Can gestational weight gain be modified by increasing physical activity and diet counseling? A meta-analysis of interventional trials

Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians University of Munich, Munich, Germany.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 10/2010; 92(4):678-87. DOI: 10.3945/ajcn.2010.29363
Source: PubMed

ABSTRACT Excessive gestational weight gain (GWG) increases the risk of a number of adverse pregnancy outcomes and was recently identified as a potential risk factor for childhood obesity. It is therefore of interest whether GWG can be modified by an intervention combining dietary counseling and physical activity.
The objective was to review published data on interventions to reduce GWG by modulating diet and physical activity during pregnancy.
We systematically reviewed 4 databases and bibliographies of various publications supplemented by a hand-search for relevant articles published in English or German and performed a meta-analysis to quantify the effect estimate by a random-effects model.
Four randomized controlled trials and 5 nonrandomized trials with a total of 1549 women enrolled were identified as being relevant. Meta-analyses of all 9 trials indicated a lower GWG in the intervention groups, with a standardized mean difference of -0.22 units (95% CI: -0.38, -0.05 units). We observed no indication for publication bias.
Interventions based on physical activity and dietary counseling, usually combined with supplementary weight monitoring, appear to be successful in reducing GWG. The results are of particular interest with respect to the objective of preventing excessive GWG.

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    • "Several trials have tested the effect of lifestyle interventions during pregnancy on weight accumulation. Randomized and non-randomized trials suggest that educational interventions comprised of physical activity (PA) and dietary counseling during pregnancy, commonly combined with weight monitoring , may lower the risk of excessive GWG [13] [14] [15]. Similarly, postpartum trials of both diet and PA or diet alone were effective in minimizing weight retention after childbirth [16]. "
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    ABSTRACT: The influence of childbearing in the development of obesity is situated within two different but related contexts: pregnancy-related weight gain and weight gain prevention and control in young adult women. Pregnancy related weight gain contributes to long-term weight retention in childbearing women. To present the study design, data collection procedures, recruitment challenges, and the baseline characteristics for the eMoms of Rochester study, a randomized clinical trial testing the effect of electronically-mediated behavioral interventions to prevent excessive gestational weight gain (GWG) and postpartum weight retention among women aged 18-35 years of diverse income and racial/ethnic backgrounds in an urban setting. Randomized double blind clinical trial. A total of 1,722 women at or below 20weeks gestation were recruited primarily from obstetrics practices and randomized to 3 treatment groups: control arm; intervention arm with access to intervention during pregnancy and control at postpartum (e-intervention 1); and intervention arm with access to intervention during pregnancy and postpartum (e-intervention 2). Enrollment and consent were completed via study staff or online. Data were collected via online surveys, medical charts, and measurement of postpartum weights. The primary endpoints are gaining more weight than recommended by the Institution of Medicine guidelines and weight retained at 12months postpartum. This study will provide evidence on the efficacy of behavioral interventions in the prevention of excessive GWG and postpartum weight retention with potential dissemination to obstetrics practices and/or health insurances. #NCT01331564. Copyright © 2015. Published by Elsevier Inc.
    Contemporary clinical trials 05/2015; 43. DOI:10.1016/j.cct.2015.04.013 · 1.94 Impact Factor
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    • "Not only has the prevalence of overweight and obesity increased in Australia, but the distribution of BMI has also shifted towards the upper end for parents and their children [9]. Recent meta-analytical studies indicate the positive outcomes of interventions to prevent overweight and obesity during pregnancy [10] [11]. Perinatal health care providers (PHCPs) increasingly acknowledge the importance of promoting healthy weight during childbearing years, yet, in practice, time, remuneration, knowledge, skills, and capacity hamper their ability to provide mothers with counselling and advice [12] [13]. "
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    ABSTRACT: Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs) to offer healthy lifestyle counselling. In response, today's Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to determine what online information was needed, in what form, and how best it should be presented. The outcome was the development of the Healthy You, Healthy Baby website and smartphone app. This clinically-endorsed, interactive online resource provides perinatal women with a personalised tool to track their weight, diet, physical activity, emotional wellbeing, and sleep patterns based on the developmental stage of their child with links to quality-assured information. One year since the launch of the online resource, data indicates it provides a low-cost intervention delivered across most geographic and socioeconomic strata without additional demands on health service staff.
    Journal of obesity 04/2014; 2014(6):573928. DOI:10.1155/2014/573928
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    • "These results are in line with a number of other small intervention studies aiming to limit GWG during pregnancy. Most studies showed a moderate reduction in GWG, but were not adequately powered for other outcome variables such as GDM or obstetric complications [40-43,61-64]. "
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    ABSTRACT: Recent studies suggest that excessive gestational weight gain (GWG) leads to adverse maternal and fetal outcomes including weight retention in the mother and an increased risk of childhood obesity in the offspring.The aim of the GeliS study is to examine the effect of a lifestyle intervention programme during pregnancy to avoid excessive GWG and, hence, to reduce pregnancy and obstetric complications as well as the risk of maternal and offspring obesity.Methods and design: The GeliS study is a multicentre cluster-randomized controlled trial. A total number of 2500 pregnant women (singleton pregnancy) with a pre-pregnancy BMI >= 18.5 kg/m2 and <= 40 kg/m2 will be recruited in practices of gynaecologists and midwives in ten Bavarian regions. The intervention comprises three structured and individualised counselling sessions on a healthy diet, regular physical activity as well as weight monitoring during pregnancy and one session after delivery, respectively. The counselling sessions are attached to routine pre- and postnatal visits using standardised materials and procedures. In the control regions, general recommendations for a healthy lifestyle are given. An oral glucose tolerance test is offered to all participants.The primary outcome is the proportion of participants with excessive GWG. Secondary outcomes include pregnancy and obstetric complications such as frequency of gestational diabetes, preeclampsia and caesarean sections as well as weight retention in the mothers and BMI and other health variables in the offspring. A 5-year follow-up of both mothers and their infants is planned. The GeliS lifestyle intervention programme has been adapted to the existing routine health care system for pregnant women. If shown to be effective, it could be immediately implemented in routine care.Trial registration: The study protocol is registered at the Protocol Registration System (NCT01958307).
    BMC Pregnancy and Childbirth 03/2014; 14(1):119. DOI:10.1186/1471-2393-14-119 · 2.19 Impact Factor
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