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

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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.
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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 1544 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 [25]. For example, the
Australian Longitudinal Study of WomensHealthhas
found women in their younger cohort (aged 1823 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].
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* 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
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Weight gained during the childbearing years is
strongly associated with adverse health outcomes later
in life. For example, the NursesHealth 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 individualsactions, 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 [1123]. 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 OMalley, [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
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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, [2771] 20.7%
(n= 18) on weight loss or preventing weight retention in
the postpartum period, [7289] and 16.1% (n= 14) fo-
cused on both preventing excessive GWG and prevent-
ing weight retention in the postpartum period [90103].
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) [104107] or weight
gain prevention (5.7%, n=5) [108112]. 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 childbearingage 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
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study (1.1%) recruited only whitewomen. 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 [27,2934,36,38,4044,46,47,50,51,
54,5659,6166,68,69,7180,8287,90103,105,
106,108111]. 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 214). 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 womens 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 participants 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
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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 20002010, 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 162500 67577 181325 40194 162500 362280
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
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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 participants ethnicity,
clinical conditions or socio-economic status.
In terms of the reviewsinclusion 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
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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 12.518.0 kg for pre-pregnancy BMI < 18.5
kg/m
2
[Underweight], 11.516.0 kg for pre-pregancy
BMI of 18.524.9 kg/m
2
[Normal weight], 7.011.5 kg
for pre-pregnancy BMI of 25.029. 9 kg/m
2
[Over-
weight], and 5.09.0 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 0.52 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 214 242324210 214
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)
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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, GPs,
obstetricians), 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
3040% 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 [130132]. For
example, when compared to a healthy pre-pregnancy
BMI (18.524.9 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 10.2511.82), preeclampsia (OR: 4.44,
95%CI:4.174.72) and pre-term birth (OR: 2.91 95% CI:
2.213.81) [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 (6080% of women dont receive precon-
ception care [133135]) 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 0.51 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
2.510 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 professionsexpertise
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
weeksgestation 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.
Authorscontributions
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
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... Women, in particular, appear more susceptible to obesity, with the prevalence of female obesity having more than doubled in the past 30 years and the prevalence of morbid obesity in women more than twice that recorded in men [3]. Evidence suggests that among adults, young women of childbearing age (18-44 years) are the most at risk of developing obesity [4,5], with this cohort demonstrating the highest rate of weight gain [6][7][8][9][10]. Furthermore, the adverse effects associated with obesity appear to be greater in women, with the risks of developing cancer and cardiovascular and metabolic disorders significantly higher than observed in men [11][12][13][14][15]. Mounting evidence highlights the strong association between excessive weight gained during early childbearing years and longer-term adverse health outcomes [4,[16][17][18]. ...
... Evidence suggests that among adults, young women of childbearing age (18-44 years) are the most at risk of developing obesity [4,5], with this cohort demonstrating the highest rate of weight gain [6][7][8][9][10]. Furthermore, the adverse effects associated with obesity appear to be greater in women, with the risks of developing cancer and cardiovascular and metabolic disorders significantly higher than observed in men [11][12][13][14][15]. Mounting evidence highlights the strong association between excessive weight gained during early childbearing years and longer-term adverse health outcomes [4,[16][17][18]. ...
... Grip strength will be measured using a hand-held dynamometer (Jamar Hydraulic Hand Dynamometer, Performance Health Supply, USA). To perform this measure, participants will Are currently physically inactive (exercising less than 150 min/week) 4 Have not undergone weight loss surgery or another surgery in the past 3 months 5 Not pregnant (or within 6 months post-pregnancy) or lactating 6 Do not have a significant mental illness or cognitive deficits 7 ...
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Introduction Obesity in women has more than doubled in the past thirty years. Increasing research suggests that increased cardiorespiratory fitness (CRF) can largely attenuate the negative health risks associated with obesity. Though previous literature suggests that combined training may be the most effective for improving CRF in adults with obesity, there is minimal research investigating the efficacy of combined and resistance programmes in women with obesity. This article outlines a protocol for a parallel pilot study which aims to evaluate the feasibility and efficacy of three exercise modalities in women with obesity for increasing CRF and strength and improving body composition and other health outcomes (i.e. quality of life). Methods and analysis Sixty women (aged 18–50) with obesity (body mass index [BMI] ≥ 30 and/or waist circumference ≥ 88 cm) who are physically inactive, have no unstable health conditions and are safe to exercise will be recruited from September 2021 to December 2022. The main outcome will be feasibility and acceptability of the intervention and procedures. Trial feasibility outcomes will be evaluated to determine if a definitive trial should be undertaken. Trial acceptability will be explored through follow-up qualitative interviews with participants. Secondary outcomes will include CRF (predicted VO 2 max), anthropometrics (i.e. BMI), strength (5RM bench press, leg dynamometry, grip strength) and other health outcomes (i.e., pain). Participants will be block randomised into one of four trial arms (aerobic exercise, resistance training and combined training groups, non-active control group) and measurements will be completed pre- and post-intervention. The exercise groups will receive an individualised supervised exercise programme for 3× sessions/week for 12 weeks. The change in mean values before and after intervention will be calculated for primary and secondary outcomes. ANOVA and t -tests will be applied to evaluate within-group and between-group differences. If sufficient participants are recruited, the data will be analysed using ANCOVA with the age and BMI as covariates. Discussion This pilot will provide data on the feasibility and acceptability of trial procedures and of the programmes’ three progressive time-matched exercise interventions (aerobic, resistance and combined) for women living with obesity, which will help inform future research and the potential development of a full-scale randomised clinical trial. Trial registration ISRCTN, ISRCTN13517067 . Registered 16 November 2021—retrospectively registered.
... Since the prevalence of obesity and diabetes mellitus over the past decades in women of childbearing age worldwide increased (up to 35%) (Hutchesson et al., 2020; Ministerio Nacional de Salud del Gobierno de Chile (MINSAL) 2017; World Health Organization (WHO), 2021a,b), the prevalence of maternal obesity and other pregnancy pathologies will likely continue to increase in the years ahead. Early events during foetal life contribute to the developmental origin of diseases. ...
... In line with this, unfortunately, worldwide GDM prevalence also increased between 2005 and 2018, reaching country-specific prevalence, with a mean range varying between 6 and 16% of the total pregnant women (McIntyre et al., 2019). Recent reports show that obesity in women of their childbearing age has also increased over the last decade (Hutchesson et al., 2020;MINSAL 2017;WHO, 2021a,b). This phenomenon is a critical determinant predicting a substantial increase in women with gestational diabesity (Cornejo et al., 2021). ...
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A balanced communication between the mother, placenta and foetus is crucial to reach a successful pregnancy. Several windows of exposure to environmental toxins are present during pregnancy. When the women metabolic status is affected by a disease or environmental toxin, the foetus is impacted and may result in altered development and growth. Gestational diabetes mellitus (GDM) is a disease of pregnancy characterised by abnormal glucose metabolism affecting the mother and foetus. This disease of pregnancy associates with postnatal consequences for the child and the mother. The whole endogenous and exogenous environmental factors is defined as the exposome. Endogenous insults conform to the endo-exposome, and disruptors contained in the immediate environment are the ecto-exposome. Some components of the endo-exposome, such as Selenium, vitamins D and B12, adenosine, and a high-fat diet, and ecto-exposome, such as the heavy metals Arsenic, Mercury, Lead and Copper, and per- and polyfluoroakyl substances, result in adverse pregnancies, including an elevated risk of GDM or gestational diabesity. The impact of the exposome on the human placenta's vascular physiology and function in GDM and gestational diabesity is reviewed.
... Patients diagnosed with GDM are, in general, included in a group of women irrespective of their nutritional status and metabolic conditions [7]. Yet, obesity is a pandemic also affecting women of childbearing age [15][16][17][18][19], driving a higher prevalence of pre-pregnancy maternal obesity. Pre-pregnancy maternal obesity is a risk factor for developing GDM [1][2][3][4]7,9,10]. ...
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Pregnant women may develop gestational diabetes mellitus (GDM), a disease of pregnancy characterised by maternal and fetal hyperglycaemia with hazardous consequences to the mother, the fetus, and the newborn. Maternal hyperglycaemia in GDM results in fetoplacental endothelial dysfunction. GDM-harmful effects result from chronic and short periods of hyperglycaemia. Thus, it is determinant to keep glycaemia within physiological ranges avoiding short but repetitive periods of hyper or hypoglycaemia. The variation of glycaemia over time is defined as ‘glycaemia dynamics’. The latter concept regards with a variety of mechanisms and environmental conditions leading to blood glucose handling. In this review we summarized the different metrics for glycaemia dynamics derived from quantitative, plane distribution, amplitude, score values, variability estimation, and time series analysis. The potential application of the derived metrics from self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) in the potential alterations of pregnancy outcome in GDM are discussed.
... However, WLO studies often neglect to investigate the physiological responses to exercise and, instead, primarily focus upon improving body composition and physical activity levels (10,11,15). Thus, guidance for exercise prescription as an intervention to improve health in this population is mainly informed by male-only literature and, therefore, it fails to account for the sex-specific biological differences and life events that influence exercise-induced responses (16)(17)(18). ...
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... Most studies have assessed women with obesity during their reproductive period, including pregnancy. During this period, a healthy and balanced diet, associated with nutritional education provided by a nutritionist/dietitian, has been shown to be crucial to prevent excessive weight gain and postpartum weight retention in women [117][118][119][120][121][122]. It also is a protective factor for the occurrence of gestational diabetes and hypertension, and pre-eclampsia [119,123]. ...
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Background Obesity among women of childbearing age has becoming an important public health concern. We aimed to describe the trends of central obesity among Chinese women of childbearing age from 2004 to 2011 and to examine its associations with nutrients intake and daily behaviors. Methods Longitudinal data were derived from the China Health and Nutrition Survey. Participants consisted of 2481 women aged 15–44 years old. WC (Waist circumference) and WHtR (Waist to height ratio) were adopted as indicators of central obesity. Generalized linear mixed model was performed to analyze the associations of nutrients intake and daily behaviors with central obesity. Results From 2004 to 2011, the prevalence of central obesity among Chinese women of childbearing age increased from 21.6 to 30.7% (WC as indice) or from 22.8 to 32.6% (WHtR as indice) (both p < 0.001). Protein intake above the AMDR (Acceptable macronutrient distribution range) (OR = 1.21, 95% CI 1.05–1.39, p < 0.01) and non-participation in LTPA (Leisure time physical activity) (OR = 1.45, 95% CI 1.17–1.80, p < 0.001) were risk factors for high WC, and the latter was also associated with high WHtR (OR = 1.36, 95% CI 1.10–1.67, p < 0.01). For those women who had high WC & high WHtR, the impacts of protein intake and LTPA became stronger, especial LTPA (OR = 1.53, 95% CI 1.21–1.94, p < 0.001). Age-stratified analyses found that non-participation in LTPA was key factor for central obesity in 15–34 age group, while protein intake above the AMDR was pronounced in the 35–44 age group. Conclusions Non-participation in LTPA and protein intake above the AMDR were significant contributors of central obesity, which could be intervention targets to deal with the growing trend of central obesity among women of childbearing age.
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Effective, evidence-based strategies to prevent and treat obesity are urgently required. Dietitians have provided individualized weight management counselling for decades, yet evidence of the effectiveness of this intervention has never been synthesized. The aim of this study was to examine the effectiveness of individualized nutrition care for weight management provided by dietitians to adults in comparison to minimal or no intervention. Databases (Cochrane, CINAHL plus, MedLine ovid, ProQuest family health, PubMed, Scopus) were searched for terms analogous with patient, dietetics and consultation with no date restrictions. The search yielded 5796 unique articles, with 14 randomized controlled trials meeting inclusion criteria. The risk of bias for the included studies ranged from unclear to high. Six studies found a significant intervention effect for the dietitian consultation, and a further four found significant positive change for both the intervention and control groups. Data were synthesized through random effects meta-analysis from five studies (n = 1598) with weight loss as the outcome, and from four studies (n = 1224) with Body Mass Index (BMI) decrease as the outcome. Groups receiving the dietitian intervention lost an additional 1.03 kg (95% CI:−1.40; −0.66, p < 0.0001) of weight and 0.43 kg/m2 (95% CI:−0.59, −0.26; p < 0.0001) of BMI than those receiving usual care. Heterogeneity was low for both weight loss and BMI, with the pooled means varying from 1.26 to −0.93 kg and −0.4 kg/m2 for weight and BMI, respectively, with the removal of single studies. This study is the first to synthesize evidence on the effectiveness of individualized nutrition care delivered by a dietitian. Well-controlled studies that include cost-effectiveness measures are needed to strengthen the evidence base.
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Excessive gestational weight gain (GWG) and postpartum weight retention (PPWR) may predispose women to the development of obesity. The objective of this systematic review was to evaluate the effectiveness of lifestyle interventions in overweight or obese pregnant and/or postpartum women for managing postpartum weight up to 2 years after giving birth. Eighteen randomised controlled trials were included (2559 participants) and divided into three categories according to the timing of the intervention: pregnancy only (n = 3), postpartum only (n = 12) and pregnancy and postpartum (n = 3). The intervention duration varied from 10 weeks to 10 months and included diet only (n = 5) or diet and physical activity (n = 13). Seven postpartum only interventions reported significant improvements in postpartum weight when compared to the control group. Most of these interventions were short and intensive, lasting 10–16 weeks. One pregnancy only and one pregnancy and postpartum intervention reported reduced PPWR at 6 months. Nine trials did not report an effect of the intervention on postpartum weight. However, of these, four reported associations between GWG and PPWR. This review suggests that successful postpartum weight management is achievable with intensive lifestyle interventions starting in the postpartum period; however, there is insufficient evidence to conclude whether interventions starting in pregnancy are effective. Larger trials utilising comparative methodologies in the pregnancy and postpartum periods are required to inform the development of targeted strategies preventing PPWR or reducing postpartum weight.
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Background: Maternal obesity, excessive gestational weight gain (GWG) and post-partum weight retention (PPWR) constitute new public health challenges, due to the association with negative short- and long-term maternal and neonatal outcomes. The aim of this evidence review was to identify effective lifestyle interventions to manage weight and improve maternal and infant outcomes during pregnancy and postpartum. Methods: A review of systematic reviews and meta-analyses investigating the effects of lifestyle interventions on GWG or PPWR was conducted (Jan 2009–2018) via electronic searches in the databases Medline, Pubmed, Web of Science and Cochrane Library using all keywords related to obesity/weight gain/loss, pregnancy or postpartum and lifestyle interventions;15 relevant reviews were selected. Results: In healthy women from all BMI classes, diet and physical activity interventions can decrease: GWG (mean difference −1.8 to −0.7 kg, high to moderate-quality evidence); the risks of GWG above the IOM guidelines (risk ratio [RR] 0.72 to 0.80, high to low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low to very low-quality evidence); cesarean section (RR 0.91 to 0.95; high to moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.56, high-quality evidence); without any maternal/fetal/neonatal adverse effects. In women with overweight/obesity, multi-component interventions can decrease: GWG (−0.91 to −0.63 kg, moderate to very low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low-quality evidence); macrosomia (RR 0.85, 0.73 to 1.0, moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.47, 0.26 to 0.85, moderate-quality evidence). Diet is associated with greater reduction of the risks of GDM, pregnancy-induced hypertension and preterm birth, compared with any other intervention. After delivery, combined diet and physical activity interventions reduce PPWR in women of any BMI (−2.57 to −2.3 kg, very low quality evidence) or with overweight/obesity (−3.6 to −1.22, moderate to very low-quality-evidence), but no other effects were reported. Conclusions: Multi-component approaches including a balanced diet with low glycaemic load and light to moderate intensity physical activity, 30–60 min per day 3–5 days per week, should be recommended from the first trimester of pregnancy and maintained during the postpartum period. This evidence review should help inform recommendations for health care professionals and women of child-bearing age.
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Background: Estimates of pregnancy incidence by intention status and outcome indicate how effectively women and couples are able to fulfil their childbearing aspirations, and can be used to monitor the impact of family-planning programmes. We estimate global, regional, and subregional pregnancy rates by intention status and outcome for 1990-2014. Methods: We developed a Bayesian hierarchical time series model whereby the unintended pregnancy rate is a function of the distribution of women across subgroups defined by marital status and contraceptive need and use, and of the risk of unintended pregnancy in each subgroup. Data included numbers of births and of women estimated by the UN Population Division, recently published abortion incidence estimates, and findings from surveys of women on the percentage of births or pregnancies that were unintended. Some 298 datapoints on the intention status of births or pregnancies were obtained for 105 countries. Findings: Worldwide, an estimated 44% (90% uncertainty interval [UI] 42-48) of pregnancies were unintended in 2010-14. The unintended pregnancy rate declined by 30% (90% UI 21-39) in developed regions, from 64 (59-81) per 1000 women aged 15-44 years in 1990-94 to 45 (42-56) in 2010-14. In developing regions, the unintended pregnancy rate fell 16% (90% UI 5-24), from 77 (74-88) per 1000 women aged 15-44 years to 65 (62-76). Whereas the decline in the unintended pregnancy rate in developed regions coincided with a declining abortion rate, the decline in developing regions coincided with a declining unintended birth rate. In 2010-14, 59% (90% UI 54-65) of unintended pregnancies ended in abortion in developed regions, as did 55% (52-60) of unintended pregnancies in developing regions. Interpretation: The unintended pregnancy rate remains substantially higher in developing regions than in developed regions. Sexual and reproductive health services are needed to help women avoid unintended pregnancies, and to ensure healthy outcomes for those who do experience such pregnancies. Funding: Dutch Ministry of Foreign Affairs and UK Aid from the UK Government.
Article
Objectives: The objective of this systematic review was to evaluate the effectiveness of interventions that include a nutrition component aimed at improving gestational weight gain and/or postpartum weight retention. Introduction: Excessive gestational weight gain and postpartum weight retention increase the risk of adverse maternal and neonatal outcomes. Current evidence comprises many interventions targeting gestational weight gain and postpartum weight retention that incorporate a nutrition component. To date, no review has synthesized evidence from pregnancy through the postpartum period or described the intervention approaches in detail. Inclusion criteria: The review included women (≥18 years) during pregnancy and/or up to 12 months postpartum. Studies were included if they involved a weight management intervention with a nutrition component and had the primary objective of determining the impact of gestational weight gain and/or postpartum weight change. Interventions were compared to usual care (i.e. control conditions with no intervention or wait-list control or standard pregnancy or postpartum care) or "other" (alternative intervention). The review considered randomized controlled trials published between 1980 and January 21, 2016. Studies that included a weight related primary outcome measured during pregnancy and/or postpartum were included. Methods: Seven databases were searched and the reference lists of included studies were searched for additional studies not previously identified. Two independent reviewers assessed the methodological quality of studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI SUMARI). The JBI SUMARI standardized data extraction tool was used to extract data. A narrative synthesis was undertaken to qualitatively synthesize included studies, with meta-analyses used to pool weight outcome data from studies conducted separately for pregnancy and postpartum. Effect sizes for meta-analyses have been expressed as weighted mean differences (95% confidence intervals). Results: The search yielded 4063 articles of which 48 articles from 39 studies were included. Eleven of 20 studies during pregnancy reported significant reductions in gestational weight gain with the intervention when compared to control groups. One of five studies where the intervention was conducted during both pregnancy and postpartum reported statistically significant reductions in gestational weight gain, and postpartum weight retention between intervention and control groups. Nine of 14 studies conducted after childbirth reported statistically significant intervention effects, indicating lesser postpartum weight retention. Random effects meta-analyses indicated that despite considerable heterogeneity, interventions conducted during pregnancy (-1.25 kg; 95% CI: -2.10 kg, -0.40 kg; p = 0.004), and postpartum (-3.25 kg; 95% CI: -4.69 kg, -1.82 kg; p < 0.001) were significantly more effective at improving weight outcomes compared to usual care or other interventions. Most studies were of moderate quality due to lack of clarity in describing study details required for appraising methodological quality. Few interventions were conducted from pregnancy through the postpartum period (n = 5). Limited interventions adopted online modalities in intervention delivery (n = 4). Intention-to-treat analysis was used in only 12 studies. Conclusions: The pregnancy and postpartum period presents a unique opportunity to engage women in interventions to help optimize lifestyle behaviors for weight management, however the optimal approach is unclear. Improving consistency in intervention implementation and reporting will improve future evidence synthesis.
Article
Background: Prevention of excessive gestational weight gain during pregnancy is difficult; targeting women before pregnancy may be more effective. Aims: In order to generate knowledge that may influence the development of effective interventions to promote healthy weight in reproductive-aged women, this study aimed to explore knowledge and belief formation regarding gestational weight gain for preconception and pregnant women. Materials and methods: Women ≥18 years (preconception n = 265; pregnant women at 16 weeks gestation n = 271) completed questionnaires assessing knowledge and beliefs about gestational weight gain. Responses were categorised according to the 2009 Institute of Medicine gestational weight gain recommendations. Results: Preconception women exhibited poorer gestational weight gain knowledge than pregnant women, yet only half of pregnant women reported accurate gestational weight gain knowledge within the Institute of Medicine recommendations. Beliefs about gestational weight gain were also inaccurate for both preconception and pregnant women, with 34.1% of pregnant and 44.6% of preconception women expecting to gain less than recommendations. Gestational weight gain knowledge accounted for about half of the variance in gestational weight gain beliefs. Conclusions: Overall, the large inaccuracies in gestational weight gain knowledge and beliefs reported by both preconception and pregnant women suggest significant gaps in dissemination of gestational weight gain advice throughout the reproductive life phase. Knowledge is an important part of belief formation that can lead to appropriate weight gain. Hence, health professionals and policy makers should actively pursue opportunities to improve gestational weight gain knowledge in reproductive-aged women.
Article
Objective In longitudinal studies, women gain significant amounts of weight during young adulthood, pointing to pregnancy as an important trigger for weight gain. Studies examining the effect of parity vary in their findings and are complicated by multiple potential confounders. This study examines the association between parity and long‐term weight gain in a cohort of young women participating in the Australian Longitudinal Study on Women's Health (ALSWH). Methods A sample of 8,009 parous and nulliparous women was drawn from this cohort and allocated to one of six parity groups (0‐5+). Weight gain and factors associated with BMI ≥ 25 over a 16‐year period were identified by using generalized linear equations. Results Median BMI increased by between 2.95 and 4.9 units over 16 years, with women of parity 5 + showing the biggest gain. Associations between several variables and a BMI ≥ 25 (controlling for multiple demographic and behavioral factors) demonstrated no effect for parity but significant effects for survey year, no paid job, and depression. University education and high levels of physical activity were protective. Conclusions In this sample, parity was not associated with a BMI ≥ 25 over a 16‐year period.
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A woman who is healthy at the time of conception is more likely to have a successful pregnancy and a healthy child. We reviewed published evidence and present new data from high, low and middle income countries on the timing and importance of preconception health for subsequent maternal and child health. We describe the extent to which pregnancy is planned, and whether planning is linked to preconception health behaviours. Observational studies show strong links between health before pregnancy and maternal and child health outcomes, with consequences that can extend across generations, but awareness of these links is not widespread. Poor nutrition and obesity are rife among women of reproductive age, and differences between high and lower income countries have become less distinct, with typical diets falling far short of nutritional recommendations in both settings and especially among adolescents. Numerous studies show that micronutrient supplementation starting in pregnancy can correct important maternal nutrient deficiencies, but effects on child health outcomes are disappointing. Other interventions to improve diet during pregnancy have had little impact on maternal and newborn health outcomes. There have been comparatively few attempts at preconception diet and lifestyle intervention. Improvements in the measurement of pregnancy planning have quantified the degree of pregnancy planning and suggest that this is more common than previously recognised. Planning for pregnancy is associated with a mixed pattern of health behaviours before conception. We propose novel definitions of the preconception period relating to embryo development and to action at individual or population level. A sharper focus on intervention before conception is needed to improve maternal and child health and reduce the growing burden of non-communicable disease. Alongside continued efforts to reduce smoking, alcohol and obesity in the population, we call for heightened awareness of preconception health, particularly regarding diet and nutrition. Importantly health professionals should be alerted to ways of identifying women who are planning a pregnancy. <br/
Article
Objective: Small intervention studies suggest that modest weight loss increases the chance of conception and may improve perinatal outcome, but large randomized controlled trials (RCT) are lacking. Our objective was to investigate the effects of a lifestyle intervention in obese infertile women in a multicenter RCT. Design: We randomly assigned infertile women with body mass index ≥ 29 k/m² to a six-month lifestyle intervention preceding infertility treatment or to prompt infertility treatment. The primary outcome was the vaginal birth of a healthy singleton at term within 2 years of randomization. Results: Between June 2009-June 2102 we randomly allocated 577 women to one of two treatment strategies: 290 to lifestyle intervention preceding infertility treatment (intervention group) and 287 to prompt infertility treatment (control group). Three women withdrew informed consent, leaving 289 and 285 women for analysis. Discontinuation rate during the lifestyle intervention was 22%. Mean weight loss in the intervention group was 4.4 kg and in the control group 1.1 kg ( p < 0.001); the primary outcome occurred in 76 women (27%) in the intervention group versus 100 (35%) in the control group (RR: 0.77, 95% CI 0.60 to 0.99). The number of natural conceptions leading to ongoing pregnancies was 73 (26%) versus 46 (16%) (RR: 1.6, 95% CI 1.2 to 2.2). Maternal pregnancy-related and labor-related complications and neonatal complications were comparable. Conclusion: In obese infertile women lifestyle intervention preceding infertility treatment did not result in better rates of vaginal birth of healthy singletons at term as compared to prompt infertility treatment.