Plan-it study report published

The Centre for Trials Research is investigating how best support people to achieve a healthy weight before they conceive.

The Plan-it study report, which explored the acceptability of one potential intervention, and the phase 1 results paper have been published and the results were presented at the 5^th European conference  on preconception health and care in London in September 2022.

Dr Sue Channon, is Chief Investigator of the Plan-It study.

About half of women of childbearing age have overweight or obesity, but it can be difficult to discuss preparing for pregnancy and weight before they conceive because people do not usually talk with a health-care practitioner such as their GP before becoming pregnant. However, one group who do are those who need to have a long-acting reversible contraceptive (e.g. a coil or an implant) removed.

Weight is a really personal and sensitive subject, as is conception, so it is important to make sure that any intervention designed to support people with preconception weight loss is acceptable to the people who are going to receive it.  Plan-it was designed specifically to look at acceptability, as preparatory work for a potential future study of a preconception weight loss intervention.

The team wanted to answer three questions:

1. Would people with experience of overweight and of using a long-acting reversible contraceptive think that it would be acceptable to ask them to delay having their long-acting reversible contraceptive removed to take part in a weight loss intervention before pregnancy?
2. What did health-care practitioners think about that idea, and would they be happy to ask people to take part?
3. Can NHS routine data tell us how many people might potentially take part in such an intervention?

They looked at NHS routine data and the research on preconception weight loss interventions. A total of 100 health-care practitioners and 243 users of long-acting reversible contraceptives (known as LARCs) completed surveys, and 10 health-care practitioners and 20 users of long-acting reversible contraceptives took part in interviews.

They found that routine data could not be relied on to identify people  who could be eligible for the intervention: Whilst the removal of LARC was (we think) well recorded in GP notes, the reasons for the removal (e.g.  planning of a pregnancy) were not. It was also difficult to accurately assess the person’s current weight.

Although people could see there might be some benefits of a weight loss intervention that involved  delaying the removal of a long-acting reversible contraceptive, overall it was not acceptable to LARC users for a range of practical and ethical reasons:  Their key concerns were about the quality of existing healthcare practitioner communication about weight, that was often described as insensitive and caused distress, the practicalities of the intervention in an overstretched service where getting appointments was hard and they were pushed for time,  and crucially an ethical consideration that the ethos of the intervention was experienced as undermining the person’s right to choose when they could conceive.

“I understand that you are concerned about fat people having babies and the implications for the healthcare system but if a woman wants her coil taken out at any time for any reason that is her choice.” (contraceptive user) 

A population-based preconception weight loss intervention with a positive focus could be  acceptable, but, for such a programme to be delivered by the NHS, health-care practitioners would need more knowledge, skills and confidence in talking about weight with patients.

The Plan-it study was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Programme.

The Centre for Trials Research at Cardiff University is core funded by Welsh Government through Health and Care Research Wales and Cancer Research UK.