A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial. Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women A pilot walking program promotes moderate-intensity physical activity during pregnancy. Effect of Physical Activity and/or Healthy Eating on GDM Risk: The DALI Lifestyle Study. Exercise during pregnancy enhances cerebral maturation in the newborn: A randomized controlled trial Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial Intake of Sweets, Snacks and Soft Drinks Predicts Weight Gain in Obese Pregnant Women: Detailed Analysis of the Results of a Randomised Controlled Trial Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial Preventing excessive gestational weight gain—a secondary analysis of a cluster-randomised controlled trial The effect of a personalized intervention on weight gain and physical activity among pregnant women in China. Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial. Physical and psychological changes with vigorous exercise in sedentary primigravidae. The Comparative Effectiveness of Diabetes Prevention Strategies to Reduce Postpartum Weight Retention in Women With Gestational Diabetes Mellitus: The Gestational Diabetes’ Effects on Moms (GEM) Cluster Randomized Controlled Trial Effects of aerobic exercise training on maternal and neonatal outcome: a randomized controlled trial on pregnant women in Iran. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant women. Nutrition and exercise reduce excessive weight gain in normal-weight pregnant women. Limiting postpartum weight retention through early antenatal intervention: the HeLP-her randomised controlled trial Exercise Training and Weight Gain in Obese Pregnant Women: A Randomized Controlled Trial (ETIP Trial) Exercise during pregnancy improves maternal glucose screen at 24–28 weeks: a randomised controlled trial Exercise during pregnancy improves maternal health perception: a randomized controlled trial. Water‐gymnastics reduced the intensity of back/low back pain in pregnant women Lifestyle intervention to prevent excessive maternal weight gain: mother and infant follow-up at 12 months postpartum Results From a European Multicenter Randomized Trial of Physical Activity and/or Healthy Eating to Reduce the Risk of Gestational Diabetes Mellitus: The DALI Lifestyle Pilot A 12-Week Exercise Program for Pregnant Women with Obesity to Improve Physical Activity Levels: An Open Randomised Preliminary Study Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial Physical activity for smoking cessation in pregnancy: randomised controlled trial Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Randomized controlled trial to prevent excessive weight gain in pregnant women Home-based walking during pregnancy affects mood and birth outcomes among sedentary women: A randomized controlled trial. Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial Beginning regular exercise in early pregnancy: effect on fetoplacental growth. GRADE guidelines: 3. Rating the quality of evidence. Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: a randomised clinical trial Web-Based Behavioral Intervention Increases Maternal Exercise but Does Not Prevent Excessive Gestational Weight Gain in Previously Sedentary Women. Effect of regular exercise on prevention of excessive weight gain in pregnancy: A randomised controlled trial [GRADE guidelines: 5. Rating the quality of evidence: publication bias]. Exercise Is Associated with a Reduction in Gestational Diabetes Mellitus. A Program of Exercise Throughout Pregnancy. Is it Safe to Mother and Newborn? The London Exercise And Pregnant smokers (LEAP) trial: a randomised controlled trial of physical activity for smoking cessation in pregnancy with an economic evaluation. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Postpartum Weight Retention Risk Factors and Relationship to Obesity at 1 Year The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.
OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed OBJECTIVE to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum , or from birth to six months post partum , on weight retention among Taiwanese women . DESIGN a r and omised controlled trial assigned participants to two experimental groups [ from pregnancy to six months post partum ( EP ) and from birth to six months post partum ( EPP ) ] and one comparison group . SETTING a 3900-bed medical centre in northern Taiwan with around 3000 births annually . PARTICIPANTS a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre . INTERVENTIONS the comparison group received the routine outpatient department obstetric educational programme . The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum , and received on brochure . The EPP group received the same educational intervention as the EP group from 24 - 48 hours after birth to six months post partum . MEASUREMENTS body weight , body mass index , health-promoting behaviour and psycho-social variables ( self-efficacy , body image , depression and social support ) . FINDINGS average gestational weight gain was 14.02 , 15.27 and 16.22 kg in the three EP , EPP and comparison groups respectively , and average weight retention at six months post partum was 2.34 , 4.06 and 5.08 kg in the three groups , respectively . KEY CONCLUSIONS a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention . IMPLICATION S FOR PRACTICE the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle Background To evaluate the effectiveness and safety of water aerobics during pregnancy . Methods A r and omized controlled trial carried out in 71 low-risk sedentary pregnant women , r and omly allocated to water aerobics or no physical exercise .  Maternal body composition and perinatal outcomes were evaluated . For statistical analysis Chi-square , Fisher 's or Student 's t-tests were applied . Risk ratios and their 95 % CI were estimated for main outcomes . Body composition was evaluated across time using MANOVA or Friedman multiple analysis . Results There were no significant differences between the groups regarding maternal weight gain , BMI or percentage of body fat during pregnancy . Incidence of preterm births ( RR = 0.84 ; 95%CI:0.28–2.53 ) , vaginal births ( RR = 1.24 ; 95%CI:0.73–2.09 ) , low birthweight ( RR = 1.30 ; 95%CI:0.61–2.79 ) and adequate weight for gestational age ( RR = 1.50 ; 95%CI:0.65–3.48 ) were also not significantly different between groups . There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session . Conclusion Water aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition , type of delivery , preterm birth rate , neonatal well-being or weight INTRODUCTION Walking may be a strategy for increasing moderate-intensity physical activity ( MPA )  during pregnancy . PURPOSE This study aim ed to promote MPA among overweight and obese pregnant women , via walking , and to evaluate the effect of the intervention on maternal and birth outcomes . METHODS Thirty-seven overweight or obese pregnant women were r and omly assigned to a walking intervention or control group . Anthropometric and objective PA ( StepWatch ™ Activity Monitor ) data were collected for four 1-wk periods : weeks 10 - 14 ( V1 ) , weeks 17 - 19 ( V2 ) , weeks 27 - 29 ( V3 ) , and weeks 34 - 36 ( V4 ) of gestation . Participants provided information about maternal and birth outcomes . A cadence of ≥ 80 steps per minute was defined as MPA , and " meaningful walking " was defined as moderate walking in ≥ 8-min bouts . ANOVA was used to determine the differences in walking amount and meaningful walks , the Kolmogorov-Smirnov test was used for walking intensity distribution analysis , and Fisher 's exact test was used for maternal and infant outcomes analyses . Pearson correlation was used to examine the association between prepregnancy body mass index and gestational weight gain ( GWG ) . RESULTS There was significantly more MPA among women in the intervention group compared with those in the control group at V2 ( overweight , P < 0.0001 ; obese , P < 0.025 ) , V3 ( overweight , P < 0.0001 ) , and V4 ( overweight , P < 0.0001 ; obese , P < 0.025 ) . Women in the intervention group significantly increased their meaningful walks at V2 ( P = 0.054 ) , V3 ( P = 0.01 ) , and V4 ( P = 0.014 ) . There were trends for intervention group women to have more favorable maternal and birth outcomes compared with the control group . Rates of GWG at measurement points during pregnancy were significantly associated with preceding rates of GWG . CONCLUSION The pilot , unsupervised walking intervention increased the MPA of overweight and obese women during pregnancy Context Lifestyle approaches for preventing gestational diabetes mellitus ( GDM ) have produced mixed results . Objective The aim of the present study was to compare the effectiveness of 3 lifestyle interventions [ healthy eating ( HE ) , physical activity ( PA ) , and both HE and PA ( HE+PA ) ] with usual care ( UC ) in reducing GDM risk . Design The present study was a multicenter r and omized controlled trial conducted from 2012 to 2014 [ the DALI ( vitamin D and lifestyle intervention for GDM prevention ) lifestyle study ] . Setting The study occurred at antenatal clinics across 11 centers in 9 European countries . Patients Consecutive pregnant women at < 20 weeks of gestation with a body mass index ( BMI ) of ≥29 kg/m2 and without GDM using the International Association of Diabetes and Pregnancy Study Group criteria ( n = 436 ) . For the intervention , women were r and omized , stratified by site , to UC , HE , PA , or HE+PA . The women received 5 face-to-face and ≤4 telephone coaching sessions using the principles of motivational interviewing . A gestational weight gain ( GWG ) < 5 kg was targeted . The coaches received st and ardized training and an intervention toolkit tailored to their culture and language . Main Outcome Measures The endpoints were the GWG at 35 to 37 weeks and the fasting glucose and insulin sensitivity [ homeostasis model assessment insulin resistance ( HOMA-IR ) ] at 24 to 28 weeks . Results We r and omized 108 women to HE+PA , 113 to HE , 110 to PA , and 105 to UC . In the HE+PA group , but not HE or PA alone , women achieved substantially less GWG than did the controls ( UC ) by 35 to 37 weeks ( -2.02 ; 95 % confidence interval , -3.58 to -0.46 kg ) . Despite this reduction , no improvements were seen in fasting or postload glucose levels , insulin concentrations , or HOMA-IR . The birthweights and large and small for gestational age rates were similar . Conclusions The combined HE+PA intervention was able to limit GWG but did not reduce fasting glycemia . Thus , lifestyle changes alone are unlikely to prevent GDM among women with a BMI of ≥29 kg/m2 ABSTRACT Accumulating research indicates that the regular practice of physical exercise is beneficial to the human brain . From the improvement of academic achievement in children to the prevention of Alzheimer ’s disease in the elderly , exercise appears beneficial across the developmental spectrum . Recent work from animal studies also indicates that a pregnant mother can transfer the benefits of exercise during gestation to her offspring ’s brain . Exercising pregnant rats give birth to pups that have better memory and spatial learning as well as increased synaptic density . To investigate whether this transfer from the pregnant mother to her child also occurs in humans , we conducted a r and omized controlled trial ( n = 18 ) and measured the impact of exercise during pregnancy on the neuroelectric response of the neonatal brain with electroencephalography ( EEG ) . Here we show that , compared to the newborns of mothers who were inactive during their pregnancy , the children of exercising pregnant women are born with more mature brains . This was measured with the infant slow positive mismatch response ( SPMMR ) , an electroencephalographic potential known to decrease in amplitude with age . The SPMMR reflects processes associated with brain maturation via its response to sound discrimination and auditory memory . In this study , the children of the mothers who exercised throughout their pregnancy  have a smaller SPMMR than the children of mothers who remained sedentary ( p = .019 ) . Our results demonstrate the impact regular exercise during pregnancy can have on the development of the human fetal brain Background Excessive gestational weight gain ( GWG ) is associated with short- and long-term health problems among mothers and their offspring . There is a strong need for effective intervention strategies targeting excessive GWG to prevent adverse outcomes . Methods We performed a cluster-r and omized controlled intervention trial in eight gynecological practice s evaluating the feasibility and effectiveness of a lifestyle intervention presented to all pregnant women ; 250 healthy , pregnant women were recruited for the study . The intervention program consisted of two individually delivered counseling sessions focusing on diet , physical activity , and weight monitoring . The primary outcome was the proportion of pregnant women exceeding weight gain recommendations of the Institute of Medicine ( IOM ) . Secondary outcome variables were maternal weight retention and short-term obstetric and neonatal outcomes . Results The intervention result ed in a lower proportion of women exceeding IOM guidelines among women in the intervention group ( 38 % ) compared with the control group ( 60 % ) ( odds ratio ( OR ) : 0.5 ; 95 % confidence interval ( CI ) : 0.3 to 0.9 ) without prompting an increase in the proportion of pregnancies with suboptimal weight gain ( 19 % vs. 21 % ) . Participants in the intervention group gained significantly less weight than those in the control group . Only 17 % of the women in the intervention group showed substantial weight retention of more than 5 kg compared with 31 % of those in the control group at month four postpartum ( pp ) ( OR : 0.5 ; 95 % CI : 0.2 to 0.9 ) . There were no significant differences in obstetric and neonatal outcomes . Conclusions Lifestyle counseling given to pregnant women reduced the proportion of pregnancies with excessive GWG without increasing suboptimal weight gain , and may exert favorable effects on pp weight retention . Trial registration German Clinical Trials Register DRKS00003801 Background Lifestyle interventions targeting obese pregnant women often result in modest reduction in gestational weight gain , pregnancy complications and related risk factors . Examining adherence to the intervention can , however , provide valuable information on the importance of the different factors targeted . Objective To evaluate improvements and relevance of different dietary factors targeted with respect to gestational weight gain in a 3-arm R and omised Controlled Trial ( n=342 ) among obese pregnant women with BMI ≥30 kg/m2 . Methods R and omisation 1:1:1 to either hypocaloric Mediterranean type of diet and physical activity intervention ( D+PA ) ; physical activity intervention alone ( PA ) ; or control ( C ) . Diet was assessed at baseline ( weeks 11–14 ) and endpoint ( weeks 36–37 ) using a vali date d food frequency question naire . Results During the intervention women in the D+PA group significantly lowered their intakes of added sugars and saturated fat and increased their protein intake by ~1 % of total energy compared to controls . Of these dietary variables only intakes of added sugar appeared to be related to GWG , while no association was observed for saturated fat or protein . Further analyses revealed that foods that contributed to intake of added sugars , including sweets , snacks , cakes , and soft drinks were strongly associated with weight gain , with women consuming sweets ≥2/day having 5.4 kg ( 95 % CI 2.1 - 8.7 ) greater weight gain than those with a low ( < 1wk ) intake . The results for soft drinks were more conflicting , as women with high weight gain tended to favour artificially sweetened soft drinks . Conclusion In our sample of obese pregnant women , craving for sweets , snacks , and soft drinks strongly predicts GWG . Emphasis on reducing intakes of these foods may be more relevant for limiting gestational weight gain than encouraging strict compliance to more specific diets . Trial Registration Clinical Trials.gov Objective To determine the effect of antenatal dietary and lifestyle interventions on health outcomes in overweight and obese pregnant women . Design Multicentre r and omised trial . We utilised a central telephone r and omisation server , with computer generated schedule , balanced variable blocks , and stratification for parity , body mass index ( BMI ) category , and hospital . Setting Three public maternity hospitals across South Australia . Participants 2212 women with a singleton pregnancy , between 10 + 0 and 20 + 0 weeks ’ gestation , and BMI ≥25 . Interventions 1108 women were r and omised to a comprehensive dietary and lifestyle intervention delivered by research staff ; 1104 were r and omised to st and ard care and received pregnancy care according to local guidelines , which did not include such information . Main outcome measures Incidence of infants born large for gestational age ( birth weight ≥90th centile for gestation and sex ) . Prespecified secondary outcomes included birth weight > 4000 g , hypertension , pre-eclampsia , and gestational diabetes . Analyses used intention to treat principles . Results 2152 women and 2142 liveborn infants were included in the analyses . The risk of the infant being large for gestational age was not significantly different in the two groups ( lifestyle advice 203/1075 ( 19 % ) v st and ard care 224/1067 ( 21 % ) ; adjusted relative risk 0.90 , 95 % confidence interval 0.77 to 1.07 ; P=0.24 ) . Infants born to women after lifestyle advice were significantly less likely to have birth weight above 4000 g ( lifestyle advice 164/1075 ( 15 % ) v st and ard care 201/1067 ( 19 % ) ; 0.82 , 0.68 to 0.99 ; number needed to treat ( NNT ) 28 , 15 to 263 ; P=0.04 ) . There were no differences in maternal pregnancy and birth outcomes between the two treatment groups . Conclusions For women who were overweight or obese , the antenatal lifestyle advice used in this study did not reduce the risk delivering a baby weighing above the 90th centile for gestational age and sex or improve maternal pregnancy and birth outcomes . Trial registration Australian and New Zeal and Clinical Trials Registry ( ACTRN12607000161426 ) Background : Healthy diet , physical activity and modest weight gain during pregnancy may prevent developing gestational diabetes mellitus ( GDM ) . We examined whether a lifestyle intervention design ed to prevent GDM was effective in reducing excessive gestational weight gain ( GWG ) . Methods : A cluster-r and omised controlled trial ( n=399 ) was conducted in maternity clinics in 14 municipalities in Southern Finl and . Pregnant women with at least one risk factor for GDM ( for example , overweight ) but no pre-existing diabetes were recruited at 8–12 weeks ’ gestation . The intervention included counselling on GWG , physical activity and healthy eating at five routine visits . Usual counselling practice s were continued in the usual care municipalities . Statistical analyses were performed using multilevel linear and logistic regression models adjusted for weeks ’ gestation at last weight measurement , pre-pregnancy body mass index and smoking status . Results : The intervention group had a lower mean GWG by weeks ’ gestation than the usual care group ( adjusted coefficient for the between-group difference −0.016 kg per day , P=0.041 ) . There was no difference in mean ( ±s.d . ) GWG between the intervention and the usual care groups ( 13.7±5.8 vs 14.3±5.0 kg , P=0.64 ) . In total , 46.8 % of the intervention group and 54.4 % of the usual care group exceeded the GWG recommendations . The adjusted odds ratio for excessive GWG was 0.82 ( 95 % CI 0.53–1.26 , P=0.36 ) in the intervention group as compared with the usual care group . Conclusions : The intervention had minor effects on GWG  among women who were at increased risk for GDM . In order to prevent excessive GWG , additional focus on restriction of energy intake may be needed OBJECTIVE To examine whether personalized interventions could improve dietary intake and physical activity among pregnant women . METHODS A r and omized controlled trial was conducted at a center in Chengdu , China , between September 2012 and February 2013 . Women with a singleton pregnancy ( aged ≥18years , could underst and written Chinese , did not have pre-existing diabetes ) were enrolled at approximately 12weeks of pregnancy . They were r and omly assigned ( 1:1 ) to an intervention group ( received personalized educational material s ) or a control group ( conventional interventions only ) . Data for dietary intake and physical activity were recorded via question naires . Only pregnant women who completed the study were included in the analysis . RESULTS Analyses included 106 women in the control group and 115 in the intervention group . After intervention , the intake of energy , protein , fruit , milk , seafood , and nuts differed significantly between groups ( P<0.05 ) , with intakes closer to the recommended amounts in the intervention group . Women in the intervention group spent significantly less time resting ( P=0.033 ) and more time doing mild activity ( P=0.016 ) . Mean weight gain per week was significantly lower in the intervention group ( P=0.023 ) , and significantly fewer women in this group developed gestational diabetes ( P=0.043 ) . CONCLUSION Personalized educational interventions can improve dietary behavior and physical activity levels , and reduce prevalence of gestational diabetes among pregnant women in China . Chinese Clinical Trial Register : ChiCTR-IPR-15005809 OBJECTIVE To determine if an interactive , computerized Video Doctor counseling tool improves self-reported diet and exercise in pregnant women . METHODS A r and omized trial comparing a Video Doctor intervention to usual care in ethnically diverse , low-income , English-speaking pregnant women was conducted . Brief messages about diet , exercise , and weight gain were delivered by an actor-portrayed Video Doctor twice during pregnancy . RESULTS In the  Video Doctor group ( n=158 ) , there were statistically significant increases from baseline in exercise ( + 28 min ) , intake of fruits and vegetables , whole grains , fish , avocado and nuts , and significant decreases in intake of sugary foods , refined grains , high fat meats , fried foods , solid fats , and fast food . In contrast , there were no changes from baseline for any of these outcomes in the usual care group ( n=163 ) . Nutrition knowledge improved significantly over time in both groups but more so in the Video Doctor group . Clinician-patient discussion s about these topics occurred significantly more frequently in the Video Doctor group . There was no difference in weight gain between groups . CONCLUSION A brief Video Doctor intervention can improve exercise and dietary behaviors in pregnant women . PRACTICE IMPLICATION S The Video Doctor can be integrated into prenatal care to assist clinicians with effective diet and exercise counseling PURPOSE The present study examined the effects of exercise on physical and psychological variables in sedentary primigravidae ( PRA ) . METHODS A total of nine women r and omly assigned to an exercise ( E ) ( mean age = 31.3 + /- 3.1 yr ) and six subjects r and omly assigned to a control ( C ) group ( mean age = 27.8 + /- 3.1 yr ) fulfilled all requirements for the study . Exercise included a variety of exercise activities performed to a target heart rate of 150 - 156 beats x min(-1 ) , three times per week for 15 wk . RESULTS Results showed no significant differences between E and C groups in physical characteristics initially . A repeated measures ANOVA showed a significant group effect ( P < 0.05 ) and a significant group by time interaction ( P = 0.001 ) with the E group showing a significantly longer amount of time on the PWC150 test than the C group . There was no significant group , time , or group by time interaction for lactate accumulation . This occurred , despite the fact that the E group spent 56 % longer on the PWC150 test and the C group spent 30 % less time on the same test at the conclusion of the study . Finally , the E group in comparison to the C group showed more favorable improvements in several items related to health and well-being on the Body Cathexis Scale . There were no significant differences between E and C groups in any pregnancy outcome measures . All babies were delivered healthy  at term . CONCLUSIONS These data suggest that a vigorous exercise program can lead to significant improvements in aerobic fitness at similar lactate concentrations compared to a control group and can be well tolerated by low risk sedentary PRA without any deleterious effects occurring to herself or unborn child OBJECTIVE To compare the effectiveness of diabetes prevention strategies addressing postpartum weight retention for women with gestational diabetes mellitus ( GDM ) delivered at the health system level : mailed recommendations ( usual care ) versus usual care plus a Diabetes Prevention Program (DPP)–derived lifestyle intervention . RESEARCH DESIGN AND METHODS This study was a cluster r and omized controlled trial of 44 medical facilities ( including 2,280 women with GDM ) r and omized to intervention or usual care . The intervention included mailed gestational weight gain recommendations plus 13 telephone sessions between 6 weeks and 6 months postpartum . Primary outcomes included the following : proportion meeting the postpartum goals of 1 ) reaching pregravid weight if pregravid BMI < 25.0 kg/m2 or 2 ) losing 5 % of pregravid weight if BMI ≥25.0 kg/m2 ; and pregravid to postpartum weight change . RESULTS On average , over the 12-month postpartum period , women in the intervention had significantly higher odds of meeting weight goals than women in usual care ( odds ratio [ OR ] 1.28 [ 95 % CI 1.10 , 1.47 ] ) . The proportion meeting weight goals was significantly higher in the intervention than usual care at 6 weeks ( 25.5 vs. 22.4 % ; OR 1.17 [ 1.01 , 1.36 ] ) and 6 months ( 30.6 vs. 23.9 % ; OR 1.45 [ 1.14 , 1.83 ] ) . Condition differences were reduced at 12 months ( 33.0 vs. 28.0 % ; OR 1.25 [ 0.96 , 1.62 ] ) . At 6 months , women in the intervention retained significantly less weight than women in usual care ( mean 0.39 kg [ SD 5.5 ] vs. 0.95 kg [ 5.5 ] ; mean condition difference −0.64 kg [ 95 % CI −1.13 , −0.14 ] ) and had greater increases in vigorous-intensity physical activity ( mean condition difference 15.4 min/week [ 4.9 , 25.8 ] ) . CONCLUSIONS A DPP-derived lifestyle intervention modestly reduced postpartum weight retention and increased vigorous-intensity physical activity OBJECTIVE To assess the effect of aerobic exercise training on maternal and neonatal outcome METHODS The case-control study was conducted between January and July , 2011 . It was approved by the Research Ethics Committee of Toyserkan Azad University , and data was collected at prenatal clinics and delivery centres located in Hamedan , Iran . It comprised 80 pregnant women between 20 - 26 weeks of gestation r and omly assigned to two equal and matching groups of cases and controls . The intervention group did exercise continuously on a bicycle ergometre for 15 minutes , three times a week ; the intensity being 50 - 60 % of maximal heart rate . The control group did not do any exercise training . All information was obtained from the clinics , delivery centres , and from the reports of delivery room midwives . RESULTS No statistically significant difference was found between the two groups in gestational weight gain , pregnancy length , mode of delivery , first and second stage of labour , perineal tear , and 1st and 5th min Apgar score . Mean neonatal weight was significantly less in the intervention group than the control group ( p < 0.001 ) . CONCLUSION Exercising on a bicycle ergometer during pregnancy seems to be safe for the mother and the neonate Please cite this paper as : Hui A , Back L , Ludwig S , Gardiner P , Sevenhuysen G , Dean H , Sellers E , McGavock J , Morris M , Bruce S , Murray R , Shen G. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a r and omised controlled trial . BJOG 2012;119:70–77 In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias AIM The significant deterioration of insulin sensitivity and glucose tolerance during pregnancy can have serious health implication s for both the pregnant woman and her baby . Although it is well established that regular exercise benefits insulin sensitivity in the nonpregnant population , the effect on glucose tolerance in obese pregnant women is not known . The purpose of this study was to investigate the effect of a supervised 10-week , home-based , exercise programme , beginning at week 18 of gestation , on glucose tolerance and aerobic fitness in previously sedentary obese women . METHODS Twelve sedentary obese women were r and omized into an exercise ( EX ; n=6 ) or control ( CON ; n=6 ) group at 18 weeks of gestation . Those r and omized to EX engaged in 10 weeks of supervised home-based exercise ( three sessions a week of stationary cycling ) , while those in the CON group maintained their usual daily activity . Their glucose and insulin responses to an oral glucose tolerance test ( OGTT ) , as well as their aerobic fitness , were assessed both pre- and postintervention . RESULTS Reduced glucose tolerance in the CON , but not EX , group was indicated by a tendency postintervention towards higher blood glucose levels at 1h of the OGTT ( P=0.072 ) . Furthermore , at 2h of the postintervention OGTT , blood glucose tended to remain elevated from baseline in the CON ( P=0.077 ) . There was also a trend towards increased fitness in the EX ( P=0.064 ) , but not the CON group . CONCLUSION Regular aerobic exercise begun during pregnancy may have favourable effects on glucose tolerance and fitness in obese women , and warrants further investigation in a larger sample population PURPOSE This study aim ed to evaluate the effect of an exercise program of two different intensities , with nutritional control , on gestational weight gain ( GWG ) , infant birth weight , and maternal weight retention at 2 months postpartum ( 2 mopp ) . METHODS Pregnant women ( prepregnancy body mass index = 18.5 - 24.9 kg·m ) were r and omized at study entry ( 16 - 20 wk of gestation ) to a low-intensity ( LI , 30 % HR reserve ( HRR ) , n = 23 ) or moderate-intensity ( MI , 70 % HRR , n = 26 ) exercise program , with nutritional control . The exercise program consisted of walking sessions three to four times per week , gradually increasing exercise time from 25 to 40 min per session . Forty-five normal-weight women who did not participate in any structured exercise program during pregnancy and had singleton births were used as a historical control group .  RESULTS Total GWG was higher in the control group ( 18.3 ± 5.3 kg ) compared with the LI ( 15.3 ± 2.9 kg , P = 0.01 ) and MI ( 14.9 ± 3.8 kg , P = 0.003 ) groups . During the intervention , GWG was similar in both intervention groups , with weekly rates of weight gain of 0.49 ± 0.1 and 0.47 ± 0.1 kg·wk in the LI and MI groups , respectively . Excessive GWG during the intervention was prevented in 70 % of the women in the LI group and 77 % of those in the MI group . Excessive GWG occurred before the intervention began . At 2 mopp , 18 % and 28 % of the women in the LI and MI groups , respectively , retained ≤2.0 kg compared with only 7 % of those in the control group . Infant birth weight was not different between the groups . CONCLUSIONS Results suggest that a prenatal nutrition and exercise program regardless of exercise intensity , reduced excessive GWG and decreased weight retention at 2 mopp in women of normal weight before pregnancy Background Pregnancy is a recognised high risk period for excessive weight gain , contributing to postpartum weight retention and obesity development long-term . We aim ed to reduce postpartum weight retention following a low-intensity , self-management intervention integrated with routine antenatal care during pregnancy . Methods 228 women at increased risk of gestational diabetes , < 15 weeks gestation were r and omised to intervention ( 4 self-management sessions ) or control ( generic health information ) . Outcomes , collected at baseline and 6 weeks postpartum , included anthropometrics ( weight and height ) , physical activity ( pedometer ) and question naires ( health behaviours ) . Results Mean age ( 32.3 ± 4.7 and 31.7 ± 4.4 years ) and body mass index ( 30.4 ± 5.6 and 30.3 ± 5.9 kg/m2 ) were similar between intervention and control groups , respectively at baseline . By 6 weeks postpartum , weight change in the control group was significantly higher than the intervention group with a between group difference of 1.45 ± 5.1 kg ( 95 % CI : -2.86,-0.02 ; p < h0.05 ) overall , with a greater difference in weight found in overweight , but not obese women . Intervention group allocation , higher baseline BMI , GDM diagnosis , country of birth and higher age were all independent predictors of lower weight retention at 6 weeks postpartum on multivariable linear regression . Other factors related to weight including physical activity , did not differ between groups . Conclusions A low intensity intervention , integrated with st and ard antenatal care is effective in limiting postpartum weight retention . Implementation research is now required for scale-up to optimise antenatal health care . Trial registration Australian New Zeal and Clinical Trial Registry Number : ACTRN12608000233325 . Registered 7/5/2008 Background The effectiveness of exercise training for preventing excessive gestational weight gain ( GWG ) and gestational diabetes mellitus ( GDM ) is still uncertain . As maternal obesity is associated with both GWG and GDM , there is a special need to assess whether prenatal exercise training programs provided to obese women reduce the risk of adverse pregnancy outcomes . Our primary aim was to assess whether regular supervised exercise training in pregnancy could reduce GWG in women with prepregnancy overweight/obesity . Secondary aims were to examine the effects of exercise in pregnancy on 30 outcomes including GDM incidence , blood pressure , blood measurements , skinfold thickness , and body composition . Methods and Findings This was a single-center study where we r and omized ( 1:1 ) 91 pregnant women with a prepregnancy body mass index ( BMI ) ≥ 28 kg/m2 to exercise training ( n = 46 ) or control ( st and ard maternity care ) ( n = 45 ) . Assessment s were done at baseline ( pregnancy week 12–18 ) and in late pregnancy ( week 34–37 ) , as well as at delivery . The exercise group was offered thrice weekly supervised sessions of 35 min of moderate intensity endurance exercise and 25 min of strength training . Seventeen women were lost to follow-up ( eight in the exercise group and nine in the control group ) . Our primary endpoint was GWG from baseline testing to delivery . The principal analyses were done as intention-to-treat analyses , with supplementary per protocol analyses where we assessed outcomes in the women who adhered to the exercise program ( n = 19 ) compared to the control group . Mean GWG from baseline to delivery was 10.5 kg in the exercise group and 9.2 kg in the control group , with a mean difference of 0.92 kg ( 95 % CI −1.35 , 3.18 ; p = 0.43 ) . Among the 30 secondary outcomes in late pregnancy , an apparent reduction was recorded in the incidence of GDM ( 2009 WHO definition ) in the exercise group ( 2 cases ; 6.1 % ) compared to the control group ( 9 cases ; 27.3 % ) , with an odds ratio of 0.1 ( 95 % CI 0.02 , 0.95 ; p = 0.04 ) . Systolic blood pressure was significantly lower in the exercise group ( mean 120.4 mm Hg ) compared to the control group ( mean 128.1 mm Hg ) , with a mean difference of −7.73 mm Hg ( 95 % CI −13.23 , −2.22 ; p = 0.006 ) . No significant between-group differences were seen in diastolic blood pressure , blood measurements , skinfold thickness , or body composition in late pregnancy . In per protocol analyses , late pregnancy systolic blood pressure was 115.7 ( 95 % CI 110.0 , 121.5 ) mm Hg in the exercise group ( significant between-group difference , p = 0.001 ) , and diastolic blood pressure was 75.1 ( 95 % CI 71.6 , 78.7 ) mm Hg ( significant between-group difference , p = 0.02 ) . We had planned to recruit 150 women into the trial ; hence , under-recruitment represents a major limitation of our results . Another limitation to our study was the low adherence to the exercise program , with only 50 % of the women included in the intention-to-treat analysis adhering as described in the study protocol . Conclusions In this trial we did not observe a reduction in GWG among overweight/obese women who received a supervised exercise training program during their pregnancy . The incidence of GDM in late pregnancy seemed to be lower in the women r and omized to exercise training than in the women receiving st and ard maternity care only .  Systolic blood pressure in late pregnancy was also apparently lower in the exercise group than in the control group . These results indicate that supervised exercise training might be beneficial as a part of st and ard pregnancy care for overweight/obese women . Trial Registration Clinical Trials.gov Objective The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied . Study design A physical activity ( PA , l and /aquatic activities ) programme during the entire pregnancy ( three sessions per week ) was conducted by a qualified instructor . 83 healthy pregnant women were r and omly assigned to either an exercise group ( EG , n=40 ) or a control ( CG , n=43 ) group . 50 g maternal glucose screen ( MGS ) , maternal weight gain and several pregnancy outcomes were recorded . Results Significant differences were found between study groups on the 50 g MGS . Values corresponding to the EG ( 103.8±20.4 mg/dl ) were better than those of the CG ( 126.9±29.5 mg/dl ) , p=0.000 . In addition , no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG ( 7 % ) ( p>0.05 ) were found . Conclusion A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance OBJECTIVE We have studied the effect of moderate physical activity that is performed by healthy women during their entire pregnancy on their perception of health status . STUDY DESIGN Eighty sedentary women were assigned r and omly to either an exercise group ( n = 40 ) or a control group ( n = 40 ) . Maternal perception of health status and several pregnancy outcomes were recorded . RESULTS Significant differences ( P = .03 ) were found between study groups in the percentage of women who perceived their health status as " very good " ; the values that corresponded to the exercise group ( n = 18 ; 54.5 % ) were better than those of the control group ( n = 9 ; 27.3 % ) . In addition , the women of the exercise group gained less weight ( 11,885 ± 3146 g ) than those of the control group ( 13,903 ± 2113 ; P = .03 ) . CONCLUSION A moderate physical activity program that is performed over the first , second , and third trimester of pregnancy improves the maternal perception of health status OBJECTIVE To investigate if water-gymnastics during pregnancy may reduce the intensity of back/low back pain and the number of days on sick-leave . METHODS A prospect i ve , r and omized study . One hundred and twenty-nine women were r and omized to participate in water-gymnastics once a week during the second half of pregnancy and 129 were r and omized to a control group . The women in both groups filled in question naires in gestational weeks 18 , 34 and within the first postpartum week . Every day from week 18 to labor they assessed the intensity of back/low back pain . RESULTS Back pain intensity increased during pregnancy . No excess risk for the pregnancy associated with water-gymnastics was observed . The women participating in water-gymnastics recorded a lower intensity of back/low back pain . The total number of days on sick-leave because of back/low back pain was 982 in the water-gymnastics group ( 124 women ) compared with 1484 in the control group ( 120 women ) . After weeks 32 33 , seven women in the water-gymnastics group compared with 17 in the control group were on sickleave because of back/ low back pain ( p=0.031 ) . CONCLUSIONS Intensity of back/low back pain increased with advancing pregnancy . There was no excess risk for urinary or vaginal infections associated with water-gymnastics . Water-gymnastics during the second half of pregnancy significantly reduced the intensity of back/ low back pain .  Water-gymnastics decreased the number of women on sick-leave because of back/low back pain .  Water-gymnastics during pregnancy can be recommended as a method to relieve back pain and may reduce the need for sick-leave Background Excessive gestational weight gain ( GWG ) is associated with elevated weight retention in mothers and might be related to adiposity of their offspring . Little is known if lifestyle intervention during pregnancy has beneficial effects for mothers and children beyond gestation . Methods A cluster-r and omized controlled intervention trial was performed with 250 pregnant women in 8 gynaecological practice s.  Lifestyle intervention was carried out twice with individual counselling sessions on nutrition , physical activity and weight monitoring . Participants in the control group received routine prenatal care and an information leaflet . Follow-up data of women and their offspring were collected one year postpartum ( pp ) by phone call and /or via e-mail using a structured question naire . Maternal weight retention at 12 months pp and weight development of the children in their first year of life was compared between groups using linear regression . The association between energy and macronutrient intake during pregnancy with maternal weight retention and children weight development was also assessed . Results The intervention result ed in a trend towards lower mean weight retention 12 months pp ( 0.2 vs. 0.8 kg ) , but was not statistically significant ( p = 0.321 ) . Among women receiving lifestyle counselling , only 8 % retained more than 5 kg weight while 17 % in the control group retained > 5 kg ( OR : 0.40 ( 95 % CI : 0.16 , 0.97 ) ) . For the whole study cohort , an association between higher GWG and increased 12 month weight retention was found ( 0.4 kg weight retention per 1 kg increase in GWG , p < 0.001 ) . Weight development of the infants did not differ between groups in the first months after birth . At the 10th–12th month weight measurement , infants born to mothers in the intervention group tended towards lower body weights . Both energy intake and macronutrient composition of the diet during pregnancy did not affect maternal weight retention and weight development of the infants . Conclusions Lifestyle counselling during pregnancy to avoid GWG had a rather modest effect on maternal pp weight retention and weight development of the infants . However , larger intervention studies and longer follow-up are required to be able to draw definite conclusions .Trial registration German Clinical Trials Register DRKS00003801 OBJECTIVE Ways to prevent gestational diabetes mellitus ( GDM ) remain unproven . We compared the impact of three lifestyle interventions ( healthy eating [ HE ] , physical activity [ PA ] , and both HE and PA [ HE+PA ] ) on GDM risk in a pilot multicenter r and omized trial . RESEARCH DESIGN AND METHODS Pregnant women at risk for GDM ( BMI ≥29 kg/m2 ) from nine European countries were invited to undertake a 75-g oral glucose tolerance test before 20 weeks ' gestation . Those without GDM were r and omized to HE , PA , or HE+PA . Women received five face-to-face and four optional telephone coaching sessions , based on the principles of motivational interviewing . A gestational weight gain ( GWG ) < 5 kg was targeted . Coaches received st and ardized training and an intervention toolkit . Primary outcome measures were GWG , fasting glucose , and insulin sensitivity ( HOMA ) at 35–37 weeks . RESULTS Among the 150 trial participants , 32 % developed GDM  by 35–37 weeks and 20 % achieved GWG < 5 kg . HE women had less GWG ( −2.6 kg [ 95 % CI −4.9 , −0.2 ] ; P = 0.03 ) and lower fasting glucose ( −0.3 mmol/L [ −0.4 , −0.1 ] ; P = 0.01 ) than those in the PA group at 24–28 weeks . HOMA was comparable . No significant differences between HE+PA and the other groups were observed . CONCLUSIONS An antenatal HE intervention is associated with less GWG and lower fasting glucose compared with PA alone . These findings require a larger trial for confirmation but support the use of early HE interventions in obese pregnant women Objective To evaluate whether a 12-week supervised exercise program promotes an active lifestyle throughout pregnancy in pregnant women with obesity . Methods In this preliminary r and omised trial , pregnant women ( body mass index ≥ 30 kg/m2 ) were allocated to either  st and ard care or supervised training , from 15 to 27 weeks of gestation . Physical activity was measured by accelerometry at 14 , 28 and 36 weeks , while fitness ( oxygen consumption ( VO2 ) at the anaerobic threshold ) , nutrition ( caloric intake and macronutrients percentage ) and anthropometry were assessed at 14 and 28 weeks of gestation . Analyses were performed using repeated measures ANOVA . Results A total of fifty ( 50 ) women were r and omised , 25 in each group . There was no time-group interaction for time spent at moderate and vigorous activity ( pinteraction = 0.064 ) , but the exercise group ’s levels were higher than controls ’ at all times ( pgroup effect = 0.014 ) . A significant time-group interaction was found for daily physical activity ( p = 0.023 ) ; similar at baseline ( ( 22.0 ± 6.7 vs 21.8 ± 7.3 ) x 104 counts/day ) the exercise group had higher levels than the control group following the intervention ( ( 22.8 ± 8.3 vs 19.2 ± 4.5 ) x 104 counts/day , p = 0.020 ) and at 36 weeks of gestation ( ( 19.2 ± 1.5 vs 14.9 ± 1.5 ) x 104 counts/day , p = 0.034 ) . Exercisers also gained less weight than controls during the intervention period despite similar nutritional intakes ( difference in weight change = -0.1 kg/week , 95 % CI -0.2 ; -0.02 , p = 0.016 ) and improved cardiorespiratory fitness ( difference in fitness change = 8.1 % , 95 % CI 0.7 ; 9.5 , p = 0.041 ) . Conclusions Compared with st and ard care , a supervised exercise program allows pregnant women with obesity to maintain fitness , limit weight gain and attenuate the decrease in physical activity levels observed in late pregnancy . Trial Registration Clinical Trials.gov Background The objectives of this study were to assess the efficacy of lifestyle intervention on gestational weight gain in pregnant women with normal and above normal body mass index ( BMI ) in a r and omized controlled trial . Methods A total of 116 pregnant women ( < 20 weeks of pregnancy ) without diabetes were enrolled and 113 pregnant women completed the program . Participants were r and omized into intervention and control groups . Women in the intervention group received weekly trainer-led group exercise sessions , instructed home exercise for 3 - 5-times/week during 20 - 36 weeks of gestation , and dietary counseling twice during pregnancy . Participants in the control group did not receive the intervention . All participants completed a physical activity question naire and a 3-day food record at enrolment and 2 months after enrolment . Results The participants in the intervention group with normal pre-pregnancy BMI ( ≤24.9 kg/M2 , n = 30 ) had lower gestational weight gain ( GWG ) , offspring birth weight and excessive gestational weight gain ( EGWG ) on pregnancy weight gain compared to the control group ( n = 27 , p < 0.05 ) . Those weight related-changes were not detected between the intervention ( n = 27 ) and control group ( n = 29 ) in the above normal pre-pregnancy BMI participants . Intervention reduced total calorie , total fat , saturated fat and cholesterol intake were detected in women with normal or above normal pre-pregnancy BMI compared to the control group ( p < 0.05 or 0.01 ) . Increased physical activity and reduced carbohydrate intake were detected in women with normal ( p < 0.05 ) , but not above normal , pre-pregnancy BMI at 2 months after the onset of the intervention compared to the control group . Conclusion The results of the present study demonstrated that the lifestyle intervention program decreased EGWG , GWG , offspring birth weight in pregnant women with normal , but not above normal , pre-pregnancy BMI , which was associated with increased physical activity and decreased carbohydrate intake . Trial registration Objective To determine the effectiveness of a physical activity intervention for smoking cessation during pregnancy . Design Parallel group , r and omised controlled , multicentre trial . Setting 13 hospitals in Engl and , April 2009 to January 2014 . Participants 789 pregnant smokers , aged 16 - 50 years and at 10 - 24 weeks ’ gestation , who smoked at least one cigarette daily and were prepared to quit smoking one week after enrollment were r and omised ( 1:1 ) ; 785 were included in the intention to treat analyses , with 392 assigned to the physical activity group . Interventions Interventions began one week before a target quit date . Participants were r and omised to six weekly sessions of behavioural support for smoking cessation ( control ) or to this support plus 14 sessions combining supervised treadmill exercise and physical activity consultations . Main outcome measures The primary outcome was continuous smoking abstinence from the target quit date until end of pregnancy , vali date d by exhaled carbon monoxide or salivary cotinine levels . To assess adherence , levels of moderate-vigorous intensity physical activity were self reported and in a 11.5 % ( n=90 ) r and om sub sample of participants , physical activity was objective ly measured by an accelerometer . Results No significant difference was found in rates of smoking abstinence at end of pregnancy between the physical activity and control groups ( 8 % v 6 % ; odds ratio 1.21 , 95 % confidence interval 0.70 to 2.10 ) . For the physical activity group compared with the control group , there was a 40 % ( 95 % confidence interval 13 % to 73 % ) , 34 % ( 6 % to 69 % ) , and 46 % ( 12 % to 91 % ) greater increase in self reported minutes carrying out physical activity per week from baseline to one week , four weeks , and six weeks post-quit day , respectively . According to the accelerometer data there was no significant difference in physical activity levels between the groups . Participants attended a median of four treatment sessions in the intervention group and three in the  control group . Adverse events and birth outcomes were similar between the two groups , except for significantly more caesarean births in the control group than in the physical activity group ( 29 % v 21 % , P=0.023 ) . Conclusion Adding a physical activity intervention to behavioural smoking cessation support for pregnant women did not increase cessation rates at end of pregnancy . During pregnancy , physical activity is not recommended for smoking cessation but remains indicated for general health benefits . Trial registration Current Controlled Trials IS RCT N48600346 Objective Observational studies suggest that minimal gestational weight gain ( GWG ) may optimize pregnancy outcomes for obese women . This trial tested the efficacy of a group-based weight management intervention for limiting GWG among obese women . Methods We r and omized 114 obese women ( BMI [ mean±SD ] 36.7±4.9 kg/m2 ) between 7–21 weeks ’ ( 14.9±2.6 ) gestation to intervention  ( n=56 ) or usual care control conditions  ( n=58 ) . The intervention included individualized calorie goals , advice to maintain weight within 3 % of r and omization and follow the Dietary Approaches to Stop Hypertension dietary pattern without sodium restriction , and attendance at weekly group meetings until delivery . Control participants received one-time dietary advice . Our three main outcomes were maternal weight change from r and omization to 2 weeks postpartum and from r and omization to 34 weeks gestation , and newborn large-for-gestational age ( birth weight > 90th percentile , LGA ) . Results Intervention participants gained less weight from r and omization to 34 weeks gestation ( 5.0 vs 8.4 kg , mean difference=−3.4 kg , 95 % CI [ −5.1 , −1.8 ] ) , and from r and omization to 2 weeks postpartum ( −2.6 vs + 1.2 kg , mean difference=−3.8 kg , 95 % CI [ −5.9 , −1.7 ] ) . They also had a lower proportion of LGA babies ( 9 % vs. 26 % , odds ratio=0.28 , 95 % CI [ 0.09 , 0.84 ] ) . Conclusions The intervention result ed in lower GWG and lower prevalence of LGA newborns BACKGROUND Maternal obesity and excessive gestational weight gain ( GWG ) are major short- and long-term risk factors for maternal and fetal complications . OBJECTIVE The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits , increase physical activity ( PA ) , and reduce GWG in obese pregnant women . DESIGN In this r and omized controlled trial , 195 white , obese pregnant women [ age : 29 + or - 4 y ; body mass index ( in kg/m(2 ) ) ; 33.6 + or - 4.2 ] were r and omly assigned into 3 groups : a group that received nutritional advice from a brochure , a group that received the brochure and lifestyle education by a nutritionist , and a control group . Nutritional habits  were evaluated every trimester through 7-d food records . PA was evaluated with the Baecke question naire . RESULTS Energy intake did not change during pregnancy and was comparable in all groups . Fat intake , specifically saturated fat intake , decreased and protein intake increased from the first to the third trimester in the passive and active groups compared with an opposite change in the control group . Calcium intake and vegetable consumption increased during pregnancy in all groups . PA decreased in all groups , especially in the third trimester . No significant differences in GWG and obstetrical or neonatal outcome could be observed between the groups . CONCLUSIONS Both lifestyle interventions improved the nutritional habits of obese women during pregnancy . Neither PA nor GWG was affected OBJECTIVE To study the effect on  maternal weight gain of a supervised light- to moderate-intensity exercise-based intervention performed from the ninth week of pregnancy . PARTICIPANTS AND METHODS A total of 962 healthy pregnant women were r and omly assigned to a st and ard care or exercise intervention group conducted between September 1 , 2007 , and January 31 , 2011 . The intervention included light- to moderate-intensity aerobic and resistance exercises performed 3 days a week ( 50 - 55 minutes per session ) . Excessive gestational weight gain was calculated on the basis of the 2009 Institute of Medicine ( IOM ) recommendations . Gestational body weight gain was calculated on the basis of the weight measured at the first prenatal visit ( fifth to sixth weeks of gestation ) and weight measured at the last visit to the clinic before delivery . Women were categorized into normal weight or overweight or obese . RESULTS Women in the intervention group gained less weight ( adjusted mean difference , 1.039 kg ; 95 % CI , 0.534 - 1.545 kg ; P<.001 ) and were less likely to gain weight above the IOM recommendations ( odds ratio , 0.625 ; 95 % CI , 0.461 - 0.847 ) compared with those in the st and ard care group . The main treatment effects according to body mass index category were that normal weight women in the intervention group gained less weight ( adjusted mean difference , 1.393 kg ; 95 % CI , 0.813 - 1.972 kg ; P<.001 ) and were less likely to gain weight above the IOM recommendations ( odds ratio , 0.508 ; 95 % CI , 0.334 - 0.774 ) than normal weight women who received st and ard care . No significant treatment effect was observed in overweight or obese women . CONCLUSION Supervised exercise of light to moderate intensity can be used to prevent excessive gestational weight gain , especially in normal weight women . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01790347 BACKGROUND Excessive weight gain during pregnancy is a risk factor for postpartum weight retention and future weight gain and obesity . Whether a behavioral intervention in pregnancy can reduce long-term weight retention is unknown . OBJECTIVE This r and omized trial tested whether a low-intensity behavioral intervention to prevent excessive gestational weight gain could increase the proportion of women who returned to prepregnancy weight by 12 mo postpartum . DESIGN Women ( n = 401 , 13.5 wk of gestation , 50 % normal weight , 50 % overweight/obese ) were r and omly assigned into an intervention or  control  group ; 79 % completed the 12-mo assessment . The telephone-based intervention targeted gestational weight gain , healthy eating , and exercise and was discontinued at delivery . RESULTS In modified intent-to-treat analyses that excluded women with miscarriages ( n = 6 ) , gestational diabetes ( n = 32 ) , or subsequent pregnancies ( n = 32 ) , the intervention had no significant effect on the odds of achieving prepregnancy weight at 12 mo postpartum ( n = 331 ; 35.4 % compared with 28.1 % ; P = 0.18 ) . Completer analyses suggested that the intervention tended to increase the percentages of women who reached prepregnancy weight ( n = 261 ; 45.3 % compared with 35.3 % ; P = 0.09 ) and significantly reduced the magnitude of mean ± SD postpartum weight retained ( 1.4 ± 6.3 compared with 3.0 ± 5.7 kg ; P = 0.046 ) at 12 mo . Women in the intervention group reported higher dietary restraint through 6 mo postpartum ( P = 0.023 ) and more frequent self-monitoring of body weight ( P < 0.02 for all ) throughout the study . CONCLUSIONS A low-intensity behavioral intervention in pregnancy can reduce 12-mo postpartum weight retention and improve dietary restraint and self-weighing in study completers . Future research is needed to test the long-term effects of more intensive behavioral interventions in pregnancy . This trial was registered at clinical trials.gov as NCT01117961 BACKGROUND : The Institute of Medicine ( IOM ) recommends that normal‐weight women ( BMI ( body mass index ) of 19.8–26.0 ) gain 25–35 lb ( 11.4–15.9 kg ) during pregnancy , and that overweight women ( BMI of 26.1–29.0 ) gain 15–25 lbs ( 6.8–11.4 kg ) . A significant number of normal‐weight women and an even greater proportion of overweight women exceed these guidelines , which increases postpartum weight retention and may contribute to the development of obesity . OBJECTIVE : To determine whether a stepped care , behavioral intervention will decrease the percentage of women who gain more than the IOM recommendation . DESIGN : R and omized controlled trial comparing a stepped-care behavioral intervention with usual care .  Women ( n=120 ) who had a BMI > 19.8 , age>18 and < 20 weeks gestation were recruited from a hospital-based clinic serving low-income women and r and omized by race and BMI category to the intervention or control group . The intervention group received education about weight gain , healthy eating , and exercise and individual graphs of their weight gain . Those exceeding weight gain goals were given more intensive intervention . Women were followed through pregnancy to their first postpartum clinic visit . The main outcome measure was weight gain during pregnancy categorized as above the IOM recommendations vs below or within the IOM recommendations . RESULTS : The intervention significantly decreased the percentage of normal-weight women who exceeded the IOM recommendations ( 33 vs 58 % , P<0.05 ) . There was a non-significant ( P=0.09 ) effect in the opposite direction among overweight women ( 59 % of intervention and 32 % of control gained more than recommended ) . Postpartum weight retention was strongly related to weight gain during pregnancy ( r=0.89 ) . CONCLUSIONS : The intervention reduced excessive weight gain during pregnancy among normal weight women We examined the effects of home-based walking on sedentary Japanese women 's pregnancy outcomes and mood .  A r and omized controlled trial was conducted , involving 118 women aged 22 - 36 years . Participants were r and omly assigned to walking intervention ( n = 60 ) or control ( n = 58 ) groups . The walking group was instructed to walk briskly for 30 min , three times weekly from 30 weeks ' gestation until delivery . Both groups counted their daily steps using pedometers .  Pregnancy and delivery outcomes were assessed , participants completed the Profile of Mood States , and we used the intention-to-treat principle . Groups showed no differences regarding pregnancy or delivery outcomes . The walking group exhibited decreased scores on the depression-dejection and confusion subscales of the Profile of Mood States . Five of the 54 women in the intervention group who remained in the study ( 9.2 % ) completed 100 % of the prescribed walking program ; 32 ( 59.3 % ) women completed 80 % or more . Unsupervised walking improves sedentary pregnant women 's  mood , indicating that regular walking during pregnancy should be promoted in this group Objective To examine the effect of regular moderate-intensity exercise ( three training sessions/week ) on the incidence of  gestational diabetes mellitus ( GDM  , primary outcome ) . We also examined if the exercise intervention modifies the association between GDM and birth weight and risk of macrosomia , gestational age , risk of caesarean delivery and maternal weight gain ( secondary outcomes ) . Methods We r and omly assigned 510 healthy gravida to either an exercise intervention or a usual care ( control ) group ( n=255 each ) . The exercise programme focused on moderate-intensity resistance and aerobic exercises ( three times/week , 50–55 min/session ) . GDM diabetes was diagnosed according to the WHO criteria and the International Association for Diabetes in Pregnancy Study Group ( IADPSG ) . Results The intervention did not reduce the risk of developing GDM ( OR 0.84 , 95 % CI 0.50 to 1.40 ) when using the WHO criteria . We observed that the intervention reduced by 58 % the GDM-related risk ( WHO criteria ) of having a newborn with macrosomia ( OR 1.76 , 95 % CI 0.04 to 78.90 vs 4.22 , 95 % CI 1.35 to 13.19 ) in exercise and control groups , respectively ) , and by 34 % the GDM-related risk of having acute and elective caesarean delivery ( OR 1.30 , 95 % CI 0.44 to 3.84 vs 1.99 , 95 % CI 0.98 to 4.06 in exercise and control groups , respectively ) . Gestational age was similar across the treatment groups ( control , exercise ) and GDM category ( GDM or non-GDM ) , and maternal weight gain was ∼12 % lower in the exercise group independent of whether women developed GDM . The results were similar when the IADPSG criteria were used instead . Conclusions Regular moderate-intensity exercise performed over the second-third trimesters of pregnancy can be used to attenuate important GDM-related adverse outcomes OBJECTIVE Our purpose was to test the null hypothesis that beginning regular , moderate-intensity exercise in early pregnancy has no effect on fetoplacental growth . STUDY DESIGN Forty-six women who did not exercise regularly were r and omly assigned at 8 weeks either to no exercise ( n = 24 ) or to weight-bearing exercise ( n = 22 ) 3 to 5 times a week for the remainder of pregnancy . Outcome variables included antenatal placental growth rate and neonatal and placental morphometric measurements . RESULTS The offspring of the exercising women were significantly heavier ( corrected birth weight : 3.75 + /- 0.08 kg vs 3.49 + /- 0.07 kg ) and longer ( 51.8 + /- 0.3 cm vs 50.6 + /- 0.3 cm ) than those born to control women . The difference in birth weight was the result of an increase in both lean body mass and fat mass . In addition , midtrimester placental growth rate was faster ( 26 + /- 2 cm(3)/wk vs 21 + /- 1 cm(3)/wk ) and morphometric indexes of placental function were greater in the exercise group . There were no significant differences in neonatal percentage body fat , head circumference , ponderal index , or maternal weight gain . CONCLUSIONS These data indicate that beginning a moderate regimen of weight-bearing exercise in early pregnancy enhances fetoplacental growth This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence Objective : Gestational weight gain ( GWG ) is associated with childhood obesity . We analyzed whether this effect persists into adulthood and is mediated by effects in childhood . Design : The design of the study a prospect i ve birth cohort study established in 1959–1961.Subjects : The subjects were offspring ( n=4234 of whom 2485 had information from the last follow-up ) of mothers included in ‘ The Copenhagen Perinatal Cohort ’ during pregnancy or at birth . Measurements : Information on  maternal pre-pregnancy body mass index ( BMI ) , GWG  and several potential  confounders were collected around delivery . Information on offspring BMI was available from various follow-up examinations from 1 to 42 years of age . The association of GWG with offspring BMI was analyzed by regression models including confounders . Using path analysis , the association of GWG with adult BMI was disentangled into an association mediated through childhood BMI and one independent hereof . Results : GWG was associated with offspring BMI at all ages . At the age of 42 years ( n=1540 ) , there was an increasing risk of obesity ( odds ratio ( OR ) 1.08 , 95 % confidence interval ( CI ) 1.03–1.14 per kg GWG , P=0.003 ) . Only half of the association of GWG on offspring adult BMI was mediated through birth weight and BMI up to 14 years of age . Conclusion : Greater GWG is associated with an increased BMI in childhood through adulthood and with an increased risk of obesity  in adults . Only part of the association with adult BMI is mediated by childhood BMI , suggesting that excessive GWG induces a persisting susceptibility to obesogenic environments . As GWG is greater in women with small pre-pregnancy body weight , this implies a reinforcement of the obesity epidemic in the next generation . Our findings provide support for avoiding excessive GWG Please cite this paper as : Nascimento S , Surita F , Parpinelli M , Siani S , Pinto e Silva J. The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women : a r and omised clinical trial . BJOG 2011;118:1455–1463 BACKGROUND Innovative methods are warranted to optimize prenatal outcomes . This study 's objective was to determine if a web-based behavioral intervention ( BI ) can prevent excessive gestational weight gain ( GWG ) by increasing physical activity ( PA ) . METHODS Participants were r and omized to usual care ( UC ; n = 21 ) or BI ( n = 24 ) between 10 to 14 weeks gestation . GWG , PA , and diet were assessed at baseline , mid- , and late pregnancy . RESULTS No differences in GWG or adherence to GWG recommendations presented between groups . Total UC MET-minutes significantly decreased from baseline to late-pregnancy ( 1,234 ± 372 MET-minutes , P = .013 ) . Mid-pregnancy sustained PA was greater for BI than UC ( 20-minute PA bouts : 122 ± 106 vs. 46 ± 48 minutes/week , P = .005 ; 30-minute PA bouts : 74 ± 70 vs. 14 ± 24 minutes/week , P < .001 ) , and greater for BI at mid-pregnancy compared with baseline ( 20-minute PA bouts : 61.3 ± 21.9 ; 30-minute PA bouts : 39.6 ± 14.8 , both P < .05 ) . BI energy intake at mid-pregnancy significantly increased from baseline ( 336 ± 127 kcals , P = .04 ) and was significantly greater than UC ( 2,503 ± 703 vs. 1,894 ± 594 , P = .005 ) . CONCLUSIONS Sedentary pregnant women should increase PA but may need additional dietary counseling to prevent excessive GWG Objectives To assess whether a 12-week supervised exercise-programme with an additional 30 min of moderate self-imposed physical activity on the non-supervised weekdays prevents excessive weight gain in pregnancy  , as well as postpartum weight retention . Methods One hundred and five sedentary , nulliparous pregnant women with a mean age of 30.7 ± 4.0 years and a pre-pregnancy body mass index of 23.8 ± 4.3 kg/m2 were r and omised to either an exercise group ( EG , n = 52 ) or a control group ( CG , n = 53 ) . The exercise programme consisted of 60 min supervised aerobic dance and strength training for 60 min , at least twice per week for a minimum of 12 weeks . Results Drop-out rates were 19 % and 21 % in the EG and CG , respectively . Fewer women in the EG than in the CG exceeded the Institute of Medicine recommendations ; however , only EG participants who attended 24 exercise sessions ( n = 14 ) differed significantly from controls ( p = 0.006 ) with regard to weight gain during pregnancy ( 11.0 ± 2.3 vs. 13.8 ± 3.8 kg , p < 0.01 ) and postpartum weight retention ( 0.8 ± 1.7 vs. 3.3 ± 4.1 kg , p < 0.01 ) . Conclusions Regular participation in aerobic dance exercise can contribute to significantly reduce weight gain during pregnancy In the GRADE approach , r and omized trials are classified as high quality evidence and observational studies as low quality evidence but both can be rated down if a body of evidence is associated with a high risk of publication bias . Even when individual studies included in best- evidence summaries have a low risk of bias , publication bias can result in substantial overestimates of effect . Authors should suspect publication bias when available evidence comes from a number of small studies most of which have been commercially funded . A number of approaches based on examination of the pattern of data are available to help assess publication bias . The most popular of these is the funnel plot ; all , however , have substantial limitations . Publication bias is likely frequent , and caution in the face of early results , particularly with small sample size and number of events , is warranted PURPOSE The objective of this study is to assess the effectiveness of a maternal exercise program ( l and /aquatic activities , both aerobic and muscular conditioning ) in preventing gestational diabetes mellitus ( GDM ) . METHODS Three hundred and forty-two pregnant women from Spain ( age , 33.24 ± 4.3 yr ) without obstetric contraindications were recruited for a clinical r and omized controlled trial . The intervention group ( IG , n = 101 ) exercised for 60 and 50 min on l and and in water , respectively , three times per week . The control group ( n = 156 ) received usual st and ard care .  RESULTS The prevalence of GDM was reduced in the IG group ( IG , 1 % , n = 1 , vs control group , 8.8 % , n = 13 ( χ1 = 6.84 , P = 0.009 ) ) with a significant risk estimate ( odds ratio = 0.103 ; 95 % confidence interval , 0.013 - 0.803 ) . CONCLUSION The exercise program performed during pregnancy reduced the prevalence of GDM by preserving glucose tolerance Purpose . The aim of the present study was to examine the influence of a program of moderate physical exercise throughout pregnancy on maternal and fetal parameters . Design . The study design was a r and omized controlled trial . Setting . The study took place at the Hospital of Fuenlabrada in Madrid , Spain . Sample . Analyzed were 200 pregnant women ( 31.54 ± 3.86 years ) , all of whom had uncomplicated and singleton gestation . Of these subjects , 107 were allocated to the  exercise group  ( EG ) and 93 to the  control group ( CG ) . Intervention . Women from EG participated in a physical conditioning program throughout pregnancy , which included a total of 55- to 60-minute weekly sessions , 3 days per week . Measures . Pregnancy outcomes . Maternal : gestational age , weight gain , type of delivery , blood pressure during pregnancy , gestational diabetes ( n/% ) . Fetal : birth weight , birth size , head circumference , Apgar score , pH of umbilical cord . Analysis . Student 's unpaired t-test and χ2 test were used ; p values of ≤ .05 indicated statistical significance . Cohen 's d was used to determine the effect size . Results . There were significantly more pregnant women in the CG who gained excessive weight during their pregnancies than in the EG group ( CG : N = 31 , 35.6 % versus N = 22 , 21.2 % ; χ2 = 4.95 ; p = .02 ) . The effect size was small ( Phi value = .16 ) . Other pregnancy outcome showed no differences between groups . Conclusion . A regular and moderate physical exercise program throughout pregnancy is not a risk to maternal and fetal well-being , and it helps to control excessive weight gain BACKGROUND Smoking during pregnancy is the main preventable cause of poor birth outcomes . Improved methods are needed to help women to stop smoking during pregnancy . Pregnancy provides a compelling rationale for physical activity ( PA ) interventions as cessation medication is contraindicated or ineffective , and an effective PA intervention could be highly cost-effective . OBJECTIVE To examine the effectiveness and cost-effectiveness of a PA intervention plus st and ard behavioural support for smoking cessation relative to behavioural support alone for achieving smoking cessation at the end of pregnancy . DESIGN Multicentre , two-group , pragmatic r and omised controlled trial and economic evaluation with follow-up at the end of pregnancy and 6 months postnatally . R and omisation was stratified by centre and a computer-generated sequence was used to allocate participants using a 1 : 1 ratio . SETTING 13 hospitals offering antenatal care in the UK . PARTICIPANTS Women between 10 and 24 weeks ' gestation smoking five or more cigarettes a day before pregnancy and one or more during pregnancy . INTERVENTIONS Participants were r and omised to behavioural support for smoking cessation ( control ) or behavioural support plus a PA intervention consisting of supervised treadmill exercise plus PA consultations . Neither participants nor research ers were blinded to treatment allocation . MAIN OUTCOME MEASURES The primary outcome was self-reported , continuous smoking abstinence between a quit date and end of pregnancy , vali date d by expired carbon monoxide and /or salivary cotinine . Secondary outcomes were maternal weight , depression , birth outcomes , withdrawal symptoms and urges to smoke . The economic evaluation investigated the costs of the PA intervention compared with the control intervention . RESULTS In total , 789 women were r and omised ( n = 394 PA , n = 395 control ) . Four were excluded post r and omisation ( two had been enrolled twice in sequential pregnancies and two were ineligible and r and omised erroneously ) . The intention-to-treat analysis comprised 785 participants ( n = 392 PA , n = 393 control ) . There was no significant difference in the rate of abstinence at the end of pregnancy between the PA group ( 7.7 % ) and the control group ( 6.4 % ) [ odds ratio for PA group abstinence 1.21 , 95 % confidence interval ( CI ) 0.70 to 2.10 ] . For the PA group compared with the control group , there was a 33 % ( 95 % CI 14 % to 56 % ) , 28 % ( 95 % CI 7 % to 52 % ) and 36 % ( 95 % CI 12 % to 65 % ) significantly greater increase in self-reported minutes of moderate- and vigorous-intensity PA from baseline to 1 week , 4 weeks and 6 weeks respectively . Accelerometer data showed that there was no significant difference in PA levels between the groups . There were no significant differences between the groups for change in maternal weight , depression , withdrawal symptoms or urges to smoke . Adverse events and birth outcomes were similar between the groups except for there being significantly more caesarean births in the control group than in the PA group ( 28.7 % vs. 21.3 % ; p < 0.023 ) . The PA intervention was less costly than the control intervention by £ 35 per participant . This was mainly attributable to increased health-care usage in the control group . However , there was considerable statistical uncertainty around this estimate . CONCLUSIONS During pregnancy , offering an intervention combining supervised exercise and PA counselling does not add to the effectiveness of behavioural support for smoking cessation . Only 10 % of participants had PA levels accessed by accelerometer and it is , therefore , unclear whether or not the lack of an effect on the primary outcome is the result of insufficient increases in PA . Research is needed to identify the smoking population s most suitable for PA interventions and methods for increasing PA adherence . TRIAL REGISTRATION Current Controlled Trials IS RCT N48600346 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 19 , No. 84 . See the NIHR Journals Library website for further project information OBJECTIVE A prospect i ve r and omized controlled trial was design ed to assess the benefits and possible risks of aerobic exercise during pregnancy , using a fitness regimen based on the 2002 American College of Obstetricians and Gynecologists guidelines for exercise during pregnancy . METHODS Inactive women were r and omized at 12 - 14 wk gestation to a group that remained sedentary or to a group that performed moderate aerobic exercise 45 - 60 min , 4 d·wk , through 36 wk gestation . Thirty-one subjects in each group completed the study . RESULTS Compared with women who remained sedentary , active women improved aerobic fitness ( P < 0.05 ) and muscular strength ( P < 0.01 ) , delivered comparable size infants with significantly fewer cesarean deliveries ( P < 0.01 ) , and recovered faster postpartum ( P < 0.05 ) , at least related to the lower incidence of cesarean section . Active women developed no gestational hypertension ( P = 0.16 compared with controls ) and reported no injuries related to the exercise regimen . In the active group , there was one premature birth at 33 wk by a woman with a history of premature delivery of twins at 34 wk . There were no differences between groups in the incidence of gestational diabetes , musculoskeletal pains during pregnancy , flexibility on sit- and -reach test , mean length of pregnancy , neonatal Apgar scores , placenta weights , overall length of labor , weight gain during pregnancy , or weight retention postpartum . CONCLUSION Previously sedentary women who began exercising at 12 - 14 wk improved fitness and delivery outcomes OBJECTIVE : To explore risk factors for postpartum weight retention at 1 year after delivery in predominantly low-income women . METHODS : Data were collected from 774 women with complete height and weight information from participants in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Community Child Health Network , a national five-site , prospect i ve cohort study . Participants were enrolled primarily in the hospitals immediately after delivery .  Maternal interviews conducted at 1 , 6 , and 12 months postpartum identified risk factors for weight retention and included direct measurement of height and weight at 6 and 12 months . Logistic regression assessed the independent contribution of postpartum weight retention on obesity . RESULTS : Women had a mean prepregnancy weight of 161.5 lbs ( body mass index [ BMI ] 27.7 ) . Women gained a mean of 32 lbs while pregnant and had a 1-year mean postpartum weight of 172.6 lbs ( BMI 29.4 ) . Approximately 75 % of women were heavier 1 year postpartum than they were prepregnancy , including 47.4 % retaining more than 10 lbs and 24.2 % more than 20 lbs . Women retaining at least 20 lbs were more often African American , younger , poor , less educated , or on pubic insurance . Race and socioeconomic disparities were associated with high prepregnancy BMI and excessive weight gain during pregnancy , associations that were attenuated by breastfeeding at 6 months and moderate exercise . Of the 39.8 with normal prepregnancy BMI , one third became overweight or obese 1 year postpartum . CONCLUSION : Postpartum weight retention is a significant contributor to the risk for obesity 1 year postpartum , including for women of normal weight prepregnancy . Postpartum , potentially modifiable behaviors may lower the risk . LEVEL OF EVIDENCE : OBJECTIVE The objective of the study was to assess physical activity intervention assessed by a pedometer with or without dietary intervention on gestational weight gain ( GWG ) in obese pregnant women by comparing with a control group . STUDY DESIGN This study was a r and omized controlled trial of 425 obese pregnant women comparing 3 groups : ( 1 ) PA plus D , physical activity and dietary intervention ( n = 142 ) ; ( 2 ) PA , physical activity intervention ( n = 142 ) ; and ( 3 ) C , a control group receiving st and ard care ( n = 141 ) . All participants routinely in gestational weeks 11 - 14 had an initial dietary counseling session and were advised to limit GWG to less than 5 kg . Physical activity intervention included encouragement to increase physical activity , aim ing at a daily step count of 11,000 , monitored by pedometer assessment on 7 consecutive days every 4 weeks . Dietary intervention included follow-up on a hypocaloric Mediterranean-style diet . Instruction was given by a dietician every 2 weeks . The primary outcome measure was GWG , and the secondary outcome measures were complications of pregnancy and delivery and neonatal outcome . RESULTS The study was completed by 389 patients ( 92 % ) .  Median values of GWG ( ranges ) were lower in each of the intervention groups ( PA plus D , 8.6 [ -9.6 to 34.1 ] kg , and group PA , 9.4 [ -3.4 to 28.2 ] kg ) compared with the control group ( 10.9 [ -4.4 to 28.7 ] kg [ PA+D vs C ] ; P = .01 ; PA vs C ; P = .042 ) . No significant difference was found between the 2 intervention groups . In a multivariate analysis , physical activity intervention decreased GWG by a mean of 1.38 kg ( P = .040 ) . The Institute of Medicine 's recommendations for GWG were more frequently followed in the intervention groups . CONCLUSION Physical activity intervention assessed by pedometer with or without dietary follow-up reduced GWG compared with controls in obese pregnant women Abstract Objectives : To determine whether changes in lifestyle in women with BMI > 25 could decrease gestational weight gain and unfavorable pregnancy outcomes . Methods : Women with BMI > 25 were r and omized at 1st trimester to no intervention or a Therapeutic Lifestyle Changes ( TLC ) Program including diet  ( overweight : 1700 kcal/day , obese : 1800 kcal/day ) and mild physical activity ( 30 min/day , 3 times/week ) . At baseline and at the 36th week women filled-in a Food Frequency Question naire . Outcomes : gestational weight gain , gestational diabetes mellitus , gestational hypertension , preterm delivery . Data stratified by BMI categories . Results : Socio-demographic features were similar between groups ( TLC : 33 cases , Controls : 28 cases ) . At term , gestational weight gain in obese women r and omized to TLC group was lower ( 6.7 ± 4.3 kg ) versus controls ( 10.1 ± 5.6 kg , p = 0.047 ) . Gestational diabetes mellitus , gestational hypertension and preterm delivery were also significantly lower . TLC was an independent factor in preventing gestational weight gain , gestational diabetes mellitus , gestational hypertension . Significant changes in eating habits occurred in the TLC group , which increased the number of snacks , the intake of fruits – vegetables and decreased the consumption of sugar . Conclusions : A caloric restriction associated to changes in eating behavior and constant physical activity , is able to reduce gestational weight gain and related pregnancy complications in obese women BACKGROUND Excessive weight gain during pregnancy is a major risk factor for  postpartum weight retention and future weight gain and obesity in women , but few adequately powered r and omized controlled trials have examined the efficacy of a behavioral weight-control intervention during pregnancy . OBJECTIVE This study examined whether a behavioral intervention during pregnancy could decrease the proportion of women who exceeded the 1990 Institute of Medicine ( IOM ) recommendations for gestational weight gains and increase the proportion of women who returned to pregravid weights by 6 mo postpartum . DESIGN This study was a r and omized , assessor-blind , controlled trial . Participants were pregnant ( 13.5 wk gestation ) , normal-weight ( NW ; n = 201 ) and overweight or obese ( OW/OB ; n = 200 ) women whose average age was 28.8 y. Participants were r and omly assigned within the 1990 IOM weight category ( NW compared with OW/OB ) to st and ard care ( n = 200 ) or to a behavioral intervention to prevent excessive gestational weight gain ( n = 201 ) . The intervention included one face-to-face visit ; weekly mailed material s that promoted an appropriate weight gain , healthy eating , and exercise ; individual graphs of weight gain ; and telephone-based feedback . The retention at the 6-mo postpartum assessment was 82 % . RESULTS Intent-to-treat analyses showed that the intervention , compared with st and ard care , decreased the percentage of NW women who exceeded IOM recommendations ( 40.2 % compared with 52.1 % ; P = 0.003 ) and increased the percentages of NW and OW/OB women who returned to their pregravid weights or below by 6 mo postpartum ( 30.7 % compared with 18.7 % ; P = 0.005 ) . CONCLUSION A low-intensity behavioral intervention during pregnancy reduced excessive gestational weight gains in NW women and prevented postpartum weight retention in NW and OW/OB women . This trial was registered at clinical trials.gov as NCT01117961
Objective Gestational weight gain ( GWG ) has been identified as a critical modifier of maternal and fetal health .
This systematic review and meta- analysis aim ed to examine the relationship between prenatal exercise , GWG and postpartum weight retention ( PPWR ) .