In the Journals Plus

Lifestyle interventions can limit excessive gestational weight gain

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September 12, 2018

Increased physical activity, improved diet and other behavioral interventions were shown to assist in the management of gestational weight gain for pregnant women with overweight and obesity, according to results of a meta-analysis published in Obesity.

“With more than half of U.S. women of childbearing age now considered as having overweight or obesity, interventions designed to control or limit excess [gestational weight gain] and the associated metabolic risks in this population are timely,” Alan Peaceman, MD, chief of maternal fetal medicine in the department of obstetrics and gynecology and professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, and colleagues wrote. “Pregnancy provides a unique opportunity to determine whether relatively short-term lifestyle interventions to reduce excess [gestational weight gain] could have long-lasting benefits for the health of both mother and child.”

The researchers performed a meta-analysis of individual participant data from a consortium of seven clinical centers (Lifestyle Interventions for Expectant Moms), which each used different intervention strategies in randomized trials. Some of the interventions included meal replacements, smartphone-based tools and Diabetes Prevention Program modifications. The researchers analyzed pooled data from a sample of 1,141 women, who were recruited from 2012 to 2015 and had a BMI greater than 25 kg/m2 with pregnancy confirmed between 9 and 15 weeks. The participants had been randomly assigned to two groups, with 578 receiving some form of intervention and the other 563 receiving standard care. The researchers examined excess gestational weight gain per week and the neonatal outcomes of each pregnancy.

The researchers discovered that women in the intervention groups had less excess gestational weight gain per week, defined as weight increase greater than 0.33 kg per week for women with overweight and greater than 0.27 kg per week for women with obesity vs. the standard care group (61.8% vs. 75%; OR = 0.52; 95% CI, 0.4-0.67). The researchers observed a 1.6-kg decrease in average gestational weight gain in the intervention group compared with the standard care group. They also found that 20.6% of those in the intervention group met or fell below Institute of Medicine guidelines for gestational weight gain compared with 14.2% of the standard care group (OR = 1.65; 95% CI, 1.2-2.27).

Although the results of the analysis provided evidence that assorted interventions could aid in managing gestational weight gain, they were less indicative of their impact on fetal and neonatal outcomes, according to the researchers. No significant differences were observed in number of live-born infants, birth weight or the occurrence of other complications between the two groups.

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“This consortium analysis was not powered to detect a reduction in pregnancy or neonatal morbidities, which might explain the lack of observed effects on maternal or neonatal outcomes,” the researchers wrote. “Additional factors could also have contributed to the absence of meaningful group differences in maternal and neonatal outcomes. Most notably, the intensity of the intervention and the level of adherence by the participants were not uniform across centers. It is also possible that interventions were applied too late because recent data document that the causal relationship between excess [gestational weight gain] and adverse outcomes is established in the first trimester.”

Even with additional study needed to determine the effects on pregnancy outcomes and the early life of offspring, lifestyle interventions clearly show that gestational weight gain can be managed, according to the researchers.

“This is a clinically important finding because it reaffirms that women can change behaviors to control the amount of weight gain in pregnancy,” the researchers wrote. “The withdrawal and loss to follow-up rate was low for randomized participants, and the studies were drawn from diverse populations, which increases generalizability of the findings.” – by Phil Neuffer

Disclosures: Two authors report that one of the interventions has a pending trademark and is available for licensure. The other authors report no relevant financial disclosures.