A Comparison of Walking versus Stretching Exercises to Reduce the Incidence of Preeclampsia: A Randomized Clinical Trial Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women A Medical Nutrition Therapy Program Improves Perinatal Outcomes in Mexican Pregnant Women With Gestational Diabetes and Type 2 Diabetes Mellitus The effects of maternal aerobic exercise on human placental development: placental volumetric composition and surface areas. Antepartum, Intrapartum, and Neonatal Significance of Exercise on Healthy Low‐Risk Pregnant Working Women Defined, in-home, prenatal nutrition intervention for low-income women. Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial. Physical and psychological changes with vigorous exercise in sedentary primigravidae. The Effect of Vigorous Exercise During Pregnancy on Birth‐Weight Adherence to walking or stretching, and risk of preeclampsia in sedentary pregnant women. Water aerobics in pregnancy: cardiovascular response, labor and neonatal outcomes Antenatal exercise and birthweight Major dietary patterns in pregnancy and fetal growth Preventing Excessive Weight Gain During Pregnancy Through Dietary and Lifestyle Counseling: A Randomized Controlled Trial Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. The influence of physical training during pregnancy on physical work capacity and circulatory parameters. Maternal exercise during pregnancy, physical fitness, and fetal growth. Resistance exercise training during pregnancy and newborn's birth size: a randomised controlled trial Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. Prospective study of gestational diabetes mellitus risk in relation to maternal recreational physical activity before and during pregnancy. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Aerobic exercise in pregnancy. Effect of a cholesterol-lowering diet on maternal, cord, and neonatal lipids, and pregnancy outcome: a randomized clinical trial. Randomized controlled trial to prevent excessive weight gain in pregnant women The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. Beginning regular exercise in early pregnancy: effect on fetoplacental growth. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Dietary restraint and weight gain during pregnancy The effect of exercise on the intensity of low back pain in pregnant women. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes THE EFFECT OF A LOW CALORIE DIET OR A THIAZIDE DIURETIC ON THE INCIDENCE OF PRE‐ECLAMPSIA AND ON BIRTH WEIGHT Heart volume and physical fitness of parturients. Exercise in Gestational Diabetes: An Optional Therapeutic Approach? Efficacy of yoga on pregnancy outcome. Reducing excessive weight gain in pregnancy: a randomised controlled trial. Effect of exercise on blood pressure in pregnant women with a high risk of gestational hypertensive disorders. Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation. Lifestyle modification program decreases pregnancy weight gain in obese women. Endurance exercise and pregnancy outcome. Continuing regular exercise during pregnancy: effect of exercise volume on fetoplacental growth. Decreased Insulin Requirement and Improved Control of Diabetes in Pregnant Women Given a High-Carbohydrate, High-Fiber, Low-Fat Diet
Objectives . To compare a walking exercise to a stretching exercise during pregnancy in high-risk women who were sedentary and had previously experienced preeclampsia . Methods . A r and omized clinical trial of the effects of the two types of physical exercises was conducted between November 2001 and July 2006 in Washtenaw County , Michigan . Both groups engaged in the assigned exercise five times a week until the end of pregnancy . Results . Women were r and omized to either the walking group ( n = 41 ) or the stretching group ( n = 38 ) . The walkers exercised an average of 36 ( SD , 6 ) minutes at 18 weeks gestation , 34 ( SD , 7 ) minutes at 28 weeks gestation , and 31 ( SD , 12 ) minutes at the last week of the intervention . On average , they exercised within target heart rate ranges 35 % ( SD , 32 % ) at 18 weeks gestation , 22 % ( SD , 25 % ) at 28 weeks gestation , and 17 % ( SD , 25 % ) at the last week of the intervention . The stretching group engaged in stretching exercises following a 40-minutes videotape . On average , the walking group exercised 4 ( SD , 1 ) times a week at 18 weeks gestation , 4 ( SD , 1 ) time a week at 28 weeks gestation , and 3 ( SD , 1 ) times a week at the last week of the intervention . Equally on average , the stretching group exercised 4 ( SD , 2 ) times a week at 18 weeks gestation , 5 ( SD , 1 ) times a week at 28 weeks gestation , and 3 ( SD , 1 ) times a week at the last week of the intervention . No difference between groups was observed , but both exercised significantly less frequently over the time ( p < 0.0001 ) . Together , participants reported average 7,040 ( SD , 2,612 ) steps at the beginning and 5,711 ( SD , 2,739 ) steps at the end of the study . The walkers tracked an average 8,501 ( SE , 778 ) steps a day at 20 weeks gestation and 7,418 ( SE , 788 ) steps at 34 weeks gestation ( n.s . ) . The stretchers tracked an average 6,189 ( SE , 704 ) steps at 20 weeks gestation and 4,848 ( SE , 452 ) steps at 34 weeks gestation ( p < 0.05 ) . The incidence of preeclampsia was 14.6 % ( 95 % CI , 5.6 to 29.2 ) among the walkers and 2.6 % ( 95 % CI ; 0.07 to 13.8 ) among the stretchers . The incidence of gestational hypertension was 22 % ( 95 % C.I. , 8.7 to 35.2 ) for the walkers and 40 % ( 95 % CI , 23.2 to 55.8 ) for the stretchers . The mean transferrin level , an antioxidant marker , was significantly higher in the stretching group mean ( 412 mg/dL , 95%CI , 389 to 435 ) than the walkers at the time of labor ( mean = 368 mg/dL , 95%CI , 346 to 391 ) ( p < 0.05 ) . No significant group differences were observed in birth outcomes . Conclusion . Regular stretching exercises may promote endogenous antioxidants among women at risk for preeclampsia 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 Diabetes in pregnancy is a major public health problem in Mexico .  Nutrition therapy is an important component of treatment . Intensive nutrition intervention has not been implemented for Mexican pregnant women with diabetes . Its effect on different types of diabetes mellitus has not been studied . Purpose The authors assessed the effect of a medical nutrition therapy ( MNT ) program on perinatal complications in Mexico City . Methods Quasi-experimental design with a historical control . Women were assigned to a MNT program ( n = 88 ) and were followed up with every 2 weeks until delivery ( 2004 - 2007 ) . The control group ( n = 86 ) was selected from medical charts ( 2001 - 2003 ) and the same inclusion criteria were used . In each group , 55 % of women had type 2 diabetes mellitus and 45 % had gestational diabetes . The MNT program included a moderate intake of carbohydrate ( 40%-45 % of total energy ) and reduction in energy intake , capillary glucose self-monitoring , and education . The control group received usual hospital routine care . Statistical analysis included descriptive statistics , chi-square , and multivariate logistic regression ( OR , 95 % CI ) as indicated . Results Women in the MNT program had a lower risk of preeclampsia , fewer maternal hospitalization , and neonatal deaths in both types of diabetes . Low birth weight was less frequent only in women with gestational diabetes receiving MNT , while neonatal intensive care unit admissions were lower only in women with type 2 diabetes . Conclusions An intensive MNT program , including counseling , education , and capillary glucose self-monitoring , has a positive effect over preeclampsia , maternal hospitalization , and neonatal death in women with diabetes in pregnancy . MNT guidelines should be implemented in Mexican health care facilities treating diabetes in pregnancy The histomorphometry of term placentae from women who exercised regularly throughout either the first half or all of pregnancy was compared to that of placentae from matched controls to determine if regular exercise during pregnancy produced histomorphometric evidence of altered development and transport capacity . Conventional stereological techniques were used to estimate placental volumetric composition , surface areas , and villous and vascular configurations in the three groups . Exercise confined to early pregnancy increased the parenchymal component of the placenta , total vascular volume and site-specific capillary volume and surface area .  Exercise throughout pregnancy increased these and multiple other histomorphometric parameters associated with the rate of placental perfusion and transfer function . However , significant changes were confined to villi > 80 microns in diameter . The localization of both the timing of the stimulus and the anatomical sites affected indicates that regular , sustained exercise modifies placental development primarily in early and mid-pregnancy . We speculate that the lack of significant changes in the structure and configuration of the smaller villi indicates that other adaptive mechanisms , such as increased rates of placental blood flow , must be well developed by the latter portion of the mid-trimester and adequately maintain fetal oxygenation and substrate delivery throughout the third trimester OBJECTIVE To evaluate the influence of exercise on maternal and perinatal outcome in a low‐risk healthy obstetric population . METHODS We conducted a prospect i ve observational study of low‐risk healthy women exercising during their pregnancy . An extensive question naire collected antepartum , intrapartum , and postpartum patient information on 750 women . The women were divided into four groups based on exercise level during pregnancy . RESULTS There were no differences among groups for maternal demographic characteristics , antenatal illnesses , stress , social support , or smoking . Heavily exercising women were older ( P = .042 ) , had higher incomes ( P = .001 ) , and were exercising more at conception ( P = .001 ) . Women who did more exercise were more likely to need an induction of labor ( P = .033 , relative risk 1.84 , 95 % confidence interval 1.05 , 3.20 ) , induction or augmentation with oxytocin ( P = .015 , relative risk 1.53 , 95 % confidence interval 1.19 , 1.97 ) , and had longer first‐stage labors ( P = .032 ) result ing in longer total labors ( P = .011 ) . The difference in the length of first‐stage labor was even greater if the no‐exercise group was compared with the strongly exercising group ( P = .009 , relative risk 1.38 , 95 % confidence interval 0.16 , 2.60 ) . Fewer umbilical cord abnormalities ( P = .034 ) were observed with exercise , but exercising women had more colds and flu ( P = .008 ) . Heavily exercising women had smaller infants ( mean difference 86.5 g ) compared with sedentary women . CONCLUSION Exercise  in working women is associated with smaller babies , increased number of inductions and augmentations of labor , and longer labors . Colds and flu are more frequent in exercising women OBJECTIVES The purpose of this project was to develop a detailed , in-home , prenatal nutrition intervention protocol for low-income women and to assess the effectiveness of the intervention in improving their dietary intake . A secondary objective was to identify predictors of infant birth weight . DESIGN A defined protocol was developed and nutritionists followed it to conduct in-home nutrition sessions that included nutrition assessment , education , counseling , and goal setting for low-income women during their pregnancies . A pre/post design was used to assess the effects of the nutrition program on dietary intake . A control group was used in evaluating the effect of the nutrition intervention on birth weight . SUBJECTS/ SETTING Forty low-income pregnant women selected r and omly by the county health department nursing staff completed the nutrition intervention . Twenty-six women were also selected to serve as a control group . INTERVENTION For women in the intervention group , in-home visits were conducted weekly for 4 weeks , followed by 2 monthly visits . The purpose of the in-home visits was to use the defined protocol , which included monitoring weight gain and providing individualized dietary intake assessment and nutrition education and counseling . MAIN OUTCOME MEASURES The primary outcome measures were change in dietary intake from preintervention to postintervention , mothers ' weight at time of delivery , and infant birth weight . STATISTICAL ANALYSIS PERFORMED Paired t tests were used to compare the women 's mean daily energy and nutrient intakes before and after the nutrition intervention . Correlation analysis identified relationships between infant birth weight and independent variables , and multiple stepwise regression analysis was used to identify variables that contributed to the variation in infant birth weight . Mean birth weight was compared in the intervention and control groups by means of a t test . A chi 2 test was used for categoric variables . RESULTS Comparison of dietary intakes before and after the intervention revealed significant increases in total energy ( 2,269 to 2,431 kcal , P < .05 ) , folate ( 345 to 412 micrograms , P < .01 ) , vitamin B-6 ( 2.1 to 2.5 mg , P < .01 ) , iron ( 17.5 to 21.2 mg , P < .01 ) , zinc ( 13.6 to 14.7 mg , P < .01 ) , and calcium ( 1,175 mg to 1,299 mg , P < .01 ) and significant ( P < .01 ) increases in daily servings from the vegetable group ( 1.5 + /- 1.0 to 2.2 + /- 1.1 serving per day ) and breads/grains groups ( 3.4 + /- 1.4 to 4.1 + /- 1.5 servings per day ) . There was no significant difference in mean birth weight between the intervention and control groups . Sixty-five percent of the variation in infant birth weight was accounted for by mother 's weight at time of delivery , pre-pregnancy body mass index , number of visits by the nutritionist , and change in energy intake from preintervention to postintervention . APPLICATIONS This defined , in-home , prenatal nutrition intervention protocol can be used by providers of prenatal nutrition services to document outcomes of prenatal nutrition care in high-risk women . Use of a defined protocol will facilitate collection of meaningful outcomes data by service providers 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 EDITORIAL COMMENT : When this paper was review ed the question was raised that the period of gestation is an obvious factor which can determine birth‐weight and the authors were asked how this may have affected their results The authors response was as follows Pregnant women at risk for preeclampsia may benefit from the positive effects of exercise , but they may be unlikely to adhere to an exercise program . A r and omized trial was conducted with 124 sedentary pregnant women to compare the effects of walking exercise to a stretching exercise on adherence and on the preeclampsia risk factors of heart rate ( HR ) , blood pressure , and weight gain .  Walkers exercised less than stretchers both overall and as pregnancy advanced . HR and blood pressure were lower among stretchers than walkers , but weight gain did not differ between the groups . For sedentary pregnant women , a stretching exercise may be more effective than walking in mitigating the risk of preeclampsia due to higher adherence and possible cardiac-physiologic effects Background To evaluate the association between water aerobics , maternal cardiovascular capacity during pregnancy , labor and neonatal outcomes . Methods A r and omized , controlled clinical trial was carried out in which 34 pregnant women were allocated to a water aerobics group and 37 to a control group .  All women were su bmi tted to submaximal ergometric tests on a treadmill at 19 , 25 and 35 weeks of pregnancy and were followed up until delivery . Oxygen consumption ( VO2 max ) , cardiac output ( CO ) , physical fitness , skin temperature , data on labor and delivery , and neonate outcomes were evaluated . Frequency distributions of the baseline variables of both groups were initially performed and then analysis of the outcomes was carried out . Categorical data were compared using the chi-square test , and numerical using Student 's t or Mann-Whitney tests . Wilk 's Lambda or Friedman 's analysis of repeat measurements were applied for comparison of physical capacity , cardiovascular outcomes and maternal temperature . Results VO2 max and physical fitness were higher in both groups in the second trimester , returning to basal levels in the third trimester . In both groups , CO increased as pregnancy progressed and peak exercise temperature was higher than resting temperature , increasing further after five minutes of recovery and remaining at this level until 15 minutes after exercise completion . There was no difference between the two groups regarding duration ( 457.9 ± SD 249.6 vs 428.9 ± SD 203.2 minutes ) or type of delivery . Labor analgesia was requested by significantly fewer women in the water aerobics group ( 27 % vs 65 % ; RR = 0.42 95%CI 0.23–0.77 ) . Neonatal results were similar in both groups . Conclusion The regular practice of moderate water aerobics by sedentary and low risk pregnant women was not detrimental to the health of the mother or the child . There was no influence on maternal cardiovascular capacity , duration of labor or type of delivery ; however , there were fewer requests for analgesia during labor in the water aerobics group Does strenuous antenatal exercise reduce birth‐weight ? Does reducing maternal exercise increase birthweight ? What to advise about exercise during pregnancy Objectives : To investigate possible associations between  maternal diet during pregnancy and fetal growth . Method : Factor analysis was used to explore  dietary patterns among pregnant women . The association between maternal  dietary patterns and fetal growth ( in terms of small for gestational age , SGA ) was investigated by logistic regression . Prospect i ve cohort study , including information on 44 612 women in Denmark . Results : Two major dietary patterns were defined : the first pattern was characterized by red and processed meat , high-fat dairy , and the second pattern was characterized by intake of vegetables , fruits , poultry and fish . Women were classified into three classes according to their diet : the first class had high intake of foods of the first dietary pattern , and was classified as ‘ the Western diet ’ , the second class preferred foods of the second pattern and was classified as the ‘ Health Conscious ’ ; and the third one had eaten foods of both patterns , and was classified as the ‘ Intermediate ’ . The odds ratio of having a small for gestational-age infant  ( with a birth weight below the 2.5th percentile for gestational age and gender ) was 0.74 ( 95 % CI 0.64–0.86 ) for women in the Health Conscious class compared with women in the Western Diet class . The analyses were adjusted for parity , maternal smoking , age , height , pre-pregnancy weight and father 's height . Conclusions : Our results indicated that a diet in pregnancy , based on red and processed meat and high-fat diary , was associated with increased risk for SGA . Further studies are warranted to identify specific macro- , or micronutrients that may be underlying these associations OBJECTIVE : To estimate whether an organized , consistent program of dietary and lifestyle counseling prevents excessive weight gain  in pregnancy . METHODS : This r and omized controlled trial assigned women to receive either an organized , consistent program of intensive dietary and lifestyle counseling or routine prenatal care . The primary study outcome was the proportion of patients whose gestational weight gain was within the Institute of Medicine ( IOM ) guidelines . Secondary outcomes included mode of delivery , rate of operative vaginal delivery , neonatal weight , and the incidence of preeclampsia , gestational diabetes mellitus ( GDM ) , vaginal/perineal lacerations , and shoulder dystocia . RESULTS : A total of 100 women were r and omized to the study ( lifestyle counseling 57 , routine prenatal care 43 ) . Baseline demographic characteristics were similar between the study groups . The lifestyle counseling group gained significantly less weight than did the routine prenatal care group ( 28.7±12.5 lb compared with 35.6±15.5 lb , P=.01 ) . The routine prenatal care group had significantly more cesarean deliveries due to “ failure to progress ” ( routine prenatal care 58.3 % compared with lifestyle counseling 25.0 % , P=.02 ) . Across groups , patients who were not adherent to the IOM guidelines had significantly heavier neonates ( adherent 3,203.2±427.2 g compared with not adherent 3,517.4±572.4 g , P<.01 ) . Nulliparous women  gained significantly more weight than did parous women ( 36.5±14.5 lb compared with 27.7±12.7 lb , P<.01 ) . The most predictive factor of IOM adherence was having a normal prepregnancy body mass index . No statistically significant differences were noted between the groups in adherence to IOM guidelines , rate of cesarean delivery , preeclampsia , GDM , operative vaginal delivery , or vaginal lacerations . CONCLUSION : An organized , consistent program of dietary and lifestyle counseling did reduce weight gain in pregnancy . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00792480 LEVEL OF EVIDENCE : BACKGROUND We conducted a r and omized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications . METHODS We r and omly assigned women between 24 and 34 weeks ' gestation who had gestational diabetes to receive dietary advice , blood glucose monitoring , and insulin therapy as needed ( the intervention group ) or routine care . Primary outcomes included serious perinatal complications ( defined as death , shoulder dystocia , bone fracture , and nerve palsy ) , admission to the neonatal nursery , jaundice requiring phototherapy , induction of labor , cesarean birth , and maternal anxiety , depression , and health status . RESULTS The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group ( 1 percent vs. 4 percent ; relative risk adjusted for maternal age , race or ethnic group , and parity , 0.33 ; 95 percent confidence interval , 0.14 to 0.75 ; P=0.01 ) . However , more infants of women in the intervention group were admitted to the neonatal nursery ( 71 percent vs. 61 percent ; adjusted relative risk , 1.13 ; 95 percent confidence interval , 1.03 to 1.23 ; P=0.01 ) . Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group ( 39 percent vs. 29 percent ; adjusted relative risk , 1.36 ; 95 percent confidence interval , 1.15 to 1.62 ; P<0.001 ) , although the rates of cesarean delivery were similar ( 31 percent and 32 percent , respectively ; adjusted relative risk , 0.97 ; 95 percent confidence interval , 0.81 to 1.16 ; P=0.73 ) . At three months post partum , data on the women 's mood and quality of life , available for 573 women , revealed lower rates of depression and higher scores , consistent with improved health status , in the intervention group . CONCLUSIONS Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman 's health-related quality of life A group of 62 healthy primigravidae aged 20–26 years participated in an investigation concerning physical work capacity and cardiovascular dynamics during pregnancy and the effect of physical training beginning in the 10th or 14th week of pregnancy and lasting until term . The training group consisted of 31 women who were examined every 4 weeks throughout pregnancy , the last examination occurring in the 38th week . The r and omly selected control group consisted of 31 women who were examined in the 10th or 14th , in the 26th , and in the 38th week of pregnancy . During the examination the  pulse rate and blood pressure were measured in the left lateral position after rest , in the sitting position , and at nearly maximal exertion . The  pulse-conducted triangular ECG test  was used for determination of physical work capacity . All forms of voluntary exercise were allowed and recommended to the training group , emphasizing strenuous physical exertion . The physical work capacity in the control group spontaneously rose 10 % The value of exercise during pregnancy is controversial ; both benefits and risks have been hypothesized . As empiric evidence is scant , the issue was investigated in a prospect i ve study that assessed the impact on fetal growth of maternal exercise in each trimester of pregnancy . A cohort of over 800 prenatal patients was recruited from obstetric practice s in Pennsylvania and New York between January 1987 and June 1989 . Subjects were interviewed at entry into care and recontacted at 28 and 36 weeks of gestation . In women with prior adverse outcomes or a lack of conditioning , the associations between maternal exercise and fetal growth were equivocal . In fit , low-risk , prenatal patients , exercise was positively associated with fetal growth . With low-moderate exercise levels , the adjusted mean birth weights were about 100 g higher than in nonexercisers ( 117 g ; 95 % confidence interval 17 to 217 g ) . With heavier exercise , larger birth weight increments were seen , close to 300 g in those who exercised throughout pregnancy at levels of about 2,000 kcal/week in energy expenditure ( 276 g ; 95 % confidence interval 54 to 497 g ) . These results suggest that the guidelines issued by the American College of Obstetricians and Gynecologists may be too stringent for well-conditioned , low-risk , prenatal patients . Additional research to define safe limits more precisely seems warranted Objective : We examined the effect of light intensity resistance exercise training performed during the second and third trimester of pregnancy on the  newborn 's birth size . We also studied the association between  maternal body weight prior to pregnancy and newborn 's birth size .  Design : R and omised controlled trial . Subjects : We r and omly assigned 160 sedentary gravidae to either a training ( n=80 ) or a control ( n=80 ) group . The training programme focused on light resistance and toning exercises ( three times per week , 35–40 min per session ) . We recorded the Apgar score , birth weight , birth length , and head circumference of the newborn , as well as gestational age at time of delivery from hospital perinatal records . We also measured maternal weight and height before parity and gestational weight gain . Results : Maternal characteristics neither differed between groups ( all P>0.1 ) nor newborn characteristics ( all P>0.1 ) . Maternal body weight was positively and significantly associated with newborn 's birth weight and length only in the control group ( β=19.20 and 0.065 , respectively , P<0.01 ) . Conclusion : Light intensity resistance training performed over the second and third trimester of pregnancy does not have a negative impact on the newborn 's body size or overall health . Exercise interventions might attenuate the adverse consequences of maternal body weight before pregnancy on the newborn 's birth size BACKGROUND Although obesity in pregnancy continues to be associated with ongoing health problems , many clinicians have been reluctant to place nondiabetic , obese , pregnant women on a monitored , calorie-appropriate nutritional regimen for fear of fetal growth restriction , low birth weight , or starvation ketosis . METHODS A total of 257 patients were enrolled in the r and omized study , with a loss-to-follow-up rate of 9.73 % . Patients were assigned r and omly to either the control ( unmonitored ) group ( n=116 ) , consisting of conventional prenatal dietary management , or to the study ( monitored ) group ( n=116 ) , which was prescribed a balanced nutritional regimen and were asked to record in a diary all of the foods eaten during each day .  Women were eligible for the study if they were pregnant with a single fetus between 12 and 28 weeks of gestation and had a prepregnancy body mass index of more than 30 kg/m2 . The primary outcome was to compare perinatal outcomes in the control vs the study groups . The secondary measure was to compare outcomes in adherent and nonadherent patients in the study group . RESULTS Omnibus MANOVA showed statistically significant differences between the study and control groups regarding 3 variables : ( 1 ) gestational hypertension , p < .46 ; ( 2 ) mother 's last weight before delivery , p < .001 ; and ( 3 ) mother 's 6-week postpartum weight , p < .001 . Patients gaining 15 pounds or more during their pregnancy showed statistically significant differences between the groups for 8 variables . CONCLUSION Obese pregnant women may be placed on a healthy , well-balanced , monitored nutritional program during their antepartum course without adverse perinatal outcomes Physical activity has been associated with a reduced risk of  gestational diabetes mellitus  , but inferences have been hampered by recall and selection bias . The authors examined the relation between recreational physical activity before and during pregnancy and risk of gestational diabetes mellitus in a prospect i ve cohort study . In 1996 - 2000 , 909 normotensive , nondiabetic women in Seattle and Tacoma , Washington , were question ed during early gestation about physical activity performed during the year before and 7 days prior to the interview during pregnancy . Compared with inactive women , women who participated in any physical activity during the year before experienced a 56 % risk reduction ( relative risk ( RR ) = 0.44 , 95 % confidence interval ( CI ) : 0.21 , 0.91 ) . Women spending > /=4.2 hours/week engaged in physical activity experienced a 76 % reduction in gestational diabetes mellitus risk ( RR = 0.24 , 95 % CI : 0.10 , 0.64 ) , and those expending > /=21.1 metabolic equivalent-hours/week experienced a 74 % reduction ( RR = 0.26 , 95 % CI : 0.10 , 0.65 ) compared with inactive women . Physical activity during pregnancy was also associated with reductions in gestational diabetes mellitus risk . Women who engaged in physical activity during both time periods experienced a 69 % reduced risk ( RR = 0.31 , 95 % CI : 0.12 , 0.79 ) . Findings suggest that efforts to increase maternal physical activity may contribute to substantial reductions in gestational diabetes mellitus risk 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 The effect on fetal and maternal outcome in gestational exercise in a recreational athlete was investigated in a 2 1/2-year prospect i ve study . A training effect in a pregnant subject engaged in aerobic exercise was also determined . One hundred forty-one low-risk pregnant subjects had their aerobic capacity tested during the first trimester , during the third trimester , and post partum . Predicted maximum oxygen consumption values were determined by using st and ard Bruce treadmill protocol during the first and third tests and the Astr and protocol for submaximal testing on a bicycle ergometer during the third trimester . Exercise prescriptions were given . The primiparous and multiparous subjects were r and omized into control and exercise groups , differing only in the frequency of aerobic exercise . The results showed that exercise had no associated increase in neonatal morbidity and obstetric complications . All subjects improved or maintained their level of aerobic fitness . The exercisers showed a significant training effect . The disparity in the second test 's results may suggest that the physiologic characteristics of pregnancy masked the aerobic improvement OBJECTIVE We assessed the effect of a cholesterol-lowering diet on  maternal , cord , and neonatal plasma lipids and pregnancy outcome . STUDY DESIGN Nonsmoking white women with singleton pregnancies ( n = 290 ) , aged 21 to 38 years , and with no previous pregnancy-related complications , were r and omized to either continue their usual diet or to adopt a diet that promoted fish , low-fat meats and dairy products , oils , whole grains , fruits , vegetables , and legumes from gestational week 17 to 20 to birth . RESULTS Maternal total and low-density lipoprotein cholesterol levels were lowered in the intervention compared with the control group ( P < .01 ) . Lipid levels in cord blood and in neonates born to mothers in the intervention versus the control groups did not differ . In the intention-to-treat cohort 1 ( 0.7 % ) of 141 women in the intervention group versus 11 ( 7.4 % ) of 149 women in the control group delivered before 37 weeks ( RR 0.10 ; 95 % CI 0.01 - 0.77 ) . The incidence of other pregnancy complications and birth weight was similar in both groups . CONCLUSION A cholesterol-lowering diet may modify maternal lipid levels but not cord and neonatal lipids . The marked observed effect of this diet on the reduction of preterm delivery in low-risk pregnancies should encourage future larger studies to clarify the role of such a diet in the prevention of preterm birth 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 OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity 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 OBJECTIVE The objective of this study was to estimate the effects of low and high gestational weight gain , in different maternal Body Mass Index ( BMI ) classes , on obstetric and neonatal outcomes . METHOD A prospect i ve population -based cohort study of 245,526 singleton term pregnancies . Women were grouped in five categories of BMI and in three gestational weight gain categories ; < 8 kg ( low weight gain ) , 8 - 16 kg and > 16 kg ( high weight gain ) . Obstetric and neonatal outcomes were evaluated after adjustments for maternal age , parity , smoking , year of birth . RESULT Obese women with low gestational weight gain had a decreased risk for the following outcomes ( adjusted odds ratio ; 95 % confidence interval ) : preeclampsia ( 0.52 ; 0.42 - 0.62 ) , cesarean section ( 0.81 ; 0.73 - 0.90 ) , instrumental delivery ( 0.75 ; 0.63 - 0.88 ) , and LGA births ( 0.66 ; 0.59 - 0.75 ) . There was a 2-fold increased risk for preeclampsia and LGA infants among average and overweight women with excessive weight gain . High gestational weight gain increased the risk for cesarean delivery in all maternal BMI classes . CONCLUSION The effects of high or low gestational weight gain differ depending on maternal BMI and the outcome variable studied . Obese women may benefit from a low weight gain during pregnancy Objectives : To explore dietary intake and weight gain during pregnancy in relation to dietary restraint . Design : Longitudinal prospect i ve study . Attitudes to weight gain during pregnancy were assessed using self-administered question naires and dietary intake by 7-d weighed diet records in early and late pregnancy . Setting : South West London 1995–1996.Subjects : 74 Caucasian pregnant women expecting their first or second baby were recruited through a London hospital and data from 62 women were analysed . Results : Restrained eaters were significantly less likely to experience weight gains within the recommended range for their pre-pregnancy body mass index ( BMI ) ( P=0.026 ) . They gained either more or less weight than recommended . Conclusions : Dietary restraint appears to have undesirable influences on eating and weight gain during pregnancy which require further attention . Sponsorship : South Bank University and Cow and Gate Nutricia Ltd. provided financial assistance for this project OBJECTIVE To investigate the effect of exercise during pregnancy on the intensity of  low back pain  and kinematics of spine . METHOD A prospect i ve r and omized study was design ed . 107 women participated in an exercise program three times a week during second half of pregnancy for 12 weeks and 105 as control group . All filled a question naire between 17 - 22 weeks of gestation and 12 weeks later for assessment of their back pain intensity . Lordosis and flexibility of spine were measured by Flexible ruler and Side bending test , respectively , at the same times . Weight gain during pregnancy , Pregnancy length and neonatal weight were recorded . RESULT Low back pain intensity was increased in the control group . The exercise group showed significant reduction in the intensity of low back pain after exercise ( p<0.0001 ) . Flexibility of spine decreased more in the exercise group ( p<0.0001 ) . Weight gain during pregnancy , pregnancy length and neonatal weight were not different between the two groups . CONCLUSION Exercise during second half of the pregnancy significantly reduced the intensity of low back pain , had no detectable effect on lordosis and had significant effect on flexibility of spine Summary : A r and omised controlled trial was design ed to determine the effect of moderate 30 % maternal dietary energy restriction on the requirement for maternal insulin therapy  and the incidence of macrosomia in gestational diabetes .  Although the control group restricted their intake to a level similar to that of the intervention group ( 6845 kiloJoules ( kJ ) versus 6579 kJ ) , the result ing cohort could not identify any adverse effect of energy restriction in pregnancy . Energy restriction did not alter the frequency of insulin therapy ( 17.5 % in the intervention group and 16.9 % in the control group ) . Mean birth weight  ( 3461 g in the intervention group and 3267 g in the control group ) was not affected . There was a trend in the intervention group towards later gestational age at commencement of insulin therapy ( 33 weeks versus 31 weeks ) and lower maximum daily insulin dose ( 23 units versus 60 units ) which did not reach statistical significance . Energy restriction did not cause an increase in ketonemia A 1200 calorie diet or cyclopenthiazide with potassium was given to two groups of 51 high weight gain primigravidae and baby weight and the incidence of pre‐eclampsia  were compared with those in a matched control group . There was no difference in the development of pre‐eclampsia , but the weight of babies in the control group was higher than in the treated groups . The body fat was reduced in the diet group and the total body water in the diuretic group One hundred and three primigravidae were studied to establish the correlation between physical fitness and heart volume .  Twenty-three of the mothers were allocated at r and om to the exercise group and 21 to control group 1 , between the 10th and 14th weeks of pregnancy . In addition , 59 mothers were allocated to control group 2 , which was formed two weeks before term . The exercise group underwent a rather strenuous training programme during pregnancy . Physical fitness was measured by work tests on a bicycle ergometer two weeks before term . The heart volume was determined radiologically on the 6th day post partum . There was a positive correlation between physical fitness and the relative heart volume , which was greatest when physical fitness was measured by a method which takes the level of training into consideration . The relative heart volume of the exercise group was almost significantly greater than that of control group 1 . The physical performance of the exercise group was very significantly greater than in the control groups . There was no significant correlation between either physical fitness or relative heart volume and the duration of pregnancy or the weight of newborn Forty-one patients with gestational diabetes requiring insulin were enrolled in a r and omized study to investigate the efficacy of an exercise program in normalizing glucose tolerance . Seventeen of 21 patients completed the exercise program while maintaining normoglycemia and obviating  insulin therapy . Maternal and neonatal complications did not differ between the study and control groups . The type of program described appears to be safe and can serve as a model for exercise prescription for pregnant diabetic women to attain improved glucose tolerance OBJECTIVE To study the efficacy of yoga on  pregnancy outcomes . DESIGN AND SETTING Three hundred thirty five ( 335 ) women attending the antenatal clinic at Gunasheela Surgical and Maternity Hospital in Bangalore , India , were enrolled between 18 and 20 weeks of pregnancy in a prospect i ve , matched , observational study ; 169 women in the yoga group and 166 women in the control group . METHODS Women were matched for age , parity , body weight , and Doppler velocimetry scores of umbilical and uterine arteries .  Yoga practice s , including physical postures , breathing , and meditation were practice d by the yoga group one hour daily , from the date of entry into the study until delivery . The control group walked 30 minutes twice a day ( st and ard obstetric advice ) during the study period . Compliance in both groups was ensured by frequent telephone calls and strict maintenance of an activity diary . MAIN OUTCOMES Birth weight and gestational age at delivery were primary outcomes . RESULTS The number of babies with birth weight > or = 2500 grams was significantly higher ( p < 0.01 ) in the yoga group . Preterm labor was significantly lower ( p < 0.0006 ) in the yoga group . Complications such as isolated intrauterine growth retardation ( IUGR ) ( p < 0.003 ) and pregnancy-induced hypertension ( PIH ) with associated IUGR ( p < 0.025 ) were also significantly lower in the yoga group . There were no significant adverse effects noted in the yoga group . CONCLUSIONS An integrated approach to yoga during pregnancy is safe . It improves birth weight , decreases preterm labor , and decreases IUGR either in isolation or associated with PIH , with no increased complications OBJECTIVE To determine if regular weight measurement throughout pregnancy can reduce excessive gestational weight gain . DESIGN A r and omised controlled trial . SETTING A tertiary obstetric hospital in Melbourne , between July 2007 and May 2008 . PARTICIPANTS 236 pregnant women recruited at < or = 14 weeks ' gestation . INTERVENTION Women allocated to the intervention group were given a personalised weight measurement card , advised of their optimal gestational weight gain ( based on their body mass index at the time of recruitment and the United States Institute of Medicine guidelines ) , and instructed to record their weight at 16 , 20 , 24 , 28 , 30 , 32 and 34 weeks ' gestation . The control group were weighed at recruitment , but were not given instructions about regular weight measurement . All participants were blinded to the purpose of the study . MAIN OUTCOME MEASURE Weight gain from recruitment to follow-up at 36 weeks ' gestation . RESULTS In the study population , there was a trend to less weight gain in the intervention group . The women in the intervention group experienced a mean ( SD ) per-week weight gain of 0.44 ( 0.173 ) kg compared with those in the control group , who gained 0.46 ( 0.156 ) kg/week ( mean difference , 0.02 kg/week ; 95 % CI , - 0.02 to 0.07 kg/week ) . The intervention significantly reduced gestational weight gain in the group of women who were overweight but not obese at recruitment : those in the intervention group ( 20 women ) gained a mean ( SD ) of 0.42 ( 0.153 ) kg/week and the control group ( 18 women ) gained 0.54 ( 0.123 ) kg/week ( mean difference , 0.12 kg/week ; 95 % CI , 0.03 to 0.22 kg/week ; P = 0.01 ) . CONCLUSION Regular weight measurement in pregnancy was not found to be effective in reducing weight gain , except among women who were overweight but not obese before pregnancy . TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12607000272493 OBJECTIVE To prospect ively determine whether moderate exercise during pregnancy lowers blood pressure . STUDY DESIGN A r and omized , controlled trial with one test group and one control group . All subjects have a history of mild hypertension , gestational hypertensive disorders or a family history of hypertensive disorders . Subjects were recruited before 14 weeks ' gestation . After four weeks of observation , the subjects were r and omly assigned to either the exercise or control group . The exercise group visited the laboratory three times a week for 10 weeks ( 18 - 28 gestation weeks ) to perform 30 minutes of exercise at Rating of Perceived Exertion level 13 . RESULTS A total of 16 pregnant women ( mean age , 30 years ) participated . The mean metabolic equivalent during exercise sessions was 4.7 ( SD = 0.8 ) . Blood pressure measurements were compared before and after the 10-week exercise period in the two groups . Systolic blood pressures did not change significantly , but diastolic blood pressure ( DBP ) in the exercise group decreased by 3.5 mm Hg , while that in the control group increased by 1.1 mm Hg . Thus , the pre-post change in DBP differed by 4.6 mm Hg between groups . Exercise treatment reduced the diastolic blood pressure to a near-significant level in the exercise group ( t = 2.34 , df = 7 , P = .052 ) . Percent body fat did not differ between the exercise and control groups either before or after exercise treatment . ANOVA revealed that pregnancy had a significant effect ( F(1 , 14 ) = 5.7 , P = .03 ) on increasing the percentage of fat , but exercise treatment did not ( F(1 , 14 ) = .18 , P = .68 ) . Estimated energy expenditure in overall daily physical activities during the intervention did not differ between the two groups despite the inclusion of exercise . CONCLUSION This study detected a strong trend that 10 weeks of moderate exercise lowered the  diastolic blood pressure among pregnant women at risk of hypertensive disorders . The reductions were probably due to the effect of exercise itself , not to weight or overall daily physical activity levels BACKGROUND A high prevalence of gestational diabetes mellitus and type 2 diabetes has been observed among the Cree of James Bay , Quebec . To address this problem , a diet and activity intervention during pregnancy , which was based on social learning theory , was initiated in 4 Cree communities . METHODS A prospect i ve intervention compared dietary , weight and glycemic indicators for 107 control subjects and for 112 women who received the intervention during the course of their pregnancy . A control period in 4 communities ( July 1995-March 1996 ) was followed by an intervention period ( April 1996-January 1997 ) when subjects were offered regular , individual diet counselling , physical activity sessions and other activities related to nutrition . RESULTS The intervention and control groups did not differ at baseline regarding their mean age ( 24.3 years [ SD 6.29 ] v. 23.8 years [ SD 5.86 ] ) , mean prepregnancy weight ( 81.0 kg [ SD 19.46 ] v. 78.9 kg [ SD 17.54 ] ) and mean gestational age at recruitment ( 17.1 weeks [ SD 7.06 ] v. 18.5 weeks [ SD 6.92 ] ) . The intervention did not result in differences in diet measured at 24 - 30 weeks ' gestation , rate of weight gain over the second half of pregnancy ( 0.53 kg per week [ SD 0.32 ] v. 0.53 kg per week [ SD 0.27 ] ) or plasma glucose level ( 50 g oral glucose screen ) between 24 and 30 weeks ( 7.21 mmol/L [ SD 2.09 ] v. 7.43 mmol/L [ SD 2.10 ] ) . Mean birth weights were similar ( 3741 g [ SD 523 ] v. 3686 g [ SD 686 ] ) , as was maternal weight at 6 weeks post partum ( 88.1 kg [ SD 16.8 ] v. 86.4 kg [ SD 19.0 ] ) . The only changes in dietary intake were a reduction in caffeine ( pregnancy ) and an increase in folate ( post partum ) . INTERPRETATION This intervention had only a minor impact on diet ; finding ways of encouraging appropriate body weight and activity levels remains a challenge We assessed the impact of a lifestyle modification program ( LMP ) on weight gain in pregnancy  and evaluated its effect on adverse pregnancy outcomes . A prospect i ve matched controlled study design was employed . Inclusion criteria consisted of pregnant women with singleton gestations and body mass index ( BMI ) > or = 30 without underlying medical conditions . In the study group , patients were prospect ively enrolled in the first trimester . Through the LMP , women participated in a comprehensive program on nutrition , exercise , and weight control in pregnancy . The control group consisted of matched patients by starting BMI , parity , and socioeconomic status during the same study period cared for at the same institution . The primary outcome evaluated was weight gain in pregnancy . Adverse pregnancy outcomes including preeclampsia , gestational diabetes , gestational hypertension , and various postpartum complications were evaluated between the two groups . Statistical analysis was performed using nonparametric methods , with p < 0.5 considered significant . Twenty-eight patients were recruited for this study and underwent the intervention . Patient compliance with the LMP was 75 % , two patients were lost to follow-up , one had a preterm delivery , and four had incomplete data due to various reasons . Twenty-one patients completed their pregnancy and were available for analysis . Twenty matched control patients were identified for analysis . Study participants gained significantly less weight in their pregnancies when compared with controls ( mean weight gain 17 versus 34 pounds , respectively ; p = 0.008 ) . Secondary outcomes of preeclampsia , gestational diabetes , cesarean section , as well as infant birth weight did not significantly differ between the groups . This study suggests an effective method of reducing prenatal weight gain in the obese population . This type of comprehensive intervention could be an important , cost-effective risk-reduction strategy The interaction between maternal endurance exercise at or above a minimal conditioning level , prior to and during pregnancy , and pregnancy outcome was examined prospect ively in our obstetrical populace using epidemiologic techniques . Over a 3-month interval all women registering for antepartum care were interviewed . Those planning to continue exercise during pregnancy were re-interviewed between the 28th and 34th gestational weeks . A detailed review of clinical records was used for outcome assessment . Women who continued endurance exercise at or near preconceptual levels during pregnancy gained less weight ( -4.6 kg ) , delivered earlier (-8 d ) , and had lighter-weight offspring ( -500 g ) than those who stopped exercising prior to the 28th week . The latter group gained 2.2 kg more weight but delivered similar birthweight infants at a similar gestational age as their sedentary controls OBJECTIVE The purpose of this study was to test the null hypothesis that the volume of exercise at different times during pregnancy has no effect on fetoplacental growth . STUDY DESIGN Seventy-five women who exercised regularly were evaluated before pregnancy and r and omly assigned at 8 weeks ' gestation to one of 3 exercise regimens for the remainder of pregnancy . Primary outcome variables included placental growth rate , birth weight , and placental volume at term . RESULTS The offspring of the women who were r and omly assigned to a high volume of exercise in mid and late pregnancy were significantly lighter ( 3.39 kg vs 3.81 kg ) and thinner ( 8.3 % fat vs 12.1 % fat ) than those offspring born of women who were r and omly assigned to reduce their exercise volume after the 20th week . Maternal weight gain , fresh placental volumes , and histomorphometric indices of placental function were greater in the high-low group . CONCLUSION These data indicate that a high volume of moderate-intensity , weight-bearing exercise in mid and late pregnancy symmetrically reduces fetoplacental growth , whereas a reduction in exercise volume enhances fetoplacental growth with a proportionally greater increase in fat mass than in lean body mass Five quantitative measures of diabetic control [ HbA1c determinations , mean 24-h plasma glucose values , mean amplitude of glycemic excursions ( MAGE ) , mean 24-h urinary loss of glucose , and daily exogenous insulin requirement ] were compared in 20 pregnant women who were r and omly assigned to either a high-carbohydrate , high-fiber diet ( HCF ) that was low in fat or to a control diet commonly prescribed for pregnancy . Eleven women followed the HCF diet and nine subjects , the control diet , from baseline entry into the study until delivery . Dietary compliance was excellent , with 78 % of the women in each group rated good or acceptable . HbA1c values were similar in both groups at baseline ( HCF : 11.0 ± 0.5 % versus control : 10.2 ± 0.6 % ) , with no different predelivery values ( 8.6 ± 0.4 % ) . Mean 24-h plasma glucose levels improved in patients on both diets , with lower values noted in the HCF group at predelivery . MAGE values and st and ard deviations did not differ significantly in the two groups . Glycosuria decreased markedly in both dietary groups , but differences between groups were not significant . Improved control of diabetes on the HCF diet was achieved with significantly lower increments in insulin dose during gestation ( HCF baseline : 32 ± 8 U/24 h to 66 ± 10 U/24 h versus control baseline : 27 ± 9 U/24 h to 108 ± 12 U/24 h , P < 0.03 ) . Outcome of pregnancy did not differ in the two groups of patients , but women on the HCF diet gained less weight than those on the control diet ( 26 ± 3 lb versus 35 ± 5 lb , P < 0.05 ) . Mean newborn gestational age was similar in the two groups ( HCF : 37.2 ± 0.7 wk versus control : 36.5 ± 0.7 wk ) . Mean birth weight in infants of HCF mothers ± was 3809 ± 248 g versus 3313 ± 278 g in infants of control mothers ( P < 0.05 ) . We conclude that although marked improvement of diabetic control occurred on both regimens , patients on the HCF diet achieved better control of diabetes with significantly lower increments in exogenous insulin
BACKGROUND Around 50 % of women of childbearing age are either overweight [ body mass index ( BMI ) 25 - 29.9 kg/m(2 ) ] or obese ( BMI ≥ 30 kg/m(2 ) ) .
The antenatal period provides an opportunity to manage weight in pregnancy .
This has the potential to reduce maternal and fetal complications associated with excess weight gain and obesity .
OBJECTIVES To evaluate the effectiveness of dietary and lifestyle interventions in reducing or preventing obesity in pregnancy and to assess the beneficial and adverse effects of the interventions on obstetric , fetal and neonatal outcomes .