Gestational Weight Gain in Obese Women Better With Program

Neil Osterweil

August 29, 2014

Obese women who took part in a weight management program during pregnancy gained significantly less gestational weight and had a lower proportion of large-for-gestational age (LGA) babies than obese women who received only one-time dietary advice, investigators found.

Of 114 pregnant women with a body mass index (BMI) higher than 30 kg/m2, those who were randomly assigned to a group-based weight management intervention gained a mean 5.0 kg in weight from the time of randomization to 34 weeks' gestation compared with 8.4 kg for women who received a single advice session from a dietician (P < .001), report Kimberly K. Vesco, MD, MPH, a practicing obstetrician/gynecologist and clinical investigator with the Kaiser Permanente Center for Health Research in Portland, Oregon, and colleagues. Their article was published in the September issue of Obesity.

In addition, only 9% of children born to women in the weight management group had LGA babies compared with 26% of those born to women in the control group (P = .002). Newborns who are large for their gestational age are at higher risk of being overweight, having increased body fat, and having higher systolic blood pressure than their normal-sized gestational peers.

"[O]ur comprehensive lifestyle modification intervention produced lower [gestational weight gain] and reduced the likelihood of LGA infants among obese women. Whether this or similar interventions can improve long-term maternal and child health is yet to be determined," the authors write.

"Most women in our intervention did gain some weight, but they gained and retained significantly less than women who did not participate in the intervention," Dr. Vesco said in a press release. "Even with support, it's difficult to limit weight gain during pregnancy, so women who are overweight or obese should aim for the lower end of the weight gain range recommended by the Institute of Medicine, and they should seek support and nutritional advice to help meet their goals."

Institute of Medicine guidelines, published in 2009, recommend that obese women, defined as those with a body mass index of 30 kg/m2 or greater, gain a total of 5 to 9 kg and that the rate of weight gain during the second and third trimesters be a mean of 0.22 kg/week (range, 0.17 - 0.27 kg/week).

The authors randomly assigned obese pregnant women to receive either a single, usual care dietary advice session or the lifestyle intervention, which consisted of a combination of diet and exercise recommendations and behavioral self-management techniques to help participants embark on and maintain healthy behavior changes.

Women in the intervention group were counseled to adopt a diet based on the Dietary Approaches to Stop Hypertension plan and to engage in at least 30 minutes of moderate physical activity daily if there were no medical or obstetrical contraindications.

Women in the control group were informed about eating a healthy diet, without specific reference to the Dietary Approaches to Stop Hypertension plan. The session was the only study addition to their routine obstetric care.

As noted before, women in the intervention group gained less weight during pregnancy and had a lower proportion of LGA babies, meeting 2 of the study's 3 primary endpoints.

The third endpoint, mean weight change from baseline to 2 weeks postpartum, was also significantly better among women in the active weight management group. These women had a mean weight decline of 2.6 kg compared with a mean gain of 1.2 kg among controls (mean difference of change, −3.8; P < .001).

In addition, women in the intervention group had a lower prevalence of weight gain exceeding the 0.27 kg/week recommended in the Institute of Medicine guidelines (44% vs 82%; P < .001).

The study was supported by the National Institute of Child Health and Human Development. The authors have disclosed no relevant financial relationships.

Obesity. 2014;22:1989-1996. Full text

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