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Grand Rounds

Does Lifestyle Intervention Ameliorate Pregnancy Weight Gain and Does It Affect Perinatal Outcomes?

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BACKGROUND AND PURPOSE: 

  • Peaceman et al. (Obesity, 2018) sought to determine whether excess gestational weight gain (GWG) based on IOM recommendations can be improved with lifestyle intervention programs

METHODS: 

  • Individual‐participant data meta-analysis  
  • Seven separate randomized clinical trials tested different lifestyle intervention strategies to modify GWG in diverse populations 
    • Consortium of seven independent, collaborative clinical  trials that looked at lifestyle modifications during pregnancy 
  • Lifestyle modifications included
    • Meal replacements | Modified Diabetes Prevention Program [DPP] intervention | Dietary Approaches to Stop Hypertension [DASH] diet | Smartphone‐based intervention | Parent–educator intervention 
  • Women were randomized to receive either 
    • Lifestyle intervention program 
    • Standard care 
  • Eligibility criteria, specific outcome measures, and assessment procedures were standardized across trials 
  • Primary outcome: Excess GWG per week 
  • Secondary outcomes: Other GWG measures as well as obstetrical and neonatal outcomes

RESULTS: 

  • 1,150 women were randomized 
  • Compared to the standard care group, the intervention group had a significantly lower percentage with excess GWG per week  
    • Intervention group: 61.8%   
    • Control group: 75.0% 
    • Odds ratio 0.52; 95% CI, 0.40 to 0.67 
  • Total GWG from enrollment to 36 weeks’ gestation was also lower in the intervention group 
    • Intervention group: 8.1 ± 5.2kg 
    • Control group: 9.7 ± 5.4kg   
    • Mean difference: −1.59kg; 95% CI, −2.18 to −0.99kg  
  • Results from the individual trials were similar 
  • The intervention and standard care groups did not differ in  
    • Obstetrical outcomes: Preeclampsia | Gestational diabetes | Cesarean delivery | Birthweight 
    • Neonatal outcomes: Respiratory morbidity | Neonatal hypoglycemia | NICU admission

CONCLUSION: 

  • Lifestyle intervention significantly lowered the proportion of women with excess gestational weight gain and reduced the odds of exceeding IOM recommendations by 48%  
  • This study did not show significant difference in obstetrical and neonatal outcomes 
    • Interventions may be required earlier to have impact (e.g., preconception or first trimester)  
    • Studies may need to look at dietary content and body composition (e.g. fat vs muscle), not just weight gain

Learn More – Primary Sources: 

Lifestyle Interventions Limit Gestational Weight Gain in Women with Overweight or Obesity: LIFE‐Moms Prospective Meta‐Analysis

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Related ObG Topics:

Practical obstetrics info for your women's healthcare practice
Recommended Weight Gain and Obesity Management in Pregnancy
Does Exercise During Pregnancy Impact Hypertension or Macrosomia?

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