A randomized controlled trial of prenatal physical activity to prevent gestational diabetes: design and methods. A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial. Feasibility of a lifestyle intervention in early pregnancy to prevent deterioration of glucose tolerance Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial. Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial. Design of FitFor2 study: the effects of an exercise program on insulin sensitivity and plasma glucose levels in pregnant women at high risk for gestational diabetes Effects of a low-glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial. Development and evaluation of a multimedia CD-ROM for exercise during pregnancy and postpartum. Preventing Excessive Weight Gain During Pregnancy Through Dietary and Lifestyle Counseling: A Randomized Controlled Trial Design of the New Life(style) study: a randomised controlled trial to optimise maternal weight development during pregnancy. [ISRCTN85313483] Exercise during pregnancy improves maternal health perception: a randomized controlled trial. A randomised control trial of low glycaemic index carbohydrate diet versus no dietary intervention in the prevention of recurrence of macrosomia Impact of dietary counselling and probiotic intervention on maternal anthropometric measurements during and after pregnancy: a randomized placebo-controlled trial. Can a Low–Glycemic Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus? Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. Continuity of midwifery care and gestational weight gain in obese women: a randomised controlled trial Physical activity counseling in maternity and child health care – a controlled trial Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Factors Associated With the Pattern of Maternal Weight Gain During Pregnancy Aerobic Exercise and Submaximal Functional Capacity in Overweight Pregnant Women: A Randomized Trial Randomized controlled trial to prevent excessive weight gain in pregnant women Dietary counseling to improve fat quality during pregnancy alters maternal fat intake and infant essential fatty acid status. Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes Selective effect of cefoxitin prophylaxis on post-cesarean-section microbial flora. Impact of dietary counselling on nutrient intake during pregnancy: a prospective cohort study. Prevention of Gestational Diabetes Randomized trial of a tailored nutrition education CD-ROM program for women receiving food assistance. Reducing excessive weight gain in pregnancy: a randomised controlled trial. Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation. Postpartum Depression: A Randomized Trial of Sertraline Versus Nortriptyline Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. Institute of Medicine Maternal Weight Gain Recommendations and Pregnancy Outcome in a Predominantly Hispanic Population Gestational Weight Gain, Pregnancy Outcome, and Postpartum Weight Retention Continuing regular exercise during pregnancy: effect of exercise volume on fetoplacental growth. Prevention of Gestational Diabetes: Design of a Cluster-Randomized Controlled Trial and One-Year Follow-Up Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.
BACKGROUND Women diagnosed with gestational diabetes mellitus ( GDM ) are at substantially increased risk of developing type 2 diabetes and obesity , currently at epidemic rates in the United States . GDM , therefore , identifies a population of women at high risk of developing type 2 diabetes and provides an opportunity to intervene before the development of this disorder . It is well recognized that acute as well as chronic physical activity improves glucose tolerance in type 2 diabetes . To date , however , primary prevention trials have not been conducted to test whether an increase in physical activity reduces risk of developing GDM among women at high risk of this disorder . METHODS The aims of this study are to investigate the effects of a motivationally targeted , individually tailored 12-week physical activity intervention on ( 1 ) development of GDM , ( 2 ) serum biomarkers associated with insulin resistance , and ( 3 ) the adoption and maintenance of exercise during pregnancy .  Women at high risk of GDM are recruited in early pregnancy and r and omized to either an individually tailored exercise intervention or a comparison health and wellness intervention . RESULTS The overall goal of the exercise intervention is to encourage pregnant women to achieve the American College of Obstetricians and Gynecologists guidelines for physical activity during pregnancy through increasing walking and developing a more active lifestyle . CONCLUSIONS The intervention takes into account the specific social , cultural , economic , and physical environmental challenges faced by pregnant women of diverse socioeconomic and ethnic background OBJECTIVE to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum , or from birth to six months post partum , on weight retention among Taiwanese women . DESIGN a r and omised controlled trial assigned participants to two experimental groups [ from pregnancy to six months post partum ( EP ) and from birth to six months post partum ( EPP ) ] and one comparison group . SETTING a 3900-bed medical centre in northern Taiwan with around 3000 births annually . PARTICIPANTS a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre . INTERVENTIONS the comparison group received the routine outpatient department obstetric educational programme . The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum , and received on brochure . The EPP group received the same educational intervention as the EP group from 24 - 48 hours after birth to six months post partum . MEASUREMENTS body weight , body mass index , health-promoting behaviour and psycho-social variables ( self-efficacy , body image , depression and social support ) . FINDINGS average gestational weight gain was 14.02 , 15.27 and 16.22 kg in the three EP , EPP and comparison groups respectively , and average weight retention at six months post partum was 2.34 , 4.06 and 5.08 kg in the three groups , respectively . KEY CONCLUSIONS a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention . IMPLICATION S FOR PRACTICE the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle Background In conjunction with the growing prevalence of obesity and the older age of pregnant women gestational diabetes ( GDM ) is a major health problem . The aim of the study was to evaluate if a lifestyle intervention since early pregnancy is feasible in improving the glucose tolerance of women at a high-risk for GDM in Finl and . Methods A 75-g oral glucose tolerance test ( OGTT ) was performed in early pregnancy ( n = 102 ) . Women at high risk for GDM ( n = 54 ) were r and omized at weeks 8 - 12 from Apr 2005 to May 2006 to a lifestyle intervention group ( n = 27 ) or to a close follow-up group ( n = 27 ) . An OGTT was performed again at weeks 26 - 28 for the lifestyle intervention and close follow-up groups . Results The values of the OGTT during the second trimester did not differ between the lifestyle intervention and close follow-up groups . In the lifestyle intervention group three women had GDM in the second trimester and respectively one woman in the close follow up group . Insulin therapy was not required in both groups . The intervention result ed in somewhat lower weight gain 11.4 ± 6.0 kg vs. 13.9 ± 5.1 kg , p = 0.062 , adjusted by the prepregnancy weight . Conclusions Early intervention with an OGTT and simple lifestyle advice is feasible . A more intensive lifestyle intervention did not offer additional benefits with respect to glucose tolerance , although it tended to ameliorate the weight gain . Trial Registration Clinical Trials.gov : Balanced glucose metabolism ensures optimal fetal growth with long-term health implication s conferred on both mother and child . We examined whether supplementation of probiotics with dietary counselling affects glucose metabolism in normoglycaemic pregnant women . At the first trimester of pregnancy 256 women were r and omised to receive nutrition counselling to modify dietary intake according to current recommendations or as controls ; the dietary intervention group was further r and omised to receive probiotics ( Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12 ; diet/probiotics ) or placebo ( diet/placebo ) in a double-blind manner , whilst the control group received placebo ( control/placebo ) . Blood glucose concentrations were lowest in the diet/probiotics group during pregnancy ( baseline-adjusted means 4.45 , 4.60 and 4.56 mmol/l in diet/probiotics , diet/placebo and control/placebo , respectively ; P = 0.025 ) and over the 12 months ' postpartum period ( baseline-adjusted means 4.87 , 5.01 and 5.02 mmol/l ; P = 0.025 ) . Better glucose tolerance in the diet/probiotics group was confirmed by a reduced risk of elevated glucose concentration compared with the control/placebo group ( OR 0.31 ( 95 % CI 0.12 , 0.78 ) ; P = 0.013 ) as well as by the lowest insulin concentration ( adjusted means 7.55 , 9.32 and 9.27 mU/l ; P = 0.032 ) and homeostasis model assessment ( adjusted means 1.49 , 1.90 and 1.88 ; P = 0.028 ) and the highest quantitative insulin sensitivity check index ( adjusted means 0.37 , 0.35 and 0.35 ; P = 0.028 ) during the last trimester of pregnancy . The effects observed extended over the 12-month postpartum period . The present study demonstrated that improved blood glucose control can be achieved by dietary counselling with probiotics even in a normoglycaemic population and thus may provide potential novel means for the prophylactic and therapeutic management of glucose disorders 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 Background Pregnancy is a period in the life of women that is often associated with decreased daily physical activity and /or exercise . However , maintaining adequate levels of daily physical activity during pregnancy is important for mother and child . Studies suggest that moderate daily physical activity and exercise during pregnancy are associated with reductions in the risk of gestational diabetes mellitus ( GDM ) . However , at present , physical activity is not routinely advised to pregnant women at risk for gestational diabetes in the Netherl and s. In FitFor2- study we aim to assess whether an exercise program can improve insulin sensitivity and fasting plasma glucose levels of women at high risk for gestational diabetes , assuming that this will lower their risk of gestational diabetes . Methods The FitFor2- study is a r and omised controlled trial . Women who visit one of the participating hospitals or midwifery practice s and who are at risk for gestational diabetes are eligible to participate . After baseline measurement they are r and omly allocated to in the intervention or control group . The intervention group receives an exercise program twice a week in addition to usual care . The exercise program consist of aerobic and strength exercises and takes place under close supervision of a physiotherapist . Data are collected at 15 , 24 and 32 weeks of pregnancy and 12 weeks after delivery . Primary maternal outcome measures are fasting plasma glucose and relative increase in insulin resistance . Primary neonatal outcome is birth weight . Secondary outcome measures are : maternal serum triglycerides , HDL , cholesterol , HbA1c , maternal weight gain during pregnancy , maternal physical activity level , foetal growth . Discussion If the FitFor2 intervention program proves to be effective , obstetricians and midwives should refer women at risk for GDM to a special exercise program . Exercise programs for pregnant women under supervision of an experienced trainer are already available in the Netherl and s , and these programs could be adjusted easily for this target group . Furthermore , the costs of these programs should be refunded by including them in the basic health care cost reimbursement schemes . Trial registration BACKGROUND The optimal diet for pregnancy that is complicated by excessive weight is unknown . OBJECTIVE We aim ed to examine the effects of a low-glycemic load ( low-GL ) diet in overweight and obese pregnant women . DESIGN We r and omly assigned 46 overweight or obese pregnant women to receive a low-GL or a low-fat diet .  Participants received carbohydrate-rich foods , fats , and snack foods through home delivery or study visits . The primary outcome was birth weight z score . Other endpoints included infant anthropometric measurements , gestational duration , maternal weight gain , and maternal metabolic parameters . RESULTS There were no significant differences in birth weight z score or other measures of infant adiposity between groups . However , in the low-GL compared with the low-fat group , gestational duration was longer ( mean ± SD : 39.3 ± 1.1 compared with 37.9 ± 3.1 wk ; P = 0.05 ) and fewer deliveries occurred at ≤ 38.0 wk ( 13 % compared with 48 % , P = 0.02 ; with exclusion of planned cesarean deliveries : 5 % compared with 53 % ; P = 0.002 ) . Adjusted head circumference was greater in the low-GL group ( 35.0 ± 0.8 compared with 34.2 ± 1.3 cm , P = 0.01 ) . Women in the low-GL group had smaller increases in triglycerides [ median ( interquartile range ) : 49 ( 19 , 70 ) compared with 93 ( 34 , 129 ) mg/dL ; P = 0.03 ] and total cholesterol [ 13 ( 0 , 36 ) compared with 33 ( 22 , 56 ) mg/dL , P = 0.04 ] and a greater decrease in C-reactive protein [ -2.5 ( -5.5 , -0.7 ) compared with -0.4 ( -1.4 , 1.5 ) mg/dL , P = 0.007 ] . CONCLUSIONS A low-GL diet result ed in longer pregnancy duration , greater infant head circumference , and improved maternal cardiovascular risk factors . Large-scale studies are warranted to evaluate whether dietary intervention during pregnancy aim ed at lowering GL may be useful in the prevention of prematurity and other adverse maternal and infant outcomes . This trial is registered at clinical trials.gov as NCT00364403 OBJECTIVE To meet the need for an interactive product on exercise during pregnancy and postpartum , we developed and evaluated a personally tailored multimedia CD-ROM . METHODS Pregnant and postpartum women , who were r and omly assigned to either the experimental group ( PregXercise CD-ROM ) or the control group ( CD-ROM with neutral content ) , navigated through the CD-ROM for 1 h. Main outcomes were exercise self-efficacy and knowledge . RESULTS In analyses of covariance , compared with the control group , the experimental group had significant increases in self-efficacy and knowledge . CONCLUSION The multimedia CD-ROM delivering information about exercise motivation , guidelines , and prescription was effective in improving exercise self-efficacy and knowledge . PRACTICE IMPLICATION S Our preliminary results illustrate that healthcare professionals and research ers may use interactive multimedia for improving exercise behavior and related outcomes with pregnant and postpartum women 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 Preventing excessive weight gain during pregnancy is potentially important in the prevention of overweight and obesity among women of childbearing age . However , few intervention studies aim ing at weight management during pregnancy have been performed and most of these interventions were not as successful as expected . In this paper the design of the New Life(style ) study is described as well as the content of the individually tailored intervention program , which focuses on controlling weight development during pregnancy . Methods The effectiveness of the New Life(style ) intervention program versus usual care by midwives is evaluated in a r and omised controlled trial . Women who expect their first child and visit one of the participating midwifery practice s are included . The intervention is st and ardised in a protocol and executed by trained counsellors with the women who are r and omised in the intervention group . During 5 sessions – at 18 , 22 , 30 and 36 weeks of pregnancy and at 8 weeks postpartum – individual weight gain is discussed in relation to weight gain guidelines for pregnant women of the American Institute of Medicine . Counsellors coach the women to maintain or optimise a healthy lifestyle , in a period of drastic physical and mental changes . Data is collected at 15 , 25 , 35 weeks of pregnancy and at 6 , 26 , and 52 weeks after delivery . Primary outcome measures are body weight , BMI , and skinfold thickness . Secondary outcome measures include physical activity , nutrition and blood levels of factors that are associated with energy homeostasis . Discussion Results of the current RCT will improve the knowledge of determinants of weight gain during pregnancy , weight retention after childbirth and of the effectiveness of the intervention program that is described . Caregivers and research ers in the field of health promotion are offered more insight in specific elements of the New Life(style ) intervention program OBJECTIVE We have studied the effect of moderate physical activity that is performed by healthy women during their entire pregnancy on their perception of health status . STUDY DESIGN Eighty sedentary women were assigned r and omly to either an exercise group ( n = 40 ) or a control group ( n = 40 ) . Maternal perception of health status and several pregnancy outcomes were recorded . RESULTS Significant differences ( P = .03 ) were found between study groups in the percentage of women who perceived their health status as " very good " ; the values that corresponded to the exercise group ( n = 18 ; 54.5 % ) were better than those of the control group ( n = 9 ; 27.3 % ) . In addition , the women of the exercise group gained less weight ( 11,885 ± 3146 g ) than those of the control group ( 13,903 ± 2113 ; P = .03 ) . CONCLUSION A moderate physical activity program that is performed over the first , second , and third trimester of pregnancy improves the maternal perception of health status Background Maternal weight and maternal weight gain during pregnancy exert a significant influence on infant birth weight and the incidence of macrosomia . Fetal macrosomia is associated with an increase in both adverse obstetric and neonatal outcome , and also confers a future risk of childhood obesity . Studies have shown that a low glycaemic diet is associated with lower birth weights , however these studies have been small and not r and omised [ 1 , 2 ] . Fetal macrosomia recurs in a second pregnancy in one third of women , and maternal weight influences this recurrence risk [ 3 ] . Methods / Design We propose a r and omised control trial of low glycaemic index carbohydrate diet vs. no dietary intervention in the prevention of recurrence of fetal macrosomia .  Secundigravid women whose first baby was macrosomic , defined as a birth weight greater than 4000 g will be recruited at their first antenatal visit . Patients will be r and omised into two arms , a control arm which will receive no dietary intervention and a diet arm which will be commenced on a low glycaemic index diet . The primary outcome measure will be the mean birth weight centiles and ponderal indices in each group . Discussion Altering the source of maternal dietary carbohydrate may prove to be valuable in the management of pregnancies where there has been a history of fetal macrosomia . Fetal macrosomia recurs in a second pregnancy in one third of women . This r and omised control trial will investigate whether or not a low glycaemic index diet can affect this recurrence risk . Current Controlled Trials Registration NumberIS RCT BACKGROUND & AIMS To establish whether probiotic supplemented dietary counselling influences maternal anthropometric measurements during and after pregnancy . METHODS At the first trimester of pregnancy 256 women were r and omly assigned to receive nutrition counselling to modify dietary intake according to current recommendations or as controls ; dietary intervention groups were further r and omized to receive probiotics Lactobacillus rhamnosus GG ( ATCC 53103 ) and Bifidobacterium lactis ( diet/probiotics ) or placebo ( diet/placebo ) capsules in a double-blind manner , whilst the controls received placebo ( control/placebo ) . The intervention lasted until the end of exclusive breastfeeding for up to six months . RESULTS The risk of central adiposity defined as waist circumference 80 cm or more was lowered in women in the diet/probiotics group compared with the control/placebo group ( OR 0.30 , 95%CI 0.11 - 0.85 , p = 0.023 adjusted for baseline BMI ) , whilst the diet/placebo group did not differ from the controls ( OR 1.00 , 95 % CI 0.38 - 2.68 , p = 0.994 ) at 6 months postpartum . The number needed to treat ( NNT ) with diet/probiotics to prevent one woman from developing a waist circumference of 80 cm or more was 4 . Healthy eating pattern at 12 months postpartum ( p = 0.001 ) and BMI prior to pregnancy ( p < 0.001 ) were strong determinants of BMI at 12 months postpartum when adjusted for dietary intervention and exercise . CONCLUSION The impact of probiotics-supplemented dietary counselling on central adiposity , may offer a novel means for the prevention and management of obesity . This trial was registered at clinical trials.gov as NCT 00167700 , section 3 OBJECTIVE A low – glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester . A low – glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus ( GDM ) . However , the efficacy of this advice and associated pregnancy outcomes have not been systematic ally examined . The purpose of this study was to determine whether prescribing a low – glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes . RESEARCH DESIGN AND METHODS All women with GDM seen over a 12-month period were considered for inclusion in the study . Women ( n = 63 ) were r and omly assigned to receive either a low – glycemic index diet or a conventional high-fiber ( and higher glycemic index ) diet . RESULTS Of the 31 women r and omly assigned to a low – glycemic index diet , 9 ( 29 % ) required insulin . Of the women r and omly assigned to a higher – glycemic index diet , a significantly higher proportion , 19 of 32 ( 59 % ) , met the criteria to commence insulin treatment ( P = 0.023 ) . However , 9 of these 19 women were able to avoid insulin use by changing to a low – glycemic index diet . Key obstetric and fetal outcomes were not significantly different . CONCLUSIONS Using a low – glycemic index diet for women with GDM effectively halved the number needing to use insulin , with no compromise of obstetric or fetal outcomes 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 Background The increased prevalence of obesity in pregnant women in Australia and other developed countries is a significant public health concern . Obese women are at increased risk of serious perinatal complications and guidelines recommend weight gain restriction and additional care . There is limited evidence to support the effectiveness of dietary and physical activity lifestyle interventions in preventing adverse perinatal outcomes and new strategies need to be evaluated . The primary aim of this project is to evaluate the effect of continuity of midwifery care on restricting gestational weight gain in obese women to the recommended range . The secondary aims of the study are to assess the impact of continuity of midwifery care on : women 's experience of pregnancy care ; women 's satisfaction with care and a range of psychological factors . Methods / Design A two arm r and omised controlled trial ( RCT ) will be conducted with primigravid women recruited from maternity services in Victoria , Australia . Participants will be primigravid women , with a BMI ≥30 who are less than 17 weeks gestation . Women allocated to the intervention arm will be cared for in a midwifery continuity of care model and receive an informational leaflet on managing weight gain in pregnancy . Women allocated to the control group will receive routine care in addition to the same informational leaflet  . Weight gain during pregnancy , st and ards of care , medical and obstetric information will be extracted from medical records . Data collected at recruitment ( self administered survey ) and at 36 weeks by postal survey will include socio-demographic information and the use of vali date d scales to measure secondary outcomes . Discussion Continuity of midwifery care models are well aligned with current Victorian , Australian and many international government policies on maternity care . Increasingly , midwifery continuity models of care are being introduced in low risk maternity care , and information on their application in high risk population s is required . There is an identified need to trial alternative antenatal interventions to reduce perinatal risk factors for women who are obese and the findings from this project may have application in other maternity services . In addition this study will inform a larger trial that will focus on birth and postnatal outcomes .Trial Registration Australian New Zeal and Clinical Trials RegistryACTRN12610001078044 Background The purpose of the study is to examine the effects and feasibility of individual physical activity ( PA ) counseling in maternity and child health clinics in Finl and . Methods Three clinics including both maternity and child health care signed up for the experimental ( EXP ) and three for the control group ( CON ) . The participants were 132 pregnant and 92 postpartum primiparas . The nurses in EXP integrated a primary and four booster PA counseling sessions into routine visits . An option for supervised group exercise was offered . In CON former practice s , usually including brief PA advice , were continued .  Leisure-time PA ( LTPA ) prior to pregnancy was elicited by question naire and followed 16–18 and 36–37 weeks ' gestation in maternity clinics and 5 and 10 months postpartum in child health clinics . Feasibility included safety , participant responsiveness , realization of counseling and applicability . Results According to analysis of covariance adjusted for baseline LTPA and possible confounders , no relative between-group differences in LTPA were found at the first follow-up in either maternity or child health clinics . At the last follow-up in maternity clinics the weekly number of at least moderate-intensity LTPA days was 43 % ( 95 % CI : 9 , 87 ) higher and the weekly duration of at least moderate-intensity LTPA 154 % ( 95 % CI : 16 , 455 ) higher in EXP compared with CON . Counseling proved feasible in both maternity and child health clinics . Conclusion Counseling  encouraged pregnant women to sustain their moderate-intensity LTPA and was feasible in routine practice s. No effects were observed if counseling was initiated postpartum . Trial registration Current Controlled Trials IS RCT BACKGROUND Maternal obesity and excessive gestational weight gain ( GWG ) are major short- and long-term risk factors for maternal and fetal complications . OBJECTIVE The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits , increase physical activity ( PA ) , and reduce GWG in obese pregnant women . DESIGN In this r and omized controlled trial , 195 white , obese pregnant women [ age : 29 + or - 4 y ; body mass index ( in kg/m(2 ) ) ; 33.6 + or - 4.2 ] were r and omly assigned into 3 groups : a group that received nutritional advice from a brochure , a group that received the brochure and lifestyle education by a nutritionist , and a control group . Nutritional habits  were evaluated every trimester through 7-d food records . PA was evaluated with the Baecke question naire . RESULTS Energy intake did not change during pregnancy and was comparable in all groups . Fat intake , specifically saturated fat intake , decreased and protein intake increased from the first to the third trimester in the passive and active groups compared with an opposite change in the control group . Calcium intake and vegetable consumption increased during pregnancy in all groups . PA decreased in all groups , especially in the third trimester . No significant differences in GWG and obstetrical or neonatal outcome could be observed between the groups . CONCLUSIONS Both lifestyle interventions improved the nutritional habits of obese women during pregnancy . Neither PA nor GWG was affected Objective To examine the pattern of maternal weight gain using maternal characteristics and pregnancy outcome . Methods We used maternal weight data measured prospect ively from all deliveries between 1980–1990 at the University of California , San Francisco .  Piecewise linear regression was used to estimate the rate of maternal weight gain in each trimester . Bivariate techniques were used to examine associations between maternal weight gain per trimester and maternal characteristics and pregnancy outcomes . We also used multiple regression analysis to examine the relationship between maternal characteristics and trimester weight gain . Results Weight data for at least one trimester were available for 10,418 women .  The average rate of weight gain ( kg/week ) was lowest during the first trimester ( 0.169 ± 0.268 , n = 7587 ) , peaked during the second trimester ( 0.563 ± 0.236 , n = 8000 ) , and slowed slightly in the third trimester ( 0.518 ± 0.234 , n = 10,052 ) . Maternal height , hypertension , cesarean delivery , and fetal size correlated positively with the rate of gain in each trimester , but pre-pregnancy body size , age , parity , smoking status , race-ethnicity , and diabetes were associated differently with gain , depending on which trimester was examined . The most important maternal predictors of weight gain per trimester were age and Asian race-ethnicity in the first trimester ; pre-pregnancy body mass , parity , and height in the second ; and hypertension , age , and parity in the third . Conclusion Maternal weight gain per trimester is associated with a number of maternal characteristics and pregnancy outcomes , and these relationships vary according to which trimester is being examined Objective : To evaluate the effects of aerobic training on submaximal cardiorespiratory capacity in overweight pregnant women . Methods : We conducted a r and omized clinical trial in a referral center prenatal clinic during the period 2000–2002 . Of 132 overweight ( body mass index 26–31 kg/m2 ) but otherwise healthy volunteers , at 20 years of age or older , with gestational age of 20 weeks or less , and without diabetes or hypertension , 92 consented to participate and were r and omized . Intervention consisted of 3 one-hour aerobic exercise sessions per week ; the control group received weekly relaxation and focus group discussion s. The main outcome measure was submaximal exercise capacity evaluated by oxygen uptake at the anaerobic ( first ventilatory ) threshold during cardiopulmonary treadmill testing 12 weeks after r and omization . Results : Oxygen uptake at the anaerobic threshold increased 18 % ( 15.9 ± 2.6 to 18.1 ± 3.1 mL · min−1 · kg−1 ) in the exercise group but decreased 16 % ( 16.9 ± 3.0 to 15.8 ± 2.6 mL · min−1 · kg−1 ) among the control group . Oxygen consumption at the anaerobic threshold , adjusted through analysis of covariance for baseline oxygen uptake , was 2.68 ( 95 % confidence interval 1.23 to 4.12 ) mL · min−1 · kg−1 greater in the exercise group . Women in the exercise group were approximately 5 times more likely than those in the control group to have regular or good cardiorespiratory capacity ( 12/38 versus 2/38 ; relative risk 5.2 , 95 % confidence interval 1.2 to 22.0 , number needed to treat 5 ) . Conclusion : Aerobic training in overweight pregnant women  substantially increases submaximal exercise capacity , overcoming the otherwise negative effects of pregnancy in this regard . Additional studies are required to evaluate its effect on major clinical outcomes . LEVEL OF EVIDENCE : 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 To explore the effect of maternal dietary intervention on infant essential fatty acid ( FA ) status , we conducted a prospect i ve , single-blind , r and omized nutrition intervention study . At the first trimester of pregnancy , 90 women from families with a history of allergy were r and omized either to receive intensive dietary counseling to modify dietary intake according to current recommendations or as controls . Infants ' cord and 1-mo isolated serum phospholipid FA were identified and quantified by GC . Detectable levels of eicosatrienoic acid [ ETA , 20:3(n-9 ) ] were taken as a biochemical marker for essential FA deficiency , and the DHA sufficiency index [ 22:6(n-3):22:5(n-6 ) ] and the DHA deficiency index [ 22:5(n-6):22:4(n-6 ) ] were taken as markers for DHA [ 22:6(n-3 ) ] status . The concentration of ETA was lower in cord blood in the intervention ( I ) group [ median 0.64 ( IQR 0.40 - 0.78 ) mg/L ; 2.09 ( 1.31 - 2.54 ) μmol/L ] than in the control ( C ) group [ 0.92 ( 0.54 - 1.20 ) mg/L ; 3.00 ( 1.76 - 3.92 ) μmol/L ] ( P = 0.048 ) . The proportion of ETA in total FA in the I group [ 0.73 % ( 0.48 - 0.85 % ) ] was lower than in the C group [ 0.93 % ( 0.78 - 1.22 % ) ] ( P = 0.003 ) . A higher DHA sufficiency index and lower DHA deficiency index were detected in cord blood in the I group than in the C group , although the groups did not differ in the DHA concentration or proportion of the total FA . There were no differences among groups at 1 mo for any of the variables measured . Our findings suggest a better supply of essential FA , particularly important during the period of rapid development , in infants whose mothers received dietary counseling . The results thus highlight the importance of maternal diet for child health , calling for dietary counseling for pregnant women in primary health care 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 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 double-blind study was done to test the efficacy of cefoxitin in the prevention of  post-cesarean-section infection .  The antibiotic was given in three 2-g doses ; the initial dose was given immediately after the cord was clamped , and subsequent doses were given four and eight hours later . Cefoxitin prophylaxis significantly reduced morbidity serious enough to require therapeutic antibiotics or to prolong the hospital stay and led to an overall reduction in the anaerobic microbial flora of the endocervix . However , the antibiotic was selective for the overgrowth of enterococci , which were present in nearly half the postoperative cultures of patients who had received the drug .  Enterococcal sepsis occurred in one patient , and three other patients had significant bacteriuria and /or urinary tract infections from enterococci . No  cefoxitin-resistant strains of Enterobacteriaceae , among species normally sensitive to the drug , were isolated from the stool sample s after prophylaxis . The risk of enterococcal colonization and superinfection must be weighted against the benefits of reduction of the infection risk when deciding upon routine antibiotic prophylaxis for cesarean section The aim of this study was to assess the impact of dietary counselling combined with the provision of food products on food and nutrient intake in pregnant women . We carried out a prospect i ve cohort study of healthy and atopic pregnant women ( n 209 ) , who were r and omized into dietary intervention and control groups . The intervention group received dietary counselling and food products to modify the fat composition of their diet to meet current recommendations . Three-day food records were collected during each trimester of pregnancy . Women in the intervention group consumed more vegetables , fruits , soft margarines and vegetable oils and less butter than those in the control group during the course of pregnancy ( P<0.05 ) . The main distinction between the groups in nutrient intake over the pregnancy was attributable to a higher energy intake ( % energy ) of PUFA by 0.5%energy ( 95 % CI 0.1 , 0.8 ) and to a lower intake of SFA by 0.8 % energy ( 95 % CI -1.4 , -0.4 ) in the intervention group . Dietary intake of vitamin E was 1.4 mg ( 95 % CI 0.6 , 2.2 ) , folate 20.9 microg ( 95 % CI 0.8 , 41.0 ) and ascorbic acid 19.8 mg ( 95 % CI 3.5 , 36.0 ) higher in the intervention group compared to the controls , while no differences in other nutrients were detected . Dietary counselling combined with the provision of food products during pregnancy is of importance in modifying food and nutrient intake , with potential health benefits OBJECTIVE To examine the feasibility of an individualized exercise program to prevent  gestational diabetes mellitus ( GDM ) in obese pregnant women . RESEARCH DESIGN AND METHODS The study was a pilot r and omized controlled trial with obese pregnant women ( intervention group , individualized exercise program [ n = 25 ] ; control group , usual care [ n = 25 ] ) . Average weekly energy expenditure ( MET hours per week and kilocalories per week ) of exercise-specific activity was assessed during pregnancy using the Pregnancy Physical Activity Question naire . Fasting glucose and insulin and homeostasis model assessment of insulin resistance ( HOMA-IR ) were assessed at baseline and 20 , 28 , and 36 weeks ' gestation . RESULTS Of the women in the intervention group , 16 of 22 ( 73 % ) achieved more than 900 kcal/week of exercise-based activity  at 28 weeks compared with 8 of 19 women in the control group ( 42 % ) , P = 0.047 . However , insulin resistance ( HOMA-IR ) did not differ between the groups . CONCLUSION This intervention was feasible and prompted a modest increase in physical activity . However , we are not confident that this intervention would be sufficient to prevent GDM OBJECTIVE This article describes the development and r and omized evaluation of a tailored nutrition education CD-ROM program for participants in the Special Supplemental Nutrition Program for Women , Infants and Children ( WIC ) in North Carolina . DESIGN After r and omization to intervention or control groups , participants completed a baseline survey and were resurveyed immediately after program use and 1 to 2 months postintervention . SETTING Two WIC clinics in central North Carolina . PARTICIPANTS A total of 307 respondents to the follow-up survey ( response rate 74.8 % ) comprised the study sample . Participants were female ( 96 % ) , 20 % were pregnant , and 50 % were minorities ( African American and other ) . INTERVENTION The interactive CD-ROM consisted of a targeted video soap opera , dietary assessment , and individually tailored dietary feedback and strategies for change . MAIN OUTCOME MEASURES Measures included total fat and fruit and vegetable intake , knowledge of low-fat and infant feeding choices , self-efficacy , and stages of change . ANALYSIS Descriptive statistics assessed baseline comparability of study groups ; analysis of covariance and F tests were used to assess program effects at follow-up . RESULTS INTERVENTION group members increased self-efficacy ( P < .01 ) and scored significantly higher ( P < .05 ) on both low-fat and infant feeding knowledge compared with controls . No differential effect was observed for dietary intake variables . CONCLUSIONS AND IMPLICATION S The findings suggest that one dose of an interactive CD-ROM program can impact mediators of dietary change but may be insufficient to change behavior 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 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 Abstract : Symptom reduction and improvement in functioning in women with postpartum major depression treated with a tricyclic antidepressant versus a serotonin reuptake inhibitor  were compared . The design was a double-blind , 8-week comparative trial of nortriptyline ( NTP ) versus sertraline ( SERT ) with a 16-week continuation phase . Women aged 18 to 45 years with postpartum major depression and a 17-item Hamilton Rating Scale for Depression score of 18 or more were eligible . Subjects were r and omized to  NTP or SERT  and treated with a fixed-dosing strategy . Of 420 women interviewed , 109 eligible women received medication , and 95 provided follow-up data . The proportion of women who responded and remitted did not differ between drugs at 4 , 8 , or 24 weeks . Times to response and remission also did not differ . Psychosocial functioning improved similarly in both drug-treated groups of mothers . The total side effect burden of each drug was similar , although side effect profiles differed between agents . No clinical or demographic variables differentiated responders by drug . Women who were responders and remitters at week 8 could be identified earlier if they were treated with SERT than with NTP .  Breast-fed infant serum levels were near or below the level of quantifiability for both agents OBJECTIVE The research addresses two questions : Are potentially modifiable psychosocial and behavioral factors related to gestational weight gain ? Do the same factors relate to both excessive and insufficient weight gain ? DESIGN Prospect i ve cohort study that followed women from early pregnancy until two years postpartum . Data were collected through mailed question naires and an audit of the medical record . Subjects/ setting The sample included 622 healthy adult women who gave birth to live singleton infants . Subjects were recruited from all women who registered for prenatal care in a hospital and primary care clinic system serving a 10-county area of Upstate New York . Statistical analyses performed Multiple linear and logistic regression with adjustment for timing of measurements and length of gestation were performed . RESULTS Only 38 % of women gained an amount of weight in pregnancy that was within the range recommended by the Institute of Medicine . Valid and easily implemented measures of change in food intake and physical activity from prepregnancy and cigarette smoking during pregnancy were each significantly ( P<.05 ) and independently related to gestational weight gain . Along with other variables in a biopsychosocial regression model , these variables accounted for 27 % of the variance in gestational weight gain and were also significantly related to risk of inadequate and excessive gain . APPLICATIONS/ CONCLUSIONS The findings facilitate the design of more effective nutrition interventions to promote appropriate gestational weight gain and the long-term health of women and their infants Objectives : To describe gestational weight gain patterns by pre-pregnancy weight and trimester of pregnancy , and to examine the risk of preterm birth associated with pre-pregnancy weight and gestational weight gain using various definitions of adequacy based on the Institute of Medicine ( IOM ) st and ard . Methods : We used data collected prospect ively from 8736 pregnant women receiving care in public health clinics in the West Los Angeles area . Pre-pregnancy weight was based on self-report obtained at the initial visit . Maternal weight  was measured at each prenatal visit , allowing for the calculation of total weight gain and the rate of weight gain during each trimester . Results : Women underweight before pregnancy ( body mass index less than 19.8 ) had the greatest risk of delivering preterm ( crude relative risk 1.7 , P < .05 ) . Similarities in patterns of weight gain were seen between women of low weight and normal pre-pregnancy weight status , as well as between overweight and obese women . Compared to the IOM recommendations for total weight gain , 47.8 % of underweight women and 36.6 % of normal-weight women gained the recommended amount . In contrast , 52 % and more than 75 % of overweight and obese women , respectively , had excessive gains . Inadequate weight gain during the third trimester as opposed to excessive gain , defined specifically for each pre-pregnancy weight status , was predictive of preterm birth . Conclusions : Weight monitoring during pregnancy continues to have clinical applications for the prediction of poor birth outcomes . Weight gain less than 90 % the IOM recommendation in the third trimester may serve as an indicator for identifying women at risk of delivering preterm Objective To determine whether the risk of maternal overweight associated with an excessive rate of gestational gain needs to be balanced against the risks of impaired fetal growth associated with a low rate of gain . Methods  Rate of gestational weight gain  was measured prospect ively in a sample of 274 young , low-income , and primarily minority women ( 12–29 years old ) with pregravid body mass indices ( BMI ) in the normal range ( 19.8–26.0 ) . We defined an excessive rate of gain between 20–36 weeks ' gestation as one greater than 0.68 kg/week , and a low rate of gain as one less than 0.34 kg/week . Women were followed-up at 4–6 weeks and 6 months postpartum . Results Rate of measured gestational gain between 20–36 weeks ' gestation was associated with total weight gain based on pregravid weight , with infant birth weight and gestation duration , and with maternal overweight ( BMI greater than 26 ) and weight retention postpartum . Infant birth weight and gestation duration were significantly reduced for women with low rates of gain , and there was no significant difference between women with excessive and moderate gains . Despite little difference in pregravid BMI , women with excessive rates of gain retained more weight overall , attained a greater postpartum BMI , and had higher levels of subcutaneous fat and overweight . Maternal anthropometric status showed little change between 4–6 weeks and 6 months postpartum . Conclusion Weight gained at an excessive rate by women with a pregravid BMI in the normal range does not greatly enhance fetal growth and gestation duration , contributing instead to postpartum maternal overweight 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 Background Annual prevalence of gestational diabetes mellitus ( GDM ) is 12.5 % among Finnish pregnant women . The prevalence is expected to rise with the increasing overweight among women before pregnancy .  Physical activity and diet are both known to have favourable effects on insulin resistance and possibly on the risk of GDM . We aim ed to investigate , whether GDM can be prevented by counseling on diet , physical activity and gestational weight gain during pregnancy . Methods / Design A cluster-r and omized controlled trial was conducted in 14 municipalities in the southern part of Finl and . Pairwise r and omization was performed in order to take into account socioeconomic differences . Recruited women were at 8 - 12 weeks ' gestation and fulfilled at least one of the following criteria : body mass index ≥ 25 kg/m2 , history of earlier gestational glucose intolerance or macrosomic newborn ( > 4500 g ) , age ≥ 40 years , first or second degree relative with history of type 1 or 2 diabetes . Main exclusion criterion was pathological oral glucose tolerance test ( OGTT ) at 8 - 12 weeks ' gestation . The trial included one counseling session on physical activity at 8 - 12 weeks ' gestation and one for diet at 16 - 18 weeks ' gestation , and three to four booster sessions during other routine visits . In the control clinics women received usual care . Information on height , weight gain and other gestational factors was obtained from maternity cards . Physical activity , dietary intake and quality of life  were followed by question naires during pregnancy and at 1-year postpartum . Blood sample s for lipid status , hormones , insulin and OGTT were taken at 8 - 12 and 26 - 28 weeks ' gestation and 1 year postpartum . Workability and return to work were elicited by a question naire at 1- year postpartum . Linkage to the national birth register of years 2007 - 2009 will provide information on perinatal complications and GDM incidence among the non- participants of the study . Cost-effectiveness evaluation will be based on quality -adjusted life years . This study has received ethical approval from the Ethical board of Pirkanmaa Hospital District . Discussion The study will provide information on the effectiveness and cost-effectiveness  of gestational physical activity and dietary counseling on prevention of GDM in a risk group of women . Also information on the prevalence of GDM and postpartum metabolic syndrome will be gained . Results on maintaining the possible health behaviour changes are important in order to prevent chronic diseases such as cardiovascular disease and diabetes . Trial registration The trial is registered IS RCT N 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 BACKGROUND Excessive weight gain during pregnancy is a major risk factor for  postpartum weight retention and future weight gain and obesity in women , but few adequately powered r and omized controlled trials have examined the efficacy of a behavioral weight-control intervention during pregnancy . OBJECTIVE This study examined whether a behavioral intervention during pregnancy could decrease the proportion of women who exceeded the 1990 Institute of Medicine ( IOM ) recommendations for gestational weight gains and increase the proportion of women who returned to pregravid weights by 6 mo postpartum . DESIGN This study was a r and omized , assessor-blind , controlled trial . Participants were pregnant ( 13.5 wk gestation ) , normal-weight ( NW ; n = 201 ) and overweight or obese ( OW/OB ; n = 200 ) women whose average age was 28.8 y. Participants were r and omly assigned within the 1990 IOM weight category ( NW compared with OW/OB ) to st and ard care ( n = 200 ) or to a behavioral intervention to prevent excessive gestational weight gain ( n = 201 ) . The intervention included one face-to-face visit ; weekly mailed material s that promoted an appropriate weight gain , healthy eating , and exercise ; individual graphs of weight gain ; and telephone-based feedback . The retention at the 6-mo postpartum assessment was 82 % . RESULTS Intent-to-treat analyses showed that the intervention , compared with st and ard care , decreased the percentage of NW women who exceeded IOM recommendations ( 40.2 % compared with 52.1 % ; P = 0.003 ) and increased the percentages of NW and OW/OB women who returned to their pregravid weights or below by 6 mo postpartum ( 30.7 % compared with 18.7 % ; P = 0.005 ) . CONCLUSION A low-intensity behavioral intervention during pregnancy reduced excessive gestational weight gains in NW women and prevented postpartum weight retention in NW and OW/OB women . This trial was registered at clinical trials.gov as NCT01117961
BACKGROUND Excessive weight gain during pregnancy is associated with multiple maternal and neonatal complications .
However , interventions to prevent excessive weight gain during pregnancy have not been adequately evaluated .
OBJECTIVES To evaluate the effectiveness of interventions for preventing excessive weight gain during pregnancy and associated pregnancy complications .
Interventions focused on a broad range of interventions .