CHICAGO — Obese pregnant women who adhered to an intensive nutrition and exercise program in their first trimester gained less weight and had fewer pregnancy complications compared with their peers who received standard prenatal care, a new study conducted in China found.

Guanghui Li, MD, PhD, of the department of obstetrics, Capital Medical University, Beijing, reported the findings here at ICE/ENDO 2014. Compared with the women who received standard care, those who stuck to the healthy-lifestyle program gained 3.3 kg (7 pounds) less throughout pregnancy and were less likely to develop preeclampsia or have babies who were large for their gestational age.

The results show that "obese pregnant women should start an intensive intervention involving dietary and lifestyle medications as early as possible," Dr. Li said. However, she acknowledged that it is difficult to get people to adhere to such programs ― of those assigned to the intensive intervention, only half were able to stick to it, she reported.

"Maybe in the future we can consider how to do more to improve adherence, as there are lots of reasons for lower compliance," she stated during a press briefing. Identifying what these are "will be key to providing more effective healthcare education for obese women regarding the effects of obesity on them and their babies," she commented. For example, it is important to inform women that they are not "eating for 2," she noted.

James Rose, MD, PhD, of the department of obstetrics and gynecology at Wake Forest School of Medicine, Winston-Salem, North Carolina, who was not involved in the study, said the novelty aspect of this research is in the early intervention, which "produces significant results in terms of reducing weight gain and reducing the complications associated with obesity during pregnancy.

"If you intervene early and have a positive effect early, then that carries through to the end of pregnancy," he told Medscape Medical News.

However, he acknowledged that there is "a problem with compliance, so we have to discern better approaches to improving [this]." What really ought to be done is to intervene in obesity before pregnancy, he stressed.

Dr. Li agreed: "The ideal intervention for obese women should be before they are pregnant," but she pointed out that "nearly half of all pregnancies are unplanned."

Adherence to Lifestyle Intervention Generated Benefits

Dr. Li said that although Chinese women used to be slim, this is no longer the case. "In China, about a third of the adult population is now overweight or obese, and obesity increases the risk of serious complications during pregnancy, such as gestational diabetes mellitus, preeclampsia, cesarean section, and preterm birth," she explained.

In her study, obese Chinese women who were 6 to 12 weeks pregnant were assigned to receive either standard care (n = 72) or the intensive program (n = 141), both of which included visits to the obstetrician.

Standard care consisted of 1 group session with a dietician, who discussed proper nutrition and physical activity and recommended pregnancy weight gain. The other arm participated in 1 group session followed by individual counseling tailored for each woman regarding regular exercise, eating a balanced diet of from 1500 to 2000 calories per day, and goals for weight gain.

Participants were asked to record what they ate, their physical activity, and their weekly weight gain; this information was used to modify the plan for each individual.

Only 68 of the 141 women assigned to the intensive intervention program were able to adhere to it; 73 did not, which indicates how difficult it is for obese women to modify their lifestyles.

But the women who were able to adhere to the intensive intervention gained significant benefits, Dr. Li said.

The 68 adherent participants had a significantly reduced gestational weight gain compared with the nonadherent groups. Throughout pregnancy, the former gained an average of 10.8 kg (24 pounds) compared with an average of 14.1 kg (31 pounds) in both the nonadherent women from the intervention group and those assigned to standard care.

The incidence of mild preeclampsia was also reduced, with no cases in the adherent group vs 2.7% in the nonadherent women and 6.7% in the standard-care group (P = .031). There was also a significantly lower incidence of large-for-gestational-age babies among those who adhered to the intervention (10.3% vs 32.9% in the nonadherent group vs 25.0% in the standard-care group, P = .006).

And macrosomia ― birth weight exceeding 4 kg (8 pounds, 13 oz) ― occurred less frequently among those who adhered to the intervention, at 7.4%. vs 27.4% in the nonadherent group vs 25.0% in the standard-care group (P = .006). A high-birth-weight baby increases the risk for cesarean delivery, Dr. Li noted.

The lifestyle intervention did not result in any adverse effects on fetal growth and maternal and fetal complications.

In conclusion, Dr. Li said that healthcare providers "should provide an intensive intervention program for obese women as early as possible in pregnancy" and that they should "strive to develop practical strategies to improve the compliance of obese women to the recommendations."

Dr. Li and Dr. Rose have disclosed no relevant financial relationships.

Joint Meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014; June 22, 2014. Abstract SUN-0900


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