Strengths and Limitations
obesity
OBESITY, SECONDARY
This is one of the first studies to explore the postnatal dietary and PA behaviours of women living with obesity in an area of high deprivation in the UK. Extensive data were collected as part of the GLOWING pilot trial, providing a rich dataset for analysis. However, this study was a secondary data analysis with a small sample size. Therefore, it was not designed to be an observational study or powered to detect statistical differences or make inferences at the population level. Loss to follow-up was high, and longitudinal analysis was not possible. However, there were limited statistically or clinically significant differences in the socio-demographics of women who returned questionnaires compared with those lost to follow-up. The sample sizes limited the ability to explore diet and PA behaviours or weight change between population subgroups, including by ethnic group, obesity category, or deprivation. Within the study population, women were predominantly white, employed, and could speak English, which may not reflect other UK regions. Data collection using FFQs and PPAQ has benefits in relation to low-resource options to reach many participants. However, both are subjective, relying on memory, literacy and numeracy skills and are subject to recall bias [This study identified many areas for future research, along with reflections from the research team on resolving some of the issues relating to loss to follow-up. Pregnancy and the postnatal periods are times of transition, including moving home due to a growing family. We lost some participants to follow up due to this (e.g., questionnaires were returned with “no longer at this address” written on them), and some women whom we had alternative contact details (e.g., those consenting to be interviewed as well as completing questionnaires provided email addresses or phone numbers) reported that they had moved and had not received the questionnaire. In the questionnaires, women were asked to state if they preferred paper or online versions, and paper was the main preference. However, this method does not have the flexibility that electronic follow-up would have, as email addresses are less likely to change. Additionally, posting questionnaires for follow-up was led by busy research midwife teams within the NHS Trusts, including one Trust that did not send out any questionnaires during the 9-month follow-up period. In future studies, keeping consent for contact details with university research teams for follow-up may be beneficial. Reducing loss-to-follow-up would allow a longitudinal study to be undertaken, offering important insights that could inform the development of personalised preconception interventions.