Exercise Limits Gestational Weight Gain in Obese Women

Larry Hand

September 25, 2013

Pedometer-monitored physical activity with or without dietary follow-up helped obese pregnant women in Denmark limit gestational weight gain (GWG) compared with women who had standard care, according to a study published online September 23 in the American Journal of Obstetrics & Gynecology.

Kristina M. Renault, MD, from the Department of Obstetrics and Gynaecology at Hvidovre Hospital, University of Copenhagen, Denmark, and colleagues conducted a randomized controlled trial (Treatment of Obese Pregnant Women [TOP] Study) involving 425 obese pregnant women (body mass index ≥ 30 kg/m2) at Hvidovre Hospital between March 2009 and March 2012.

The researchers randomly assigned the women to 1 of 3 groups: physical activity and dietary intervention (n = 142), physical activity (n = 142), or standard care (n = 141). They set the 2009 Institute of Medicine recommendations (5 - 9 kg GWG) on weight gain during pregnancy as a benchmark.

The physical activity intervention consisted of encouragement to increase activity, aiming for a daily step count of 11,000, monitored by pedometer. Participants registered step counts on 7 consecutive days every 4 weeks on a chart and returned it to researchers, who gave no feedback.

For the physical activity plus dietary follow-up intervention, researchers added a single consultation with a dietitian after ultrasound examination in gestational week 11 to 14, with a recommendation that the patient consume a low-fat Mediterranean diet with 1200 to 1675 kcal/day. Participants also were in contact with a dietitian by telephone or in person every 2 weeks, during which dietitians offered encouragement and corrective advice.

Of 758 obese pregnant women presenting to the hospital during the study period, 425 participated and 389 completed the study.

Women in the physical activity plus dietary follow-up intervention group had a GWG median of 8.6 kg (range, −9.6 to 34.1 kg), women in the physical activity group had a GWG median of 9.4 (range, −3.4 to 28.2 kg), and women in the control group had a GWG median of 10.9 (range, −4.4 to 28.7 kg). Although the GWG totals were significantly lower for both intervention groups (physical activity plus dietary follow-up intervention vs control, P = .01; physical activity vs control, P = .042), researchers found no statistically significant difference between the 2 interventions.

Researchers found that GWG of less than 5 kg was achieved by 26% of the physical activity plus dietary follow-up intervention group, 22% of the physical activity group, and 17% of the control group, although the differences did not reach statistical significance. However, they did find a significant difference between intervention groups combined compared with controls (P = .021).

In addition, a significantly larger proportion of the women in the intervention groups stayed under the maximum Institute of Medicine recommended GWG of 9 kg compared with the control group (55% of the physical activity plus dietary follow-up intervention group, 49% of the physical activity group, and 37% of controls; P = .013). The difference was significant between the intervention groups as well (P = .010).

The pedometer-monitored step counts were similar among the intervention groups. In week 13, step counts were in the 8000 range.

For the whole group, a higher birth weight, absolute and adjusted for sex and gestational age, was significantly associated with increased maternal weight gain (P = .005).

Limitations of the study include possible lack of generalizability to a diverse population, as 97% of the study population was white and the study population had a higher level of education than the general Danish population.

Some data from this study were presented October 19, 2012, at the Annual Meeting of the Diabetes in Pregnancy Study in Lille, France.

This research was supported by the Sygekassernes Helsefond and the Broedrene Hartmann Fund. The authors have disclosed no relevant financial relationships.

Am J Obstet Gynecol. Published online September 23, 2013. Abstract

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