Supporting women of childbearing age in the prevention and treatment of overweight and obesity: A scoping review of randomized control trials of behavioral interventions

Abstract

Background:
Women of childbearing age are vulnerable to weight gain. This scoping review examines the extent and range of research undertaken to evaluate behavioral interventions to support women of childbearing age to prevent and treat overweight and obesity.

Methods:
Eight electronic databases were searched for randomized controlled trials (RCT) or systematic reviews of RCTs until 31st January 2018. Eligible studies included women of childbearing age (aged 15-44 years), evaluated interventions promoting behavior change related to diet or physical activity to achieve weight gain prevention, weight loss or maintenance and reported weight-related outcomes.

Results:
Ninety studies met the inclusion criteria (87 RCTs, 3 systematic reviews). Included studies were published from 1998 to 2018. The studies primarily focused on preventing excessive gestational weight gain (n = 46 RCTs, n = 2 systematic reviews), preventing postpartum weight retention (n = 18 RCTs) or a combination of the two (n = 14 RCTs, n = 1 systematic review). The RCTs predominantly evaluated interventions that aimed to change both diet and physical activity behaviors (n = 84) and were delivered in-person (n = 85).

Conclusions:
This scoping review identified an increasing volume of research over time undertaken to support women of childbearing age to prevent and treat overweight and obesity. It highlights, however, that little research is being undertaken to support the young adult female population unrelated to pregnancy or preconception.

Full text

R E S E A R C H A R T I C L E Open Access
Supporting women of childbearing age in
the prevention and treatment of
overweight and obesity: a scoping review
of randomized control trials of behavioral
interventions
Melinda J. Hutchesson
1*
, Mette de Jonge Mulock Houwer
1,2
, Hannah M. Brown
1
, Siew Lim
3
, Lisa J. Moran
3
,
Lisa Vincze
4
, Megan E. Rollo
1
and Jenna L. Hollis
1,5,6,7,8
Abstract
Background: Women of childbearing age are vulnerable to weight gain. This scoping review examines the extent
and range of research undertaken to evaluate behavioral interventions to support women of childbearing age to
prevent and treat overweight and obesity.
Methods: Eight electronic databases were searched for randomized controlled trials (RCT) or systematic reviews of
RCTs until 31st January 2018. Eligible studies included women of childbearing age (aged 15–44 years), evaluated
interventions promoting behavior change related to diet or physical activity to achieve weight gain prevention,
weight loss or maintenance and reported weight-related outcomes.
Results: Ninety studies met the inclusion criteria (87 RCTs, 3 systematic reviews). Included studies were published
from 1998 to 2018. The studies primarily focused on preventing excessive gestational weight gain (n= 46 RCTs, n=
2 systematic reviews), preventing postpartum weight retention (n= 18 RCTs) or a combination of the two (n=14
RCTs, n= 1 systematic review). The RCTs predominantly evaluated interventions that aimed to change both diet
and physical activity behaviors (n= 84) and were delivered in-person (n= 85).
Conclusions: This scoping review identified an increasing volume of research over time undertaken to support
women of childbearing age to prevent and treat overweight and obesity. It highlights, however, that little research
is being undertaken to support the young adult female population unrelated to pregnancy or preconception.
Keywords: Childbearing, Women, Obesity treatment, Obesity prevention, Scoping review
Background
Prevalence of women affected by obesity is increasing glo-
bally, with prevalence rates increasing from 6.4% in 1975
to 14.9% in 2014 [1]. Women of childbearing age (15 to
44 years) are particularly vulnerable to weight gain, with
many large cohort studies demonstrating this life stage is
the time of greatest weight gain [2–5]. For example, the
Australian Longitudinal Study of Women’sHealthhas
found women in their younger cohort (aged 18–23 years
at survey 1) experience an average weight gain of 6.3 kg
over 10 years [3]. Notably, in women of childbearing age,
pregnancy has been investigated as a potential trigger for
excessive weight gain and the development of overweight
and obesity. The results however are inconsistent, with
some studies in women of childbearing age demonstrating
an association between parity and weight gain and/or the
development of overweight and obesity, while others have
shown no association [6,7].
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
* Correspondence: Melinda.hutchesson@newcastle.edu.au
1
School of Health Sciences, Faculty of Health and Medicine, and Priority
Research Centre for Physical Activity and Nutrition, University of Newcastle,
University Drive, Callaghan, New South Wales, Australia
Full list of author information is available at the end of the article
Hutchesson et al. BMC Women's Health (2020) 20:14
https://doi.org/10.1186/s12905-020-0882-3
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Weight gained during the childbearing years is
strongly associated with adverse health outcomes later
in life. For example, the Nurses’Health Study (n= 92,
837) identified that for every additional 5 kg of weight
gained from 21 years of age there were 142.6 additional
cases of Type 2 diabetes (per 100,000 person-years
from age 55 onwards), 458.8 for hypertension, 36.9 for
cardiovascular disease, 36.9 for cancer, and 76.7 for
overall mortality [8]. Furthermore, obesity during the
childbearing years has been associated with adverse
pregnancy outcomes for the mother (e.g. gestational
diabetes, pre-eclampsia, gestational hypertension, ante-
natal anxiety and postpartum depression), as well as for
the babies (e.g. pre-term birth, and large for gestational
age babies) [9,10].
Behavioral interventions to support women to prevent
weight gain during the childbearing years, or treat over-
weight or obesity, have the potential to have an impact
on the health and well-being of women, as well as their
offspring. Behavioral interventions are those designed to
influence individuals’actions, more specifically for
weight management, interventions include those which
influence physical activity and sedentary and/or dietary
behaviors. A large number of systematic reviews have
been undertaken to determine the most effective inter-
ventions to support women during this life stage to pre-
vent and treat overweight and obesity [11–23]. However,
reviews published to date have typically been limited to
one type of intervention (e.g. treatment or prevention of
obesity, preventing excessive gestational weight gain
(GWG)), population group (e.g. pregnant/postpartum
women) or mode of delivery (e.g. web-based), or com-
bined a variety of intervention approaches (e.g. behav-
ioral, surgical, pharmacological) in the one review.
Therefore, previous systematic reviews are unable to de-
termine the most appropriate time for intervention dur-
ing this life stage (e.g. pre-conception, postpartum), the
most efficacious behavioral intervention approach (e.g.
treatment, prevention) nor the optimal mode of delivery
for intervention.
To our knowledge, no single review has identified all
behavioral interventions aiming to support women of
childbearing age to prevent weight gain, or achieve
weight loss or weight loss maintenance. Therefore, the
aim of this scoping review is to examine the extent and
range of research undertaken to evaluate behavioral in-
terventions that support women of childbearing age to
prevent or treat overweight and obesity. The scoping
review methodology allows mapping of the range of re-
search that has been undertaken over time. The scoping
review is the first step in determining the most effica-
cious intervention approach. It will help identify gaps
in research undertaken to date, and determine whether
a full systematic review can be undertaken.
Methods
A scoping review was undertaken using a predefined
protocol following the methodological framework of
Arksey and O’Malley, [24] including identifying the re-
search question, searching for relevant studies, selecting
studies, charting the data and collating, summarizing,
and reporting the results. The conduct and reporting of
the scoping review is consistent with the Preferred
Reporting Items for Systematic reviews and Meta-
Analyses extension for Scoping Reviews (PRISMA-ScR)
Checklist. Preliminary findings of the scoping review
were previously presented [25].
Identifying the research question
The research question was operationalized using the
Population-Intervention-Comparison-Outcome-Study
design (PICOS) format. Inclusion criteria for the scoping
review were therefore as follows:
Participants
Women of childbearing age (i.e. aged 15 to 44 years as
per US Centre for Disease Control Definition).
Interventions
Interventions promoting behavior change (e.g. dietary
behavior, physical activity and/or sedentary behavior) to
prevent weight gain or overweight and obesity, or
achieve weight loss or weight loss maintenance were in-
cluded. Non-behavioral interventions, including very low
energy diets (including meal replacements), weight loss
medications and surgery alone or in combination with
behavioral interventions will be excluded.
Comparators
No intervention control group, wait-list control group,
standard/usual care or another active behavioral
intervention.
Outcomes
To be included in the review studies must have mea-
sured and reported weight-related outcomes (e.g. weight,
BMI, percentage body fat, waist circumference).
Study design
Systematic reviews of randomized control trials (RCTs)
and RCTs as the two highest levels of evidence for evalu-
ating interventions [26].
Selection of studies relevant to the research question
Search strategy
The search strategy, including database selection and
search teams, was developed in consultation with an ex-
pert medical librarian. The search aimed to find peer
reviewed journal articles published in English. All
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 2 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

sources were searched from the date of inception up
until the 31st January 2018 (Additional file 1: Table S1).
The databases searched were MEDLINE (Ovid), MED-
LINE in process (Ovid), EMBASE (Ovid), PsycINFO
(Ovid), Scopus, CINAHL (EbscoHost) and Cochrane Li-
brary (Wiley). The reference lists of all included articles
and reports were also searched for additional studies.
Screening
Screening was managed using Covidence (www.covi-
dence.org). Title, abstract and keywords of all identified
papers were each assessed by two independent reviewers
(Reviewer 1: MMH; Reviewer 2: MH, JG, SL, LM, LV).
Full text screening was conducted by two independent
reviewers, and reasons for exclusions recorded (MMH,
MH). A third reviewer was consulted for all conflicts for
both abstract and full text screening (MR).
Charting of information and data within the included
studies
Data were extracted by one reviewer (MMH) and
checked by a second reviewer (LV, LM, SL, JH, MR).
Any differences between the first and second extractor
were resolved by a third reviewer (HB). Data extracted
included: study characteristics (i.e. year study con-
ducted/published, country of origin, study design, num-
ber of study arms and comparators, intervention
duration); participants (i.e. study inclusion criteria relat-
ing to age, BMI, ethnicity, socio-economic status, parity,
clinical conditions or pregnancy); interventions (i.e. goal
[weight loss, weight loss maintenance, weight gain pre-
vention, excessive gestational weight gain prevention],
behavior change promoted [dietary behavior, physical
activity and/or sedentary behavior], setting [e.g. clinic,
community], mode of delivery [i.e. individual, group or
combination] and medium of delivery [e.g. in-person,
website] and profession of intervention deliverer) and
outcomes (i.e. what weight-related outcomes were mea-
sured and when, and other outcomes measured).
Collating, summarizing and reporting results of the
review
As is convention in scoping reviews, a numerical analysis
was undertaken to elucidate the number of the studies,
as well as changes overtime (based on publication date).
In addition, results are presented by intervention goal,
with studies group as general weight loss, post-partum
weight loss/preventing weight retention, general weight
gain prevention, excessive GWG, and combine excessive
GWG prevention and post-partum weight loss. ‘General’
weight loss and weigh gain prevention includes those in-
terventions unrelated to pregnancy status.
Results
Of the 8543 articles identified, 307 full text articles were
assessed for eligibility and 115 articles met the inclusion
criteria (Fig. 1). The articles described 87 RCTs and
three systematic reviews.
Randomized control trials
Table 1describes the study characteristics of the in-
cluded RCTs overall, and by intervention goal. Individual
study characteristics are described in Additional file 1:
Table S2. Of the 87 included RCTs, 52.9% (n= 46)
focused on preventing excessive GWG, [27–71] 20.7%
(n= 18) on weight loss or preventing weight retention in
the postpartum period, [72–89] and 16.1% (n= 14) fo-
cused on both preventing excessive GWG and prevent-
ing weight retention in the postpartum period [90–103].
Few studies supported general reproductive-aged women
(i.e. not specifically related to current or recent preg-
nancy) in weight loss (4.6%, n=4) [104–107] or weight
gain prevention (5.7%, n=5) [108–112]. Most of the in-
cluded studies were conducted in the United States
(46.0%, n= 40), followed by Australia (16.1%, n= 14).
Figure 2demonstrates the year of publication of the
included RCTs, by weight focus. Studies were published
from 1998 up until 2018, but with no studies published
from 1998 to 2000, and only zero to two studies pub-
lished per year from 2000 to 2008. From 2009 to 2017
the number of studies conducted per year ranged from
three (2010) to 14 (2014). The intervention goal of
included studies varied over time. While the number of
studies focusing solely on postpartum weight loss/pre-
venting weight retention has remained consistent focus
over time, the number of weight gain prevention and
weight loss studies unrelated to pregnancy decreased
overtime, with more of a focus on prevention of exces-
sive GWG, and the prevention of excessive GWG
combined with postpartum weight loss/preventing post-
partum weight retention.
Across the included RCTs there were 26,750 partici-
pants (Mean: 307.5). Many of the RCTs (59.8%, n= 52)
recruited women of childbearing age as per our defin-
ition for inclusion (i.e. 18 to 44 years) or did not specific-
ally define the age range for participant inclusion but
implied they were ‘of childbearing’age due to other in-
clusion criteria (i.e. pregnancy) (19.5%, n= 17). A signifi-
cant number of RCTs (41.4%, n= 36) recruited only
women who were affected by overweight or obesity,
while many also did not report a BMI inclusion criteria
(24.1%, n=21).
Only five studies required women to be of a specific
parity, with all five recruiting women during their first
pregnancy. Twelve studies recruited participants from
specific ethnicities, including African American (6.9%,
n= 6) and Latina/Hispanic (5.7%, n= 5) women, and one
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 3 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

study (1.1%) recruited only ‘white’women. Ten RCTs
(11.5%) had participant recruitment criteria related to
the socio-economic status of the participant, with all
specifically recruiting women of lower socio-economic
status (e.g. lower income). Five studies recruited women
with specific clinical conditions, including three studies
(3.4%) that recruited women with gestational diabetes,
one (1.1%) recruited women who were infertile, and one
(1.1%) recruited women who were breastfeeding.
Table 2describes the outcomes measured across the
included RCTs. All studies measured weight related out-
comes, with 78.2% (n= 62) having a weight-related pri-
mary outcome [27,29–34,36,38,40–44,46,47,50,51,
54,56–59,61–66,68,69,71–80,82–87,90–103,105,
106,108–111]. Over half of the included RCTs (62.1%,
n= 54) measured dietary and physical activity-related
outcomes, with eight RCTs (9.2%) having a diet-related
[45,49,51,67,71,73,75,80] and five (5.7%) a physical
activity related primary outcome [45,49,51,73,80]. At
a minimum, all studies measured outcomes twice (i.e.
baseline and follow-up), but the mean number of data
collection points were 3.7 ± 2.0 (Range 2–14). There was
a notable greater number of data collection points
among studies focusing on GWG and preventing weight
retention in the postpartum period (mean 5.1 ± 2.8).
Acrossthe87includedRCTs,therewere105active
intervention arms. Table 3describes the characteris-
tics of the 105 interventions overall and by weight
focus. The majority (80.0%, n= 84) of the interven-
tions focused on promoting both changes to dietary
behavior and physical activity to achieve changes to
weight-related outcomes. The interventions were most
commonly delivered by those with expertise in nutri-
tion, such as dietitians or nutritionists (42.9%, n= 45),
or clinicians involved in the women’s care, such as
midwives and/or general practitioners (GPs) (29.5%,
n= 31). The setting for the interventions were com-
monly within the hospital or clinic (30.5%, n= 32),
the participant’s home (28.6%, n= 30), or was not re-
ported (27.6%, n= 29). Two-thirds (66.7%, n= 70) of
interventions were delivered individually, 14 (13.3%)
were group-based, and 23 (21.9%) used a combination
of individual and group-based delivery.
Approximately half (49.5%, n= 52) of the interventions
were delivered using one medium, and approximately
one third (35.2%, n= 37) using two media. One study
Fig. 1 Flow diagram of included studies
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 4 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

used five media to deliver the intervention. Most inter-
ventions (81.0%, n= 85) included components delivered
in-person. A variety of other delivery mediums however
were used across studies, including telephone (29.5%,
n= 31), paper-based (27.6%, n= 29) (e.g. brochures), text
message (10.5%, n= 11) and websites (9.5%, n= 10). Fig-
ure 3shows the number of studies using different deliv-
ery modes by year of publication, demonstrating that the
number of different delivery mediums utilized had in-
creased over time.
Table 1 Summary of study characteristics by intervention goal and in total
Total
(n= 87)
General
weight
loss
(n=4)
Postpartum weight
loss/ preventing
weight retention
(n= 18)
General
weight gain
prevention
(n=5)
Excessive
GWG
prevention
(n= 46)
Combined excessive GWG
prevention & postpartum
weight loss (n= 14)
Publication year 2000–2010, n (%) 17 (19.5) 2 (50) 4 (22.2) 2 (40) 8 (17.4) 1 (7.1)
2011 - Jan 2018, n (%) 70 (80.5) 2 (50) 14 (77.8) 3 (60) 38 (82.6) 13 (92.9)
Country United States, n (%) 40 (46.0) 2 (50) 14 (77.8) 4 (80) 12 (26.1) 8 (57.1)
Australia, n (%) 14 (16.1) 1 (25) 1 (5.6) –11 (23.9) 1 (7.1)
Sweden, n (%) 5 (5.8) –2 (11.1) 1 (20) 2 (4.4) –
Canada, n (%) 4 (4.6) –– – 4 (8.7) –
Denmark, n (%) 3 (3.5) –– – 3 (6.5) –
Other, n (%) 21 (24.1) 1 (25) 1 (5.6) –14 (30.4) 5 (35.7)
Number of
participants
Total 26, 750 976 3878 586 15,929 5381
Mean ± SD 307.5 ±
459.7
244 ±
198.2
215.4 ± 313.7 117.2 ± 65.9 346.3 ±
502.6
384.4 ± 555.1
Median 150 166 82.5 102 197.5 237.5
Range 16–2500 67–577 18–1325 40–194 16–2500 36–2280
Participant inclusion
criteria: Age
Broad range- all
childbearing women, n (%)
54 (62.1) –12 (66.7) 1 (20) 29 (63.0) 12 (85.7)
Younger age groups
(< 30 years), n (%)
5 (5.8) 1 (25) 1 (5.6) 1 (20) 1 (2.2) 1 (7.1)
Specific/limited range, n (%) 12 (13.8) 3 (75) 2 (11.1) 3 (60) 2 (4.4) –
Age range not reported, n (%) 18 (20.7) –3 (16.7) –14 (30.4) 1 (7.1)
Participant inclusion
criteria: BMI
a
Underweight, healthy weight,
overweight and obese, n (%)
2 (2.3) –– – 2 (4.4) –
Underweight, healthy weight
and overweight, n (%)
1 (1.2) –– – 1 (2.2) –
Healthy weight and
overweight, n (%)
1 (1.2) –– 1 (20) ––
Healthy weight, overweight
and obese, n (%)
16 (18.4) –3 (16.7) 1 (20) 10 (21.7) 2 (14.3)
Overweight only, n (%) 1 (1.2) –1 (5.6) –––
Overweight and obese, n (%) 36 (41.4) 4 (100) 12 (66.7) 3 (60) 13 (28.3) 4 (28.6)
Obese only, n (%) 9 (10.3) –– – 7 (15.2) 2 (14.3)
Not reported, n (%) 21 (24.1) 2 (11.1) 13 (28.3) 6 (42.9)
Participant inclusion
criteria: Pregnancy
related
Antenatal, n (%) 59 (67.8) –– – 45 (97.8) 14 (100)
Postpartum, n (%) 18 (20.7) –18 (100) –––
Planning pregnancy, n (%) 1 (1.15) –– – 1 (2.2) –
Not pregnancy related, n (%) 9 (10.3) 4 (100) –5 (100) ––
Participant inclusion
criteria: Other
Parity, n (%) 5 (5.8) –– – 3 (6.5) 2 (14.3)
Ethnicity, n (%) 12 (13.8) 1 (25) 2 (11.1) 3 (60) 3 (6.5) 3 (21.4)
Socio-economic status, n (%) 10 (11.5) 1 (25) 4 (22.2) 1 (20) 3 (6.5) 1 (7.1)
Clinical condition, n (%) 5 (5.8) 1 (25) 2 (11.1) ––2 (14.3)
a
BMI classifications as per the World Health Organization International Classification of adult underweight, overweight and obesity according to BMI
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 5 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Systematic reviews
Three systematic reviews of RCTs were included in the
scoping review, [15,18,113] which are described in de-
tail in Additional file 1: Table S3. They included a total
of 12 RCTs published from 1998 to 2011. Two of the re-
views simply included studies with women of childbear-
ing age, [18,113] while the third included women of
childbearing age ≥18 years of age [15]. Only one of the
reviews specified that it only included participants af-
fected by overweight or obesity [18]. None of the reviews
had inclusion criteria related to participant’s ethnicity,
clinical conditions or socio-economic status.
In terms of the reviews’inclusion criteria for interven-
tions, all reviews included studies with interventions that
focused on modifying dietary intake, and two on modify-
ing physical activity levels [15,113]. Two of the reviews
focused on prevention of excessive GWG, [15,18] and
one on prevention of excessive GWG and preventing
weight retention in the postpartum period [113]. The re-
views had no other specific inclusion criteria related to
intervention types (e.g. mode of delivery, setting etc).
All three reviews required weight be reported as an
outcome in the included studies, with one requiring it to
be the primary outcome of the study [15]. There was no
requirement in the three systematic reviews for diet or
physical activity outcomes to be measured for the stud-
ies to be included in the review.
Discussion
This is the first scoping review, to our knowledge, to
comprehensively examine the extent and range of re-
search undertaken to evaluate behavioral interventions
that support women of childbearing age to prevent and
treat overweight and obesity. The review identified 87
RCTs and three systematic reviews published in the last
two decades. All of the systematic reviews addressed
gestational weight gain, [15,18,113]andonealsofo-
cused on postpartum weight retention [113]. There has
been an increasing volume of research on supporting
this age group of women through weight-related behav-
ioral interventions over time, particularly in the last
decade. The majority of studies were conducted in the
United States and Australia although there was repre-
sentation of studies from middle income (although not
lower income) countries, supporting evidence from glo-
bal data on the rising prevalence of women affected by
overweight and obesity, that supporting women of
childbearing age in weight management is an inter-
national issue [114].
Fig. 2 Number of included RCTs per year by weight focus
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 6 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Almost 90% of the RCTs aimed to support women to
gain an appropriate amount of weight during pregnancy,
and/or support weight loss or prevent weight retention
following pregnancy. The surge in studies addressing ex-
cess gestational weight gain aligns with the 2009 publica-
tion of the revised United States Institute of Medicine
(IOM) Weight Gain during Pregnancy: Re-examining the
Guidelines [115]. National pregnancy guidelines of many
countries, including Canada [116] and Australia, [117]
follow the pregnancy weight gain recommended ranges
established by the IOM (i.e. total weight gain during
pregnancy of 12.5–18.0 kg for pre-pregnancy BMI < 18.5
kg/m
2
[Underweight], 11.5–16.0 kg for pre-pregancy
BMI of 18.5–24.9 kg/m
2
[Normal weight], 7.0–11.5 kg
for pre-pregnancy BMI of 25.0–29. 9 kg/m
2
[Over-
weight], and 5.0–9.0 kg for pre-pregnancy BMI ≥30.0 kg/
m
2
[Obese]). There are many strengths to the approach
of engaging women in weight management interventions
during or following pregnancy. Pregnancy has been pro-
posed as a time when effective behavioral interventions
can impact the health of two generations, [118]
potentially increasing the return for investment. There
may be a heightened level of interest and motivation by
women to address weight, healthy eating and physical
activity behaviors to improve pregnancy and health out-
comes for themselves and their child [118,119]. It may
also be easier to reach women through existing routine
antenatal and postnatal health care services when they
come in to regular contact with a range of health care
providers including doctors, midwives, nurses, dietitians,
pharmacists, and reproductive health specialists [120].
However, there are limitations to heavily relying on
pregnancy and postpartum interventions. Pregnant
women are typically recruited to participate in gesta-
tional weight gain behavioral interventions midway
through their second trimester [121]. This limits the po-
tential impact of the intervention to support weight
management since women who conceive with an obese,
overweight or healthy weight BMI on average surpass
their recommended weight gain by 18, 20 and 30 weeks
of pregnancy, respectively [122]. First trimester weight
gain in excess of 0.5–2 kg is also predictive of excess
Table 2 Summary of study outcomes by intervention goal and in total
Total
(n= 87)
General
weight
loss
(n=4)
Postpartum weight
loss/preventing weight
retention (n= 18)
General
weight gain
prevention
(n=5)
Excessive
GWG
prevention
(n= 46)
Combined excessive GWG
prevention and postpartum
weight loss (n= 14)
Outcome
measures- Number
of data collection points
Mean, time points 3.7 ± 2.0 3.0 ±
0.7
2.6 ± 0.5 3.2 ± 0.8 3.8 ± 2.0 5.1 ± 2.8
Median, time points 3 3 3 3 3 4
Range, time points 2–14 2–42–32–42–10 2–14
Unclear/not
reported, n (%)
10
(11.5)
–– – 10 (21.7) –
Weight Primary outcome,n
(%)
68
(78.2)
2 (50) 15 (83.3) 4 (80) 33 (71.7) 14 (100)
Not reported if primary
outcome, n (%)
3 (3.5) –3 (16.7) –––
Not primary
outcome, n (%)
16
(18.4)
2 (50) –1 (20) 13 (28.3) –
Dietary behavior An outcome, n (%) 54
(62.1)
2 (50) 16 (88.9) 2 (40) 26 (56.5) 8 (57.1)
Primary outcome, n
(%)
8 (9.2) –3 (16.7) –5 (10.9) –
Not reported if primary
outcome, n (%)
5 (5.8) 1 (25) 2 (11.1) –2 (4.4) –
Not primary
outcome, n (%)
41
(47.1)
1 (25) 11 (61.1) 2 (40) 19 (41.3) 8 (57.1)
Physical activity An outcome, n (%) 54
(62.1)
2 (50) 14 (77.8) 3 (60) 26 (56.5) 9 (64.3)
Primary outcome, n
(%)
5 (5.8) –2 (11.1) –3 (6.5) –
Not reported if primary
outcome, n (%)
5 (5.8) 1 (25) 2 (11.1) –2 (4.4) –
Not primary
outcome, n (%)
44
(50.6)
1 (25) 10 (55.6) 3 (60) 21 (45.7) 9 (64.3)
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 7 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Table 3 Summary of intervention characteristics by intervention goal and in total
Total
(n= 105)
General
weight loss
(n=6
intervention
arms)
Postpartum weight
loss/preventing
weight retention
(n= 21 intervention
arms)
General weight
gain prevention
(n=6
intervention
arms)
Excessive GWG
prevention
(n=53
intervention
arms)
Combined excessive GWG
prevention and postpartum
weight loss (n=19
intervention arms)
Behavior
change
promoted
Dietary behavior
only, n (%)
13 (12.4) –4 (19.1) 1 (16.7) 5 (9.4) 3 (15.8)
Physical activity
only, n (%)
5 (4.8) –2 (9.5) –2 (3.8) 1 (5.3)
Combination, n (%) 85 (81) 6 (100) 15 (71.4) 5 (83.3) 44 (83.0) 16 (84.2)
Mode of
delivery
Individual, n (%) 70 (66.7) 3 (50) 12 (57.1) 3 (50) 38 (71.7) 14 (73.7)
Group, n (%) 14 (13.3) 2 (33.3) 2 (9.5) 2 (33.3) 6 (11.3) 2 (10.5)
Combination, n (%) 23 (21.9) 1 (16.7) 7 (33.3) 1 (16.7) 10 (18.9) 4 (21.1)
Medium of
delivery:
Type
In-person, n (%) 85 (81.0) 5 (83.3) 17 (81.0) 3 (50) 43 (81.1) 17 (89.5)
Telephone, n (%) 31 (29.5) 2 (33.3) 7 (33.3) 3 (50) 10 (18.9) 9 (47.4)
Email, n (%) 7 (6.7) 2 (33.3) 1 (4.8) 2 (33.3) 1 (1.9) 1 (5.3)
Web-based, n (%) 10 (9.5) 2 (33.3) 4 (19.1) –4 (7.6) –
Paper-based, n (%) 29 (27.6) –4 (19.1) 2 (33.3) 17 (32.1) 6 (31.6)
Text message, n (%) 11 (10.5) –6 (28.6) –4 (7.6) 1 (5.3)
Social media, n (%) 3 (2.9) –1 (4.8) –1 (1.9) 1 (5.3)
Video, n (%) 7 (6.7) 1 (16.7) 1 (4.8) –5 (9.4) –
App, n (%) 1 (1.0) –1 (4.8) –––
Medium of
delivery:
Number
used
One medium, n (%) 52 (49.5) 2 (33.3) 5 (23.8) 4 (66.7) 32 (60.4) 9 (47.4)
Two media, n (%) 37 (35.2) 2 (33.3) 10 (47.6) 1 (16.7) 16 (30.2) 8 (42.1)
Three media, n (%) 14 (13.3) 2 (33.3) 6 (28.6) –4 (7.6) 2 (10.5)
Four media, n (%) 3 (2.9) –– 1 (16.7) 1 (1.9) 1 (5.3)
Five media, n (%) 1 (1.0) –– – 1 (1.9) –
Profession of
intervention
deliverer
Dietetic professional
(dietitian, nutritionist),
n (%)
45 (42.9) 1 (16.7) 12 (57.1) 3 (50) 22 (41.5) 7 (36.8)
Exercise professional (EP,
physiotherapist, fitness
trainers), n (%)
10 (9.5) –3 (14.3) –6 (11.3) 1 (5.3)
Clinicians (nurses,
midwifes, GP’s,
obstetrician’s), n (%)
31 (29.5) 1 (16.7) 1 (4.8) –24 (45.3) 5 (26.3)
Health coach/educators,
n (%)
16 (15.2) 1 (16.7) 5 (23.8) 1 (16.7) 6 (11.3) 3 (15.8)
Psychology professionals
(counsellors), n (%)
6 (5.7) 2 (33.3) 2 (9.5) –2 (3.8) –
Research staff (research
assistants, students,
interventionists), n (%)
11 (10.5) –1 (4.8) –8 (15.1) 2 (10.5)
Other, n (%) 2 (1.9) ––1 (1.9) 1 (5.3)
Not reported, n (%) 18 (17.1) 2 (33.3) 2 (9.5) 2 (33.3) 7 (13.2) 5 (26.3)
Setting Home, n (%) 30 (28.6) 2 (33.3) 10 (47.6) 3 (50) 8 (15.1) 7 (36.8)
Clinic/hospital, n (%) 32 (30.5) 1 (16.7) 1 (4.8) –24 (45.3) 6 (31.6)
Community center, n (%) 10 (9.5) –3 (14.3) 2 (33.3) 4 (7.6) 1 (5.3)
Research facility, n (%) 6 (5.7) –5 (23.8) ––1 (5.3)
Other, n (%) 8 (7.6) –3 (14.3) 1 (16.7) 2 (3.8) 2 (10.5)
Not reported, n (%) 29 (27.6) 3 (50) 4 (19.1) 1 (16.7) 17 (32.1) 4 (21.1)
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 8 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

gestational weight gain during pregnancy [123]. Behav-
ioral interventions that engage and support women to
gain an appropriate amount of weight from earlier in
pregnancy are needed [124]. However, this brings further
clinical practice implementation challenges when up to
30–40% of woman do not begin receiving antenatal care
until their second trimester [125,126]. Given that preg-
nancy behavioral interventions have resulted in only
modest reductions in gestational weight gain (of about
0.7 kg), and few have improved maternal and child
health outcomes, there are compelling calls for future
intervention research to also focus on the preconception
period [127].
There is growing evidence on the role of obesity in
preconception as a major determinant of offspring
health in childhood and later adult life through the de-
velopmental origins of health and disease hypothesis
[128]. In pregnant women, a higher pre-pregnancy BMI
has been consistently identified as a strong predictor of
pregnancy complications [129] and adverse offspring
non-communicable health trajectories [130–132]. For
example, when compared to a healthy pre-pregnancy
BMI (18.5–24.9 kg/m
2
) a pre-pregnancy BMI of ≥40 kg/
m
2
has been shown to be associated with increased risk
of gestational diabetes (Odds Ratio: 11.01 95% confi-
dence interval 10.25–11.82), preeclampsia (OR: 4.44,
95%CI:4.17–4.72) and pre-term birth (OR: 2.91 95% CI:
2.21–3.81) [129]. The scoping review identified only one
behavioral intervention directly supporting women in
the preconception period who were planning a preg-
nancy. While the opportunity to support women at the
individual level who are actively planning a pregnancy is
important, it is also limited by low preconception care
engagement (60–80% of women don’t receive precon-
ception care [133–135]) and unplanned pregnancies,
with global estimates that 44% of all pregnancies are un-
intended [136].
By only addressing weight management associated
with a pregnancy event, an opportunity is missed to sup-
port weight management in the young female popula-
tion, regardless of their intention or ability to have
children. Only nine intervention studies that were unre-
lated to pregnancy were identified through the scoping
review demonstrating a substantial research gap.
Women tend to gain 0.5–1 kg each year from early
adulthood until middle-age, [137,138] with all young
women, not only those who bear children, at risk of un-
healthy weight gain [7]. An 18 year follow-up of 92,837
women from early to mid-adulthood in the Nurses’
Health Study found that women who gained between
2.5–10 kg had an increased incidence of type II diabetes,
cardiovascular disease, obesity-related cancer, and mor-
tality [8]. Effective behavioral interventions to support
the entire young adult female population to improve
health behaviors and weight management will improve
chronic disease health trajectories more broadly, with
added reproductive and intergenerational health benefits
for women whose future pregnancies are both planned
and unplanned.
Few weight management behavioral studies, with
weight as the primary focus, have been conducted with
women with clinical conditions. Engaging young women
with existing or previous clinical conditions, such as type
II diabetes, polycystic ovary syndrome, pre-eclampsia,
and women who are experiencing obesity-related infer-
tility, may help to reach and support young women at
higher risk of obesity. More than half of the studies in
this scoping review only recruited women who were
affected by overweight and/or obesity. Weight gain pre-
vention research to support young women to maintain
their weight is needed if the rising obesity epidemic is to
be halted. More research is also needed with populations
under-represented in this review, such as women from
lower socioeconomic groups and culturally diverse pop-
ulations who may experience other barriers to weight
management and have different patterns of health ser-
vice engagement. Researchers should draw on existing
behavioral modification research with lower socioeco-
nomic groups and culturally diverse population groups
to inform intervention design. Developing a better
understanding of effective socially and culturally appro-
priate behavioral support, and clinician barriers to pro-
viding best practice care (e.g. clinician BMI and personal
weight satisfaction may influence their confidence in
providing best practice care [139]), could inform the de-
livery of population and primary health care initiatives
for weight management.
The interventions included a variety of delivery modes
and mediums, with individual and in-person delivery
most commonly used. While the number of different de-
livery mediums used has increased over-time, no con-
sistent or proven delivery medium has emerged [140].
Half of the interventions used more than one type of
medium, such as in-person, telephone and text mes-
sages. Interventions delivered in the postpartum period
tended to use more than one medium, and a greater var-
iety of mediums. The use of multiple communication av-
enues may highlight efforts to overcome the difficulty of
reaching new mothers who face complex barriers to par-
ticipation, including a lack of time and need for child-
care [141,142]. Identifying whether one or more of the
delivery modes and mediums are more effective in help-
ing young women to manage their weight could help to
inform the delivery of future interventions. Assessment
of the intervention feasibility and acceptability by those
delivering, and women receiving, weight management
care should also be undertaken. Interventions were com-
monly provided by dietitians or nutritionists, or health
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 9 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

care providers such as midwives and GPs. However, half
of the studies did not deliver care through a dietetic or
exercise professional, despite the professions’expertise
in nutrition [143,144] and physical activity [145] for
weight management. Systematic review evidence has
shown that weight management interventions delivered
by health care providers, [146] including dietitians, [147]
are more effective than those delivered by non-health
care providers.
This review has several strengths. It is the first scop-
ing review to comprehensively examine the extent and
range of research undertaken to evaluate behavioral in-
terventions that support women of childbearing age to
prevent and treat overweight and obesity. The review
employed a comprehensive search strategy across nu-
merous databases, and summarized the evidence from
systematic reviews and RCTs, the two highest levels of
evidence [26]. However, by limiting to systematic re-
views and RCTs, evaluations of relevant interventions
using other experimental study designs (e.g. pre-post
studies, non-randomized control trials) were excluded
from the review. In addition, the review only consid-
ered the extent and range of studies, and did not
explore the efficacy of the interventions. Another main
limitation of the scoping review was the challenge of
combining data of studies that spanned different life
periods (e.g. preconception, pregnancy, postpartum,
non-pregnancy related) to accurately describe inter-
vention duration and the timing of measurement out-
comes, as they were variable within studies (e.g. due to
timing of intervention delivery approximately based on
weeks’gestation in pregnancy) and across studies (e.g.
due to differences in health service delivery, and the
timing of when women are seen during and after preg-
nancy). Further, while 92 and 85% of studies reported
interventions that targeted diet and/or physical activity
behaviour change, respectively, only 62% of studies
measured diet and 62% measured physical activity as
outcomes. There is a need for studies to include valid
and reliable diet and physical activity outcomes, par-
ticularly to investigate changes in diet and physical ac-
tivity as a mediator of weight change. Finally, the
scoping review included studies published up until
31st January 2018, therefore it is possible that add-
itional studies meeting the inclusion criteria have been
published since that time.
Fig. 3 Medium of intervention delivery across included RCTs per year
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 10 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Conclusions
There is a substantial body of research from the two
highest levels of evidence on behavioral interventions
that support women of childbearing age to prevent and
treat overweight and obesity, particularly from research
published within the last decade. The majority has fo-
cused on weight management during or after a preg-
nancy event, demonstrating a research gap to support
weight management in the young adult female popula-
tion in preconception and unrelated to pregnancy to im-
prove their own chronic disease health trajectories, with
reproductive and intergenerational health benefits for fu-
ture planned and unplanned pregnancies. Future re-
search to examine delivery modes and mediums, optimal
intervention duration and intensity, involvement of
health care providers, and involvement of under-
represented populations should be considered, both to
understand effective behavioral interventions, and to en-
sure that interventions are scalable and can be imple-
mented within policy and practice, such as through
population and primary health care.
Supplementary information
Supplementary information accompanies this paper at https://doi.org/10.
1186/s12905-020-0882-3.
Additional file 1: Table S1. Full electronic search for one database
(MEDLINE). Table S2. Summary of included Randomised Control Trials.
Table S3. Summary of Included Systematic Reviews.
Abbreviations
BMI: Body mass index; GWG: Gestational weight gain; IOM: Institute of
Medicine; RCT: Randomized controlled trial
Acknowledgements
Not applicable.
Authors’contributions
MJH, MMH, HB, SL, LM, LV, MR, JH contributed to the design/methodology
of the scoping review, as well as screening and data extraction. MJH, MMH
and HB collated the results, MH and JH drafted the manuscript, and MJH,
MMH, HB, SL, LM, LV, MR, JH read and approved the final manuscript.
Funding
The scoping review was supported by a School of Health Sciences small
grant. Dr. Melinda Hutchesson is supported by a Gladys M Brawn Career
Development Fellowship (Teaching Assistance).Dr. Siew Lim is supported by
a National Health and Medical Research Council Early Career Fellowship. A/
Prof Lisa Moran is supported by a National Heart Foundation Future Leader
Fellowship. The funding bodies played no role in the study.
Availability of data and materials
All data generated or analyzed during this study are included in this
published article [and its supplementary information files]. The databases
utilized in the search strategy were accessed via institutional licenses of the
University of Newcastle, and therefore public access to the databases is
closed.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1
School of Health Sciences, Faculty of Health and Medicine, and Priority
Research Centre for Physical Activity and Nutrition, University of Newcastle,
University Drive, Callaghan, New South Wales, Australia.
2
Division of Human
Nutrition and Health, Wageningen University, Wageningen, The Netherlands.
3
Monash Centre for Health Research and Implementation, Monash University,
Clayton, Victoria, Australia.
4
School of Allied Health Science, Griffith University,
Gold Coast, Queensland, Australia.
5
Hunter New England Population Health,
Longworth Avenue, Wallsend, Australia.
6
School of Medicine and Public
Health, The University of Newcastle, Callaghan, Australia.
7
Priority Research
Centre for Health Behaviour, University of Newcastle, Callaghan, New South
Wales, Australia.
8
Hunter Medical Research Institute, New Lambton Heights,
NSW, Australia.
Received: 21 May 2019 Accepted: 10 January 2020
References
1. NCD Risk Factor Collaboration. Trends in adult body-mass index in 200
countries from 1975 to 2014: a pooled analysis of 1698 population-
based measurement studies with 19.2 million participants. Lancet. 2016;
387(10026):1377–96.
2. Dutton GR, Kim Y, Jacobs DR Jr, Li X, Loria CM, Reis JP, Carnethon M,
Durant NH, Gordon-Larsen P, Shikany JM, et al. 25-year weight gain in
a racially balanced sample of U.S. adults: the CARDIA study. Obesity.
2016;24(9):1962–8.
3. Adamson L, Brown W, Byles J, Chojenta C, Dobson A, Fitzgerald D, Hockey
R, Loxton D, Powers J, Spallek M, et al. Women's weight: findings from the
Australian longitudinal study on Women’s health. Canberra: Australian
Government Department of Health and Ageing; 2007.
4. Norman JE, Bild D, Lewis CE, Liu K, West DS. The impact of weight change
on cardiovascular disease risk factors in young black and white adults: the
CARDIA study. Int J Obes Relat Metab Disord. 2003;27(3):369–76.
5. Gordon-Larsen P, The NS, Adair LS. Longitudinal trends in obesity in the
United States from adolescence to the third decade of life. Obesity. 2010;
18(9):1801–4.
6. Robinson WR, Cheng MM, Hoggatt KJ, Sturmer T, Siega-Riz AM.
Childbearing is not associated with young women's long-term obesity risk.
Obesity. 2014;22(4):1126–32.
7. Davis D, Brown WJ, Foureur M, Nohr EA, Xu F. Long-term weight gain and
risk of overweight in parous and nulliparous women. Obesity. 2018;26(6):
1072–7.
8. Zheng Y, Manson JE, Yuan C, Liang MH, Grodstein F, Stampfer MJ, Willett
WC, Hu FB. Associations of weight gain from early to middle adulthood
with major health outcomes later in life. JAMA. 2017;318(3):255–69.
9. Athukorala C, Rumbold AR, Willson KJ, Crowther CA. The risk of adverse
pregnancy outcomes in women who are overweight or obese. BMC
Pregnancy Childbirth. 2010;10:56.
10. Oteng-Ntim E, Kopeika J, Seed P, Wandiembe S, Doyle P. Impact of obesity
on pregnancy outcome in different ethnic groups: calculating population
attributable fractions. PLoS One. 2013;8(1):e53749.
11. Hutchesson MJ, Hulst J, Collins CE. Weight management interventions
targeting young women: a systematic review. J Acad Nutr Diet. 2013;113(6):
795–802.
12. Farpour-Lambert NJ, Ells LJ, Martinez de Tejada B, Scott C. Obesity and
Weight Gain in Pregnancy and Postpartum: an Evidence Review of Lifestyle
Interventions to Inform Maternal and Child Health Policies. Front Endocrinol.
2018;9:546.
13. Berger AA, Peragallo-Urrutia R, Nicholson WK. Systematic review of the
effect of individual and combined nutrition and exercise interventions on
weight, adiposity and metabolic outcomes after delivery: evidence for
developing behavioral guidelines for post-partum weight control. BMC
Pregnancy Childbirth. 2014;14:319.
14. Dalrymple KV, Flynn AC, Relph SA, O'Keeffe M, Poston L. Lifestyle
Interventions in Overweight and Obese Pregnant or Postpartum Women for
Postpartum Weight Management: A Systematic Review of the Literature.
Nutrients. 2018;10:11.
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 11 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

15. Brown MJ, Sinclair M, Liddle D, Hill AJ, Madden E, Stockdale J, et al. PLoS
ONE. 2012;7(7):e39503.
16. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Duda W, Borowiack E,
Roseboom T, Tomlinson J, Walczak J, Kunz R, et al. Interventions to reduce
or prevent obesity in pregnant women: a systematic review. Health Technol
Assess. 2012;16(31):iii–v 1-191.
17. Kuhlmann AK, Dietz PM, Galavotti C, England LJ. Weight-management
interventions for pregnant or postpartum women (structured abstract). Am
J Prev Med. 2008;34:523–8.
18. 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. Obstet Gynecol. 2011;118(6):1395–401.
19. Dodd JM, Grivell RM, Crowther CA, Robinson JS. Antenatal interventions for
overweight or obese pregnant women: a systematic review of randomised
trials. BJOG. 2010;117(11):1316–26.
20. Flynn AC, Dalrymple K, Barr S, Poston L, Goff LM, Rogozinska E, van Poppel
MN, Rayanagoudar G, Yeo S, Barakat Carballo R, et al. Dietary interventions
in overweight and obese pregnant women: a systematic review of the
content, delivery, and outcomes of randomized controlled trials. Nutr Rev.
2016;74(5):312–28.
21. Tanentsapf I, Heitmann BL, Adegboye AR. Systematic review of clinical trials
on dietary interventions to prevent excessive weight gain during pregnancy
among normal weight, overweight and obese women. BMC Pregnancy
Childbirth. 2011;11:81.
22. O'Brien CM, Grivell RM, Dodd JM. Systematic review of antenatal dietary and
lifestyle interventions in women with a normal body mass index. Acta
Obstet Gynecol Scand. 2016;95(3):259–69.
23. Spencer L, Rollo M, Hauck Y, MacDonald-Wicks L, Wood L, Hutchesson M,
Giglia R, Smith R, Collins C. The effect of weight management interventions
that include a diet component on weight-related outcomes in pregnant
and postpartum women: a systematic review protocol. JBI Database System
Rev Implement Rep. 2015;13(1):88–98.
24. Arksey H, O'Malley L. Scoping studies: towards a methodological framework.
Int J Soc Res Methodol. 2005;8(1):19–32.
25. Hutchesson M, de Jonge Mulock Houwer M, Rollo M, Hollis J, Lim S, Vincze
L, Moran L. Behavioural interventions to treat and prevent overweight and
obesity among women of childbearing age: A scoping review, vol. 2018.
Melbourne: Australian and New Zealand Obesity Society-Breakthrough
Discoveries Joint Annual Scientific Meeting 2018; 2018.
26. Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in
evidence-based medicine. Plast Reconstr Surg. 2011;128(1):305.
27. Abdel-Aziz SB, Hegazy IS, Mohamed DA, MMA AEK, Hagag SS. Effect of
dietary counseling on preventing excessive weight gain during pregnancy.
Public Health. 2018;154:172–81.
28. Adamo KB, Ferraro ZM, Goldfield G, Keely E, Stacey D, Hadjiyannakis S, Jean-
Philippe S, Walker M, Barrowman NJ. The maternal obesity management
(MOM) trial protocol: a lifestyle intervention during pregnancy to minimize
downstream obesity. Contemp Clin Trials. 2013;35(1):87–96.
29. Althuizen E, Poppel MNM, Seidell JC, Wijden C, Mechelen W. Design of the
New Life(style) study: a randomised controlled trial to optimise maternal
weight development during pregnancy. In. BMC Public Health. 2006;6:168.
30. Asbee SM, Jenkins TR, Butler JR, White J, Elliot M, Rutledge A.
Preventing excessive weight gain during pregnancy through dietary
and lifestyle counseling: a randomized controlled trial. Obstet Gynecol.
2009;113(2, Part 1):305–12.
31. Asci O, Rathfisch G. Effect of lifestyle interventions of pregnant women on
their dietary habits, lifestyle behaviors, and weight gain: a randomized
controlled trial. J Health Popul Nutr. 2016;35:7.
32. Bogaerts A, Devlieger R, Nuyts E, Witters I, Gyselaers W, Van den Bergh B.
Effects of lifestyle intervention in obese pregnant women on gestational
weight gain and mental health: a randomized controlled trial. Int J
Gynaecol Obstet. 2013;37(6):814.
33. Brownfoot FC, Davey MA, Kornman L. Routine weighing to reduce
excessive antenatal weight gain: a randomised controlled trial. BJOG.
2016;123(2):254–61.
34. Clements V, Leung K, Khanal S, Raymond J, Maxwell M, Rissel C. Pragmatic
cluster randomised trial of a free telephone-based health coaching program
to support women in managing weight gain during pregnancy: the get
healthy in pregnancy trial. BMC Health Serv Res. 2016;16:454.
35. Daley AJ, Jolly K, Jebb SA, Lewis AL, Clifford S, Roalfe AK, Kenyon S, Aveyard
P. Feasibility and acceptability of regular weighing, setting weight gain
limits and providing feedback by community midwives to prevent excess
weight gain during pregnancy: Randomised controlled trial and qualitative
study. BMC Obesity. 2015;2(1):35.
36. Di Carlo C, Iannotti G, Sparice S, Chiacchio MP, Greco E, Tommaselli GA,
Nappi C. The role of a personalized dietary intervention in managing
gestational weight gain: a prospec tive, controlled study in a low-ris k
antenatal population. Arch Gynecol Obstet. 2014;289(4):765–70.
37. Dodd JM, Cramp C, Sui Z, Yelland LN, Deussen AR, Grivell RM, Moran
LJ, Crowther CA, Turnbull D, McPhee AJ, et al. The effects of antenatal
dietary and lifestyle advice for women who are overweight or obese
on maternal diet and physical activity: The LIMIT randomised trial. BMC
Med. 2014;12(1):161.
38. Farajzadegan Z, Pozveh ZA. The design of maternal centered life-style
modification program for weight gain management during pregnancy - a
study protocol. J Res Med Sci. 2013;18(8):683–7.
39. Gesell SB, Katula JA, Strickland C, Vitolins MZ. Feasibility and initial efficacy
evaluation of a community-based cognitive-behavioral lifestyle intervention
to prevent excessive weight gain during pregnancy in Latina women.
Matern Child Health J. 2015;19:1842–52.
40. Graham ML, Strawderman MS, Demment M, Olson CM. Does usage of an
eHealth intervention reduce the risk of excessive gestational weight gain?
Secondary analysis from a randomized controlled trial. J Med Internet Res.
2017;19(1):e6.
41. Guelinckx I, Devlieger R, Mullie P, Vansant G. Effect of lifestyle intervention
on dietary habits, physical activity, and gestational weight gain in obese
pregnant women: a randomized controlled trial. Am J Clin Nutr.
2010;91(2):373–80.
42. Haby K, Glantz A, Hanas R, Premberg A. Mighty mums - an antenatal health
care intervention can reduce gestational weight gain in women with
obesity. Midwifery. 2015;31(7):685–92.
43. Harden SM, Beauchamp MR, Pitts BH, Nault EM, Davy BM, You W, Weiss P,
Estabrooks PA. Group-based lifestyle sessions for gestational weight gain
management: a mixed method approach. Am J Health Behav. 2014;38(4):
560–9.
44. Harrison CL, Lombard CB, Strauss BJ, Teede HJ. Optimizing healthy
gestational weight gain in women at high risk of gestational diabetes: a
randomized controlled trial. Obesity. 2013;21(5):904–9.
45. Hawkins M, Hosker M, Marcus BH, Rosal MC, Braun B, Stanek EJ 3rd,
Markenson G, Chasan-Taber L. A pregnancy lifestyle intervention to prevent
gestational diabetes risk factors in overweight Hispanic women: a feasibility
randomized controlled trial. Diabet Med. 2015;32(1):108–15.
46. Hui A, Back L, Ludwig S, Gardiner P, Sevenhuysen G, Dean H, Sellers E,
McGavock J, Morris M, Bruce S, et al. Lifestyle intervention on diet and
exercise reduced excessive gestational weight gain in pregnant women
under a randomised controlled trial. BJOG. 2012;119(1):70–7.
47. Hui AL, Back L, Ludwig S, Gardiner P, Sevenhuysen G, Dean HJ, Sellers
E, McGavock J, Morris M, Jiang D, et al. Effects of lifestyle intervention
on dietary intake, physical activity level, and gestational weight gain in
pregnant women with different pre-pregnancy body mass index in a
randomized control trial. BMC Pregnancy Childbirth.
2014;14:331.
48. Hui AL, Ludwig S, Gardiner P, Sevenhuysen G, Murray R, Morris M, Shen GX.
Community-based exercise and dietary intervention during pregnancy:a
pilot study. Can J Diab. 2006;30(2):1–7.
49. Jackson RA, Stotland NE, Caughey AB, Gerbert B. Improving diet and
exercise in pregnancy with video doctor counseling: a randomized trial.
Patient Educ Couns. 2011;83(2):203–9.
50. Jeffries K, Shub A, Walker SP, Hiscock R, Permezel M. Reducing excessive
weight gain in pregnancy: a randomised controlled trial. Med J Aust. 2009;
191(8):429–33.
51. Jing W, Huang Y, Liu X, Luo B, Yang Y, Liao S. The effect of a personalized
intervention on weight gain and physical activity among pregnant women
in China. Int J Gynaecol Obstet. 2015;129(2):138–41.
52. Kinnunen TI, Raitanen J, Aittasalo M, Luoto R. Preventing excessive
gestational weight gain-a secondary analysis of a cluster-randomised
controlled trial. Eur J Clin Nutr. 2012;66(12):1344–50.
53. Koivusalo SB, Rono K, Klemetti MM, Roine RP, Lindstrom J, Erkkola M, Kaaja
RJ, Poyhonen-Alho M, Tiitinen A, Huvinen E, et al. Gestational diabetes
mellitus can be prevented by lifestyle intervention: the Finnish gestational
diabetes prevention study (RADIEL): a randomized controlled trial. Diab
Care. 2016;39(1):24–30.
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 12 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

54. LeBlanc ES, Vesco KK, Funk KL, Karanja N, Smith N, Stevens VJ. Prepare, a
randomized trial to promote and evaluate weight loss among overweight
and obese women planning pregnancy: study design and rationale.
Contemp Clin Trials. 2016;49:174–80.
55. McCarthy EA, Walker SP, Ugoni A, Lappas M, Leong O, Shub A. Self-
weighing and simple dietary advice for overweight and obese pregnant
women to reduce obstetric complications without impact on quality of life:
a randomised controlled trial. BJOG. 2016;123(6):965–73.
56. Nagle C, Skouteris H, Hotchin A, Bruce L, Patterson D, Teale G. Continuity of
midwifery care and gestational weight gain in obese women: a randomised
controlled trial. BMC Public Health. 2011;11:174.
57. Petrella E, Malavolti M, Bertarini V, Pignatti L, Neri I, Battistini NC, Facchinetti
F. Gestational weight gain in overweight and obese women enrolled in a
healthy lifestyle and eating habits program. J Matern Fetal Neonatal Med.
2014;27(13):1348–52.
58. Pollak KI, Alexander SC, Bennett G, Lyna P, Coffman CJ, Bilheimer A, Farrell
D, Bodner ME, Swamy GK, Ostbye T. Weight-related SMS texts promoting
appropriate pregnancy weight gain: a pilot study. Patient Educ Couns. 2014;
97(2):256–60.
59. Polley B, Wing R, Sims C. Randomized controlled trial to prevent excessive
weight gain in pregnant women. Int J Obes. 2002;26(11):1494–502.
60. Quinlivan JA, Lam LT, Fisher J. A randomised 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.
61. Rauh K, Gabriel E, Kerschbaum E, Schuster T, Kries R, Amann-Gassner U,
Hauner H. Safety and efficacy of a lifestyle intervention for pregnant women
to prevent excessive maternal weight gain: a cluster-randomized controlled
trial. BMC Pregnancy Childbirth. 2013;13:151.
62. Rauh K, Kunath J, Rosenfeld E, Kick L, Ulm K, Hauner H. Healthy living in
pregnancy: a cluster-randomized controlled trial to prevent excessive
gestational weight gain - rationale and design of the GeliS study. BMC
Pregnancy Childbirth. 2014;14:119.
63. Renault KM, Carlsen EM, Haedersdal S, Nilas L, Secher NJ, Eugen-Olsen J,
Cortes D, Olsen SF, Halldorsson TI, Norgaard K. Impact of lifestyle
intervention for obese women during pregnancy on maternal metabolic
and inflammatory markers. Int J Obes. 2017;41(4):598–605.
64. Ronnberg AK, Ostlund I, Fadl H, Gottvall T, Nilsson K. Intervention during
pregnancy to reduce excessive gestational weight gain - a randomised
controlled trial. BJOG. 2015;122:537–44.
65. Skouteris H, McPhie S, Hill B, McCabe M, Milgrom J, Kent B, Bruce L, Herring
S, Gale J, Mihalopoulos C, et al. Health coaching to prevent excessive
gestational weight gain: a randomized-controlled trial. Br J Health Psychol.
2016;21(1):31–51.
66. Smith K, Lanningham-Foster L, Welch A, Campbell C. Web-based behavioral
intervention increases maternal exercise but does not prevent excessive
gestational weight gain in previously sedentary women. J Phys Act Health.
2016;13(6):587–93.
67. Szmeja MA, Cramp C, Grivell RM, Deussen AR, Yelland LN, Dodd JM. Use of
a DVD to provide dietary and lifestyle information to pregnant women who
are overweight or obese: a nested randomised trial. BMC Pregnancy
Childbirth. 2014;14:409.
68. Thornton YS. Preventing excessive weight gain during pregnancy through
dietary and lifestyle counseling: a randomized controlled trial. Obstet
Gynecol. 2009;114(1):173 author reply 173-174.
69. Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jorgensen JS. The LiP
(lifestyle in pregnancy) study: a randomized controlled trial of lifestyle
intervention in 360 obese pregnant women. Diab Care. 2011;34(12):
2502–7.
70. Willcox J, Wilkinson S, Lappas M, Ball K, Crawford D, McCarthy E, Fjeldsoe B,
Whittaker R, Maddison R, Campbell K. A mobile health intervention
promoting healthy gestational weight gain for women entering pregnancy
at a high body mass index: the txt4two pilot randomised controlled trial.
BJOG. 2017;124:1718.
71. Wolff S, Lega rth J, Vangsgaard K, Toubro S, Astrup A. A randomized
trial of the effects of dietary counseling on gestational weight gain and
glucose metabolism in obese pregnant women. Int J Obes. 2008;32(3):
495–501.
72. Berry D, Verbiest S, Hall EG, Dawson I, Norton D, Willis S, McDonald K,
Stuebe A. A postpartum community-based weight management
intervention designed for low-income women: feasibility and initial efficacy
testing. J Natl Black Nurses Assoc. 2015;26(1):29–39.
73. Bertz F, Brekke HK, Ellegard L, Rasmussen KM, Wennergren M, Winkvist A.
Diet and exercise weight-loss trial in lactating overweight and obese
women. Am J Clin Nutr. 2012;96(4):698–705.
74. Chang MW, Brown R, Nitzke S. Results and lessons learned from a
prevention of weight gain program for low-income overweight and obese
young mothers: mothers in motion. BMC Public Health. 2017;17(1):182.
75. Colleran HL, Lovelady CA. Use of MyPyramid menu planner for moms in a
weight-loss intervention during lactation. J Acad Nutr Diet. 2012;112(4):553–8.
76. Craigie AM, Macleod M, Barton KL, Treweek S, Anderson AS. Supporting
postpartum weight loss in women living in deprived communities: design
implications for a randomised control trial. Eur J Clin Nutr. 2011;65(8):952–8.
77. Gilmore LA, Klempel MC, Martin CK, Myers CA, Burton JH, Sutton EF,
Redman LM. Personalized Mobile health intervention for health and weight
loss in postpartum women receiving women, infants, and children benefit:
a randomized controlled pilot study. J Women's Health (Larchmt). 2017;
26(7):719–27.
78. Haire-Joshu DL, Schwarz CD, Peskoe SB, Budd EL, Brownson RC, Joshu CE. A
group randomized controlled trail integrating obesity prevention and
control for postpartum adolescents in a home visiting program. Int J Behav
Nutr Phy. 2015;12:88.
79. Herring SJ, Cruice JF, Bennett GG, Davey A, Foster GD. Using technology to
promote postpartum weight loss in urban, low-income mothers: a pilot
randomized controlled trial. J Nutr Educ Behav. 2014;46(6):610–5.
80. Huseinovic E, Bertz F, Agelii ML, Johansson EH, Winkvist A, Brekke HK.
Effectiveness of a weight loss intervention in postpartum women: results
from a randomized controlled trial in primary health care. Am J Clin Nutr.
2016;104(2):362–70.
81. Keller C, Ainsworth B, Records K, Todd M, Belyea M, Vega-Lopez S, Permana
P, Coonrod D, Nagle-Williams A. A comparison of a social support physical
activity intervention in weight management among post-partum Latinas.
BMC Public Health. 2014;14:971.
82. Krummel D, Semmens E, MacBride AM, Fisher B. Lessons learned from the
mothers' overweight management study in 4 West Virginia WIC offices. J
Nutr Educ Behav. 2010;42(3 Suppl):S52–8.
83. Leermakers EA, Anglin K, Wing RR. Reducing postpartum weight retention
through a correspondence intervention. Int J Obesity Related Metabol
Disord. 1998;22(11):1103–9.
84. Nicklas JM, Zera CA, England LJ, Rosner BA, Horton E, Levkoff SE, Seely EW.
A web-based lifestyle intervention for women with recent gestational
diabetes mellitus: a randomized controlled trial. Obstet Gynecol. 2014;124(3):
563–70.
85. Østbye T, Krause KM, Lovelady CA, Morey MC, Bastian LA, Peterson BL,
Swamy GK, Brouwer RJN, McBride CM. Active mothers postpartum. A
randomized controlled weight-loss intervention trial. Am J Prev Med. 2009;
37(3):173–80.
86. O'Toole ML, Sawicki MA, Artal R. Structured diet and physical activity
prevent postpartum weight retention. J Women's Health (Larchmt). 2003;
12(10):991–8.
87. Phelan S, Brannen A, Erickson K, Diamond M, Schaffner A, Muñoz-Christian
K, Stewart A, Sanchez T, Rodriguez VC, Ramos DI, et al. ‘Fit Moms/Mamás
Activas’internet-based weight control program with group support to
reduce postpartum weight retention in low-income women: study protocol
for a randomized controlled trial. Trials. 2015;16:59.
88. Stendell-Hollis NR, Thompson PA, West JL, Wertheim BC, Thomson CA. A
comparison of Mediterranean-style and MyPyramid diets on weight loss
and inflammatory biomarkers in postpartum breastfeeding women. J
Women's Health (Larchmt). 2013;22(1):48–57.
89. Wilkinson SA, Pligt P, Gibbons KS, McIntyre HD. Trial for reducing weight
retention in new mums: a randomised controlled trial evaluating a low
intensity, postpartum weight management programme. J Hum Nutr Diet.
2015;28(Suppl 1):15–28.
90. Bechtel-Blackwell DA. Computer-assisted self-interview and nutrition
education in pregnant teens. Clin Nurs Res. 2002;11(4):450–62.
91. Chasan-Taber L, Marcus BH, Rosal MC, Tucker KL, Hartman SJ, Pekow P,
Stanek E, Braun B, Solomon CG, Manson JAE, et al. Proyecto Mama: A
lifestyle intervention in overweight and obese Hispanic women: A
randomised controlled trial - study protocol. BMC Pregnancy Childbirth.
2015;15(1):157.
92. Ferrara A, Hedderson MM, Brown SD, Albright CL, Ehrlich SF, Tsai AL, Caan
BJ, Sternfeld B, Gordon NP, Schmittdiel JA, et al. The comparative
effectiveness of diabetes prevention strategies to reduce postpartum
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 13 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

weight retention in women with gestational diabetes mellitus: the
gestational Diabetes' effects on moms (GEM) cluster randomized controlled
trial. Diabetes Care. 2016;39(1):65–74.
93. Haakstad LA, Bo K. Effect of regular exercise on prevention of excessive
weight gain in pregnancy: a randomised controlled trial. Eur J Contracept
Reprod Health Care. 2011;16(2):116–25.
94. Herring SJ, Cruice JF, Bennett GG, Darden N, Wallen JJ, Rose MZ, Davey
A, Foster GD. Intervening during and after pregnancy to prevent
weight retention among African American women. Prev Med Rep. 2017;
7:119–23.
95. Huang TT, Yeh CY, Tsai YC. A diet and physical activity intervention for
preventing weight retention among Taiwanese childbearing women: a
randomised controlled trial. Midwifery. 2011;27(2):257–64.
96. John E, Cassidy DM, Playle R, Jewell K, Cohen D, Duncan D, Newcombe RG,
Busse M, Owen-Jones E, Williams N, et al. Healthy eating and lifestyle in
pregnancy (HELP): a protocol for a cluster randomised trial to evaluate the
effectiveness of a weight management intervention in pregnancy. BMC
Public Health. 2014;14:439.
97. Martin J, MacDonald-Wicks L, Hure A, Smith R, Collins CE. Reducing
postpartum weight retention and improving breastfeeding outcomes in
overweight women: a pilot randomised controlled trial. Nutrients. 2015;7(3):
1464–79.
98. Peccei A, Blake-Lamb T, Rahilly D, Hatoum I, Bryant A. Intensive prenatal
nutrition counseling in a community health setting: a randomized
controlled trial. Obstet Gynecol. 2017;130(2):423–32.
99. Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR.
Randomized trial of a behavioral intervention to prevent excessive
gestational weight gain: the fit for delivery study. Am J Clin Nutr. 2011;
93(4):772–9.
100. Sagedal LR, Sanda B, Overby NC, Bere E, Torstveit MK, Lohne-Seiler H,
Hillesund ER, Pripp AH, Henriksen T, Vistad I. The effect of prenatal lifestyle
intervention on weight retention 12 months postpartum: results of the
Norwegian fit for delivery randomised controlled trial. BJOG. 2017;124(1):
111–21.
101. Tawfik MY. The impact of health education intervention for prevention and
early detection of type 2 diabetes in women with gestational diabetes. J
Community Health. 2017;42(3):500–10.
102. Thomson JL, Tussing-Humphreys LM, Goodman MH. Delta healthy sprouts:
a randomized comparative effectiveness trial to promote maternal weight
control and reduce childhood obesity in the Mississippi Delta. Contemp
Clin Trials. 2014;38(1):82–91.
103. Vesco KK, Karanja N, King JC, Gillman MW, Perrin N, McEvoy C, Eckhardt C,
Smith KS, Stevens VJ. Healthy moms, a randomized trial to promote and
evaluate weight maintenance among obese pregnant women: study design
and rationale. Contemp Clin Trials. 2012;33(4):777–85.
104. Ames GE, Perri MG, Fox LD, Fallon EA, De Braganza N, Murawski ME, Pafumi
L, Hausenblas HA. Changing weight-loss expectations: a randomized pilot
study. Eat Behav. 2005;6(3):259–69.
105. Chang MW, Nitzke S, Brown R. Design and outcomes of a mothers in
motion behavioral intervention pilot study. J Nutr Educ Behav. 2010;42(3
Suppl):S11–21.
106. Lim SS, Norman RJ, Clifton PM, Noakes M. Psychological effects of
prescriptive vs general lifestyle advice for weight loss in young women. J
Am Diet Assoc. 2009;109(11):1917–21.
107. Mutsaerts M. Randomized trial of a lifestyle program in obese infertile
women. Ned Tijdschr Geneeskd. 2017;161:1942.
108. Bennett GG, Foley P, Levine E, Whiteley J, Askew S, Steinberg DM, Batch B,
Greaney ML, Miranda H, Wroth TH, et al. Behavioral treatment for weight
gain prevention among black women in primary care practice: a
randomized clinical trial. JAMA Intern Med. 2013;173:1770–7.
109. Berry D, Colindres M, Sanchez-Lugo L, Sanchez M, Neal M, Smith-Miller C.
Adapting, feasibility testing, and pilot testing a weight management
intervention for recently immigrated Spanish-speaking women and their 2-
to 4-year-old children. Hispanic Health Care Int. 2011;9(4):186–93.
110. Eiben G, Lissner L. Health hunters - an intervention to prevent overweight
and obesity in young high-risk women. Int J Gynaecol Obstet. 2006;30(4):
691–6.
111. Foley P, Levine E, Askew S, Puleo E, Whiteley J, Batch B, Heil D, Dix D, Lett V,
Lanpher M, et al. Weight gain prevention among black women in the rural
community health center setting: the shape program. BMC Public Health.
2012;12(1):305.
112. Klem ML, Viteri JE, Wing RR. Primary prevention of weight gain for women
aged 25-34: the acceptability of treatment formats. Int J Obes. 2000;24(2):
219–25.
113. Kuhlmann AK, Dietz PM, Galavotti C, England LJ. Weight-management
interventions for pregnant or postpartum women. Am J Prev Med. 2008;
34(6):523–8.
114. Poston L, Caleyachetty R, Cnattingius S, Corvalán C, Uauy R, Herring S,
Gillman MW. Preconceptional and maternal obesity: epidemiology and
health consequences. Lancet Diab Endocrinol. 2016;4(12):1025–36.
115. Institute of Medicine, National Research Council. Weight Gain During
Pregnancy: Reexamining the Guidelines. Washington: The National
Academies Press; 2009.
116. Health Canada. Prenatal nutrition guidelines for health professionals. In.
Ottawa: Health Canada; 2010.
117. Department of Health. Clinical Practice Guidelines: Pregnancy Care.
Canberra: Australian Government Department of Health; 2018.
118. Phelan S. Pregnancy: a "teachable moment" for weight control and obesity
prevention. Am J Obstet Gynecol. 2010;202(2):135.e131–8.
119. Kocher EL, Sternberg Lamb JM, McGarvey ST, Faiai M, Muasau-Howard BT,
Hawley NL. Conceptions of pregnancy health and motivations for healthful
behavior change among women in American Samoa. Women Birth. 2018;
31(1):e32–41.
120. Hanson M, Barker M, Dodd JM, Kumanyika S, Norris S, Steegers E,
Stephenson J, Thangaratinam S, Yang H. Interventions to prevent maternal
obesity before conception, during pregnancy, and post partum. Lancet
DiabEndocrinol. 2017;5(1):65–76.
121. Deputy NP, Sharma AJ, Kim SY, Hinkle SN. Prevalence and characteristics
associated with gestational weight gain adequacy. Obstet Gynecol. 2015;
125(4):773.
122. Jarman M, Yuan Y, Pakseresht M, Shi Q, Robson PJ, Bell RC. Patterns and
trajectories of gestational weight gain: a prospective cohort study. CMAJ
open. 2016;4(2):E338.
123. Knabl J, Riedel C, Gmach J, Ensenauer R, Brandlhuber L, Rasmussen KM,
Schiessl B, von Kries R. Prediction of excessive gestational weight gain from
week-specific cutoff values: a cohort study. J Perinatol: official journal of the
California Perinatal Association. 2014;34(5):351–6.
124. Hill B, Hayden M, McPhie S, Bailey C, Skouteris H. Preconception and
antenatal knowledge and beliefs about gestational weight gain. Aust N Z J
Obstet Gynaecol. 2019;59(5):634–640.
125. National Core Maternity Indicators [https://www.aihw.gov.au/reports/
mothers-babies/ncmi-data-visualisations/contents/antenatal-period-
indicators].
126. Guevarra MV, Stubbs JM, Assareh H, Achat HM. Risk factors associated with
late entry to antenatal care visits in NSW in 2014. Aust N Z J Public Health.
2017;41(5):543–4.
127. Stephenson J, Heslehurst N, Hall J, Schoenaker DA, Hutchinson J, Cade JE,
Poston L, Barrett G, Crozier SR, Barker M. Before the beginning: nutrition and
lifestyle in the preconception period and its importance for future health.
Lancet. 2018.
128. Godfrey KM, Reynolds RM, Prescott SL, Nyirenda M, Jaddoe VW, Eriksson JG,
Broekman BF. Influence of maternal obesity on the long-term health of
offspring. Lancet Diab Endocrinol. 2017;391(10132):1830–1841.
129. Marchi J, Berg M, Dencker A, Olander E, Begley C. Risks associated with
obesity in pregnancy, for the mother and baby: a systematic review of
reviews. Obes Rev. 2015;16(8):621–38.
130. Baidal JAW, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM.
Risk factors for childhood obesity in the first 1,000 days: a systematic review.
Am J Prev Med. 2016;50(6):761–79.
131. Montazeri P, Vrijheid M, Martinez D, Basterrechea M, Fernandez-Somoano A,
Guxens M, Iñiguez C, Lertxundi A, Murcia M, Tardon A. Maternal metabolic
health parameters during pregnancy in relation to early childhood BMI
trajectories. Obesity. 2018;26(3):588–96.
132. Ziyab AH, Karmaus W, Kurukulaaratchy RJ, Zhang H, Arshad SH.
Developmental trajectories of body mass index from infancy to 18 years of
age: prenatal determinants and health consequences. J Epidemiol
Community Health. 2014;68(10):934–41.
133. Steel A, Lucke J, Adams J. The prevalence and nature of the use of
preconception services by women with chronic health conditions: an
integrative review. BMC Womens Health. 2015;15(1):14.
134. Oza-Frank R, Kachoria R, Keim SA, Klebanoff MA. Provision of specific
preconception care messages and associated maternal health behaviors
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 14 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

before and during pregnancy. Am J Obstet Gynecol. 2015;212(3):372 e371–
372. e378.
135. Oza-Frank R, Gilson E, Keim SA, Lynch CD, Klebanoff MA. Trends and factors
associated with self-reported receipt of preconception care: PRAMS, 2004–
2010. Birth. 2014;41(4):367–73.
136. Bearak J, Popinchalk A, Alkema L, Sedgh G. Global, regional, and subregional
trends in unintended pregnancy and its outcomes from 1990 to 2014:
estimates from a Bayesian hierarchical model. Lancet Global Health. 2018;
6(4):e380–9.
137. Anthropometric Reference Data for Children and Adults: United States,
2007–2010.[https://www.cdc.gov/nchs/data/series/sr_11/sr11_252.pdf].
138. Gomersall S, Dobson A, Brown W. Weight gain, overweight, and obesity:
determinants and health outcomes from the Australian longitudinal study
on Women’s health. Curr Obes Rep. 2014;3(1):46–53.
139. Wilkinson S, Poad D, Stapleton H. Maternal overweight and obesity: a survey
of clinicians’characteristics and attitudes, and their responses to their
pregnant clients. BMC Pregnancy Childbirth. 2013;13(1):117.
140. Vincze L, Rollo M, Hutchesson M, Hauck Y, MacDonald-Wicks L, Wood L,
Callister R, Collins C. Interventions including a nutrition component aimed
at managing gestational weight gain or postpartum weight retention: a
systematic review and meta-analysis. JBI Database System Rev Implement
Rep. 2019;17(3):297–364.
141. Vincze L, Rollo ME, Hutchesson MJ, Burrows TL, MacDonald-Wicks L,
Blumfield M, Collins CE. A cross sectional study investigating weight
management motivations, methods and perceived healthy eating and
physical activity influences in women up to five years following childbirth.
Midwifery. 2017;49:124–33.
142. Carter-Edwards L, Østbye T, Bastian LA, Yarnall KS, Krause KM. Barriers to
adopting a healthy lifestyle: insight from postpartum women. BMC Res
Notes. 2009;2(1):161.
143. Why Choose an Accredited Practising Dietitian? [https://daa.asn.au/what-
dietitans-do/choosing-your-nutrition-expert/].
144. Cummings S, Parham ES, Strain GW. Position of the American dietetic:
association weight management. J Am Diet Assoc. 2002;102(8):1145–55.
145. Franklin B, Fern A, Fowler A, Spring T. Exercise physiologist’s role in clinical
practice. Br J Sports Med. 2009;43(2):93–8.
146. Yeo S, Walker JS, Caughey MC, Ferraro AM, Asafu-Adjei JK. What
characteristics of nutrition and physical activity interventions are key to
effectively reducing weight gain in obese or overweight pregnant women?
A systematic review and meta-analysis. Obes Rev. 2017;18(4):385–99.
147. Williams LT, Barnes K, Ball L, Ross LJ, Sladdin I, Mitchell LJ. How Effective Are
Dietitians in Weight Management? A Systematic Review and Meta-Analysis
of Randomized Controlled Trials. Healthcare (Basel). 2019;7(1):e20.
Publisher’sNote
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Hutchesson et al. BMC Women's Health (2020) 20:14 Page 15 of 15
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com