The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: the LIMIT randomised trial Limiting weight gain in overweight and obese women during pregnancy to improve health outcomes: the LIMIT randomised controlled trial Primary prevention of gestational diabetes for women who are overweight and obese: a randomised controlled trial A Pregnancy and Postpartum Lifestyle Intervention in Women With Gestational Diabetes Mellitus Reduces Diabetes Risk Factors A randomized controlled trial of prenatal physical activity to prevent gestational diabetes: design and methods. Health care costs associated with gestational diabetes mellitus among high-risk women – results from a randomised trial Lifestyle counseling during pregnancy and offspring weight development until four years of age: follow-up study of a controlled trial A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial. Effect of Daily Consumption of Probiotic Yoghurt on Serum Levels of Calcium, Iron and Liver Enzymes in Pregnant Women Feasibility of a lifestyle intervention in early pregnancy to prevent deterioration of glucose tolerance Protocol for a randomized controlled trial of a specialized health coaching intervention to prevent excessive gestational weight gain and postpartum weight retention in women: the HIPP study A pragmatic cluster randomized clinical trial of diabetes prevention strategies for women with gestational diabetes: design and rationale of the Gestational Diabetes’ Effects on Moms (GEM) study Exercise Training in Pregnancy for obese women (ETIP): study protocol for a randomised controlled trial A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial Maternal low glycaemic index diet, fat intake and postprandial glucose influences neonatal adiposity – secondary analysis from the ROLO study Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial A pilot walking program promotes moderate-intensity physical activity during pregnancy. The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on neonatal health outcomes: the LIMIT randomised trial Delta Healthy Sprouts: a randomized comparative effectiveness trial to promote maternal weight control and reduce childhood obesity in the Mississippi Delta. Postpartum Weight Retention is Associated with Elevated Ratio of Oxidized LDL Lipids to HDL-Cholesterol Synbiotic Food Consumption Reduces Levels of Triacylglycerols and VLDL, but not Cholesterol, LDL, or HDL in Plasma from Pregnant Women Proportions and concentrations of serum n-3 fatty acids can be increased by dietary counseling during pregnancy Diet and blood lipids in 1-4 year-old children. Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial Developing a complex intervention for diet and activity behaviour change in obese pregnant women (the UPBEAT trial); assessment of behavioural change and process evaluation in a pilot randomised controlled trial Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial Antenatal exercise in overweight and obese women and its effects on offspring and maternal health: design and rationale of the IMPROVE (Improving Maternal and Progeny Obesity Via Exercise) randomised controlled trial The impact of exercise during pregnancy on neonatal outcomes: a randomized controlled trial. Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes? Secondary analysis of a cluster randomized NELLI study in Finland Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial. Cost-effectiveness of an exercise program during pregnancy to prevent gestational diabetes: Results of an economic evaluation alongside a randomised controlled trial [Impact of a dietary counseling program on the gain weight speed of pregnant women attended in a primary care service]. 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 Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a randomised controlled trial Feasibility and Efficacy of a Physical Activity Intervention Among Pregnant Women: The Behaviors Affecting Baby and You (B.A.B.Y.) Study. Nutrition and exercise reduce excessive weight gain in normal-weight pregnant women. 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] Effect of reducing the n-6:n-3 long-chain PUFA ratio during pregnancy and lactation on infant adipose tissue growth within the first year of life: an open-label randomized controlled trial. Exercise during pregnancy improves maternal health perception: a randomized controlled trial. Dietary and Lifestyle Advice for Pregnant Women Who Are Overweight or Obese: The LIMIT Randomized Trial Well-being in pregnancy: an examination of the effect of socioeconomic, dietary and lifestyle factors including impact of a low glycaemic index dietary intervention 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? Healthy eating and lifestyle in pregnancy (HELP): a protocol for a cluster randomised trial to evaluate the effectiveness of a weight management intervention in pregnancy Exercise in pregnant women and birth weight: a randomized controlled trial Healthy living in pregnancy: a cluster-randomized controlled trial to prevent excessive gestational weight gain - rationale and design of the GeliS study 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 The influence of a low glycemic index dietary intervention on maternal dietary intake, glycemic index and gestational weight gain during pregnancy: a randomized controlled trial A Randomized Controlled Trial Investigating the Effects of a Low–Glycemic Index Diet on Pregnancy Outcomes in Gestational Diabetes Mellitus Effect of daily consumption of probiotic yoghurt on insulin resistance in pregnant women: a randomized controlled trial Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial The theory, development, and implementation of an e-intervention to prevent excessive gestational weight gain: e-Moms Roc. Physical activity counseling in maternity and child health care – a controlled trial Effect of intensive counselling on the quality of dietary fats in pregnant women at high risk of gestational diabetes mellitus. 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 A pregnancy lifestyle intervention to prevent gestational diabetes risk factors in overweight Hispanic women: a feasibility randomized controlled trial. Aerobic Exercise and Submaximal Functional Capacity in Overweight Pregnant Women: A Randomized Trial Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Identification of those most likely to benefit from a low-glycaemic index dietary intervention in pregnancy. Randomized controlled trial to prevent excessive weight gain in pregnant women The feasibility and acceptability of regular weighing of pregnant women by community midwives to prevent excessive weight gain: RCT. Healthy Moms, a randomized trial to promote and evaluate weight maintenance among obese pregnant women: study design and rationale. Weight status and dietary intake determine serum leptin concentrations in pregnant and lactating women and their infants. The role of a personalized dietary intervention in managing gestational weight gain: a prospective, controlled study in a low-risk antenatal population The design of maternal centered life-style modification program for weight gain management during pregnancy — a study protocol Dietary counseling to improve fat quality during pregnancy alters maternal fat intake and infant essential fatty acid status. Association between Physical Activity in Obese Pregnant Women and Pregnancy Outcomes: The UPBEAT Pilot Study Effect of a Physical Exercise Program During Pregnancy on Uteroplacental and Fetal Blood Flow and Fetal Growth: A Randomized Controlled Trial Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Is pelvic floor muscle training effective when taught in a general fitness class in pregnancy? A randomised controlled trial. From Theory to Practice A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes Pregnancy and Glycemic Index Outcomes study: effects of low glycemic index compared with conventional dietary advice on selected pregnancy outcomes. The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women: a randomised clinical trial Selective effect of cefoxitin prophylaxis on post-cesarean-section microbial flora. Regular Exercise During Pregnancy to Prevent Gestational Diabetes: A Randomized Controlled Trial Impact of dietary counselling on nutrient intake during pregnancy: a prospective cohort study. Impact of an exercise intervention on physical activity during pregnancy: the behaviors affecting baby and you study. Type of delivery and gestational age is not affected by pregnant Latin-American women engaging in vigorous exercise: a secondary analysis of data from a controlled randomized trial. How effective is self‐weighing in the setting of a lifestyle intervention to reduce gestational weight gain and postpartum weight retention? Prevention of Gestational Diabetes Effect of regular exercise on prevention of excessive weight gain in pregnancy: A randomised controlled trial Effect of Daily Consumption of Probiotic Yogurt on Oxidative Stress in Pregnant Women: A Randomized Controlled Clinical Trial Effect of daily consumption of probiotic yoghurt on lipid profiles in pregnant women: a randomized controlled clinical trial Influence of regular aerobic exercise on endothelium-dependent vasodilation and cardiorespiratory fitness in pregnant women. 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. Exercise Is Associated with a Reduction in Gestational Diabetes Mellitus. No effect of the FitFor2 exercise programme on blood glucose, insulin sensitivity, and birthweight in pregnant women who were overweight and at risk for gestational diabetes: results of a randomised controlled trial Effects of daily consumption of probiotic yoghurt on inflammatory factors in pregnant women: a randomized controlled trial. Postpartum Depression: A Randomized Trial of Sertraline Versus Nortriptyline Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. 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 The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women. The Effects of Exercise Conditioning in Normal and Overweight Pregnant Women on Blood Pressure and Heart Rate Variability Weight-related SMS texts promoting appropriate pregnancy weight gain: a pilot study. Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.
Background Overweight and obesity is a significant health concern during pregnancy . Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity . Methods We conducted a r and omised controlled trial , in which pregnant women with a body mass index ≥25 kg/m2 , and singleton gestation between 10 + 0 to 20 + 0 weeks were recruited and r and omised to Lifestyle Advice ( involving a comprehensive dietary and lifestyle intervention over their pregnancy ) or St and ard Care . Within the intervention group , we conducted a nested r and omised trial in which a subgroup of women were further r and omised to receive access to supervised group walking sessions in addition to the st and ard information presented during the intervention contacts ( the Walking group ) or st and ard information only . The outcome measures were maternal dietary intake , ( including food groups , macronutrient and micronutrient intake , diet quality ( using the Healthy Eating Index ; HEI ) , dietary glycaemic load , and glycaemic index ) and maternal physical activity . Women completed the Harvard Semi-Structured Food Frequency Question naire , and the Short Question naire to Assess Health-enhancing Physical Activity ( SQUASH ) , at trial entry , 28 and 36 weeks ’ gestational age , and 4 months postpartum . Analyses were performed on an intention-to-treat basis , using linear mixed effects models with adjustment for the stratification variables . Results Women r and omised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day , as well as increased consumption of fibre , and reduced percentage energy intake from saturated fats ( P < 0.05 for all ) . Maternal HEI was significantly improved at both 28 ( 73.35 ± 6.62 versus 71.86 ± 7.01 ; adjusted difference in means 1.58 ; 95 % CI 0.89 to 2.27 ; P < 0.0001 ) and 36 ( 72.95 ± 6.82 versus 71.17 ± 7.69 ; adjusted difference in means 1.77 ; 95 % CI 1.01 to 2.53 ; P < 0.0001 ) weeks . There were no differences in dietary glycaemic index or glycaemic load . Women r and omised to Lifestyle Advice also demonstrated greater total physical activity ( adjusted difference in means 359.76 metabolic equivalent task units ( MET ) minutes/week ; 95 % CI 74.87 to 644.65 ; P = 0.01 ) compared with women receiving St and ard Care . The supervised walking group was poorly utilised . Conclusions For women who are overweight or obese , antenatal lifestyle advice improves maternal diet and physical activity during pregnancy . Please see related articles : http://www.biomed central .com/1741 - 7015/12/163 and http://www.biomed central .com/1741 - 7015/12/201.Trial registration Australian and New Zeal and Clinical Trials Registry ( http://ACTRN12607000161426 Background Obesity is a significant global health problem , with the proportion of women entering pregnancy with a body mass index greater than or equal to 25 kg/m2 approaching 50 % . Obesity during pregnancy is associated with a well-recognised increased risk of adverse health outcomes both for the woman and her infant , however there is more limited information available regarding effective interventions to improve health outcomes .The aims of this r and omised controlled trial are to assess whether the implementation of a package of dietary and lifestyle advice to overweight and obese women during pregnancy to limit gestational weight gain is effective in improving maternal , fetal and infant health outcomes . Methods / Design Design : Multicentred r and omised , controlled trial . Inclusion Criteria : Women with a singleton , live gestation between 10 + 0 - 20 + 0 weeks who are obese or overweight ( defined as body mass index greater than or equal to 25 kg/m2 ) , at the first antenatal visit . Trial Entry & R and omisation : Eligible , consenting women will be r and omised between 10 + 0 and 20 + 0 weeks gestation using a central telephone r and omisation service , and r and omisation schedule prepared by non- clinical research staff with balanced variable blocks . Stratification will be according to maternal BMI at trial entry , parity , and centre where planned to give birth . Treatment Schedules : Women r and omised to the Dietary and Lifestyle Advice Group will receive a series of inputs from research assistants and research dietician to limit gestational weight gain , and will include a combination of dietary , exercise and behavioural strategies .  Women r and omised to the St and ard Care Group will continue to receive their pregnancy care according to local hospital guidelines , which does not currently include routine provision of dietary , lifestyle and behavioural advice . Outcome assessors will be blinded to the allocated treatment group . Primary Study Outcome : infant large for gestational age ( defined as infant birth weight ≥ 90th centile for gestational age ) . Sample Size : 2,180 women to detect a 30 % reduction in large for gestational age infants from 14.40 % ( p = 0.05 , 80 % power , two-tailed ) . Discussion This is a protocol for a r and omised trial . The findings will contribute to the development of evidence based clinical practice guidelines .Trial Registration Australian and New Zeal and Clinical Trials Registry Background Gestational Diabetes Mellitus ( GDM ) has well recognised adverse health implication s for the mother and her newborn that are both short and long term . Obesity is a significant risk factor for developing GDM and the prevalence of obesity is increasing globally . It is a matter of public health importance that clinicians have evidence based strategies to inform practice and currently there is insufficient evidence regarding the impact of dietary and lifestyle interventions on improving maternal and newborn outcomes . The primary aim of this study is to measure the impact of a telephone based intervention  that promotes positive lifestyle modifications on the incidence of GDM . Secondary aims include : the impact on gestational weight gain ; large for gestational age babies ; differences in blood glucose levels taken at the Oral Glucose Tolerance Test ( OGTT ) and selected factors relating to self-efficacy and psychological wellbeing . Method / design A r and omised controlled trial ( RCT ) will be conducted involving pregnant women who are overweight ( BMI > 25 to 29.9 k/gm2 ) or obese ( BMI > 30 kgm/2 ) , less than 14 weeks gestation and recruited from the Barwon South West region of Victoria , Australia . From recruitment until birth , women in the intervention group will receive a program informed by the Theory of Self-efficacy and employing Motivational Interviewing . Brief ( less than 5 minute ) phone contact will alternate with a text message/email and will involve goal setting , behaviour change reinforcement with weekly weighing and charting , and the provision of health information . Those in the control group will receive usual care . Data for primary and secondary outcomes will be collected from medical record review and a question naire at 36 weeks gestation . Discussion Evidence based strategies that reduce the incidence of GDM are a priority for contemporary maternity care . Changing health behaviours is a complex undertaking and trialling a composite intervention that can be adopted in various primary health setting s is required so women can be accessed as early in pregnancy as possible . Using a sound theoretical base to inform such an intervention will add depth to our underst and ing of this approach and to the interpretation of results , contributing to the evidence base for practice and policy . Trial registration This trial is registered with the Australian New Zeal and Clinical Trials Registry ( ANZCTR ) : OBJECTIVE To pilot , among women with gestational diabetes mellitus ( GDM ) , the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program . The intervention was delivered by telephone , and support for breastfeeding was addressed . RESEARCH DESIGN AND METHODS The goal was to help women return to their prepregnancy weight , if it was normal , or achieve a 5 % reduction from prepregnancy weight if overweight . Eligible participants were identified shortly after a GDM diagnosis ; 83.8 % consented to be r and omly assigned to intervention or usual medical care ( 96 and 101 women , respectively ) . The retention was 85.2 % at 12 months postpartum . RESULTS The proportion of women who reached the postpartum weight goal was higher , although not statistically significant , in the intervention condition than among usual care ( 37.5 vs. 21.4 % , absolute difference 16.1 % , P = 0.07 ) . The intervention was more effective among women who did not exceed the recommended gestational weight gain ( difference in the proportion of women meeting the weight goals : 22.5 % , P = 0.04 ) . The intervention condition decreased dietary fat intake more than the usual care ( condition difference in the mean change in percent of calories from fat : −3.6 % , P = 0.002 ) and increased breastfeeding , although not significantly ( condition difference in proportion : 15.0 % , P = 0.09 ) . No differences in postpartum physical activity were observed between conditions . CONCLUSIONS This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight . Strategies to help postpartum women overcome barriers to increasing physical activity are needed 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 Background The costs of gestational diabetes mellitus ( GDM ) screening have been frequently reported , but total GDM-related health care costs compared to the health care costs of women without GDM have not been reported . The aim of this study was to analyse GDM-related health care costs among women with an elevated risk of GDM . Methods The study was based on a cluster-r and omised GDM prevention trial ( N = 848 ) carried out at maternity clinics , combined with data from the Finnish Medical Birth Register and Care Registers for Social Welfare and Health Care . Costs of outpatient visits to primary and secondary care , cost of inpatient hospital care before and after delivery , the use of insulin , delivery costs and babies ’ stay in the neonatal intensive care unit were analysed . Women who developed GDM were compared to those who were not diagnosed with GDM . Results Total mean health care costs adjusted for age , body mass index and education were 25.1 % higher among women diagnosed with GDM ( € 6,432 vs. € 5,143 , p < 0.001 ) than among women without GDM . The cost of inpatient visits was 44 % higher and neonatal intensive care unit use was 49 % higher in the GDM group than among women without GDM . The delivery costs were the largest single component in both groups . Conclusions A confirmed GDM diagnosis was associated with a significant increase in total health care costs . Effective lifestyle counselling by primary health care providers may offer a means of reducing the high costs of secondary care Background Fetal conditions are known to be partly responsible for the child ’s risk for obesity . Our pilot study aim ed to determine the effect of gestational lifestyle counseling on the  offspring weight gain until 4 years of age and to estimate power for future studies . Design and methods First-time pregnant mothers participated in a controlled trial conducted in maternity health clinics during 2004 – 2006 . The intervention included individual counseling on physical activity and diet , and an option to attend supervised group exercise sessions .  The participant mothers ( N = 109 ) received a follow-up question naire concerning 13 repeated growth measurements of their offspring . Response rate to the follow-up question naire was 66.1 % ( N = 72/109 ) . Results The increase of BMI z-score between 24–48 months was not significantly slower among the intervention group offspring ( 95 % CI −0.025 to 0.009 , p = 0.34 ) compared to control group . Z-scores for weight-for-length/height did not differ between groups when the period 0–48 months was analyzed ( 95 % CI −0.010 to 0.014 , p = 0.75 ) . Conclusions In this pilot study gestational lifestyle counseling did not significantly slow the weight gain of the offspring . Gestational intervention studies with at least 300 mothers per group are needed to confirm the possible effect on offspring ’s risk for obesity . Trial registration Current Controlled Trials IS RCT N21512277 OBJECTIVE to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum , or from birth to six months post partum , on weight retention among Taiwanese women . DESIGN a r and omised controlled trial assigned participants to two experimental groups [ from pregnancy to six months post partum ( EP ) and from birth to six months post partum ( EPP ) ] and one comparison group . SETTING a 3900-bed medical centre in northern Taiwan with around 3000 births annually . PARTICIPANTS a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre . INTERVENTIONS the comparison group received the routine outpatient department obstetric educational programme . The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum , and received on brochure . The EPP group received the same educational intervention as the EP group from 24 - 48 hours after birth to six months post partum . MEASUREMENTS body weight , body mass index , health-promoting behaviour and psycho-social variables ( self-efficacy , body image , depression and social support ) . FINDINGS average gestational weight gain was 14.02 , 15.27 and 16.22 kg in the three EP , EPP and comparison groups respectively , and average weight retention at six months post partum was 2.34 , 4.06 and 5.08 kg in the three groups , respectively . KEY CONCLUSIONS a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention . IMPLICATION S FOR PRACTICE the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle Background : To reach fetal appropriate growth during the third trimester , the requirements for dietary calcium and iron intakes during the pregnancy increases . This study was carried out to determine the effects of daily consumption of probiotic yoghurt on serum calcium and iron levels and liver enzymes among Iranian healthy pregnant women . Methods : In this controlled clinical trial , 70 primigravida pregnant women carrying singleton pregnancy at their third trimester were participated . Participants were r and omly divided into two groups of consuming 200 g/d of conventional ( n = 33 ) or probiotic yogurts ( n = 37 ) for 9 weeks . The probiotic yogurt contained Lactobacillus acidophilus and Bifidobacterium lactis with a total of min 1 × 107 CFU . To measure serum calcium , iron , aspartate aminotransferase ( AST ) and alanine aminotransferase ( ALT ) levels , blood sample s were drawn in a fasting state at baseline and after 9 weeks intervention . Results : Consumption of probiotic yogurt result ed in maintaining serum calcium levels compared with the conventional yogurt ( P = 0.01 ) . Within-group differences in the conventional yogurt group revealed a significant reduction of serum calcium levels ( −1.7 mg/dL , P < 0.0001 ) . No significant differences were found between the two yogurts in terms of their effects on serum iron , AST and ALT levels . Conclusions : Consumption of probiotic yogurt among pregnant women result ed in maintaining serum calcium levels compared with the conventional yogurt ; however , it could not affect serum iron , ALT and AST levels 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 : Background Pregnancy is a time of significant physiological and physical change for women . In particular , it is a time at which many women are at risk of gaining excessive weight . We describe the rationale and methods of the Health in Pregnancy and Post-birth ( HIPP ) Study , a study which aims primarily to determine the effectiveness of a specialized health coaching ( HC ) intervention during pregnancy , compared to education alone , in preventing excessive gestational weight gain and postpartum weight retention 12 months post birth . A secondary aim of this study is to evaluate the mechanisms by which our HC intervention impacts on weight management both during pregnancy and post birth . Methods / Design The r and omized controlled trial will be conducted with 220 women who have a BMI > 18.5 ( American IOM cut-off for normal weight ) , are 18 years of age or older , English speaking , no history of disordered eating or diabetes and are less than 18 weeks gestation at recruitment . Women will be r and omly allocated to either a specialized HC intervention group or an Education Alone group . Our specialized HC intervention has two components : ( 1 ) one-on-one sessions with a Health Coach , and ( 2 ) two by two hour educational group sessions led by a Health Coach . Women in the Education Alone group will receive two by two hour educational group sessions with no HC components .  Body Mass Index , waist circumference , and psychological factors including motivation , readiness to change , symptoms of depression and anxiety , and body dissatisfaction will be assessed at baseline ( 14 - 16 weeks gestation ) , and again at follow-up : 32 weeks gestation , 6 weeks , 6 months and 12 months postpartum . Discussion Our study responds to the urgent need to design effective interventions in pregnancy to prevent excessive gestational weight gain and postpartum weight retention . Our pregnancy HC intervention is novel and innovative and has been design ed to be easily adopted by health professionals who work with pregnant women , such as obstetricians , midwives , allied health professionals and health psychologists . Trial registration Australian New Zeal and Clinical Trials Registry Background Women with gestational diabetes ( GDM ) are at high risk of developing diabetes later in life . After a GDM diagnosis , women receive prenatal care to control their blood glucose levels via diet , physical activity and medications . Continuing such lifestyle skills into early motherhood may reduce the risk of diabetes in this high risk population . In the Gestational Diabetes ’ Effects on Moms ( GEM ) study , we are evaluating the comparative effectiveness of diabetes prevention strategies for weight management design ed for pregnant/postpartum women with GDM and delivered at the health system level . Methods / Design The GEM study is a pragmatic cluster r and omized clinical trial of 44 medical facilities at Kaiser Permanente Northern California r and omly assigned to either the intervention or usual care conditions , that includes 2,320 women with a GDM diagnosis between March 27 , 2011 and March 30 , 2012 . A Diabetes Prevention Program-derived print/telephone lifestyle intervention of 13 telephonic sessions tailored to pregnant/postpartum women was developed . The effectiveness of this intervention added to usual care is to be compared to usual care practice s alone , which includes two pages of printed lifestyle recommendations sent to postpartum women via mail . Primary outcomes include the proportion of women who reach a postpartum weight goal and total weight change . Secondary outcomes include postpartum glycemia , blood pressure , depression , percent of calories from fat , total caloric intake and physical activity levels . Data were collected through electronic medical records and surveys at baseline ( soon after GDM diagnosis ) , 6 weeks ( range 2 to 11 weeks ) , 6 months ( range 12 to 34 weeks ) and 12 months postpartum ( range 35 to 64 weeks ) . Discussion There is a need for evidence regarding the effectiveness of lifestyle modification for the prevention of diabetes in women with GDM , as well as confirmation that a diabetes prevention program delivered at the health system level is able to successfully reach this population . Given the use of a telephonic case management model , our Diabetes Prevention Program-derived print/telephone intervention has the potential to be adopted in other setting s and to inform policies to promote the prevention of diabetes among women with GDM.Trial registration Clinical Trials.gov number , NCT01344278 Background Both maternal pre-pregnancy obesity and excessive gestational weight gain are increasing in prevalence and associated with a number of adverse pregnancy outcomes for both mother and child . Observational studies regarding physical activity in pregnancy have found reduced weight gain in active mothers , as well as reduced risk of adverse pregnancy outcomes . There is however a lack of high quality , r and omized controlled trials on the effects of regular exercise training in pregnancy , especially those with a pre-pregnancy body mass index ( BMI ) at or above 30 kg/m2 . Methods We are conducting a r and omised , controlled trial in Norway with two parallel arms ; one intervention group and one control group . We will enroll 150 previously sedentary , pregnant women with a pre-pregnancy BMI at or above 30 kg/m2 . The intervention group will meet for organized exercise training three times per week , starting in gestation week 14 ( range 12 - 16 ) . The control group will get st and ard antenatal care . The main outcome measure will be weight gain from baseline to delivery . Among the secondary outcome measures are changes in exercise capacity , endothelial function , physical activity level , body composition , serum markers of cardiovascular risk , incontinence , lumbopelvic pain and cardiac function from baseline to gestation week 37 ( range 36 - 38 ) . Offspring outcome measures include anthropometric variables at birth , Apgar score , as well as serum markers of inflammation and metabolism in cord blood . Discussion The results of this trial will provide knowledge about effects of regular exercise training in previously sedentary , obese pregnant women . If the program proves effective in reducing gestational weight gain and adverse pregnancy outcomes , such programs should be considered as part of routine pregnancy care for obese women . Trial Registration Clinical Trials.gov : Background Despite the widespread recognition that obesity in pregnant women is associated with adverse outcomes for mother and child , there is no intervention proven to reduce the risk of these complications . The primary aim of this r and omised controlled trial is to assess in obese pregnant women , whether a complex behavioural intervention , based on changing diet ( to foods with a lower glycemic index ) and physical activity , will reduce the risk of gestational diabetes ( GDM ) and delivery of a large for gestational age ( LGA ) infant . A secondary aim is to determine whether the intervention lowers the long term risk of obesity in the offspring . Methods / Design Multicentre r and omised controlled trial comparing a behavioural intervention design ed to improve glycemic control with st and ard antenatal care in obese pregnant women . Inclusion criteria ; women with a BMI ≥30 kg/m2 and a singleton pregnancy between 15 + 0 weeks and 18 + 6 weeks ’ gestation . Exclusion criteria ; pre-defined , pre-existing diseases and multiple pregnancy . R and omisation is on-line by a computer generated programme and is minimised by BMI category , maternal age , ethnicity , parity and centre . Intervention ; this is delivered by a health trainer over 8 sessions . Based on control theory , with elements of social cognitive theory , the intervention is design ed to improve maternal glycemic control . Women r and omised to the control arm receive st and ard antenatal care until delivery according to local guidelines . All women have a 75 g oral glucose tolerance test at 27 + 0- 28 + 6 weeks ’ gestation . Primary outcome ; Maternal : diagnosis of GDM , according to the International Association of Diabetes in Pregnancy Study Group ( IADPSG ) criteria . Neonatal ; infant LGA defined as > 90th customised birth weight centile . Sample size ; 1546 women to provide 80 % power to detect a 25 % reduction in the incidence of GDM and a 30 % reduction in infants large for gestational age . Discussion All aspects of this protocol have been evaluated in a pilot r and omised controlled trial , with subsequent optimisation of the intervention . The findings of this trial will inform whether lifestyle mediated improvement of glycemic control in obese pregnant women can minimise the risk of pregnancy complications . Trial registration Current controlled trials ; IS RCT N89971375 Background The in utero environment is known to affect fetal development however many of the mechanisms by which this occurs remain unknown . The aim of this study was to examine the association between maternal dietary macronutrient intake and lifestyle throughout pregnancy and neonatal weight and adiposity . Methods This was an analysis of 542 mother and infant pairs from the ROLO study ( R and omised cOntrol trial of LOw glycaemic index diet versus no dietary intervention to prevent recurrence of fetal macrosomia ) . Food diaries as well as food frequency and lifestyle and physical activity question naires were completed during pregnancy . Maternal anthropometry was measured throughout pregnancy and neonatal anthropometry was measured at birth . Results Multiple linear regression analysis revealed the main maternal factor associated with increased birth weight was greater gestational weight gain R2adj23.3 % ( F = 11.547 , p < 0.001 ) . The main maternal factor associated with increased birth length was non-smoking status R2adj27.8 % ( F = 6.193 , p < 0.001 ) . Neonatal central adiposity ( determined using waist : length ratio ) was negatively associated with maternal age , and positively associated with the following parameters : smoking status , maternal pre-pregnancy arm circumference , percentage energy from saturated fat in late pregnancy , postpr and ial glucose at 28 weeks gestation and membership of the control group with a positive trend towards association with trimester 2 glycaemic load R2adj 38.1 % ( F = 8.000 , p < 0.001 ) . Conclusions Several maternal diet and lifestyle factors were associated with neonatal anthropometry .  Low glycaemic index dietary intervention in pregnancy was found to have a beneficial effect on neonatal central adiposity . Additionally , central adiposity was positively associated with maternal dietary fat intake and postpr and ial glucose highlighting the important role of healthy diet in pregnancy in promoting normal neonatal adiposity . Trial registration Current Controlled Trials IS RCT N54392969 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 a low glycaemic index diet in pregnancy could reduce the incidence of macrosomia in an at risk group . Design R and omised controlled trial . Setting Maternity hospital in Dublin , Irel and . Participants 800 women without diabetes , all in their second pregnancy between January 2007 to January 2011 , having previously delivered an infant weighing greater than 4 kg . Intervention Women were r and omised to receive no dietary intervention or start on a low glycaemic index diet from early pregnancy . Main outcomes The primary outcome measure was difference in birth weight . The secondary outcome measure was difference in gestational weight gain . Results No significant difference was seen between the two groups in absolute birth weight , birthweight centile , or ponderal index . Significantly less gestational weight gain occurred in women in the intervention arm ( 12.2 v 13.7 kg ; mean difference −1.3 , 95 % confidence interval −2.4 to −0.2 ; P=0.01 ) . The rate of glucose intolerance was also lower in the intervention arm : 21 % ( 67/320 ) compared with 28 % ( 100/352 ) of controls had a fasting glucose of 5.1 mmol/L or greater or a 1 hour glucose challenge test result of greater than 7.8 mmol/L ( P=0.02 ) . Conclusion A low glycaemic index diet in pregnancy did not reduce the incidence of large for gestational age  infants in a group at risk of fetal macrosomia . It did , however , have a significant positive effect on gestational weight gain and maternal glucose intolerance . Trial registration Current Controlled Trials IS RCT N54392969 INTRODUCTION Walking may be a strategy for increasing moderate-intensity physical activity ( MPA )  during pregnancy . PURPOSE This study aim ed to promote MPA among overweight and obese pregnant women , via walking , and to evaluate the effect of the intervention on maternal and birth outcomes . METHODS Thirty-seven overweight or obese pregnant women were r and omly assigned to a walking intervention or control group . Anthropometric and objective PA ( StepWatch ™ Activity Monitor ) data were collected for four 1-wk periods : weeks 10 - 14 ( V1 ) , weeks 17 - 19 ( V2 ) , weeks 27 - 29 ( V3 ) , and weeks 34 - 36 ( V4 ) of gestation . Participants provided information about maternal and birth outcomes . A cadence of ≥ 80 steps per minute was defined as MPA , and " meaningful walking " was defined as moderate walking in ≥ 8-min bouts . ANOVA was used to determine the differences in walking amount and meaningful walks , the Kolmogorov-Smirnov test was used for walking intensity distribution analysis , and Fisher 's exact test was used for maternal and infant outcomes analyses . Pearson correlation was used to examine the association between prepregnancy body mass index and gestational weight gain ( GWG ) . RESULTS There was significantly more MPA among women in the intervention group compared with those in the control group at V2 ( overweight , P < 0.0001 ; obese , P < 0.025 ) , V3 ( overweight , P < 0.0001 ) , and V4 ( overweight , P < 0.0001 ; obese , P < 0.025 ) . Women in the intervention group significantly increased their meaningful walks at V2 ( P = 0.054 ) , V3 ( P = 0.01 ) , and V4 ( P = 0.014 ) . There were trends for intervention group women to have more favorable maternal and birth outcomes compared with the control group . Rates of GWG at measurement points during pregnancy were significantly associated with preceding rates of GWG . CONCLUSION The pilot , unsupervised walking intervention increased the MPA of overweight and obese women during pregnancy Background Overweight and obesity during pregnancy represents a considerable health burden . While research has focused on interventions to limit gestational weight gain , there is little information describing their impact on neonatal health . Our aim was to investigate the effect on a range of pre-specified secondary neonatal outcomes of providing antenatal dietary and lifestyle advice to women who are overweight or obese . Methods We report a range of pre-specified secondary neonatal outcomes from a large r and omised trial in which antenatal dietary and lifestyle advice was provided to women who were overweight or obese . Pregnant women were eligible for participation with a body mass index of 25 kg/m2 or over , and singleton gestation between 10 + 0 and 20 + 0 weeks . Outcome measures included gestational age at birth ; Apgar score below 7 at 5 minutes of age ; need for resuscitation at birth ; birth weight above 4.5 kg or below 2.5 kg ; birth weight , length and head circumference ( and Z-scores ) ; admission to the nursery ; respiratory distress syndrome ; and postnatal length of stay . Data relating to the primary outcome ( large for gestational age infants defined as birth weight above the 90th centile ) and birth weight above 4 kg have been reported previously . Analyses used intention-to-treat principles . Results In total , 2,142 infants were included in the analyses . Infants born to women following lifestyle advice were significantly less likely to have birth weight above 4.5 kg ( 2.15 % versus 3.69 % ; adjusted risk ratio ( aRR ) = 0.59 ; 95 % confidence interval ( CI ) 0.36 to 0.98 ; P = 0.04 ) , or respiratory distress syndrome ( 1.22 % versus 2.57 % ; aRR = 0.47 ; 95 % CI 0.24 to 0.90 ; P = 0.02 ) , particularly moderate or severe disease , and had a shorter length of postnatal hospital stay ( 3.94 ± 7.26 days versus 4.41 ± 9.87 days ; adjusted ratio of means 0.89 ; 95 % CI 0.82 to 0.97 ; P = 0.006 ) compared with infants born to women who received St and ard Care . Conclusions For women who are overweight or obese , antenatal dietary and lifestyle advice has health benefits for infants , without an increase in the risk of harm . Continued follow-up into childhood will be important to assess the longer-term effects of a reduction in high infant birth weight on risk of child obesity . Please see related articles : http://www.biomed central .com/1741 - 7015/12/161 and http://www.biomed central .com/1741 - 7015/12/201 . Clinical trial registration Australian and New Zeal and Clinical Trials Registry ( http://ACTRN12607000161426 INTRODUCTION Excessive and inadequate gestational weight gain can complicate a woman 's pregnancy and put her and her child at risk for poor delivery and birth outcomes . Further , feeding and activity habits established early in life can significantly impact the development of childhood obesity . METHODS The on-going Delta Healthy Sprouts Project is a r and omized , controlled , comparative trial testing the efficacy of two Maternal , Infant , and Early Childhood Home Visiting programs on weight status and health behaviors of 150 mothers and their infants residing in the rural Mississippi Delta region of the United States . Women are enrolled in their second trimester of pregnancy and r and omized to one of two treatment arms . The control arm curriculum is based on Parents as Teachers , an evidence based approach to increase parental knowledge of child development and improve parenting practice s. The experimental arm , labeled Parents as Teachers Enhanced , builds upon the control curriculum by including culturally tailored nutrition and physical activity components specifically design ed for the gestational and postnatal periods . We hypothesize that , as compared to the control arm , the experimental arm will be more effective in preventing inappropriate gestational weight gain , reducing postnatal weight retention , and decreasing infant obesity rates . We also will evaluate mother and child dietary and physical activity outcomes , breastfeeding initiation and continuation , and child feeding practice s. CONCLUSION The Delta Healthy Sprouts Project tests a novel , combined approach to maternal weight management and childhood obesity prevention in pregnant women and their children at high risk for obesity and chronic disease Oxidized LDL lipids ( ox-LDL ) are associated with lifestyle diseases such as cardiovascular diseases , metabolic syndrome and type 2 diabetes . The present study investigated how postpartum weight retention effects on ox-LDL and serum lipids . The study is a nested comparative research of a cluster-r and omized controlled trial , NELLI ( lifestyle and counselling during pregnancy ) . During early pregnancy ( 8–12 weeks ) and 1 year postpartum , 141 women participated in measurements for determining of plasma lipids : total cholesterol ( T-C ) , LDL-cholesterol ( LDL-C ) , HDL-cholesterol ( HDL-C ) , triacylglycerols ( TAG ) and ox-LDL . Subjects were stratified into tertiles ( weight loss , unaltered weight and weight gain groups ) based on their weight change from baseline to follow-up . Ox-LDL was determined by baseline level of conjugated dienes in LDL lipids . Among the group of weight gainers , concentration of TAG reduced less ( −0.14 vs. −0.33 , p = 0.002 ) , HDL-C reduced more ( −0.31 vs. −0.16 , p = 0.003 ) and ox-LDL/HDL-C ratio increased ( 3.0 vs. −0.2 , p = 0.003 ) when compared to group of weight loss . Both T-C and LDL-C elevated more ( 0.14 vs. −0.21 , p = 0.008 ; 0.31 vs. 0.07 , p = 0.015 ) and TAG and ox-LDL reduced less ( −0.33 vs. 0.20 , p = 0.033 ; −3.33 vs. −0.68 , p = 0.026 ) in unaltered weight group compared to weight loss group . The women who gained weight developed higher TAG and ox-LDL/HDL-C ratio as compared to those who lost weight . Postpartum weight retention of 3.4 kg or more is associated with atherogenic lipid profile To our knowledge , no reports are available indicating the effects of synbiotic food consumption on blood lipid profiles and biomarkers of oxidative stress among pregnant women . This study was conducted to evaluate the effects of daily consumption of a synbiotic food on blood lipid profiles and biomarkers of oxidative stress in pregnant women . This r and omized , double-blind , controlled clinical trial was performed among 52 primigravida pregnant women , aged 18 to 35-year-old at their third trimester . After a 2-week run-in period , subjects were r and omly assigned to consume either a synbiotic ( n = 26 ) or control food ( n = 26 ) for 9 weeks . The synbiotic food consisted of a probiotic viable and heat-resistant Lactobacillus sporogenes ( 1 × 107 CFU ) and 0.04 g inulin (HPX)/g as the prebiotic . Patients were asked to consume the synbiotic and control foods two times a day . Biochemical measurements including blood lipid profiles , plasma total antioxidant capacity ( TAC ) and total glutathione ( GSH ) were conducted before and after 9 weeks of intervention . Consumption of a synbiotic food for 9 weeks result ed in a significant reduction in serum TAG ( P = 0.04 ) , VLDL ( P = 0.04 ) and a significant rise in plasma GSH levels ( P = 0.004 ) compared to the control food . No significant effects of the synbiotic food consumption on serum TC , LDL , HDL and plasma TAC levels ( P > 0.05 ) were observed . Trial registry code : http://www.i rct .ir . I RCT 201212105623N3 Background / Objectives : The mother is an important mediator to the infant of polyunsaturated fatty acids ( PUFA ) , the essential constituents of membranes particularly in the brain and retina . We here aim ed in a prospect i ve study initiated in early pregnancy to establish whether serum fatty acid ( FA ) compositions and concentrations in the mother can be modified by dietary means emphasizing counseling on a recommended diet . Subjects/ Methods : Ninety women in the first trimester of pregnancy were r and omized into intervention ( n=45 ) or  control ( n=45 ) groups . The intervention comprised individual dietary counseling advocating choice of foods that will increase the intake of unsaturated and reduce that of saturated FA . To support this , appropriate products , including spreads , were provided for consumption at home . Dietary intakes were measured from food records and serum phospholipids , cholesteryl esters and triacylglycerols FA were analyzed by gas chromatography . Results : Dietary counseling result ed in lower intake of saturated and higher intake of unsaturated FA compared with the controls . These changes were reflected in higher proportions of serum phospholipid PUFA ( mean difference between groups 0.61 % ( 95 % confidence interval , CI 0.05–1.17 ) , P=0.03 ) , docosahexaenoic acid ( 0.5 % ( 0.15–0.85 ) , P=0.01 ) , sum of n-3 FA ( 0.61 % ( 0.07–1.15 ) , P=0.03 ) and lower ratio of n-6/n-3 FA ( −0.42 % ( −0.81–0.03 ) , P=0.03 ) in the intervention group at the third trimester of pregnancy but not at 1 month postpartum . Similar changes were seen in the FA of cholesteryl esters and triacylglycerols . Conclusion : Maternal serum n-3 FA status during pregnancy can be improved by dietary means emphasizing the importance of dietary advice BACKGROUND AND AIM Early nutrition may programme blood lipid levels and thereby later  cardiovascular health of children . The objective here was to evaluate the effects of maternal dietary counselling during pregnancy and breastfeeding on  dietary intakes and blood lipid values in 1 - 4 year-old children . Further , the nutritional determinants of children 's lipid profiles were assessed . METHODS AND RESULTS Mothers were r and omised into dietary counselling or control groups at the first trimester of pregnancy . Their children were followed up clinical ly at 1 , 2 and 4 years of age , by three-day food records and analyses of total cholesterol , HDL cholesterol and apolipoproteins A-I and B as well as lipoprotein ( a ) . In general , the mean intake of saturated fatty acids as a proportion of total energy intake ( E% ) was higher than the recommended , while the mean intake of polyunsaturated fatty acids was low in children 's diet . Over the first years , girls had higher concentration of non-HDL cholesterol than boys ; 2.64 mmol/l ( 95 % CI 2.54 - 2.74 ) vs. 2.49 ( 2.38 - 2.60 ) ; p = 0.038 . Maternal dietary counselling was not reflected in the children 's lipid values . Children 's monounsaturated fatty acid intake ( E% ) correlated with apoA-I ( p = 0.048 ) and , furthermore , there was a negative correlation between polyunsaturated fatty acid intake ( E% ) and apoB ( p = 0.046 ) . CONCLUSION Children 's dietary fatty acid intake , but not maternal dietary counselling was shown to be related to blood apolipoproteins in children Background Excessive gestational weight gain ( GWG ) is associated with short- and long-term health problems among mothers and their offspring . There is a strong need for effective intervention strategies targeting excessive GWG to prevent adverse outcomes . Methods We performed a cluster-r and omized controlled intervention trial in eight gynecological practice s evaluating the feasibility and effectiveness of a lifestyle intervention presented to all pregnant women ; 250 healthy , pregnant women were recruited for the study . The intervention program consisted of two individually delivered counseling sessions focusing on diet , physical activity , and weight monitoring . The primary outcome was the proportion of pregnant women exceeding weight gain recommendations of the Institute of Medicine ( IOM ) . Secondary outcome variables were maternal weight retention and short-term obstetric and neonatal outcomes . Results The intervention result ed in a lower proportion of women exceeding IOM guidelines among women in the intervention group ( 38 % ) compared with the control group ( 60 % ) ( odds ratio ( OR ) : 0.5 ; 95 % confidence interval ( CI ) : 0.3 to 0.9 ) without prompting an increase in the proportion of pregnancies with suboptimal weight gain ( 19 % vs. 21 % ) . Participants in the intervention group gained significantly less weight than those in the control group . Only 17 % of the women in the intervention group showed substantial weight retention of more than 5 kg compared with 31 % of those in the control group at month four postpartum ( pp ) ( OR : 0.5 ; 95 % CI : 0.2 to 0.9 ) . There were no significant differences in obstetric and neonatal outcomes . Conclusions Lifestyle counseling given to pregnant women reduced the proportion of pregnancies with excessive GWG without increasing suboptimal weight gain , and may exert favorable effects on pp weight retention . Trial registration German Clinical Trials Register DRKS00003801 Background Complex interventions in obese pregnant women should be theoretically based , feasible and shown to demonstrate anticipated behavioural change prior to inception of large r and omised controlled trials ( RCTs ) . The aim was to determine if a ) a complex intervention in obese pregnant women leads to anticipated changes in diet and physical activity behaviours , and b ) to refine the intervention protocol through process evaluation of intervention fidelity . Methods We undertook a pilot RCT of a complex intervention in obese pregnant women , comparing routine antenatal care with an intervention to reduce dietary glycaemic load and saturated fat intake , and increase physical activity . Subjects included 183 obese pregnant women ( mean BMI 36.3 kg/m2).Diet was assessed by repeated triple pass 24-hour dietary recall and physical activity by accelerometry and question naire , at 16 + 0 to 18 + 6 and at 27 + 0 to 28 + 6 weeks ’ gestation in women in control and intervention arms . Attitudes to behaviour change and quality of life were assessed and a process evaluation undertaken . The full RCT protocol was undertaken to assess feasibility . Results Compared to women in the control arm , women in the intervention arm had a significant reduction in dietary glycaemic load ( 33 points , 95 % CI −47 to −20 ) , ( p < 0.001 ) and saturated fat intake ( −1.6 % energy , 95 % CI −2.8 to −0 . 3 ) at 28 weeks ’ gestation . Objective ly measured physical activity did not change . Physical discomfort and sustained barriers to physical activity were common at 28 weeks ’ gestation . Process evaluation identified barriers to recruitment , group attendance and compliance , leading to modification of intervention delivery . Conclusions This pilot trial of a complex intervention in obese pregnant women suggests greater potential for change in dietary intake than for change in physical activity , and through process evaluation illustrates the considerable advantage of performing an exploratory trial of a complex intervention in obese pregnant women before undertaking a large RCT .Trial registration Trial Registration Number : IS RCT Objective To determine the effect of antenatal dietary and lifestyle interventions on health outcomes in overweight and obese pregnant women . Design Multicentre r and omised trial . We utilised a central telephone r and omisation server , with computer generated schedule , balanced variable blocks , and stratification for parity , body mass index ( BMI ) category , and hospital . Setting Three public maternity hospitals across South Australia . Participants 2212 women with a singleton pregnancy , between 10 + 0 and 20 + 0 weeks ’ gestation , and BMI ≥25 . Interventions 1108 women were r and omised to a comprehensive dietary and lifestyle intervention delivered by research staff ; 1104 were r and omised to st and ard care and received pregnancy care according to local guidelines , which did not include such information . Main outcome measures Incidence of infants born large for gestational age ( birth weight ≥90th centile for gestation and sex ) . Prespecified secondary outcomes included birth weight > 4000 g , hypertension , pre-eclampsia , and gestational diabetes . Analyses used intention to treat principles . Results 2152 women and 2142 liveborn infants were included in the analyses . The risk of the infant being large for gestational age was not significantly different in the two groups ( lifestyle advice 203/1075 ( 19 % ) v st and ard care 224/1067 ( 21 % ) ; adjusted relative risk 0.90 , 95 % confidence interval 0.77 to 1.07 ; P=0.24 ) . Infants born to women after lifestyle advice were significantly less likely to have birth weight above 4000 g ( lifestyle advice 164/1075 ( 15 % ) v st and ard care 201/1067 ( 19 % ) ; 0.82 , 0.68 to 0.99 ; number needed to treat ( NNT ) 28 , 15 to 263 ; P=0.04 ) . There were no differences in maternal pregnancy and birth outcomes between the two treatment groups . Conclusions For women who were overweight or obese , the antenatal lifestyle advice used in this study did not reduce the risk delivering a baby weighing above the 90th centile for gestational age and sex or improve maternal pregnancy and birth outcomes . Trial registration Australian and New Zeal and Clinical Trials Registry ( ACTRN12607000161426 ) Background Obesity during pregnancy is associated with adverse outcomes for the offspring and mother . Lifestyle interventions in pregnancy such as antenatal exercise , are proposed to improve both short- and long-term health of mother and child . We hypothesise that regular moderate-intensity exercise during the second half of pregnancy will result in improved maternal and offspring outcomes , including a reduction in birth weight and adiposity in the offspring , which may be protective against obesity in later life . Methods / Design The IMPROVE ( Improving Maternal and Progeny Risks of Obesity Via Exercise ) study is a two-arm parallel r and omised controlled clinical trial being conducted in Auckl and , New Zeal and . Overweight and obese women ( BMI ≥25 kg/m2 ) aged 18–40 years , with a singleton pregnancy of < 20 weeks of gestation , from the Auckl and region , are eligible for the trial . Exclusion criteria are ongoing smoking or medical contra-indications to antenatal exercise . Participants are r and omised with 1:1 allocation ratio to either intervention or control group , using computer-generated r and omisation sequences in variable block sizes , stratified on ethnicity and parity , after completion of baseline assessment s. The intervention consists of a 16-week structured home-based moderate-intensity exercise programme utilising stationary cycles and heart rate monitors , commencing at 20 weeks of gestation . The control group do not receive any exercise intervention . Both groups undergo regular fetal ultrasonography and receive st and ard antenatal care . Due to the nature of the intervention , participants are un-blinded to group assignment during the trial . The primary outcome is offspring birth weight . Secondary offspring outcomes include fetal and neonatal body composition and anthropometry , neonatal complications and cord blood metabolic markers . Maternal outcomes include weight gain , pregnancy and delivery complications , aerobic fitness , quality of life , metabolic markers and post-partum body composition . Discussion The results of this trial will provide valuable insights on the effects of antenatal exercise on health outcomes in overweight and obese mothers and their offspring . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12612000932864 AIM The effect of exercise training during the course of pregnancy on the newborn 's birth weight is unclear . This study examines the effect of aerobic and strength conditioning exercise performed during the second and the third trimester of pregnancy in nulliparous , previously inactive women on the newborn 's outcome . METHODS Sixty-three nulliparous , previously sedentary , were r and omly assigned to either an exercise ( N.=30 ) or a control ( N.=33 ) group . The subjects participated in the exercise group ( EG ) focused on aerobic and strength-conditioning exercise in three sessions for about 20 weeks . We registered the birth weight , birth length , gestational age at time of delivery , Apgar score and head circumference of the newborn . RESULTS There were no statistically significant differences between the two groups in mean birth weight , length , head circumference , and length of gestation . There was a significant difference between two groups in Apgar scores at 1 min ( P=0.036 ) and 5 min ( P=0.015 ) with newborns of the EG scoring higher than the CG . CONCLUSION Supervised , aerobic and strength conditioning exercise performed over the second and third trimester of pregnancy does not have a negative impact on the newborn 's body size and health OBJECTIVE Optimizing gestational weight gain ( GWG ) in early pregnancy is of clinical and public health importance , especially in higher risk pregnancies . DESIGN AND METHODS In a robustly design ed , r and omized controlled trial , 228 pregnant women at risk of developing gestational diabetes mellitus ( GDM ) were allocated to either control ( written health information only ) or intervention ( four-session lifestyle program ) . All women received st and ard maternal care . Measures were completed at 12 - 15 and 26 - 28 weeks gestation . Measures included anthropometrics ( weight and height ) , physical activity ( pedometer and International Physical Activity Question naire ) , question naires ( risk perception ) , and GDM screening . RESULTS The mean ( SD ) age [ 31.7 ( 4.5 ) and 32.4 ( 4.7 ) years ] and body mass index [ BMI ; 30.3 ( 5.9 ) and 30.4 ( 5.6 ) kg/m(2 ) ] were similar between control and intervention groups , respectively . By 28 weeks , GWG was significantly different between control and intervention groups [ 6.9 ( 3.3 ) vs. 6.0 ( 2.8 ) kg , P < 0.05 ] . When stratified according to baseline BMI , overweight women in the control group gained significantly more weight compared to overweight women in the intervention group [ 7.8 ( 3.4 ) vs. 6.0 ( 2.2 ) kg , P < 0.05 ] , yet in obese women , GWG was similar in both groups . Physical activity levels declined by 28 weeks gestation overall ( P < 0.01 ) ; however , the intervention group retained a 20 % higher step count compared to controls [ 5,203 ( 3,368 ) vs. 4,140 ( 2,420 ) steps/day , P < 0.05 ] . Overall , GDM prevalence was 22.8 % [ Corrected ] , with a trend toward less cases in the intervention group ( P = 0.1 ) . CONCLUSIONS Results indicate that a low-intensity lifestyle intervention , integrated with antenatal care , optimizes healthy GWG and attenuates physical activity decline in early pregnancy . Efficacy in limiting weight gain was greatest in overweight women and in high-risk ethnically diverse women Abstract Background Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women . The purpose of the intervention was to examine whether intensified physical activity ( PA ) counseling in Finnish maternity care is feasible and effective in promoting leisure-time PA ( LTPA ) among pregnant women at risk of gestational diabetes . Methods Fourteen municipalities were r and omized to intervention ( INT ) and usual care group ( UC ) . Nurses in INT integrated five PA counseling sessions into routine maternity visits and offered monthly group meetings on PA instructed by physiotherapists . In UC conventional practice s were continued . Feasibility evaluation included safety ( incidence of PA-related adverse events ; question naire ) , realization ( timing and duration of sessions , number of sessions missed , attendance at group meetings ; systematic record-keeping of the nurses and physiotherapists ) and applicability ( nurses ’ views ; telephone interview ) . Effectiveness outcomes were weekly frequency and duration of total and intensity-specific LTPA and meeting PA recommendation for health self-reported at 8 - 12 ( baseline ) , 26 - 28 and 36 - 37 weeks ’ gestation . Multilevel analysis with adjustments was used in testing for between-group differences in PA changes . Results The decrease in the weekly days of total and moderate-to-vigorous-intensity LTPA was smaller in INT ( N = 219 ) than in UC ( N = 180 ) from baseline to the first follow-up ( 0.1 vs. -1.2 , p = 0.040 and −0.2 vs. -1.3 , p = 0.016 ) . A similar trend was seen in meeting the PA recommendation ( −11%-points vs. -28%-points , p = 0.06 ) . INT did not experience more adverse events classified as warning signs to terminate exercise than UC , counseling was implemented as planned and viewed positively by the nurses . Conclusions Intensified counseling had no effects on the duration of total or intensity-specific weekly LTPA . However , it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity LTPA from baseline to the end of second trimester and was feasibly embedded into routine practice s . Trial registration IS RCT N 33885819 ( http://www.is rct n.org 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 The prevalence of gestational diabetes mellitus ( GDM ) is increasing worldwide . GDM and the risks associated with GDM lead to increased health care costs and losses in productivity . The objective of this study is to evaluate whether the FitFor2 exercise program during pregnancy is cost-effective from a societal perspective as compared to st and ard care . Methods A r and omised controlled trial ( RCT ) and simultaneous economic evaluation of the FitFor2 program were conducted . Pregnant women at risk for GDM were r and omised to an exercise program to prevent high maternal blood glucose ( n = 62 ) or to  st and ard care  ( n = 59 ) . The exercise program consisted of two sessions of aerobic and strengthening exercises per week . Clinical outcome measures were maternal fasting blood glucose levels , insulin sensitivity and infant birth weight . Quality of life was measured using the EuroQol 5-D and quality -adjusted life-years ( QALYs ) were calculated . Re source utilization and sick leave data were collected by question naires . Data were analysed according to the intention-to-treat principle . Missing data were imputed using multiple imputations . Bootstrapping techniques estimated the uncertainty surrounding the cost differences and incremental cost-effectiveness ratios . Results There were no statistically significant differences in any outcome measure . During pregnancy , total health care costs and costs of productivity losses were statistically non-significant ( mean difference € 1308 ; 95%CI € -229 - € 3204 ) . The cost-effectiveness analyses showed that the exercise program was not cost-effective in comparison to the control group for blood glucose levels , insulin sensitivity , infant birth weight or QALYs . Conclusion The twice-weekly exercise program for pregnant women at risk for GDM evaluated in the present study was not cost-effective compared to st and ard care . Based on these results , implementation of this exercise program for the prevention of GDM can not be recommended . Trial registration PURPOSE to evaluate the impact of dietary counseling on controlling weight gain in pregnant women , who were served in a public health service facility . METHODS the study was conducted at a known health unit located in the metropolitan region of the city of Porto Alegre , in Rio Gr and e do Sul , Brazil . Three hundred and fifteen pregnant women between the 10th and 29th week of gestation were r and omized to Control and Intervention Groups . The Intervention Group received dietary counseling according to nutritional status , and pregnant women in the Control Group were instructed to follow the routine of the health service facility . Weight and height were measured , and the body mass index ( BMI ) was calculated . The pre-gestational nutritional status was determined according to the following BMI criteria : low weight ( < 18.5 kg/m² ) , eutrophy ( 18.5 to 24.9 kg/m² ) , overweight ( 25.0 to 29.9 kg/m² ) , and obesity ( > 30 kg/m² ) . The nutritional status during pregnancy was determined according to the BMI curve for gestational age adopted by the Health Ministry of Brazil . Data were analyzed by the relative risk and respective 95 % confidence interval , and by the Student 's t-test and χ2 test . Statistical significance was set at p<0.05 . RESULTS the assessment of nutritional status before pregnancy showed that 28.0 % of the women were overweight and 4.1 % were underweight . In the first and last interview during pregnancy , the rates of prevalence of excessive weight were 36.2 and 46.0 % , respectively . The intervention proved to be effective in reducing the rate of weekly weight gain of pregnant women with excess weight ( 342.2 versus 420.2 ; p=0.015 ) and the prevalence of clinical complications ( 9.2 versus 24.85 ; p<0.001 ) . CONCLUSIONS dietary counseling was effective in decreasing the weight gain of pregnant women who were overweight and reducing clinical complications , such as gestational diabetes , preeclampsia , infant low weight , and prematurity in the Intervention Group 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 Please cite this paper as : Hui A , Back L , Ludwig S , Gardiner P , Sevenhuysen G , Dean H , Sellers E , McGavock J , Morris M , Bruce S , Murray R , Shen G. Lifestyle intervention on diet and exercise reduced excessive gestational weight gain in pregnant women under a r and omised controlled trial . BJOG 2012;119:70–77 BACKGROUND Physical activity during pregnancy is associated with reduced risk of adverse maternal and fetal outcomes . However , the majority of pregnant women are inactive and interventions design ed to increase exercise during pregnancy are sparse . We evaluated the feasibility and preliminary efficacy of an exercise intervention among a diverse sample of pregnant women . METHODS The B.A.B.Y. ( Behaviors Affecting Baby and You ) Study is conducted at a large tertiary care facility in Western Massachusetts . We r and omized 110 prenatal care patients ( 60 % Hispanic ) to an individually tailored 12-week exercise intervention arm ( n = 58 ) or to a health and wellness control arm ( n = 52 ) at mean = 11.9 weeks gestation . Physical activity was assessed via the Pregnancy Physical Activity Question  naire ( PPAQ ) . RESULTS After the 12-week intervention , the exercise arm experienced a smaller decrease ( -1.0 MET-hrs/wk ) in total activity vs. the control arm ( -10.0 MET-hrs/wk ; P = .03 ) , and a higher increase in sports/exercise ( 0.9 MET-hrs/wk ) vs. the control arm ( -0.01 MET-hrs/wk ; P = .02 ) . Intervention participants ( 95 % ) reported being satisfied with the amount of information received and 86 % reported finding the study material s interesting and useful . CONCLUSIONS Findings support the feasibility and preliminary efficacy of a tailored exercise intervention in increasing exercise in a diverse sample of pregnant women PURPOSE This study aim ed to evaluate the effect of an exercise program of two different intensities , with nutritional control , on gestational weight gain ( GWG ) , infant birth weight , and maternal weight retention at 2 months postpartum ( 2 mopp ) . METHODS Pregnant women ( prepregnancy body mass index = 18.5 - 24.9 kg·m ) were r and omized at study entry ( 16 - 20 wk of gestation ) to a low-intensity ( LI , 30 % HR reserve ( HRR ) , n = 23 ) or moderate-intensity ( MI , 70 % HRR , n = 26 ) exercise program , with nutritional control . The exercise program consisted of walking sessions three to four times per week , gradually increasing exercise time from 25 to 40 min per session . Forty-five normal-weight women who did not participate in any structured exercise program during pregnancy and had singleton births were used as a historical control group .  RESULTS Total GWG was higher in the control group ( 18.3 ± 5.3 kg ) compared with the LI ( 15.3 ± 2.9 kg , P = 0.01 ) and MI ( 14.9 ± 3.8 kg , P = 0.003 ) groups . During the intervention , GWG was similar in both intervention groups , with weekly rates of weight gain of 0.49 ± 0.1 and 0.47 ± 0.1 kg·wk in the LI and MI groups , respectively . Excessive GWG during the intervention was prevented in 70 % of the women in the LI group and 77 % of those in the MI group . Excessive GWG occurred before the intervention began . At 2 mopp , 18 % and 28 % of the women in the LI and MI groups , respectively , retained ≤2.0 kg compared with only 7 % of those in the control group . Infant birth weight was not different between the groups . CONCLUSIONS Results suggest that a prenatal nutrition and exercise program regardless of exercise intensity , reduced excessive GWG and decreased weight retention at 2 mopp in women of normal weight before pregnancy BACKGROUND 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 BACKGROUND The composition of long-chain PUFAs ( LCPUFAs ) in the maternal diet may affect obesity risk in the mother 's offspring . OBJECTIVE We hypothesized that a reduction in the n-6 (omega-6):n-3 ( omega-3 ) LCPUFA ratio in the diet of pregnant women and breastfeeding mothers may prevent expansive adipose tissue growth in their infants during the first year of life . DESIGN In a r and omized controlled trial , 208 healthy pregnant women were r and omly assigned to an intervention ( 1200 mg n-3 LCPUFAs as a supplement per day and a concomitant reduction in arachidonic acid intake ) or a control diet from the 15th wk of pregnancy to 4 mo of lactation . The primary outcome was infant fat mass estimated by skinfold thickness ( SFT ) measurements at 4 body sites at 3 - 5 d , 6 wk , and 4 and 12 mo postpartum . Secondary endpoints included sonographic assessment of abdominal subcutaneous and preperitoneal fat , fat distribution , and child growth . RESULTS Infants did not differ in the sum of their 4 SFTs at ≤1 y of life [ intervention : 24.1 ± 4.4 mm ( n = 85 ) ; control : 24.1 ± 4.1 mm ( n = 80 ) ; mean difference : -0.0 mm ( 95 % CI : -1.3 , 1.3 mm ) ] or in growth . Likewise , longitudinal ultrasonography showed no significant differences in abdominal fat mass or fat distribution . CONCLUSIONS We showed no evidence that supplementation with n-3 fatty acids and instructions to reduce arachidonic acid intake during pregnancy and lactation relevantly affects fat mass in offspring during the first year of life . Prospect i ve long-term studies are needed to explore the efficacy of this dietary approach for primary prevention . This trial was registered at clinical trials.gov as NCT00362089 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 Overweight and obesity during pregnancy are common and are associated with an increased risk of adverse health outcomes for both the mother and the infant . However , robust evidence about the effect of antenatal dietary and lifestyle interventions on health outcomes is lacking . We conducted a multicenter , r and omized trial , recruiting 2,212 women ( from 3 public maternity hospitals across South Australia ) with a singleton pregnancy between 10 + 0 and 20 + 0 weeks ' gestation and a BMI ≥25 . The women were r and omized to lifestyle advice  ( n = 1,108 ) or st and ard care ( n = 1,104 ) . Women r and omized to lifestyle advice participated in a comprehensive dietary and lifestyle intervention over the course of their pregnancy ( delivered by research staff ) , while women r and omized to st and ard care received pregnancy care according to local guidelines , which did not include such information . Provision of the lifestyle intervention was associated with a significant 18 % relative risk reduction in the chance of infants being born with a birth weight above 4 kg . No other significant differences were identified in maternal pregnancy and birth outcomes between the two treatment groups . Observational studies highlight the association between a high infant birth weight and the subsequent risk of childhood and adulthood obesity .  Antenatal interventions that are effective in reducing high infant birth weights therefore represent a significant strategy to tackle obesity from a population health perspective , while ongoing interrogation of the biospecimens and measurements , including ongoing childhood follow-up , will provide a unique opportunity to evaluate the mechanistic pathways of maternal-to-infant/childhood obesity Background / Objective : Well-being has been linked to the quality of diet and lifestyle in adults ; however , there is a paucity of data in pregnancy . The aim of this study was to examine the relationship between well-being and socioeconomic status , diet and lifestyle during pregnancy and to consider the effect of intervention with low glycaemic index ( GI ) diet on well-being . Subjects/ Methods : This was a cohort analysis of 619 participants of the ROLO study ( R and omised cOntrol trial of LOw GI diet versus no dietary intervention to prevent recurrence of fetal macrosomia ) . The following data were collected : educational attainment , dietary intakes ( food frequency question naire ) , physical activity ( self-reported ) and well-being ( WHO-5-Item Wellbeing Index — expressed as a percentage ) . Results : Well-being was positively associated with education and physical activity . Third-level education was associated with a 3.07-point higher well-being percentage score , and each day that an individual achieved > 30 min walking per week was associated with a 1.10-point increase in percentage well-being score , Radj2 2.4 % ( F=7.260 , P=0.001 ) . The intervention low GI group had a significantly lower percentage well-being score than the usual diet group ( 56.3 % vs 59.9 % , P=0.015 ) . No correlation was noted between well-being and GI status calculated from food diaries ( P=0.469 ) . Well-being was not associated with micronutrient intake . Conclusions : Well-being in pregnancy was independently and positively associated with education and physical activity and negatively associated with low GI dietary intervention . These findings have significance not only for women at risk of low mood but also for healthcare professionals when counselling women about the importance of healthy lifestyle in pregnancy 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 Abstract Background Approximately 1 in 5 pregnant women in the United Kingdom are obese . In addition to being associated generally with poor health , obesity is known to be a contributing factor to pregnancy and birth complications and the retention of gestational weight can lead to long term obesity . This paper describes the protocol for a cluster r and omised trial to evaluate whether a weight management intervention for obese pregnant women is effective in reducing women ’s Body Mass Index at 12 months following birth . Methods / design The study is a cluster r and omised controlled trial involving 20 maternity units across Engl and and Wales . The units will be r and omised , 10 to the intervention group and 10 to the control group . 570 pregnant women aged 18 years or over , with a Body Mass Index of + /=30 ( kg/m2 ) and between 12 and 20 weeks gestation will be recruited . Women allocated to the control group will receive usual care and two leaflets giving advice on diet and physical activity . In addition to their usual care and the leaflets , women allocated to the intervention group will be offered to attend a weekly 1.5 hour weight management group , which combines expertise from Slimming World with clinical advice and supervision from National Health Service midwives , until 6 weeks postpartum . Participants will be followed up at 36 weeks gestation and at 6 weeks , 6 months and 12 months postpartum . Body Mass Index at 12 months postpartum is the primary outcome . Secondary outcomes include pregnancy weight gain , quality of life , mental health , waist-hip ratio , child weight centile , admission to neonatal unit , diet , physical activity levels , pregnancy and birth complications , social support , self-regulation and self-efficacy . A cost effectiveness analysis and process evaluation will also be conducted . Discussion This study will evaluate the effectiveness of a theory-based intervention developed for obese pregnant women . If successful the intervention will equip women with the necessary knowledge and skills to enable them to make healthier choices for themselves and their unborn child . Trial registration Current Controlled Trials : IS RCT N25260464 Date of registration : 16th April 2010 Background Birth weight plays an important role in infant mortality and morbidity , childhood development , and adult health . To date there are contradictory results regarding the role of physical activity on birth weight . In addition , it is question ed whether exercise during second and third trimesters of pregnancy might affect gestational age and increase the risk of preterm delivery . Hence , the purpose of this study was to examine the effect of a supervised exercise-program on birth weight , gestational age at delivery and Apgar-score . Methods Sedentary , nulliparous pregnant women ( N = 105 ) , mean age 30.7 ± 4.0 years , pre-pregnancy BMI 23.8 ± 4.3 were r and omized to either an exercise group ( EG , n = 52 ) or a control group ( CG , n = 53 ) . The exercise program consisted of supervised aerobic dance and strength training for 60 minutes , twice per week for a minimum of 12 weeks , with an additional 30 minutes of self-imposed physical activity on the non-supervised week-days . Results There was no statistically significant difference between groups in mean birth weight , low birth weight ( < 2500 g ) or macrosomia ( ≥ 4000 g ) . Per protocol analyses showed higher Apgar score ( 1 min ) in the EG compared with the CG ( p = 0.02 ) . No difference was seen in length of gestation  . Conclusion Aerobic-dance exercise was not associated with reduction in birth weight , preterm birth rate or neonatal well-being . Trial Registration Clinical Trials.gov : Background Recent studies suggest that excessive gestational weight gain ( GWG ) leads to adverse maternal and fetal outcomes including weight retention in the mother and an increased risk of childhood obesity in the offspring . The aim of the GeliS study is to examine the effect of a lifestyle intervention programme during pregnancy to avoid excessive GWG and , hence , to reduce pregnancy and obstetric complications as well as the risk of maternal and offspring obesity . Methods and design The GeliS study is a multicentre cluster-r and omized controlled trial . A total number of 2500 pregnant women ( singleton pregnancy ) with a pre-pregnancy BMI ≥ 18.5 kg/m2 and ≤ 40 kg/m2 will be recruited in practice s of gynaecologists and midwives in ten Bavarian regions . The intervention comprises three structured and individualised counselling sessions on a healthy diet , regular physical activity as well as weight monitoring during pregnancy and one session after delivery , respectively . The counselling sessions are attached to routine pre- and postnatal visits using st and ardised material s and procedures . In the control regions , general recommendations for a healthy lifestyle are given . An oral glucose tolerance test is offered to all participants .The primary outcome is the proportion of participants with excessive GWG . Secondary outcomes include pregnancy and obstetric complications such as frequency of gestational diabetes , preeclampsia and caesarean sections as well as weight retention in the mothers and BMI and other health variables in the offspring . A 5-year follow-up of both mothers and their infants is planned . Discussion The GeliS lifestyle intervention programme has been adapted to the existing routine health care system for pregnant women . If shown to be effective , it could be immediately implemented in routine care . Trial registration The study protocol is registered at the Clinical Trials.gov Protocol Registration System ( NCT01958307 ) 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 Maternal diet is known to impact pregnancy outcome . Following a low glycemic index ( GI ) diet during pregnancy has been shown to improve maternal glycemia and reduce infant birthweight and may be associated with a higher fibre intake . We assessed the impact of a low GI dietary intervention on maternal GI , nutritional intake and gestational weight gain ( GWG ) during pregnancy . Compliance and acceptability of the low GI diet was also examined . Method Eight hundred women were r and omised in early pregnancy to receive low GI and healthy eating dietary advice or to receive st and ard maternity care .  The intervention group received dietary advice at a group education session before 22 weeks gestation . All women completed a 3 day food diary during each trimester of pregnancy . Two hundred and thirty five women from the intervention arm and 285 women from the control arm returned complete 3x3d FDs and were included in the present analysis . Results Maternal GI was significantly reduced in the intervention group at trimester 2 and 3 . The numbers of women within the lowest quartile of GI increased from 37 % in trimester 1 to 52 % in trimester 3 ( P < 0.001 ) among the intervention group . The intervention group had significantly lower energy intake ( P < 0.05 ) , higher protein ( % TE ) ( P < 0.01 ) and higher dietary fibre intake ( P < 0.01 ) post intervention . Consumption of food groups with known high GI values were significantly reduced among the intervention group . Women in the intervention low GI group were less likely to exceed the Institute of Medicine ’s GWG goals . Conclusion A dietary intervention in early pregnancy had a positive influence on maternal GI , food and nutrient intakes and GWG . Following a low GI diet may be particularly beneficial for women at risk of exceeding the GWG goals for pregnancy . Trial registration Current Controlled Trials Registration Number : IS RCT N54392969 OBJECTIVE The prevalence of gestational diabetes mellitus ( GDM ) is rising . There is little evidence to demonstrate the effectiveness of one dietary therapy over another . We aim ed to investigate the effect of a low – glycemic index ( LGI ) versus a conventional high-fiber diet on pregnancy outcomes , neonatal anthropometry , and maternal metabolic profile in GDM . RESEARCH DESIGN AND METHODS Ninety-nine women ( age 26–42 years ; mean ± SD prepregnancy BMI 24 ± 5 kg/m2 ) diagnosed with GDM at 20–32 weeks ’ gestation were r and omized to follow either an LGI ( n = 50 ; target glycemic index [ GI ] ~50 ) or a high-fiber moderate-GI diet ( HF ) ( n = 49 ; target GI ~60 ) . Dietary intake was assessed by 3-day food records . Pregnancy outcomes were collected from medical records . RESULTS The LGI group achieved a modestly lower GI than the HF group ( mean ± SEM 47 ± 1 vs. 53 ± 1 ; P < 0.001 ) . At birth , there was no significant difference in birth weight ( LGI 3.3 ± 0.1 kg vs. HF 3.3 ± 0.1 kg ; P = 0.619 ) , birth weight centile ( LGI 52.5 ± 4.3 vs. HF 52.2 ± 4.0 ; P = 0.969 ) , prevalence of macrosomia ( LGI 2.1 % vs. HF 6.7 % ; P = 0.157 ) , insulin treatment ( LGI 53 % vs. HF 65 % ; P = 0.251 ) , or adverse pregnancy outcomes . CONCLUSIONS In intensively monitored women with GDM , an LGI diet and a conventional HF diet produce similar pregnancy outcomes Background / objectives : Owing to excess body weight and increased secretion of inflammatory cytokines primarily during the third trimester , pregnancy is associated with elevated insulin resistance . To our knowledge , no report is available indicating the effects of probiotic yoghurt consumption on serum insulin levels in pregnant women . This study was design ed to determine the effects of daily consumption of probiotic yoghurt on insulin resistance and serum insulin levels of Iranian pregnant women . Subjects/ methods : In this r and omized controlled clinical trial , 70 primigravida pregnant women with singleton pregnancy at their third trimester were participated . We r and omly assigned participants to consume 200 g per day of conventional ( n=33 ) or the probiotic group ( n=37 ) for 9 weeks . The probiotic yoghurt was a commercially available product prepared with the starter cultures of Streptococcus thermophilus and Lactobacillus bulgaricus , enriched with probiotic culture of two strains of lactobacilli ( Lactobacillus acidophilus LA5 ) and bifidobacteria ( Bifidobacterium animalis BB12 ) with a total of min 1 × 107 colony-forming units . Fasting blood sample s were taken at baseline and after 9-week intervention to measure fasting plasma glucose and serum insulin levels . Homeostatic model assessment of insulin resistance ( HOMA-IR ) was used to calculate insulin resistance score . Results : Although consumption of probiotic yogurt for 9 weeks did not affect serum insulin levels and HOMA-IR score , significant differences were found comparing changes in these variables between probiotic and conventional yogurts ( changes from baseline in serum insulin levels : + 1.2±1.2 vs + 5.0±1.1 μIU/ml , respectively , P=0.02 ; and in HOMA-IR score : −0.2±0.3 vs 0.7±0.2 , respectively , P=0.01 ) . Conclusions : It is concluded that in contrast to conventional yogurt , daily consumption of probiotic yogurt for 9 weeks maintains serum insulin levels and might help pregnant women prevent developing insulin resistance Background The objectives of this study were to assess the efficacy of lifestyle intervention on gestational weight gain in pregnant women with normal and above normal body mass index ( BMI ) in a r and omized controlled trial . Methods A total of 116 pregnant women ( < 20 weeks of pregnancy ) without diabetes were enrolled and 113 pregnant women completed the program . Participants were r and omized into intervention and control groups . Women in the intervention group received weekly trainer-led group exercise sessions , instructed home exercise for 3 - 5-times/week during 20 - 36 weeks of gestation , and dietary counseling twice during pregnancy . Participants in the control group did not receive the intervention . All participants completed a physical activity question naire and a 3-day food record at enrolment and 2 months after enrolment . Results The participants in the intervention group with normal pre-pregnancy BMI ( ≤24.9 kg/M2 , n = 30 ) had lower gestational weight gain ( GWG ) , offspring birth weight and excessive gestational weight gain ( EGWG ) on pregnancy weight gain compared to the control group ( n = 27 , p < 0.05 ) . Those weight related-changes were not detected between the intervention ( n = 27 ) and control group ( n = 29 ) in the above normal pre-pregnancy BMI participants . Intervention reduced total calorie , total fat , saturated fat and cholesterol intake were detected in women with normal or above normal pre-pregnancy BMI compared to the control group ( p < 0.05 or 0.01 ) . Increased physical activity and reduced carbohydrate intake were detected in women with normal ( p < 0.05 ) , but not above normal , pre-pregnancy BMI at 2 months after the onset of the intervention compared to the control group . Conclusion The results of the present study demonstrated that the lifestyle intervention program decreased EGWG , GWG , offspring birth weight in pregnant women with normal , but not above normal , pre-pregnancy BMI , which was associated with increased physical activity and decreased carbohydrate intake . Trial registration Objective Observational studies suggest that minimal gestational weight gain ( GWG ) may optimize pregnancy outcomes for obese women . This trial tested the efficacy of a group-based weight management intervention for limiting GWG among obese women . Methods We r and omized 114 obese women ( BMI [ mean±SD ] 36.7±4.9 kg/m2 ) between 7–21 weeks ’ ( 14.9±2.6 ) gestation to intervention  ( n=56 ) or usual care control conditions  ( n=58 ) . The intervention included individualized calorie goals , advice to maintain weight within 3 % of r and omization and follow the Dietary Approaches to Stop Hypertension dietary pattern without sodium restriction , and attendance at weekly group meetings until delivery . Control participants received one-time dietary advice . Our three main outcomes were maternal weight change from r and omization to 2 weeks postpartum and from r and omization to 34 weeks gestation , and newborn large-for-gestational age ( birth weight > 90th percentile , LGA ) . Results Intervention participants gained less weight from r and omization to 34 weeks gestation ( 5.0 vs 8.4 kg , mean difference=−3.4 kg , 95 % CI [ −5.1 , −1.8 ] ) , and from r and omization to 2 weeks postpartum ( −2.6 vs + 1.2 kg , mean difference=−3.8 kg , 95 % CI [ −5.9 , −1.7 ] ) . They also had a lower proportion of LGA babies ( 9 % vs. 26 % , odds ratio=0.28 , 95 % CI [ 0.09 , 0.84 ] ) . Conclusions The intervention result ed in lower GWG and lower prevalence of LGA newborns BACKGROUND Gaining more weight during pregnancy than is recommended by the Institute of Medicine is prevalent and contributes to the development of obesity in women . This article describes the development and use of  e-Moms of Rochester ( e-Moms Roc ) , an electronic intervention ( e-intervention ) , to address this health issue in a socioeconomically diverse sample of pregnant women . MATERIAL S AND METHODS Formative research in the form of intercept interviews , in-depth interviews , and focus groups was conducted to inform the design of the e-intervention . The Web site continuously tracked each participant 's use of e-intervention features . RESULTS An e-intervention , including Web site and mobile phone components , was developed and implemented in a r and omized control trial . Formative research informed the design . Participants in all arms accessed blogs , local re sources , articles , frequently asked questions , and events . Participants in the intervention arms also accessed the  weight gain tracker and diet and physical activity goal - setting tools .  Overall , 80 % of women logged into the Web site and used a tool or feature at least twice . Among those in the intervention arm , 70 % used the weight gain tracker , but only 40 % used the diet and physical activity goal - setting tools . CONCLUSIONS To maximize and sustain potential usage of e-Moms Roc over time , the e-intervention included customized reminders , tailored content , and community features such as blogs and re sources . Usage was comparable to those in other weight studies with young adults and higher than reported in a published study with pregnant women . This e-intervention specifically design ed for pregnant women was used by the majority of women 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 As part of a feasibility study to prevent gestational diabetes mellitus ( GDM ) , we evaluated the effect of an intensive dietary therapy on quality of diet , weight gain and birth weight in women at high risk of GDM . Women with risk factors for GDM ( n 54 ) were r and omly assigned from April 2005 to May 2006 to a  lifestyle intervention group ( n 27 ) including dietary advice six times during pregnancy or to a close follow-up group ( n 27 ) in a community-based setting in Finl and . Dietary intake was recorded three times during pregnancy using 4 d food records . The main outcome was the incidence of GDM . The secondary outcomes were the changes in nutrient intake , weight gain and birth weight . Overall , seventeen ( 65 % ) women in the intervention group and eighteen ( 69 % ) women in the close follow-up group returned all three food records . PUFA intake increased ( P = 0·008 ) during pregnancy in the intervention as compared to the close follow-up group . There were no clear differences in the changes of saturated fat or fibre intake between the groups . Intensive dietary education result ed in a somewhat lower weight gain during pregnancy ( P = 0·062 ) and higher birth weights of the infants ( P = 0·047 ) without an effect on macrosomia as compared to the close follow-up group . Individualised counselling by a clinical nutritionist as part of a lifestyle intervention improved the quality of dietary fat intake in pregnant women at high risk of GDM 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 AIMS To pilot the feasibility of a prenatal lifestyle intervention to modify physical activity and diet among pregnant overweight and obese Hispanic women , with the aim of reducing risk factors for gestational diabetes mellitus . METHODS Women were r and omized either to a  lifestyle intervention ( n = 33 , 48.5 % ) , consisting of a culturally and linguistically modified , motivationally targeted , individually tailored 6-month prenatal programme , or to st and ard care  ( n = 35 , 51.5 % ) . Bilingual and bicultural health educators encouraged women to achieve guidelines for physical activity , decrease saturated fat and increase dietary fibre . Outcomes included gestational weight gain , infant birth weight and biomarkers associated with insulin resistance . RESULTS Patient retention up to delivery was 97 % in both study groups . The lifestyle intervention attenuated the pregnancy-associated decline in moderate-intensity physical activity , but differences between groups were not significant ( mean ± se -23.4 ± 16.6 vs -27.0 ± 16.2 metabolic equivalent of task h/week ; P = 0.88 ) . Vigorous-intensity activity increased during the course of pregnancy in the lifestyle intervention group ( mean ± se 1.6 ± 0.8 metabolic equivalent of task h/week ) and declined in the st and ard care group ( -0.8 ± 0.8 metabolic equivalent of task h/week ; P = 0.04 ) . The lifestyle intervention group also had slightly lower gestational weight gain and infant birth weights compared with the st and ard care group ; however , these differences were not statistically significant . There were no statistically significant differences in biomarkers of insulin resistance between groups . CONCLUSIONS Findings suggest that a motivationally matched lifestyle intervention is feasible and may help attenuate pregnancy-related decreases in vigorous physical activity in a population of overweight and obese Hispanic women . The intervention protocol can readily be translated into clinical practice in underserved and minority population 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 : OBJECTIVE To study the effect on  maternal weight gain of a supervised light- to moderate-intensity exercise-based intervention performed from the ninth week of pregnancy . PARTICIPANTS AND METHODS A total of 962 healthy pregnant women were r and omly assigned to a st and ard care or exercise intervention group conducted between September 1 , 2007 , and January 31 , 2011 . The intervention included light- to moderate-intensity aerobic and resistance exercises performed 3 days a week ( 50 - 55 minutes per session ) . Excessive gestational weight gain was calculated on the basis of the 2009 Institute of Medicine ( IOM ) recommendations . Gestational body weight gain was calculated on the basis of the weight measured at the first prenatal visit ( fifth to sixth weeks of gestation ) and weight measured at the last visit to the clinic before delivery . Women were categorized into normal weight or overweight or obese . RESULTS Women in the intervention group gained less weight ( adjusted mean difference , 1.039 kg ; 95 % CI , 0.534 - 1.545 kg ; P<.001 ) and were less likely to gain weight above the IOM recommendations ( odds ratio , 0.625 ; 95 % CI , 0.461 - 0.847 ) compared with those in the st and ard care group . The main treatment effects according to body mass index category were that normal weight women in the intervention group gained less weight ( adjusted mean difference , 1.393 kg ; 95 % CI , 0.813 - 1.972 kg ; P<.001 ) and were less likely to gain weight above the IOM recommendations ( odds ratio , 0.508 ; 95 % CI , 0.334 - 0.774 ) than normal weight women who received st and ard care . No significant treatment effect was observed in overweight or obese women . CONCLUSION Supervised exercise of light to moderate intensity can be used to prevent excessive gestational weight gain , especially in normal weight women . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01790347 BACKGROUND Excessive weight gain during pregnancy is a risk factor for postpartum weight retention and future weight gain and obesity . Whether a behavioral intervention in pregnancy can reduce long-term weight retention is unknown . OBJECTIVE This r and omized trial tested whether a low-intensity behavioral intervention to prevent excessive gestational weight gain could increase the proportion of women who returned to prepregnancy weight by 12 mo postpartum . DESIGN Women ( n = 401 , 13.5 wk of gestation , 50 % normal weight , 50 % overweight/obese ) were r and omly assigned into an intervention or  control  group ; 79 % completed the 12-mo assessment . The telephone-based intervention targeted gestational weight gain , healthy eating , and exercise and was discontinued at delivery . RESULTS In modified intent-to-treat analyses that excluded women with miscarriages ( n = 6 ) , gestational diabetes ( n = 32 ) , or subsequent pregnancies ( n = 32 ) , the intervention had no significant effect on the odds of achieving prepregnancy weight at 12 mo postpartum ( n = 331 ; 35.4 % compared with 28.1 % ; P = 0.18 ) . Completer analyses suggested that the intervention tended to increase the percentages of women who reached prepregnancy weight ( n = 261 ; 45.3 % compared with 35.3 % ; P = 0.09 ) and significantly reduced the magnitude of mean ± SD postpartum weight retained ( 1.4 ± 6.3 compared with 3.0 ± 5.7 kg ; P = 0.046 ) at 12 mo . Women in the intervention group reported higher dietary restraint through 6 mo postpartum ( P = 0.023 ) and more frequent self-monitoring of body weight ( P < 0.02 for all ) throughout the study . CONCLUSIONS A low-intensity behavioral intervention in pregnancy can reduce 12-mo postpartum weight retention and improve dietary restraint and self-weighing in study completers . Future research is needed to test the long-term effects of more intensive behavioral interventions in pregnancy . This trial was registered at clinical trials.gov as NCT01117961 The present study is a secondary analysis of the ROLO study , a r and omised control trial of a low-glycaemic index ( GI ) diet in pregnancy to prevent the recurrence of fetal macrosomia . The objectives of the present study were to identify which women are most likely to respond to a low-GI dietary intervention in pregnancy with respect to three outcome measures : birth weight ; maternal glucose intolerance ; gestational weight gain ( GWG ) . In early pregnancy , 372 women had their mid-upper arm circumference recorded and BMI calculated . Concentrations of glucose , insulin and leptin were measured in early pregnancy and at 28 weeks . At delivery , infant birth weight was recorded and fetal glucose , C-peptide and leptin concentrations were measured in the cord blood . Women who benefited in terms of infant birth weight were shorter , with a lower education level . Those who maintained weight gain within the GWG guidelines were less overweight in both their first and second pregnancies , with no difference being observed in maternal height . Women who at 28 weeks of gestation developed glucose intolerance , despite the low-GI diet , had a higher BMI and higher glucose concentrations in early pregnancy with more insulin resistance . They also had significantly higher-interval pregnancy weight gain . For each analysis , women who responded to the intervention had lower leptin concentrations in early pregnancy than those who did not . These findings suggest that the maternal metabolic environment in early pregnancy is important in determining later risks of excessive weight gain and metabolic disturbance , whereas birth weight is mediated more by genetic factors . It highlights key areas , which warrant further interrogation before future pregnancy intervention studies , in particular , maternal education level and inter-pregnancy weight gain 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 Pregnancy is a critical period for the development of later obesity . Regular weighing of pregnant women is not currently recommended in the UK . This study aim ed to demonstrate the feasibility of regular weighing by community midwives ( CMWs ) as a potential intervention to prevent excessive gestational weight gain .  Low risk healthy/overweight pregnant women cared for by eight CMWs were r and omised to usual care or usual care plus the intervention at 10 - 14 weeks of pregnancy . The intervention involved CMWs weighing and charting weight gain on an IOM weight gain chart , setting a weight target and giving brief feedback at antenatal appointments . The focus of the study was on process evaluation outcomes . Data on other outcomes were also collected including gestational weight gain . We interviewed women and CMWs about their views of the intervention . CMWs referred 123 women , 95 agreed to participate and 76 were r and omised . Over 90 % of women were weighed at 38 weeks of pregnancy demonstrating high follow up . There was no evidence the intervention caused anxiety . Most women commented they had found the intervention useful in encouraging them to think about their weight and believed it should be part of routine antenatal care . CMW 's felt the intervention could be implemented within antenatal care without adding substantially to consultation length . To conclude , pregnant women were keen to participate in the study and the intervention was acceptable to pregnant women and CMWs . An effectiveness trial is now planned BACKGROUND Obesity and excessive weight gain during pregnancy are associated with adverse pregnancy outcomes . Observational studies suggest that minimal or no gestational weight gain ( GWG ) may minimize the risk of adverse pregnancy outcomes for obese women . OBJECTIVE This report describes the design of Healthy Moms , a r and omized trial testing a weekly , group-based , weight management intervention design ed to help limit GWG to 3 % of weight ( measured at the time of r and omization ) among obese pregnant women ( BMI ≥30 kg/m(2 ) ) . Participants are r and omized at 10 - 20 weeks gestation to either the intervention or a single dietary advice control condition . PRIMARY OUTCOMES The study is powered for the primary outcome of total GWG , yielding a target sample size of 160 women . Additional secondary outcomes include weight change between r and omization and one-year postpartum and proportion of infants with birth weight>90th percentile for gestational age . Statistical analyses will be based on intention-to-treat . METHODS Following r and omization , all participants receive a 45-minute dietary consultation . They are encouraged to follow the Dietary Approaches to Stop Hypertension diet without sodium restriction . Intervention group participants receive an individualized calorie intake goal , a second individual counseling session and attend weekly group meetings until they give birth . Research staff assesses all participants at 34-weeks gestation and at 2-weeks and one-year postpartum with their infants . SUMMARY The Healthy Moms study is testing weight management techniques that have been used with non-pregnant adults . We aim to help obese women limit GWG to improve their long-term health and the health of their offspring Leptin regulates energy homeostasis and immune and metabolic functions . Highly elevated leptin concentrations during pregnancy may be associated with aberrations in maternal metabolism and long-term health consequences both in women and children . The objective of the present study was to evaluate whether dietary counselling , probiotic supplementation , maternal characteristics or dietary intake during pregnancy has an impact on serum leptin concentrations in women , cord blood or in children . A total of 256 pregnant women were r and omised to a control group ( n 85 ) or to receive dietary counselling with probiotics ( n 85 ) or placebo ( n 86 ) . Dietary counselling aim ed at affecting the type of fat used and to increase the amount of fibre in the women 's diet . Women 's dietary intake and serum leptin concentrations were analysed at the first and third trimesters of pregnancy and at 1 month postpartum . Furthermore , leptin concentrations were measured from the cord blood and from children 's serum at 1 and 6 months of age . Weight status and dietary composition were the key determinants of leptin concentrations . Specifically , high dietary fibre and low SFA intakes were related to low serum leptin concentrations in women . Female sex and birth weight were associated with higher infant leptin , whereas cord blood leptin was additionally affected by maternal leptin concentration and protein intake . Probiotics or dietary counselling did not affect leptin concentrations . Weight control to recommended levels and modification of diet towards higher fibre and lower SFA intakes during pregnancy may through leptin concentrations provide health benefits to both women and children Purpose To compare the efficacy of a personal dietary intervention on gestational weight gain control with a general intervention promoting healthy eating . Methods Prospect i ve , controlled study including 154 low-risk pregnant women r and omly allocated to two groups : 77 receiving a personalized diet plan and a close follow-up by a dietician ( intervention group ) , 77 receiving st and ard dietary care by means of a brochure on healthy eating during pregnancy ( control group ) . Pre-pregnancy weight , gestational age , height , weight and BMI at baseline , weight at term , gestational age at delivery and newborn weight were recorded for all participants . The primary end-point was the difference in body weight between baseline and term . Secondary end-points were the difference in body weight between pre-pregnancy and term and in newborn weights . Results Maternal weight gain at term was significantly lower both as compared to pre-pregnancy weight ( 8.2 ± 4.0 vs. 13.4 ± 4.2 kg ; p < 0.001 ) and to weight at baseline ( 7.7 ± 3.8 vs. 13.7 ± 4.3 kg ; p < 0.001 ) in the intervention group as compared to controls . A positive , significant correlation between the delta weight between baseline and term and newborn weight was observed in both groups , but stronger in patients from the intervention group ( intervention group R = 0.76 , p < 0.001 ; control group R = 0.35 , p = 0.01 ) . Conclusions This study suggests that a personalized nutritional intervention , in which the dietician plays an active role within the obstetric team , may represent a successful approach in limiting weight gain in pregnant women Background : Abnormal weight gain during pregnancy increases the adverse health outcomes during the pregnancy , delivery , and the postpartum period . Most of the pregnant women develop weight gain more than the recommended limits ; therefore , interventions to manage such disproportionate weight gain are needed . In this paper , the design of the maternal centered life-style intervention study is described , which focuses on controlling weight gaining during pregnancy for all body mass index ( BMI ) groups . Material s and Methods : In our r and omized field trial , 160 pregnant women with 6 - 10 weeks of gestational age who visit one of the participating Isfahan four urban public-health centers and 4 private obstetric offices are included . The maternal centered life-style intervention carried out by trained midwives is st and ardized in a protocol . All the participants are visited at 6 - 10 , 11 - 15 , 16 - 20 , 21 - 25 , 26 - 30 , 31 - 34 , 35 - 37 , 38 , 39 , and 40 weeks of pregnancy . The women who are r and omized in the intervention group receive maternal centered educational package of prenatal care for the pregnant woman and a log book in the first visit . Counselors accompany the pregnant women to maintain or develop  a healthy life-style . Data collection will perform monthly measuring body weight , BMI . Conclusion : Because , we do n’t have structured protocol for weight management during pregnancy especially , in private sectors if the maternal centered life-style intervention proves to be effective , it will be suggested to merge this package to routine care . Therewith by empowering women to manage their weight the public-health burden can be reduced . Beside that private obstetricians also have structured protocol for their client management 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 Background : Obesity in pregnancy is associated with fetal macrosomia , a raised neonatal fat mass and an increased risk of obesity and poor metabolic health in childhood which persists into adulthood . The offspring of obese women are more likely to be obese than the offspring of lean women when they become pregnant themselves , perpetuating a cycle of obesity and its associated negative metabolic consequences . Increasing physical activity during pregnancy could improve insulin sensitivity and reduce the risk of maternal and offspring adverse outcomes . The UK Pregnancy Better Eating and Activity Trial ( UPBEAT ) is a trial of a complex intervention design ed to improve pregnancy outcomes through dietary changes and physical activity .  Data from the pilot trial of 183 women were available for analysis . The relationship between the time spent at different physical activity levels and maternal and infant pregnancy outcomes was examined . Key Messages : Strong evidence exists that physical activity improves insulin sensitivity in non-pregnant population s , and lifestyle interventions of proven effectiveness in non-pregnant population s have been developed . Women who are active in pregnancy demonstrate better glucose control and favourable pregnancy outcomes . There is a lack of effective interventions to support obese pregnant women to be physically active . Conclusions : No difference was detected in objective ly measured physical activity between women r and omised to the intervention and control arms of the UPBEAT pilot trial . Light-intensity physical activity was lower in early pregnancy in women who delivered macrosomic infants . Maternal sedentary time at 35 - 36 weeks ' gestation was positively associated and moderate-intensity physical activity was inversely associated with neonatal abdominal circumference . Maternal physical activity is associated with infant birth weight and abdominal circumference and is an appropriate target for intervention to improve infant outcomes . The challenge remains to develop an effective intervention to support obese pregnant women to be physically active OBJECTIVE : To estimate the effect of supervised physical exercise on maternal physical fitness , fetoplacental blood flow , and fetal growth . METHODS : This was a r and omized controlled trial comparing three groups of pregnant women . Groups were as follows : exercise initiated at 13 weeks ( group A ) ; exercise initiated at 20 weeks ( group B ) ; and a control group ( no supervised exercise ; group C ) . The women in groups A and B walked at moderate intensity three times weekly . Physical fitness level was evaluated at weeks 13 , 20 , and 28 . Fetal growth and uteroplacental blood flow were evaluated monthly . Birth weight was registered . Analysis of variance for repeat measures was used for outcomes evaluated throughout pregnancy . Risk ratio was used as a measure of the relative risk of preeclampsia , fetal growth restriction , macrosomia , small-for-gestational-age newborns , and large-for-gestational-age newborns . RESULTS : All the women analyzed completed more than 85 % of the program . According to the evaluation conducted at week 28 , physical fitness improved , with mean maximal oxygen consumptions ( VO2max ) of 27.3±4.3 ( group A ) , 28±3.3 ( group B ) , and 25.5±3.8 ( group C ; P=.03 ) . Mean birth weights were 3,279±453 g ( group A ) , 3,285±477 g ( group B ) , and 3,378±593 g ( group C ; P=.53 ) , with no difference in the frequency of large for gestational age or small for gestational age . No association was found between the practice of physical activity and the variables investigated ( preeclampsia , fetal weight , blood pressure , and pulsatility index of the uterine , umbilical , and middle cerebral arteries ) . CONCLUSION : Moderate-intensity walking improved the physical fitness level of healthy , pregnant , previously sedentary women without affecting fetoplacental blood flow or fetal growth . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00641550 . LEVEL OF EVIDENCE : 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 Pelvic floor muscle training ( PFMT ) following vaginal assessment of correct contraction can prevent and treat urinary incontinence in the peripartum period . The aim of this study was to evaluate the effectiveness of PFMT instructed in a general fitness class for pregnant women . DESIGN Single-blind r and omised controlled trial . SETTING University-conducted primary care study . PARTICIPANTS One hundred and five sedentary primiparous women r and omised to a general fitness class including PFMT ( n=52 ) or a control group ( n=53 ) . Ten and 11 women were lost to follow-up in the exercise and control groups , respectively . INTERVENTION Twelve weeks of training comprising twice-weekly 1-hour fitness classes including three sets of eight to 12 maximal pelvic floor muscle contractions . The control group received usual care . OUTCOME MEASURE Number of women reporting urinary , flatus or anal incontinence . RESULTS No significant differences were found in the number of women reporting urinary , flatus or anal incontinence between the exercise group and the control group during pregnancy or at 6 weeks post partum . CONCLUSIONS No effect of PFMT was found when the exercises were taught in a general fitness class for pregnant women without individual instruction of correct PFM contraction . Low adherence and the small sample size may have contributed to the negative results . Further studies are warranted to assess the effect of population -based PFMT in the prevention of urinary and fecal incontinence Background .  Intervention fidelity  is an increasingly important method ological concept in process evaluations . In this article , the authors investigated the intervention fidelity in a r and omized controlled trial on excessive weight gain prevention in pregnancy . Method . A sample of 109 audiotaped counseling sessions , linked to 65 women in the intervention group of the New Life(style ) trial , was drawn . The following criteria were quantitatively evaluated using a fidelity checklist : ( a ) reach , ( b ) dose , ( c ) adherence to study objectives , ( d ) adherence to underlying problem-solving treatment ( PST ) theory , and ( e ) counselor competence . Results . A total of 60.4 % received all counseling sessions . The dose of intervention components was generally moderate ( 50.9 % to 60.4 % ) , and the dose of PST components was low ( 17.3 % ) . Adherence to study objectives was moderate ( 64.2 % ) and adherence to PST theory was low ( 43.2 % ) . The counselors sufficiently stimulated the participant to optimize lifestyle ( 54.2 % of the sessions ) , provided positive feedback ( 50.5 % ) , and left the initiative regarding problem solving to the participant ( 71 % ) . One of the two counselors performed significantly better on all measured criteria ( p < .001 ) . Conclusions . Intervention fidelity in the New Life(style ) trial was generally low to moderate . In future interventions , it is recommended to put more emphasis on counselor recruitment , training , and intervention protocol contents . Fellow research ers are encouraged to embed a process evaluation into all study stages , taking into account all essential process elements , and to link process outcomes to more distal , health outcomes 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 BACKGROUND Eating carbohydrate foods with a high glycemic index ( GI ) has been postulated to result in fetoplacental overgrowth and higher infant body fat . A diet with a low glycemic index ( LGI ) has been shown to reduce birth percentiles and the ponderal index ( PI ) . OBJECTIVES We investigated whether offering LGI dietary advice at the first antenatal visit would result in a lower fetal birth weight , birth percentile , and PI than providing healthy eating ( HE ) advice . This advice had to be presented within the re sources of routine antenatal care . DESIGN The Pregnancy and Glycemic Index Outcomes study was a 2-arm , parallel- design , r and omized , controlled trial that compared the effects of LGI dietary advice with HE advice on pregnancy outcomes . Eligible volunteers who attended for routine antenatal care at < 20 wk of gestation were r and omly assigned to either group . RESULTS A total of 691 women were enrolled , and 576 women had final data considered . In the LGI group , the GI was reduced from a mean ( ± SEM ) of 56 ± 0.3 at enrollment to 52 ± 0.3 ( P < 0.001 ) at the final assessment . There were no significant differences in primary outcomes of fetal birth weight , birth percentile , or PI . In a multivariate regression analysis , the glycemic load was the only significant dietary predictor ( P = 0.046 ) of primary outcomes but explained < 1 % of all variation . CONCLUSION A low-intensity dietary intervention with an LGI diet compared with an HE diet in pregnancy did not result in any significant differences in birth weight , fetal percentile , or PI Please cite this paper as : Nascimento S , Surita F , Parpinelli M , Siani S , Pinto e Silva J. The effect of an antenatal physical exercise programme on maternal/perinatal outcomes and quality of life in overweight and obese pregnant women : a r and omised clinical trial . BJOG 2011;118:1455–1463 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 OBJECTIVE : To assess whether exercise during pregnancy can prevent gestational diabetes and improve insulin resistance . METHODS : A total of 855 women in gestational week 18–22 were r and omly assigned to receiving a 12-week st and ard exercise program ( intervention group ) or st and ard antenatal care ( control group ) . The exercise program followed st and ard recommendations and included moderate-intensity to high-intensity activity 3 or more days per week . Primary outcomes were gestational diabetes and insulin resistance estimated by the homeostasis model assessment method . For the power calculation , we assumed a gestational diabetes prevalence of 9 % in the control group and a prevalence of 4 % in the exercise group ( risk difference of 5 % ) . Under these assumptions , a two- sample comparison with a 5 % level of significance and power of 0.80 gave a study population of 381 patients in each group . RESULTS : At 32–36 weeks of gestation there were no differences between groups in prevalence of gestational diabetes : 25 of 375 ( 7 % ) in the intervention group compared with 18 of 327 ( 6 % ) in the control group ( P=.52 ) . There were no differences in insulin resistance between groups when adjusting for baseline values . Only 55 % of women in the intervention group managed to follow the recommended exercise protocol . No serious adverse events related to physical exercise were seen , and the outcomes of pregnancy were similar in the two groups . CONCLUSION : There was no evidence that offering women a 12-week st and ard exercise program during the second half of pregnancy prevents gestational diabetes or improves insulin resistance in healthy pregnant women with normal body mass indexes . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00476567 . LEVEL OF EVIDENCE : 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 OBJECTIVES We examined the impact of a prenatal exercise intervention on physical activity in 260 women at risk for gestational diabetes mellitus . METHODS We r and omized participants in the Behaviors Affecting Baby and You ( BABY ) Study , which took place from 2007 to 2012 , to either a 12-week individually tailored , motivationally matched exercise intervention ( n=132 ) or to a comparison health and wellness intervention ( n=128 ) . We assessed physical activity with the Pregnancy Physical Activity Question naire . We used linear mixed models to evaluate the impact of the interventions on change in physical activity according to intensity and type , total walking , and sedentary behavior . RESULTS Compared with the health and wellness arm , the exercise arm had significantly greater increases in sports or exercise activity ( 0.3 vs 5.3 metabolic equivalent of task [ MET ] hours/week ; P<.001 ) , and smaller declines in total activity ( -42.7 vs -2.1 MET hours/week ; P=.02 ) and activities of moderate to vigorous intensity ( -30.6 vs -10.6 MET hours/week ; P=.05 ) , and was more likely to achieve recommended guidelines for physical activity ( odds ratio=2.12 ; 95 % confidence interval=1.45 , 3.10 ) . CONCLUSIONS These findings extend the previous literature by demonstrating the benefits of a clinical ly feasible exercise intervention in an ethnically and socio-economically diverse population . Given the increased risk of adverse maternal health outcomes in ethnic minority groups , these findings may have important implication s for reducing health disparities OBJECTIVE There is controversy concerning whether exercise during pregnancy may increase preterm delivery risk and type of delivery . The effect of pregnant Latin-American women engaging in  vigorous exercise during the second and third trimester was examined regarding type of delivery and gestational age . MATERIAL S AND METHODS This was a secondary analysis of data from a controlled r and omized trial for determining the influence of physical exercise on pregnant women 's endothelial function . The study included 35 nulliparous women , gestational week 16 - 20 attending prenatal care at three tertiary hospitals in Colombia , who were r and omly assigned to one of two groups . The experimental group engaged in aerobic exercise involving 55 % - 75 % maximum heart rate for 60 min , three times a week for 12 weeks . The control group engaged in their usual physical activity .  Maternal weight , height , weight gain , blood pressure and type of delivery were recorded ; gender , abdominal and head circumference ( cm ) , weight ( g ) , height ( cm ) , vitality ( Apgar score at 1 and 5 min ) and gestational age at the time of delivery ( in weeks , days ) were recorded for the newborn . RESULTS There was no difference in type of delivery by the end of the 12-week program ( p > 0.05 ) , nor regarding newborn anthropometric variables , Apgar score , or maternal variables concerning weight , height , relative weight gain , blood pressure or weeks of gestation ( p>0.05 ) . CONCLUSION The potential public health benefits of vigorous exercise were enormous . This study supported existing guidelines indicating that Latin-American women may begin or maintain an on-going exercise program during pregnancy . TRIAL REGISTRATION NCT00741312 Self‐weighing is important for weight management in general population s ; however its role in optimising gestational weight gain is less clear . Our r and omised trial in early pregnancy found regular self‐weighing when combined with a self‐management intervention  , optimised weight gain at 28 weeks gestation ( 5.66 ± 2.6 kg vs 7.03 ± 3.56 kg , P = 0.02 ) and reduced postpartum weight retention ( −0.57 ± 3.94 kg vs 1.48 ± 5.49 kg , P < 0.05 ) compared with control participants . Results highlight the importance of self‐monitoring strategies during pregnancy 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 Objectives To assess whether a 12-week supervised exercise-programme with an additional 30 min of moderate self-imposed physical activity on the non-supervised weekdays prevents excessive weight gain in pregnancy  , as well as postpartum weight retention . Methods One hundred and five sedentary , nulliparous pregnant women with a mean age of 30.7 ± 4.0 years and a pre-pregnancy body mass index of 23.8 ± 4.3 kg/m2 were r and omised to either an exercise group ( EG , n = 52 ) or a control group ( CG , n = 53 ) . The exercise programme consisted of 60 min supervised aerobic dance and strength training for 60 min , at least twice per week for a minimum of 12 weeks . Results Drop-out rates were 19 % and 21 % in the EG and CG , respectively . Fewer women in the EG than in the CG exceeded the Institute of Medicine recommendations ; however , only EG participants who attended 24 exercise sessions ( n = 14 ) differed significantly from controls ( p = 0.006 ) with regard to weight gain during pregnancy ( 11.0 ± 2.3 vs. 13.8 ± 3.8 kg , p < 0.01 ) and postpartum weight retention ( 0.8 ± 1.7 vs. 3.3 ± 4.1 kg , p < 0.01 ) . Conclusions Regular participation in aerobic dance exercise can contribute to significantly reduce weight gain during pregnancy Background : Due to the enhanced oxygen requirement of the mitochondria-rich placenta primarily during the third trimester , pregnancy is associated with elevated levels of oxidative stress . This study was design ed to determine the effects of daily consumption of probiotic yogurt on oxidative stress among Iranian pregnant women . Methods : This r and omized single-blind controlled clinical trial was performed among 70 pregnant women , singleton primigravida , aged 18 - 30 in their third trimester . Subjects were r and omly assigned to two groups to consume 200 g/day of either conventional yogurt ( n = 33 ) or probiotic yogurt ( n = 37 ) for 9 weeks . Fasting blood sample s were taken at baseline and after a 9-week intervention to measure oxidative stress parameters . Results : Consumption of probiotic yogurt result ed in increased erythrocyte glutathione reductase ( GR ) levels as compared to the conventional yogurt ( p = 0.01 ) . Despite the significant effect of probiotic yogurt consumption on plasma glutathione ( 67.9 µmol/l , p = 0.01 ) , erythrocyte glutathione peroxidase ( 163 mmol/min/ml , p = 0.04 ) and serum 8-oxo-7,8-dihydroguanine levels ( -74.3 ng/ml , p = 0.04 ) , no significant differences were found between the two yogurts in terms of their effects on the mentioned parameters . Conclusion : Consumption of probiotic yogurt among pregnant women result ed in increased levels of erythrocyte GR as compared to the conventional yogurt , but could not affect other indices of oxidative stress Background : Due to enhanced fat storage primarily during the mid-pregnancy period , pregnancy is associated with elevated levels of lipid profiles . To our knowledge , no reports are available indicating the effects of probiotic yoghurt consumption on serum lipid profiles in pregnant women . Objective : This study was design ed to determine the effects of daily consumption of probiotic yoghurt on lipid profiles of Iranian pregnant women . Methods : This r and omized single-blinded controlled clinical trial was performed among 70 pregnant women , primigravida , aged 18–30 years old who were carrying singleton pregnancy at their third trimester . Subjects were r and omly assigned to consume 200 g/d of conventional ( n = 33 ) or the probiotic group ( n = 37 ) for 9 weeks . The probiotic yoghurt was a commercially available product prepared with the starter cultures of Streptococcus thermophilus and Lactobacillus bulgaricus , enriched with probiotic culture of two strains of lactobacilli ( Lactobacillus acidophilus LA5 ) and bifidobacteria ( Bifidobacterium animalis BB12 ) with a total of min 1 × 107 colony-forming units . The conventional yoghurt contained the starter cultures of S. thermophilus and L. bulgaricus . Fasting blood sample s were taken at baseline and after 9-weeks intervention to measure serum lipid profiles . Results : Although consumption of probiotic yogurt for 9 weeks had been result ed in a significant reduction in serum total- ( −53.7 mg/dL , p = 0.001 ) , LDL- ( −35.2 mg/dL , p = 0.006 ) and HDL-cholesterol levels ( −9.8 mg/dL , p = 0.002 ) as well as serum triglyceride concentrations ( −42.8 mg/dL , p = 0.029 ) , no significant differences were found comparing probiotic and conventional yogurts in terms of their effect on serum lipid profiles . Within-Group differences in conventional yogurt group revealed a significant reduction in HDL-cholesterol levels ( −8.4 mg/dL , p = 0.005 ) and borderline significant reduction in serum total cholesterol concentrations ( −21.6 mg/dL , p = 0.08 ) . Conclusion : In conclusion , consumption of probiotic yogurt among pregnant women could not affect serum lipid profiles as compared to the conventional yogurt AIM To evaluate the effect of regular aerobic exercise on the endothelial function and cardiorespiratory fitness in pregnant women . METHOD This was a r and omized , double-blinded , controlled clinical trial of 64 healthy primigravid women between 16 and 20 weeks ' gestation . The experimental group took part in aerobic exercise at an intensity of 50 - 65 % of their maximum heart rate for 60 min , three times a week for 16 weeks . The control group undertook their usual physical activity . The outcomes were the endothelial function evaluated by flow-mediated dilatation and cardiorespiratory fitness evaluated by the maximum indirect oxygen consumption ( VO2max ) in a 6-min walk test . RESULTS Initially , no differences were found between the groups in any of the variables . At the end of the intervention , the participants that performed exercise showed a higher cardiorespiratory fitness , measured by the walked distance in the 6-min walk test ( P = 0.014 ) and by the VO2max ( P = 0.014 ) . Also , the exercise group showed a lower heart rate at rest and a higher flow-mediated dilatation than the control group ( P = 0.02 ) . CONCLUSIONS Regular aerobic exercise improves endothelium-dependent vasodilation in pregnancy . This intervention may be an early and effective alternative to strengthen the prevention of disorders associated to endothelial dysfunction 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 PURPOSE The objective of this study is to assess the effectiveness of a maternal exercise program ( l and /aquatic activities , both aerobic and muscular conditioning ) in preventing gestational diabetes mellitus ( GDM ) . METHODS Three hundred and forty-two pregnant women from Spain ( age , 33.24 ± 4.3 yr ) without obstetric contraindications were recruited for a clinical r and omized controlled trial . The intervention group ( IG , n = 101 ) exercised for 60 and 50 min on l and and in water , respectively , three times per week . The control group ( n = 156 ) received usual st and ard care .  RESULTS The prevalence of GDM was reduced in the IG group ( IG , 1 % , n = 1 , vs control group , 8.8 % , n = 13 ( χ1 = 6.84 , P = 0.009 ) ) with a significant risk estimate ( odds ratio = 0.103 ; 95 % confidence interval , 0.013 - 0.803 ) . CONCLUSION The exercise program performed during pregnancy reduced the prevalence of GDM by preserving glucose tolerance Please cite this paper as : Oostdam N , van Poppel M , Wouters M , Eekhoff E , Bekedam D , Kuchenbecker W , Quartero H , Heres M , van Mechelen W. No effect of the FitFor2 exercise programme on blood glucose , insulin sensitivity , and birthweight in pregnant women who were overweight and at risk for gestational diabetes : results of a r and omised controlled trial . BJOG 2012;119:1098–1107 Previous studies have shown that inflammatory factors increases in pregnancy and is associated with several complications of pregnancy . The aim of this study was to assess effects of daily consumption of probiotic yoghurt on inflammatory factors in pregnant women . In a r and omized clinical trial , seventy primigravid ( the first pregnancy ) and singleton pregnant women aged 18 - 30 years were assigned to two groups . Subjects consumed daily 200 g probiotic yoghurt containing Lactobacillus acidophilus La5 and Bifidobacterium animalis BB12 ( 10(7 ) CFU g(-1 ) for each ) or 200 g conventional yoghurt for 9 weeks . Fasting blood sample s were collected at baseline ( 28 weeks of gestation ) and after intervention ( 37 weeks of gestation ) . Inflammatory factors , hs-CRP and TNF-alpha , were measured by Enzyme-linked Immunosorbent Assay ( ELISA ) . Independent t-test was used to compare the two groups after intervention and paired- sample t-test compared variables before and after treatment . The results showed that the probiotic yogurt brought about a decrease in the serum hs-CRP level , from 10.44 + /- 1.56 to 7.44 + /- 1.03 microg mL(-1 ) ( p = 0.041 ) . There was no significant change in the conventional yogurt group in the serum hs-CRP level ( 12.55 + /- 1.57 to 14.51 + /- 1.62 microg mL(-1 ) , p = 0.202 ) . The probiotic yogurt had no effect on TNF-alpha ( from 73.75 + /- 6.59 to 77.91 + /- 5.61 pg mL(-1 ) , p = 0.633 ) . Serum TNF-alpha did not change in the conventional yogurt group ( p = 0.134 ) . In conclusion probiotic yogurt significantly decreased hs-CRP in pregnant women but had no effect on TNF-alpha 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 A prospect i ve r and omized controlled trial was design ed to assess the benefits and possible risks of aerobic exercise during pregnancy , using a fitness regimen based on the 2002 American College of Obstetricians and Gynecologists guidelines for exercise during pregnancy . METHODS Inactive women were r and omized at 12 - 14 wk gestation to a group that remained sedentary or to a group that performed moderate aerobic exercise 45 - 60 min , 4 d·wk , through 36 wk gestation . Thirty-one subjects in each group completed the study . RESULTS Compared with women who remained sedentary , active women improved aerobic fitness ( P < 0.05 ) and muscular strength ( P < 0.01 ) , delivered comparable size infants with significantly fewer cesarean deliveries ( P < 0.01 ) , and recovered faster postpartum ( P < 0.05 ) , at least related to the lower incidence of cesarean section . Active women developed no gestational hypertension ( P = 0.16 compared with controls ) and reported no injuries related to the exercise regimen . In the active group , there was one premature birth at 33 wk by a woman with a history of premature delivery of twins at 34 wk . There were no differences between groups in the incidence of gestational diabetes , musculoskeletal pains during pregnancy , flexibility on sit- and -reach test , mean length of pregnancy , neonatal Apgar scores , placenta weights , overall length of labor , weight gain during pregnancy , or weight retention postpartum . CONCLUSION Previously sedentary women who began exercising at 12 - 14 wk improved fitness and delivery outcomes OBJECTIVE 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 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 OBJECTIVE The objective of the study was to assess physical activity intervention assessed by a pedometer with or without dietary intervention on gestational weight gain ( GWG ) in obese pregnant women by comparing with a control group . STUDY DESIGN This study was a r and omized controlled trial of 425 obese pregnant women comparing 3 groups : ( 1 ) PA plus D , physical activity and dietary intervention ( n = 142 ) ; ( 2 ) PA , physical activity intervention ( n = 142 ) ; and ( 3 ) C , a control group receiving st and ard care ( n = 141 ) . All participants routinely in gestational weeks 11 - 14 had an initial dietary counseling session and were advised to limit GWG to less than 5 kg . Physical activity intervention included encouragement to increase physical activity , aim ing at a daily step count of 11,000 , monitored by pedometer assessment on 7 consecutive days every 4 weeks . Dietary intervention included follow-up on a hypocaloric Mediterranean-style diet . Instruction was given by a dietician every 2 weeks . The primary outcome measure was GWG , and the secondary outcome measures were complications of pregnancy and delivery and neonatal outcome . RESULTS The study was completed by 389 patients ( 92 % ) .  Median values of GWG ( ranges ) were lower in each of the intervention groups ( PA plus D , 8.6 [ -9.6 to 34.1 ] kg , and group PA , 9.4 [ -3.4 to 28.2 ] kg ) compared with the control group ( 10.9 [ -4.4 to 28.7 ] kg [ PA+D vs C ] ; P = .01 ; PA vs C ; P = .042 ) . No significant difference was found between the 2 intervention groups . In a multivariate analysis , physical activity intervention decreased GWG by a mean of 1.38 kg ( P = .040 ) . The Institute of Medicine 's recommendations for GWG were more frequently followed in the intervention groups . CONCLUSION Physical activity intervention assessed by pedometer with or without dietary follow-up reduced GWG compared with controls in obese pregnant women Pre-pregnancy obesity is a risk factor for preeclampsia , gestational diabetes , and hypertension . Regular exercise during pregnancy has been shown to decrease the risk of these obstetrical complications . The purpose of this prospect i ve study was to measure the effects of an exercise program in normal-weight and overweight/obese pregnant women on blood pressure ( BP ) and cardiac autonomic function , determined by heart rate variability ( HRV ) and baroreflex sensitivity ( BRS ) . Twenty-two sedentary pregnant women , recruited at 20 weeks gestational age ( GA ) , were grouped as normal weight or overweight/obese . They were systematic ally assigned to an exercise ( walking ) group or control ( nonwalking ) group after the first participants were r and omly assigned . Women in the walking groups participated in a 16-week , low-intensity walking program .  BP , HRV , and BRS were measured at rest and during exercise at the beginning ( 20 weeks GA ) and end ( 36 weeks GA ) of the walking program . Results indicated that women in the control groups ( especially overweight women ) showed changes in BP , HRV , and BRS over pregnancy that were not seen in the walking group . Overweight women in the control group increased resting systolic BP by 10 mmHg and diastolic BP by 7 mmHg . HRV declined in the control group but not in the walking group . A reduction in BRS and R-R interval at rest was found in all groups except the walking normal-weight group . The results suggest that an exercise program could attenuate the increase in BP and the loss of parasympathetic tone associated with pregnancy , especially in overweight women OBJECTIVES Excessive gestational weight gain ( GWG ) puts women and children at risk of obesity . We piloted an SMS-texting intervention to promote healthy GWG among overweight and obese women . METHODS We recruited 35 women and r and omized them in a 2:1 fashion to : a tailored SMS-texting intervention ( Preg CHAT ) vs. a generic texting intervention ( Txt4baby ) . Preg CHAT texts provided personalized feedback based on women 's intake of sweetened beverages , fruits and vegetables , fast food , daily steps taken , and weight . We abstract ed women 's weights from charts and surveyed women at baseline and 32 weeks gestation . RESULTS Few women refused the study ; many ( 30 % ) did not complete the study , however . Of those in the Preg CHAT arm , 86 % responded to texts , and 80 % said they would recommend this program to a friend . For women who completed the surveys ( n=23 ) , those in the Preg CHAT arm had a mean gain of 6 less pounds than women in the Txt4Baby arm ( 95 % CI -15.9 , 4.0 ; p=0.24 ) . CONCLUSIONS This pilot study shows feasibility , acceptability , and potential efficacy of a low-intensity and disseminable intervention to help overweight and obese women reduce GWG . PRACTICE IMPLICATION S An SMS texting program might help overweight women reduce excessive GWG 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 Abstract Objectives : To determine whether changes in lifestyle in women with BMI > 25 could decrease gestational weight gain and unfavorable pregnancy outcomes . Methods : Women with BMI > 25 were r and omized at 1st trimester to no intervention or a Therapeutic Lifestyle Changes ( TLC ) Program including diet  ( overweight : 1700 kcal/day , obese : 1800 kcal/day ) and mild physical activity ( 30 min/day , 3 times/week ) . At baseline and at the 36th week women filled-in a Food Frequency Question naire . Outcomes : gestational weight gain , gestational diabetes mellitus , gestational hypertension , preterm delivery . Data stratified by BMI categories . Results : Socio-demographic features were similar between groups ( TLC : 33 cases , Controls : 28 cases ) . At term , gestational weight gain in obese women r and omized to TLC group was lower ( 6.7 ± 4.3 kg ) versus controls ( 10.1 ± 5.6 kg , p = 0.047 ) . Gestational diabetes mellitus , gestational hypertension and preterm delivery were also significantly lower . TLC was an independent factor in preventing gestational weight gain , gestational diabetes mellitus , gestational hypertension . Significant changes in eating habits occurred in the TLC group , which increased the number of snacks , the intake of fruits – vegetables and decreased the consumption of sugar . Conclusions : A caloric restriction associated to changes in eating behavior and constant physical activity , is able to reduce gestational weight gain and related pregnancy complications in obese women BACKGROUND Excessive weight gain during pregnancy is a major risk factor for  postpartum weight retention and future weight gain and obesity in women , but few adequately powered r and omized controlled trials have examined the efficacy of a behavioral weight-control intervention during pregnancy . OBJECTIVE This study examined whether a behavioral intervention during pregnancy could decrease the proportion of women who exceeded the 1990 Institute of Medicine ( IOM ) recommendations for gestational weight gains and increase the proportion of women who returned to pregravid weights by 6 mo postpartum . DESIGN This study was a r and omized , assessor-blind , controlled trial . Participants were pregnant ( 13.5 wk gestation ) , normal-weight ( NW ; n = 201 ) and overweight or obese ( OW/OB ; n = 200 ) women whose average age was 28.8 y. Participants were r and omly assigned within the 1990 IOM weight category ( NW compared with OW/OB ) to st and ard care ( n = 200 ) or to a behavioral intervention to prevent excessive gestational weight gain ( n = 201 ) . The intervention included one face-to-face visit ; weekly mailed material s that promoted an appropriate weight gain , healthy eating , and exercise ; individual graphs of weight gain ; and telephone-based feedback . The retention at the 6-mo postpartum assessment was 82 % . RESULTS Intent-to-treat analyses showed that the intervention , compared with st and ard care , decreased the percentage of NW women who exceeded IOM recommendations ( 40.2 % compared with 52.1 % ; P = 0.003 ) and increased the percentages of NW and OW/OB women who returned to their pregravid weights or below by 6 mo postpartum ( 30.7 % compared with 18.7 % ; P = 0.005 ) . CONCLUSION A low-intensity behavioral intervention during pregnancy reduced excessive gestational weight gains in NW women and prevented postpartum weight retention in NW and OW/OB women . This trial was registered at clinical trials.gov as NCT01117961
BACKGROUND This is an up date of a Cochrane review first published in 2012 , Issue 4 .
Excessive weight gain  during pregnancy is associated with poor maternal and neonatal outcomes including gestational diabetes , hypertension , caesarean section , macrosomia , and stillbirth .
Diet or exercise interventions , or both , may reduce excessive gestational weight gain ( GWG ) and associated poor outcomes ; however , evidence from the original review was inconclusive .
OBJECTIVES To evaluate the effectiveness of diet or exercise , or both , interventions for preventing excessive weight gain during pregnancy and associated pregnancy complications .