Randomized Controlled Trial Investigating the Effects of a Low–Glycemic Index Diet on Pregnancy Outcomes in Women at High Risk of Gestational Diabetes Mellitus: The GI Baby 3 Study Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention. 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. A pregnancy lifestyle intervention to prevent gestational diabetes risk factors in overweight Hispanic women: a feasibility randomized controlled trial. Mighty Mums - An antenatal health care intervention can reduce gestational weight gain in women with obesity. 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. Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program
OBJECTIVE Dietary interventions can improve pregnancy outcomes in women with gestational diabetes mellitus ( GDM ) . We compared the effect of a low – glycemic index ( GI ) versus a conventional high-fiber ( HF ) diet on pregnancy outcomes , birth weight z score , and maternal metabolic profile in women at high risk of GDM . RESEARCH DESIGN AND METHODS One hundred thirty-nine women [ mean ( SD ) age 34.7 ( 0.4 ) years and prepregnancy BMI 25.2 ( 0.5 ) kg/m2 ] were r and omly assigned to a low-GI ( LGI ) diet ( n = 72 ; target GI ∼50 ) or a high-fiber , moderate-GI ( HF ) diet ( n = 67 ; target GI ∼60 ) at 14–20 weeks ’ gestation .  Diet was assessed by 3-day food records and infant body composition by air-displacement plethysmography , and pregnancy outcomes were assessed from medical records . RESULTS The LGI group achieved a lower GI than the HF group [ mean ( SD ) 50 ( 5 ) vs. 58 ( 5 ) ; P < 0.001 ] . There were no differences in glycosylated hemoglobin , fructosamine , or lipids at 36 weeks or differences in birth weight [ LGI 3.4 ( 0.4 ) kg vs. HF 3.4 ( 0.5 ) kg ; P = 0.514 ] , birth weight z score [ LGI 0.31 ( 0.90 ) vs. HF 0.24 ( 1.07 ) ; P = 0.697 ] , ponderal index [ LGI 2.71 ( 0.22 ) vs. HF 2.69 ( 0.23 ) kg/m3 ; P = 0.672 ] , birth weight centile [ LGI 46.2 ( 25.4 ) vs. HF 41.8 ( 25.6 ) ; P = 0.330 ] , % fat mass [ LGI 10 ( 4 ) vs. HF 10 ( 4 ) ; P = 0.789 ] , or incidence of GDM . CONCLUSIONS In intensively monitored women at risk for GDM , a low-GI diet and a healthy diet produce similar pregnancy outcomes OBJECTIVE Optimizing gestational weight gain ( GWG ) in early pregnancy is of clinical and public health importance , especially in higher risk pregnancies . DESIGN AND METHODS In a robustly design ed , r and omized controlled trial , 228 pregnant women at risk of developing gestational diabetes mellitus ( GDM ) were allocated to either control ( written health information only ) or intervention ( four-session lifestyle program ) . All women received st and ard maternal care . Measures were completed at 12 - 15 and 26 - 28 weeks gestation . Measures included anthropometrics ( weight and height ) , physical activity ( pedometer and International Physical Activity Question naire ) , question naires ( risk perception ) , and GDM screening . RESULTS The mean ( SD ) age [ 31.7 ( 4.5 ) and 32.4 ( 4.7 ) years ] and body mass index [ BMI ; 30.3 ( 5.9 ) and 30.4 ( 5.6 ) kg/m(2 ) ] were similar between control and intervention groups , respectively . By 28 weeks , GWG was significantly different between control and intervention groups [ 6.9 ( 3.3 ) vs. 6.0 ( 2.8 ) kg , P < 0.05 ] . When stratified according to baseline BMI , overweight women in the control group gained significantly more weight compared to overweight women in the intervention group [ 7.8 ( 3.4 ) vs. 6.0 ( 2.2 ) kg , P < 0.05 ] , yet in obese women , GWG was similar in both groups . Physical activity levels declined by 28 weeks gestation overall ( P < 0.01 ) ; however , the intervention group retained a 20 % higher step count compared to controls [ 5,203 ( 3,368 ) vs. 4,140 ( 2,420 ) steps/day , P < 0.05 ] . Overall , GDM prevalence was 22.8 % [ Corrected ] , with a trend toward less cases in the intervention group ( P = 0.1 ) . CONCLUSIONS Results indicate that a low-intensity lifestyle intervention , integrated with antenatal care , optimizes healthy GWG and attenuates physical activity decline in early pregnancy . Efficacy in limiting weight gain was greatest in overweight women and in high-risk ethnically diverse women 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 BACKGROUND Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes . Although most guidance on pregnancy weight is focused on the prepregnancy period , pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health . METHODS The hospital-based Bumps and Beyond intervention invited all pregnant women with a body mass index ( BMI ) > 35 kg m(-2 ) to take part in a programme of health education around diet and exercise , accompanied by one-to-one guidance and monitoring of dietary change . This service evaluation compares 89 women who completed at a programme of seven sessions with healthy lifestyle midwives and advisors ( intervention ) versus a group of 89 women who chose not to attend ( non-intervention ) . RESULTS Mean ( SD ) weight gain in the intervention group [ 4.5 ( 4.6 ) kg ] was less than in the non-intervention group [ 10.3 ( 4.4 ) kg ] between antenatal booking and 36 weeks of gestation ( < 0.001 ) . This was associated with a 95 % reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications . There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage ( reduced by 55 % ) . The impact of the intervention on gestational weight gain was greater in women with BMI > 40 kg m(-2 ) at booking . There were no adverse effects of the intervention , even though 21 % of the intervention group lost weight during their pregnancy . CONCLUSIONS Intensive , personalised weight management intervention may be an effective strategy for the prevention of hypertensive disorders during pregnancy 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 AIMS To pilot the feasibility of a prenatal lifestyle intervention to modify physical activity and diet among pregnant overweight and obese Hispanic women , with the aim of reducing risk factors for gestational diabetes mellitus . METHODS Women were r and omized either to a  lifestyle intervention ( n = 33 , 48.5 % ) , consisting of a culturally and linguistically modified , motivationally targeted , individually tailored 6-month prenatal programme , or to st and ard care  ( n = 35 , 51.5 % ) . Bilingual and bicultural health educators encouraged women to achieve guidelines for physical activity , decrease saturated fat and increase dietary fibre . Outcomes included gestational weight gain , infant birth weight and biomarkers associated with insulin resistance . RESULTS Patient retention up to delivery was 97 % in both study groups . The lifestyle intervention attenuated the pregnancy-associated decline in moderate-intensity physical activity , but differences between groups were not significant ( mean ± se -23.4 ± 16.6 vs -27.0 ± 16.2 metabolic equivalent of task h/week ; P = 0.88 ) . Vigorous-intensity activity increased during the course of pregnancy in the lifestyle intervention group ( mean ± se 1.6 ± 0.8 metabolic equivalent of task h/week ) and declined in the st and ard care group ( -0.8 ± 0.8 metabolic equivalent of task h/week ; P = 0.04 ) . The lifestyle intervention group also had slightly lower gestational weight gain and infant birth weights compared with the st and ard care group ; however , these differences were not statistically significant . There were no statistically significant differences in biomarkers of insulin resistance between groups . CONCLUSIONS Findings suggest that a motivationally matched lifestyle intervention is feasible and may help attenuate pregnancy-related decreases in vigorous physical activity in a population of overweight and obese Hispanic women . The intervention protocol can readily be translated into clinical practice in underserved and minority population BACKGROUND overweight and obesity are growing public health problems and around 13 % of women assigned to antenatal health care ( AHC ) in Sweden have obesity ( Body Mass Index , BMI ≥30 ) . The risk of complications during pregnancy and childbirth increase with increasing BMI . Excessive gestational weight gain ( GWG ) among obese women further increases the risks of adverse pregnancy outcomes . In this pilot- study from AHC in Gothenburg , a co-ordinated project with st and ardised care , given by midwives and supported by dietitian and aim ing at reducing weight gain in obese pregnant women , is evaluated . OBJECTIVE to evaluate the effects of a behavioural intervention programme for women with BMI ≥30 , with emphasis on nutrition and physical activity , with regards to GWG and effect on weight at the post partum check-up . METHODS in the pilot study , the intervention group consisted of the first 50 enrolled obese pregnant women in a large life style project within the AHC in Gothenburg . The control group consisted of 50 obese pregnant women in the same city . The intervention included 60 minutes extra time with the midwife and also offered food discussion group , walking poles and pedometers . The intervention group was prescribed physical activity and could choose from food advice with different content . If needed , the woman was offered referral to the dietitian for a personal meeting . A network was formed with the surrounding community . Outcome measures were GWG , weight change at the postnatal check-up compared with when signing in to antenatal health care , and change in BMI during the same period . FINDINGS women in the intervention group had a significantly lower GWG ( 8.6 ± 4.9 kg versus 12.5 ± 5.1 kg ; p=0.001 ) and a significantly lower weight at the postnatal check up versus the first contact with AHC ( -0.2 ± 5.7 kg versus + 2.0 ± 4.5 kg ; p=0.032 ) , as well as a decrease in BMI ( -0.04 ± 2.1 versus + 0.77 ± 2.0 ; p=0.037 ) . More women in the intervention than in the control group managed GWG < 7 kg [ 18 ( 36 % ) versus 8 ( 16 % ) ; p=0.039 ] . CONCLUSION obese pregnant women adhering to a st and ardised life style project in primary care using restricted re sources can limit their weight gain during pregnancy , and show less weight retention after pregnancy compared to controls 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 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
Purpose The number of overweight and obese women is increasing in the obstetric population .
The aim of this study was to review studies that reported results related to the efficacy of dietary interventions on gestational weight gain ( GWG ) or the prevention of gestational diabetes ( GDM ) in overweight and obese women .