Dietary component of lifestyle interventions helps obese pregnant women

Full text

Randomised controlled trial
Dietary component of lifestyle interventions helps obese
pregnant women
Julie A Quinlivan
1,2
Commentary on: Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jørgensen JS. The LiP (Lifestyle in
Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women.
Diabetes Care 2011;34:2502–7.
Context
Approximately 30% of pregnant women in developed
countries are overweight or obese.
1
Maternal obesity is a
major risk factor for maternal and fetal complications,
including maternal and fetal mortality, miscarriage, ges-
tational diabetes mellitus, pregnancy-induced hyperten-
sive disorders, infection, thromboembolic disease,
induction of labour, macrosomia, caesarean section and
stillbirth.
2
In 2009, the Institute of Medicine revised its recom-
mendations for weight gain in pregnancy advising that
overweight and obese women should restrict gestational
weight gain to 15–25 lb (6.8–11.3 kg) and 11–20 lb
(4.9–9 kg), respectively.
2
The question then became how
to achieve this.
A meta-analysis of dietary intervention trials reported
that dietary interventions, especially when repeated
throughout pregnancy, were effective in reducing gesta-
tional weight gain in obese pregnant women by 6.5 kg
compared to control.
3
Another meta-analysis of physical
intervention trials also reported a small, but significant,
reduction in gestational weight gain of −0.61 kg com-
pared to control.
4
A meta-analysis of all intervention
types reported a 1.42 kg reduction in gestational weight
gain with any intervention compared to control.
5
Methods
The LiP (Lifestyle in Pregnancy) Study contributes to the
evaluation of lifestyle interventions for obese pregnant
women by combining dietary and exercise interventions.
In this Danish trial, obese pregnant women were rando-
mised to a lifestyle intervention that included dietary
guidance, free membership in fitness centres, physical
testing and personal coaching or to a control group.
They were also offered four dietary sessions. Interven-
tion commenced early in pregnancy with enrolment into
the trial at 10–14 weeks gestation. Randomisation was
adequate. It was not possible to blind participants but
data extraction was blinded.
Findings
The key finding was that the combined lifestyle inter-
vention was associated with a significantly lower
median gestational weight gain (7.0 vs 8.6 kg, p=0.01).
However, the Institute of Medicine’s recommendations
on gestational weight gain still exceeded by 35.4% for
women in the intervention group.
One concern was of the 1224 obese women attending
for care, 238 were excluded because of chronic illness
and adverse obstetric history. This reflects the burden of
chronic disease in overweight mothers. A further 317
women, nearly half of those eligible, declined to partici-
pate in the trial. This suggests that the subgroup of
women involved in the trial may be motivated towards
lifestyle interventions.
Given this, it is disappointing that so few took
advantage of the free exercise interventions offered.
Dietary interventions were associated with reasonable
compliance with 92% of the women in the intervention
arm completing all four dietetic counselling sessions. In
contrast, only 56% of women in the intervention group
attended the aerobic classes for at least half of the
lessons.
Commentary
It was disappointing that motivated pregnant obese
women did not attend the exercise component of the
intervention despite being personalised and free. Poor
compliance, limited efficacy and cost will probably limit
exercise interventions being implemented broadly into
antenatal care.
In contrast, previous randomised trials have established
that obese pregnant women are generally compliant with
dietary interventions.
36–9
It has been established that
dietary interventions can reduce mean gestational weight
gain to Institute of Medicine (IOM) levels.
39
The LiP study
supports these observations with reasonable compliance
with the dietary component of the intervention.
Given the cost of exercise interventions, it would
appear that dietary approaches offer the greatest oppor-
tunity for change at a population level and should be
the focus of future research. One thing is certain, we
need to find solutions in a hurry; otherwise we are con-
demning future generations to an explosion of chronic
disease.
References
1. NHMRC (Australia) Clinical practice guidelines for the
management of overweight and obesity in adults. Canberra:
Commonwealth of Australia, 2003.
2. Institute of Medicine. Weight gain during pregnancy:
reexamining the guidelines. Report brief. May 2009.
3. Quinlivan JA, Julania S, Lam L. Antenatal dietary interventions
in obese pregnant women to restrict gestational weight gain to
Institute of Medicine recommendations: a meta-analysis.
Obstetrics and Gynecology 2011;118(6):1395–401.
4. Streuling I, Beyerlein A, Rosenfeld E, et al. Physical activity and
gestational weight gain: a meta-analysis of intervention trials.
BJOG 2011;118:278–84.
10.1136/eb-2012-100794
1
Department of Obstetrics and
Gynaecology, University of Notre
Dame Australia, Joondalup,
Western Australia, Australia
2
Women’s and Children’s
Research Institute, University of
Adelaide, Joondalup, Western
Australia, Australia
Correspondence to:
Professor Julie A Quinlivan
Joondalup Health Campus, Suite
106 Private Consulting Rooms,
Joondalup, Western Australia
6027, Australia;
quinlivanj@ramsayhealth.com.au
Evidence-Based Medicine February 2013 |volume 18 |number 1 |ebmed.18.1.e4
Therapeutics

5. Thangaratinam S, Rogozinska EM, Jolly K, et al. Effects of
interventions in pregnancy on maternal weight and obstetric
outcomes: meta analysis of randomised evidence. BMJ
2012;344:e2088.
6. Wolff S, Legarth J, Vangsaard K, et al. A randomized trial of
effects of dietary counselling on gestational weight gain and
glucose metabolism in obese pregnant women. Int J Obes
2008;32:495–501.
7. Thornton YS, Smarkola C, Kopacz SM, et al. Perinatal
outcomes in nutritionally monitored obese pregnant women: a
randomized clinical trial. J Natl Med Assoc 2009;101:
569–77.
8. Quinlivan JA, Lam LT, Fisher J. A randomized trial of a
four-step multidisciplinary approach to the antenatal care of
obese pregnant women. Aust N Z J Obstet Gynaecol 2011;51
(2):141–6.
9. Guelinckx I, Devlieger R, Mullie P, et al. Effect of lifestyle
intervention on dietary habits, physical activity, and gestational
weight gain in obese pregnant women: randomized controlled
trial. Am J Clin Nutr 2010;91:373–80.
Evidence-Based Medicine February 2013 |volume 18 |number 1 |ebmed.18.1.e4
Therapeutics

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