One-year postpartum outcomes following a weight management intervention in pregnant women with obesity. Anthropometrics and Body Composition by Dual Energy X-Ray in Children of Obese Women: A Follow-Up of a Randomized Controlled Trial (the Lifestyle in Pregnancy and Offspring [LiPO] Study) Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial Delta Healthy Sprouts: a randomized comparative effectiveness trial to promote maternal weight control and reduce childhood obesity in the Mississippi Delta. Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. How much loss to follow-up is acceptable in long-term randomised trials and prospective studies? Lifestyle intervention to prevent excessive maternal weight gain: mother and infant follow-up at 12 months postpartum Effectiveness and Cost-Effectiveness of a Cluster-Randomized Prenatal Lifestyle Counseling Trial: A Seven-Year Follow-Up Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy Relationship between maternal pre‐pregnancy body mass index, gestational weight gain and childhood fatness at 6–7 years by air displacement plethysmography Subcutaneous fat mass in infancy and cardiovascular risk factors at school-age: The generation R study. Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial 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. Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial
OBJECTIVE This analysis was focused on 1-year maternal and infant follow-up of a r and omized trial that tested a weight management intervention conducted during pregnancy . METHODS One hundred fourteen women with obesity ( mean BMI 36.7 kg/m(2 ) ) were r and omly assigned at a mean of 15 weeks gestation to a weight management intervention or usual care control condition . The intervention ended at delivery and result ed in less gestational weight gain and a lower proportion of large-for-gestational-age newborns among intervention compared with control participants . The primary outcome at 12 months postpartum was maternal weight . Secondary outcomes included infant weight-for-age and weight-for-length z-scores . RESULTS At 1 year , mothers in the intervention group weighed 96.3 ± 18.6 kg and those in the control group 99.7 ± 19.2 kg . There was no significant difference between groups in change in weight from r and omization to 1 year postpartum ( b = -0.47 , 95 % CI : -4.03 to 3.08 ) . There was a significant main effect of group for infant weight-for-age z-scores ( b = -0.40 , 95 % CI : -0.75 to -0.05 ) but not infant weight-for-length z-scores ( b = -0.20 , 95 % CI : -0.59 to 0.20 ) . CONCLUSIONS A gestational weight management intervention did not influence maternal weight or infant weight-for-length at 1 year postpartum . Future studies may be warranted to determine whether extending prenatal interventions into the postpartum period would be beneficial for maternal and infant outcomes Objective In obese women , 1 ) to assess whether lower gestational weight gain ( GWG ) during pregnancy in the lifestyle intervention group of a r and omized controlled trial ( RCT ) result ed in differences in offspring anthropometrics and body composition , and 2 ) to compare offspring outcomes to a reference group of children born to women with a normal Body Mass Index ( BMI ) . Research design and methods The LiPO ( Lifestyle in Pregnancy and Offspring ) study was an offspring follow-up of a RCT with 360 obese pregnant women with a lifestyle intervention during pregnancy including dietary advice , coaching and exercise .  The trial was completed by 301 women who were eligible for follow-up . In addition , to the children from the RCT , a group of children born to women with a normal BMI were included as a reference group . At 2.8 ( range 2.5–3.2 ) years , anthropometrics were measured in 157 children of the RCT mothers and in 97 reference group children with Body Mass Index ( BMI ) Z-score as a primary outcome . Body composition was estimated by Dual Energy X-ray ( DEXA ) in 123 successful scans out of 147 ( 84 % ) . Results No differences between r and omized groups were seen in mean ( 95 % C.I. ) BMI Z-score ( intervention group 0.06 [ −0.17 ; 0.29 ] vs. controls −0.18 [ −0.43 ; 0.05 ] ) , in the percentage of overweight or obese children ( 10.9 % vs. 6.7 % ) , in other anthropometrics , or in body composition values by DEXA . Outcomes between children from the RCT and the reference group children were not significantly different . Conclusions The RCT with lifestyle intervention in obese pregnant women did not result in any detectable effect on offspring anthropometrics or body composition by DEXA at 2.8 years of age . This may reflect the limited difference in GWG between intervention and control groups . Offspring of obese mothers from the RCT were comparable to offspring of mothers with a normal BMI . Trial registration clinical trials.gov NCT00530439 , NCT01918319 and NCT01918423 . URL : NCT00530439?term = NCT00530439&rank = 1 , NCT01918319?term = NCT00530439&rank = 2 and NCT01918423?term = NCT00530439&rank = 3 Objective To determine if a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 INTRODUCTION Excessive and inadequate gestational weight gain can complicate a woman 's pregnancy and put her and her child at risk for poor delivery and birth outcomes . Further , feeding and activity habits established early in life can significantly impact the development of childhood obesity . METHODS The on-going Delta Healthy Sprouts Project is a r and omized , controlled , comparative trial testing the efficacy of two Maternal , Infant , and Early Childhood Home Visiting programs on weight status and health behaviors of 150 mothers and their infants residing in the rural Mississippi Delta region of the United States . Women are enrolled in their second trimester of pregnancy and r and omized to one of two treatment arms . The control arm curriculum is based on Parents as Teachers , an evidence based approach to increase parental knowledge of child development and improve parenting practice s. The experimental arm , labeled Parents as Teachers Enhanced , builds upon the control curriculum by including culturally tailored nutrition and physical activity components specifically design ed for the gestational and postnatal periods . We hypothesize that , as compared to the control arm , the experimental arm will be more effective in preventing inappropriate gestational weight gain , reducing postnatal weight retention , and decreasing infant obesity rates . We also will evaluate mother and child dietary and physical activity outcomes , breastfeeding initiation and continuation , and child feeding practice s. CONCLUSION The Delta Healthy Sprouts Project tests a novel , combined approach to maternal weight management and childhood obesity prevention in pregnant women and their children at high risk for obesity and chronic disease 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 Behavioural interventions might improve clinical outcomes in pregnant women who are obese . We aim ed to investigate whether a complex intervention addressing diet and physical activity could reduce the incidence of gestational diabetes and large-for-gestational-age infants . METHODS The UK Pregnancies Better Eating and Activity Trial ( UPBEAT ) is a r and omised controlled trial done at antenatal clinics in eight hospitals in multi-ethnic , inner-city locations in the UK . We recruited pregnant women ( 15 - 18 weeks plus 6 days of gestation ) older than 16 years who were obese ( BMI ≥30 kg/m(2 ) ) . We r and omly assigned participants to either a behavioural intervention or st and ard antenatal care with an internet-based , computer-generated , r and omisation procedure , minimising by age , ethnic origin , centre , BMI , and parity . The intervention was delivered once a week through eight health trainer-led sessions . Primary outcomes were gestational diabetes ( diagnosed with an oral glucose tolerance test and by criteria from the International Association of Diabetes in Pregnancy Study Groups ) and large-for-gestational-age infants ( ≥90th customised birthweight centile ) . Analysis was by intention to treat . This trial is registered with Current Controlled Trials , ISCRTN89971375 . Recruitment and pregnancy outcomes are complete but childhood follow-up is ongoing . FINDINGS Between March 31 , 2009 , and June 2 , 2014 , we assessed 8820 women for eligibility and recruited 1555 , with a mean BMI of 36·3 kg/m(2 ) ( SD 4·8 ) . 772 were r and omly assigned to st and ard antenatal care and 783 were allocated the behavioural intervention , of which 651 and 629 women , respectively , completed an oral glucose tolerance test . Gestational diabetes was reported in 172 ( 26 % ) women in the st and ard care group compared with 160 ( 25 % ) in the intervention group ( risk ratio 0·96 , 95 % CI 0·79 - 1·16 ; p=0·68 ) . 61 ( 8 % ) of 751 babies in the st and ard care group were large for gestational age compared with 71 ( 9 % ) of 761 in the intervention group ( 1·15 , 0·83 - 1·59 ; p=0·40 ) . Thus , the primary outcomes did not differ between groups , despite improvements in some maternal secondary outcomes in the intervention group , including reduced dietary glycaemic load , gestational weight gain , and maternal sum-of-skinfold thicknesses , and increased physical activity . Adverse events included neonatal death ( two in the st and ard care group and three in the intervention group ) and fetal death in utero ( ten in the st and ard care group and six in the intervention group ) . No maternal deaths were reported . Incidence of miscarriage ( 2 % in the st and ard care group vs 2 % in the intervention group ) , major obstetric haemorrhage ( 1 % vs 3 % ) , and small-for-gestational-age infants ( ≤5th customised birthweight centile ; 6 % vs 5 % ) did not differ between groups . INTERPRETATION A behavioural intervention addressing diet and physical activity in women with obesity during pregnancy is not adequate to prevent gestational diabetes , or to reduce the incidence of large-for-gestational-age infants . FUNDING National Institute for Health Research , Guys and St Thomas ' Charity , Chief Scientist Office Scotl and , Tommy 's Charity to test early  nutritional interventions  and prospect i ve observational cohorts . RCTs are generally accepted as method ologically the best approach for informing health policy . They can equalise unknown as well as known confounding factors and so can demonstrate causation ; they permit estimation of effect size and so can be used to assess likely 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 There is a link between the pregnancy and its long-term influence on health and susceptibility to future chronic disease both in mother and offspring . The objective was to determine whether individual counseling on physical activity and diet and weight gain at five antenatal visits can prevent type 2 diabetes mellitus ( T2DM ) and overweight or improve glycemic parameters , among all at-risk-mothers and their children . Another objective was to evaluate whether gestational lifestyle intervention was cost-effective as measured with mother ’s sickness absence and quality -adjusted life years ( QALY ) . This study was a seven-year follow-up study for women , who were enrolled to the antenatal cluster-r and omized controlled trial ( RCT ) . Analysis of the outcome included all women whose outcome was available , in addition with subgroup analysis including women adherent to all lifestyle aims . A total of 173 women with their children participated to the study , representing 43 % ( 173/399 ) of the women who finished the original RCT . Main outcome measures were : T2DM based on medication use or fasting blood glucose or oral glucose tolerance test ( OGTT ) , body mass index ( BMI ) , glycosylated hemoglobin ( HbA1c ) . None of the women were diagnosed to have T2DM . HbA1c or fasting blood glucose differences were not found among mothers or children . Differences in BMI were non-significant among mothers ( Intervention 27.3 , Usual care 28.1 kg/m2 , p = 0.33 ) and children ( I 21.3 vs U 22.5 kg/m2 , p = 0.07 ) . Children ’s BMI was significantly lower among adherent group ( I 20.5 vs U 22.5 , p = 0.04 ) . The mean total cost per person was 30.6 % lower in the intervention group than in the usual care group ( I € 2,944 vs. U € 4,243 ; p = 0.74 ) . Intervention was cost-effective in terms of sickness absence but not in QALY gained i.e. if society is willing to pay additional € 100 per one avoided sickness absence day ; there is a 90 % probability of the intervention arm to be cost-effective . Long-term effectiveness of antenatal lifestyle counseling was not shown , in spite of possible effect on children ’s BMI . Cost-effectiveness of the intervention in terms of sickness absence may have larger societal impact 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 Objectives : R and omised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity . The aim of this study was to determine whether an antenatal lifestyle intervention , associated with improvements in maternal diet and reduced gestational weight gain ( GWG ) in obese pregnant women leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum . Subjects and methods : We conducted a planned postnatal follow-up of a r and omised controlled trial ( UK Pregnancies Better Eating and Activity Trial ( UPBEAT ) ) of a complex behavioural intervention targeting maternal diet ( glycaemic load ( GL ) and saturated fat intake ) and physical activity in 1555 obese pregnant women . The main outcome measure was infant adiposity , assessed by subscapular and triceps skinfold thicknesses . Maternal diet and physical activity , indices of the familial lifestyle environment , were assessed by question naire . Results : A total of 698 ( 45.9 % ) infants ( 342 intervention and 356 st and ard antenatal care ) were followed up at a mean age of 5.92 months . There was no difference in triceps skinfold thickness z-scores between the intervention vs st and ard care arms ( difference −0.14 s.d . , 95 % confidence interval −0.38 to 0.10 , P=0.246 ) , but subscapular skinfold thickness z-score was 0.26 s.d . ( −0.49 to −0.02 ; P=0.03 ) lower in the intervention arm . Maternal dietary GL ( −35.34 ; −48.0 to −22.67 ; P<0.001 ) and saturated fat intake ( −1.93 % energy ; −2.64 to −1.22 ; P<0.001 ) were reduced in the intervention arm at 6 months postpartum . Causal mediation analysis suggested that lower infant subscapular skinfold thickness was partially mediated by changes in antenatal maternal diet and GWG rather than postnatal diet . Conclusions : This study provides evidence from follow-up of a r and omised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum Abstract This study aims to investigate the effect of  maternal pre‐pregnancy body mass index ( BMI ) and gestational weight gain ( GWG ) on offspring body composition . In this prospect i ve cohort study , offspring body composition at 6 years of age was obtained through air displacement plethysmography . Linear regression was used to obtain crude and adjusted coefficients . Information regarding offspring body composition and maternal pre‐pregnancy BMI was available for 3156 children and on offspring body composition and GWG for 3129 children . There was a direct association of maternal pre‐pregnancy BMI and GWG with offspring 's fat mass ( FM ) , fat‐free mass ( FFM ) , fat mass index ( FMI ) , fat‐free mass index ( FFMI ) and body fat percent ( BF% ) in crude and adjusted analyses . After adjustment for co‐variables , for each kg m−2 of maternal pre‐pregnancy BMI increase , there was a mean increment of 0.13 kg in the offspring FFM , 0.06 kg m−2 in FFMI , 0.11 kg in FM , 0.07 kg m−2 in FMI and 0.18 % in BF% . For each kilogram of maternal GWG increase , there was a mean increment of 0.08 kg in offspring 's FM , 0.05 kg m−2 in FMI , 0.04 kg in FFM , 0.01 kg m−2 in FFMI and 0.18 % in BF% . Mothers with a higher pre‐pregnancy BMI or GWG tend to have children with greater adiposity at age 6 years . Fetal overnutrition is more likely among mothers with greater BMI during pregnancy ; as a consequence , it can accelerate the childhood obesity epidemic OBJECTIVE To examine the associations of  infant subcutaneous fat with cardiovascular risk factors at school-age . METHODS In a population -based prospect i ve cohort study among 808 children , total subcutaneous fat ( sum of biceps , triceps , suprailiacal , and subscapular skinfold thicknesses ) and central -to-total subcutaneous fat ratio ( sum of suprailiacal and subscapular skinfold thicknesses/total subcutaneous fat ) at 1.5 and 24 months were estimated . At 6 years , body mass index , blood pressure , cholesterol , triglycerides , and insulin levels were measured . RESULTS Infant subcutaneous fat measures were not associated with childhood blood pressure , triglycerides , or insulin levels . A 1-st and ard-deviation score ( SDS ) higher total subcutaneous fat at 1.5 months was , independently of body mass index , associated with lower low-density lipoprotein (LDL)-cholesterol levels at 6 years . In contrast , a 1-SDS higher total subcutaneous fat at 24 months was associated with higher total-cholesterol [ difference 0.13 ( 95 % confidence interval ( CI ) 0.03 , 0.23 ) SDS ] and LDL-cholesterol levels [ difference 0.12 ( 95 % CI 0.02 , 0.21 ) SDS ] at 6 years . There were no associations of central -to-total subcutaneous fat ratio with childhood cholesterol levels . CONCLUSIONS These results suggest that infant total subcutaneous fat is weakly associated with cholesterol levels at school-age . Further studies are needed to assess the long-term cardiometabolic consequences of infant body fat Objective : Lifestyle intervention could help obese pregnant women to limit their weight gain during pregnancy and improve their psychological comfort , but has not yet been evaluated in r and omized controlled trials . We evaluated whether a targeted antenatal lifestyle intervention programme for obese pregnant women  influences gestational weight gain ( GWG ) and levels of anxiety or depressed mood . Design and subjects : This study used a longitudinal interventional design . Of the 235 eligible obese pregnant women , 205 ( mean age ( years ) : 29±4.5 ; body mass index ( BMI , kg m−2 ) : 34.7±4.6 ) were r and omized to a  control  group , a brochure group receiving written information on healthy lifestyle and an experimental group receiving an additional four antenatal lifestyle intervention sessions by a midwife trained in motivational lifestyle intervention . Anxiety ( State and Trait Anxiety Inventory ) and feelings of depression ( Edinburgh Depression Scale ) were measured during the first , second and third trimesters of pregnancy . Socio-demographical , behavioural , psychological and medical variables were used for controlling and correcting outcome variables . Results : We found a significant reduction of GWG in the brochure ( 9.5 kg ) and lifestyle intervention ( 10.6 kg ) group compared with normal care group ( 13.5 kg ) ( P=0.007 ) . Furthermore , levels of anxiety significantly decreased in the lifestyle intervention group and increased in the normal care group during pregnancy ( P=0.02 ) ; no differences were demonstrated in the brochure group . Pre-pregnancy BMI was positively related to levels of anxiety . Obese pregnant women who stopped smoking recently showed a significant higher GWG ( β=3.04 ; P=0.01 ) ; those with concurrent gestational diabetes mellitus ( GDM ) ( β=3.54 ; P=0.03 ) and those who consumed alcohol on a regular base ( β=3.69 ; P=0.04 ) showed significant higher levels of state anxiety . No differences in depressed mood or obstetrical/neonatal outcomes were observed between the three groups . Conclusions : A targeted lifestyle intervention programme based on the principles of motivational interviewing reduces GWG and levels of anxiety in obese pregnant women 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 In a cluster-r and omized trial , Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing  gestational diabetes mellitus ( GDM  ) , but fail to find an effect on GDM
Evidence suggests that adverse nutritional exposures during in utero development may contribute to heightened risk of obesity in childhood .
Pregnancy offers the opportunity to modify the intrauterine environment by manipulation of diet and /or physical activity , which may result in favourable health benefits for the child .
The objective of this systematic review was to determine whether antenatal lifestyle interventions in pregnant women , aim ed at modifying diet and /or physical activity , and lead to a reduction in measures of offspring obesity in early childhood .