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  • Print publication year: 2012
  • Online publication date: August 2012

14 - Intervention strategies to improve outcome in obese pregnancies: focus on gestational weight gain

from Section 4 - Interventions



Excessive gestational weight gain (GWG) is common and on the rise. While mean weight gains tend to be lower among women entering pregnancy at higher pre-pregnancy weights, weight gain ranges associated with optimal outcomes are also lower for heavier women [1,2]. Thus overweight and obese women are substantially more likely to gain more weight than recommended (“excessive weight gain”), compared with women who were normal weight or underweight entering pregnancy [1].

As summarized in Chapter 4, a large number of observational studies have demonstrated increased risks for adverse short- and long-term pregnancy outcomes associated with excessive GWG [1,3]. For the mother, these adverse outcomes include gestational glucose intolerance, cesarean or complicated vaginal delivery, failure to initiate or maintain breastfeeding, and postpartum weight retention [3,4]. For the child, they include large for gestational age, birth trauma, and infant mortality, as well as increased risk for later obesity [2,3,5–7]. Observational data further suggest that risks for many adverse outcomes associated with greater GWG are similar or greater among obese women than among women of normal pre-pregnancy weight. In studies of birth outcomes among obese women, higher gains appear to raise the risk of large for gestational age more strongly than they reduce the risk of small for gestational age birth [5,8–13]. These findings suggest that reducing GWG among obese women may have beneficial effects without causing undue risk.

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Institute of Medicine and National Research Council of the National Academies Weight Gain During Pregnancy: Reexamining the Guidelines Washington, DC National Academies Press 2009
Oken, E Kleinman, K P Belfort, M B Hammitt, J K Gillman, M W Associations of gestational weight gain with short- and longer-term maternal and child health outcomes Am J Epidemiol 2009 170 173
Siega-Riz, A M Viswanathan, M Moos, M K A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention Am J Obstet Gynecol 2009 201 339 e1
Herring, S Oken, E Rifas-Shiman, S Weight gain in pregnancy and risk of maternal hyperglycemia Am J Obstet Gynecol 2009 201 61e1
Chen, A Feresu, S A Fernandez, C Rogan, W J Maternal obesity and the risk of infant death in the United States Epidemiology 2009 20 74
Oken, E Taveras, E M Kleinman, K P Rich-Edwards, J W Gillman, M W Gestational weight gain and child adiposity at age 3 years Am J Obstet Gynecol 2007 196 322e1
Oken, E Rifas-Shiman, S L Field, A E Frazier, A L Gillman, M W Maternal gestational weight gain and offspring weight in adolescence Obstet Gynecol 2008 112 999
Cedergren, M I Optimal gestational weight gain for body mass index categories Obstet Gynecol 2007 110 759
Kiel, D W Dodson, E A Artal, R Boehmer, T K Leet, T L Gestational weight gain and pregnancy outcomes in obese women: how much is enough? Obstet Gynecol 2007 110 752
Nohr, E A Vaeth, M Baker, J L Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy Am J Clin Nutr 2008 87 1750
Vesco, K K Dietz, P M Rizzo, J Excessive gestational weight gain and postpartum weight retention among obese women Obstet Gynecol 2009 114 1069
Vesco, K K Sharma, A J Dietz, P M Newborn size among obese women with weight gain outside the 2009 Institute of Medicine recommendation Obstet Gynecol 2011 117 812
Hinkle, S N Sharma, A J Dietz, P M Gestational weight gain in obese mothers and associations with fetal growth Am J Clin Nutr 2010 92 644
Beyerlein, A Schiessl, B Lack, N von Kries, R Associations of gestational weight loss with birth-related outcome: a retrospective cohort study BJOG 2011 118 55
Dodd, J M Grivell, R M Crowther, C A Robinson, J S Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials BJOG 2010 117 1316
Gardner, B Wardle, J Poston, L Croker, H Changing diet and physical activity to reduce gestational weight gain: a meta-analysis Obes Rev 2011 12 e602
Ronnberg, A K Nilsson, K Interventions during pregnancy to reduce excessive gestational weight gain: a systematic review assessing current clinical evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system BJOG 2010 117 1327
Skouteris, H Hartley-Clark, L McCabe, M Preventing excessive gestational weight gain: a systematic review of interventions Obes Rev 2010 11 757
Streuling, I Beyerlein, A Rosenfeld, E Physical activity and gestational weight gain: a meta-analysis of intervention trials BJOG 2010 118 278
Streuling, I Beyerlein, A von Kries, R Can gestational weight gain be modified by increasing physical activity and diet counseling? A meta-analysis of interventional trials Am J Clin Nutr 2010 92 678
Magee, M S Knopp, R H Benedetti, T J Metabolic effects of 1200-kcal diet in obese pregnant women with gestational diabetes Diabetes 1990 39 234
Prevedel, T Calderon, I De Conti, M Consonni, E Rudge, M Maternal and perinatal effects of hydroptherapy in pregnancy Revista Brasileira de Ginecologia e Obstetricia 2003 25 53
Asbee, S M Jenkins, T R Butler, J R Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial Obstet Gynecol 2009 113 305
Barakat, R Lucia, A Ruiz, J R Resistance exercise training during pregnancy and newborn’s birth size: a randomised controlled trial Int J Obes (Lond) 2009 33 1048
Brankston, G N Mitchell, B F Ryan, E A Okun, N B Resistance exercise decreases the need for insulin in overweight women with gestational diabetes mellitus Am J Obstet Gynecol 2004 190 188
Cavalcante, S R Cecatti, J G Pereira, R I Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women Reprod Health 2009 6 1
Clapp, J F Kim, H Burciu, B Lopez, B Beginning regular exercise in early pregnancy: effect on fetoplacental growth Am J Obstet Gynecol 2000 183 1484
Garshasbi, A Faghih Zadeh, S The effect of exercise on the intensity of low back pain in pregnant women Int J Gynaecol Obstet 2005 88 271
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 91 373
Haakstad, L A , K Effect of regular exercise on prevention of excessive weight gain in pregnancy: a randomised controlled trial Eur J Contracept Reprod Health Care 2011 16 116
Hopkins, S A Baldi, J C Cutfield, W S McCowan, L Hofman, P L Exercise training in pregnancy reduces offspring size without changes in maternal insulin sensitivity J Clin Endocrinol Metab 2010 95 2080
Hui, A L Ludwig, S M Gardiner, P Community-based exercise and dietary intervention during pregnancy: a pilot study Can J Diabetes 2006 30 169
Jackson, R A Stotland, N E Caughey, A B Gerbert, B Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial Patient Educ Couns 2011 83 203
Jeffries, K Shub, A Walker, S P Hiscock, R Permezel, M Reducing excessive weight gain in pregnancy: a randomised controlled trial Med J Aust 2009 191 429
Korpi-Hyovalti, E A Laaksonen, D E Schwab, U S Feasibility of a lifestyle intervention in early pregnancy to prevent deterioration of glucose tolerance BMC Public Health 2011 11 179
Laitinen, K Poussa, T Isolauri, E Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial Br J Nutr 2009 101 1679
Luoto, R Kinnunen, T I Aittasalo, M Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counseling: a cluster-randomized controlled trial PLoS Med 2011 8 e1001036
Marquez-Sterling, S Perry, A C Kaplan, T A Halberstein, R A Signorile, J F Physical and psychological changes with vigorous exercise in sedentary primigravidae Med Sci Sports Exerc 2000 32 58
Ong, M J Guelfi, K J Hunter, T Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant women Diabetes Metab 2009 35 418
Phelan, S Phipps, M G Abrams, B Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study Am J Clin Nutr 2011 93 772
Polley, B A Wing, R R Sims, C J Randomized controlled trial to prevent excessive weight gain in pregnant women Int J Obes Relat Metab Disord 2002 26 1494
Quinlivan, J A Lam, L T 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 51 141
Rae, A Bond, D Evans, S A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes Aust N Z J Obstet Gynaecol 2000 40 416
Rhodes, E T Pawlak, D B Takoudes, T C Effects of a low-glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial Am J Clin Nutr 2010 92 1306
Santos, I A Stein, R Fuchs, S C Aerobic exercise and submaximal functional capacity in overweight pregnant women: a randomized trial Obstet Gynecol 2005 106 243
Sedaghati, P Zaiee, V Ardjmand, A The effect of an ergometric training program on pregnants weight gain and low back pain Gazz Med Ital-Arch Sci Med 2007 166 209
Thornton, Y S Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial Obstet Gynecol 2009 114 173
Weisman, C S Hillemeier, M M Downs, D S Improving women’s preconceptional health: long-term effects of the Strong Healthy Women behavior change intervention in the Central Pennsylvania Women’s Health Study Womens Health Issues 2011 21 265
Wolff, S Legarth, 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 (Lond) 2008 32 495
Yeo, S Adherence to walking or stretching, and risk of preeclampsia in sedentary pregnant women Res Nurs Health 2009 32 379
Godwin, M Ruhland, L Casson, I Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity BMC Med Res Methodol 2003 3 28
Gartlehner, G Hansen, R A Nissman, D Lohr, K N Carey, T S Rockville, MD Agency for Healthcare Research and Quality 2006
Kinnunen, T I Pasanen, M Aittasalo, M Preventing excessive weight gain during pregnancy – a controlled trial in primary health care Eur J Clin Nutr 2007 61 884
Rayner, G Gracia, M Young, E Why are we fat? Discussions on the socioeconomic dimensions and responses to obesity Global Health 2010 6 7
Davison, K K Birch, L L Childhood overweight: a contextual model and recommendations for future research Obes Rev 2001 2 159
Stokols, D Allen, J Bellingham, R L The social ecology of health promotion: implications for research and practice Am J Health Promot 1996 10 247
Gray-Donald, K Robinson, E Collier, A Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation CMAJ 2000 163 1247
Artal, R Catanzaro, R B Gavard, J A Mostello, D J Friganza, J C A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus Appl Physiol Nutr Metab 2007 32 596
Claesson, I M Sydsjo, G Brynhildsen, J Weight gain restriction for obese pregnant women: a case-control intervention study BJOG 2008 115 44
Shirazian, T Monteith, S Friedman, F Rebarber, A Lifestyle modification program decreases pregnancy weight gain in obese women Am J Perinatol 2010 27 411
Institute of Medicine Nutrition During Pregnancy Washington, DC National Academy Press 1990
Olson, C M Strawderman, M S Reed, R G Efficacy of an intervention to prevent excessive gestational weight gain Am J Obstet Gynecol 2004 191 530
Claesson, I M Sydsjo, G Brynhildsen, J Weight after childbirth: a 2-year follow-up of obese women in a weight-gain restriction program Acta Obstet Gynecol Scand 2011 90 103
Weisman, C S Hillemeier, M M Downs, D S Chuang, C H Dyer, A M Preconception predictors of weight gain during pregnancy: prospective findings from the Central Pennsylvania Women’s Health Study Womens Health Issues 2011 20 126
Campbell, F Johnson, M Messina, J Guillaume, L Goyder, E Behavioural interventions for weight management in pregnancy: a systematic review of quantitative and qualitative data BMC Public Health 2011 11
Barakat, R Stirling, J R Lucia, A Does exercise training during pregnancy affect gestational age? A randomised controlled trial Br J Sports Med 2008 42 674
Baciuk, E P Pereira, R I Cecatti, J G Braga, A F Cavalcante, S R Water aerobics in pregnancy: cardiovascular response, labor and neonatal outcomes Reprod Health 2008 5 10
Piirainen, T Isolauri, E Lagstrom, H Laitinen, K Impact of dietary counselling on nutrient intake during pregnancy: a prospective cohort study Br J Nutr 2006 96 1095
Thornton, Y S Smarkola, C Kopacz, S M Ishoof, S B Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial J Natl Med Assoc 2009 101 569
Bechtel-Blackwell, D A Computer-assisted self-interview and nutrition education in pregnant teens Clin Nurs Res 2002 11 450
Claesson, I M Josefsson, A Sydsjo, G Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study BMC Public Health 2010 10 766