diabetes patients to self-manage their condition in a home-based setting while working in concert with their family physicians. Results We have been successful in creating and conducting a usability assessment of the physician decision support tool. These results will be published once the patient self- management application has been evaluated. Conclusions D-WISE will be evaluated through pilot studies measuring 1) the usability of the e-Health interventions; and 2) the impact of the interventions on patients' behaviour changes and diabetes control.

OBJECTIVE: This study assessed Nova Scotia's general practi-tioners’ awareness of and familiarity with the 2006 Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity in Adults and Children. It also explored the frequency with which general practitioners measured adult or pediatric weight, calculated adult or pediatric body mass index (BMI), and measured adult waist circumference in overweight and obese patients. METHODS: A random sample of 425 office-based general practitioners was selected to complete a mailed questionnaire. RESULTS: Overall, 37.5% of respondents reported being aware of the guidelines. Those who were aware of the guidelines were significantly more likely to calculate pediatric or adult BMI than those who were not. The mean familiarity rating was low: the higher a respondent's familiarity with the guidelines, the more likely that pediatric weight would be measured and pediatric BMI calculated. Respondents with access to electronic medical records (EMRs) were more likely to calculate BMI and measure adult waist circumference than those without EMRs. CONCLUSIONS: General practitioners' awareness of and familiarity with the guidelines was low, but for those who were aware of them, the guidelines had a significant impact on the frequency of some of the recommended assessments.

ObjectiveTo understand current gestational weight gain (GWG) counselling practices of healthcare providers, and the relationships between practices, knowledge and attitudes.DesignConcurrent mixed methods with data integration: cross-sectional survey and semistructured interviews.ParticipantsPrenatal healthcare providers in Canada: general practitioners, obstetricians, midwives, nurse practitioners and registered nurses in primary care settings.ResultsTypically, GWG information was provided early in pregnancy, but not discussed again unless there was a concern. Few routinely provided women with individualised GWG advice (21%), rate of GWG (16%) or discussed the risks of inappropriate GWG to mother and baby (20% and 19%). More routinely discussed physical activity (46%) and food requirements (28%); midwives did these two activities more frequently than all other disciplines (PConclusionsInterventions for healthcare providers to enhance GWG counselling practices should consider the range of factors that influence the priority level healthcare providers place on GWG counselling.

To adapt the 5 As model in order to provide primary care practitioners with a framework for obesity counseling.A systematic literature search of MEDLINE using the search terms 5 A's (49 articles retrieved, all relevant) and 5 A's and primary care (8 articles retrieved, all redundant) was conducted. The National Institute of Health and the World Health Organization websites were also searched.The 5 As (ask, assess, advise, agree, and assist), developed for smoking cessation, can be adapted for obesity counseling. Ask permission to discuss weight; be nonjudgmental and explore the patient's readiness for change. Assess body mass index, waist circumference, and obesity stage; explore drivers and complications of excess weight. Advise the patient about the health risks of obesity, the benefits of modest weight loss, the need for a long-term strategy, and treatment options. Agree on realistic weight-loss expectations, targets, behavioural changes, and specific details of the treatment plan. Assist in identifying and addressing barriers; provide resources, assist in finding and consulting with appropriate providers, and arrange regular follow-up.The 5 As comprise a manageable evidence-based behavioural intervention strategy that has the potential to improve the success of weight management within primary care.

s / Can J Diabetes 39 (2015) S10eS16 S16 ground-breaking program is led by an inter-professional team and integrates current practices and resources from health care and public health, including group based Incredible Years Parenting Program, individual appointments with team members, and home visiting to support families in implementing healthy lifestyle goals. The program is for families with children under 6 years old, focusing on healthy lifestyle habits, building strong family relationships and parent-child attachment, promoting child mental health, and preventing obesity related disorders. This multi-level intervention addresses the social determinants of health that impact children and families living with obesity, and has been developing strong community partnerships to promote health equity and accessibility. Through discussion, brainstorming and group activities, participants of the workshop will learn about the program and have the opportunity to share experiences from their own programs and communities.

Thus, there is a need to promote healthy pregnancy weight gain in an effort to optimize mater-nal-fetal outcomes and secure the future of public health in Brazil.A large body of evidence supports the importance of a healthy lifestyle (i.e. healthy eating behaviour, adequate sleep, stress management, regular physical activity and limiting sedentary behaviour) during pregnancy for both mother and fetus.