Author response to: Weight gain restriction for obese pregnant women: a case‐control intervention study Supervised home-based exercise may attenuate the decline of glucose tolerance in obese pregnant women. Preventing Excessive Weight Gain During Pregnancy Through Dietary and Lifestyle Counseling: A Randomized Controlled Trial Exercise during pregnancy improves maternal glucose screen at 24–28 weeks: a randomised controlled trial Feasibility of a controlled trial aiming to prevent excessive pregnancy-related weight gain in primary health care Obesity in Pregnancy: Implications for the Mother and Lifelong Health of the Child. A Consensus Statement Women’s compliance with nutrition and lifestyle recommendations before pregnancy: general population cohort study Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial. Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Randomized controlled trial to prevent excessive weight gain in pregnant women 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 A randomized comparative trial of the efficacy and safety of exercise during pregnancy: design and methods. 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. Lifestyle modification program decreases pregnancy weight gain in obese women. Primary Prevention of Gestational Diabetes Mellitus and Large-for-Gestational-Age Newborns by Lifestyle Counseling: A Cluster-Randomized Controlled Trial
OBJECTIVE To minimise obese women 's total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome . DESIGN A prospect i ve case-control intervention study . SETTING Antenatal care clinics in the southeast region of Sweden . POPULATION One hundred fifty-five pregnant women in an index group and one hundred ninety-three women in a control group . METHODS An intervention programme with weekly motivational talks and aqua aerobic classes for obese pregnant women . MAIN OUTCOME MEASURES Weight gain in kilograms , delivery and neonatal outcome . RESULTS The index group had a significantly lower weight gain during pregnancy compared with the control group ( P < 0.001 ) . The women in the index group weighed less at the postnatal check-up compared with the weight registered in early pregnancy ( P < 0.001 ) . The percentage of women in the index group who gained less than 7 kg was greater than that of women in the control group who gained less than 7 kg ( P= 0.003 ) . The percentage of nulliparous women  in this group was greater than that in the control group ( P= 0.018 ) . In addition , the women in the index group had a significantly lower body mass index at the postnatal check-up , compared with the control group ( P < 0.001 ) . There were no differences between the index group and the control group regarding birthweight , gestational age and mode of delivery . CONCLUSION The intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome AIM The significant deterioration of insulin sensitivity and glucose tolerance during pregnancy can have serious health implication s for both the pregnant woman and her baby . Although it is well established that regular exercise benefits insulin sensitivity in the nonpregnant population , the effect on glucose tolerance in obese pregnant women is not known . The purpose of this study was to investigate the effect of a supervised 10-week , home-based , exercise programme , beginning at week 18 of gestation , on glucose tolerance and aerobic fitness in previously sedentary obese women . METHODS Twelve sedentary obese women were r and omized into an exercise ( EX ; n=6 ) or control ( CON ; n=6 ) group at 18 weeks of gestation . Those r and omized to EX engaged in 10 weeks of supervised home-based exercise ( three sessions a week of stationary cycling ) , while those in the CON group maintained their usual daily activity . Their glucose and insulin responses to an oral glucose tolerance test ( OGTT ) , as well as their aerobic fitness , were assessed both pre- and postintervention . RESULTS Reduced glucose tolerance in the CON , but not EX , group was indicated by a tendency postintervention towards higher blood glucose levels at 1h of the OGTT ( P=0.072 ) . Furthermore , at 2h of the postintervention OGTT , blood glucose tended to remain elevated from baseline in the CON ( P=0.077 ) . There was also a trend towards increased fitness in the EX ( P=0.064 ) , but not the CON group . CONCLUSION Regular aerobic exercise begun during pregnancy may have favourable effects on glucose tolerance and fitness in obese women , and warrants further investigation in a larger sample population 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 : Objective The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied . Study design A physical activity ( PA , l and /aquatic activities ) programme during the entire pregnancy ( three sessions per week ) was conducted by a qualified instructor . 83 healthy pregnant women were r and omly assigned to either an exercise group ( EG , n=40 ) or a control ( CG , n=43 ) group . 50 g maternal glucose screen ( MGS ) , maternal weight gain and several pregnancy outcomes were recorded . Results Significant differences were found between study groups on the 50 g MGS . Values corresponding to the EG ( 103.8±20.4 mg/dl ) were better than those of the CG ( 126.9±29.5 mg/dl ) , p=0.000 . In addition , no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG ( 7 % ) ( p>0.05 ) were found . Conclusion A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance Background Excessive gestational weight gain and postpartum weight retention may predispose women to long-term overweight and other health problems . Intervention studies aim ing at preventing excessive pregnancy-related weight gain are needed . The feasibility of implementing such a study protocol in primary health care setting was evaluated in this pilot study . Methods A non-r and omized controlled trial was conducted in three intervention and three control maternity and child health clinics in primary health care in Finl and . Altogether , 132 pregnant and 92 postpartum women and 23 public health nurses ( PHN ) participated in the study . The intervention consisted of individual counselling on physical activity and diet at five routine visits to a PHN and of an option for supervised group exercise until 37 weeks ' gestation or ten months postpartum . The control clinics continued their usual care . The components of the feasibility evaluation were 1 ) recruitment and participation , 2 ) completion of data collection , 3 ) realization of the intervention and 4 ) the public health nurses ' experiences . Results 1 ) The recruitment rate was slower than expected and the recruitment period had to be prolonged from the initially planned three months to six months . The average participation rate of eligible women at study enrolment was 77 % and the drop-out rate 15 % . 2 ) In total , 99 % of the data on weight , physical activity and diet and 96 % of the blood sample s were obtained . 3 ) In the intervention clinics , 98 % of the counselling sessions were realized , their contents and average duration s were as intended , 87 % of participants regularly completed the weekly records for physical activity and diet , and the average participation percentage in the group exercise sessions was 45 % . 4 ) The PHNs regarded the extra training as a major advantage and the high additional workload as a disadvantage of the study . Conclusion The study protocol was mostly feasible to implement , which encourages conducting large trials in comparable setting s . Trial registration Current Controlled Trials IS RCT Obesity among pregnant women is becoming one of the most important women 's health issues . Obesity is associated with increased risk of almost all pregnancy complications : gestational hypertension , preeclampsia , gestational diabetes mellitus , delivery of large-for-GA infants , and higher incidence of congenital defects all occur more frequently than in women with a normal BMI . Evidence shows that a child of an obese mother may suffer from exposure to a suboptimal in utero environment and that early life adversities may extend into adulthood . In September 2009 , ILSI Europe convened a workshop with multidisciplinary expertise to review practice s and science base of health and nutrition of obese pregnant women , with focus on the long-term health of the child . The consensus viewpoint of the workshop identified gaps and gave recommendations for future research on gestational weight gain , gestational diabetes , and research method ologies . The evidence available on short- and long-term health impact for mother and child currently favors actions directed at controlling prepregnancy weight and preventing obesity in women of reproductive ages . More r and omized controlled trials are needed to evaluate the effects of nutritional and behavioral interventions in pregnancy outcomes . Moreover , suggestions that maternal obesity may transfer obesity risk to child through non-Mendelian ( e.g. epigenetic ) mechanisms require more long-term investigation Objective To examine the extent to which women planning a pregnancy comply with recommendations for nutrition and lifestyle . Design Prospect i ve cohort study . Setting Southampton , United Kingdom . Participants 12 445 non-pregnant women aged 20 - 34 recruited to the Southampton Women ’s Survey through general practice s , 238 of whom became pregnant within three months of being interviewed . Main outcome measures Folic acid supplement intake , alcohol consumption , smoking , diet , and physical activity before pregnancy . Results The 238 women who became pregnant within three months of the interview were only marginally more likely to comply with recommendations for those planning a pregnancy than those who did not become pregnant in this period . Among those who became pregnant , 2.9 % ( 95 % confidence interval 1.2 % to 6.0 % ) were taking 400 μg or more of folic acid supplements  a day and drinking four or fewer units of alcohol a week , compared with 0.66 % ( 0.52 % to 0.82 % ) of those who did not become pregnant . 74 % of those who became pregnant were non-smokers compared with 69 % of those who did not become pregnant ( P=0.08 ) . Women in both groups were equally likely to consume five or more portions of fruit and vegetables a day ( 53 % in each group , P=1.0 ) , but only 57 % of those who became pregnant had taken any strenuous exercise in the past three months compared with 64 % in those who did not become pregnant ( P=0.03 ) . Conclusion Only a small proportion of women planning a pregnancy follow the recommendations for nutrition and lifestyle . Greater publicity for the recommendations is needed , but as many pregnancies are unplanned , improved nutrition and lifestyles of women of childbearing age is also required 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 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 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 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 Use of an exercise intervention for high-risk and vulnerable population s , such as pregnant women at risk for gestational hypertension or preeclampsia , requires special consideration . A comparative trial testing the effects of two types of physical exercises - stretching ( a comparator ) and walking ( a testing intervention ) - for sedentary pregnant women at risk for preeclampsia - is presented in this paper . The study was design ed to reduce post-r and omization bias and dropout rates from both groups , and closely to monitor safety of subjects . The strengths of the study design and methods include use of a run-in phase ; use of a stretching exercise as a comparator ; multiple ways to measure daily physical activities and the exercise intervention ; and tailored support to remove barriers to exercise for subjects . The intervention consists of 40 min of walking at moderate intensity ( i.e. , 55 - 69 % of maximum heart rate and rating of perceived exhaustion 12 - 13 ) five times a week from 18 weeks gestation until birth . The comparator exercise consists of 40 min of stretching exercise without increasing heart rate to more than 10 % of resting heart rate , five times a week from 18 weeks gestation until birth . The primary outcome is the incidence of preeclampsia . Secondary outcomes include the physiologic effects of the intervention and birth outcomes 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 We assessed the impact of a lifestyle modification program ( LMP ) on weight gain in pregnancy  and evaluated its effect on adverse pregnancy outcomes . A prospect i ve matched controlled study design was employed . Inclusion criteria consisted of pregnant women with singleton gestations and body mass index ( BMI ) > or = 30 without underlying medical conditions . In the study group , patients were prospect ively enrolled in the first trimester . Through the LMP , women participated in a comprehensive program on nutrition , exercise , and weight control in pregnancy . The control group consisted of matched patients by starting BMI , parity , and socioeconomic status during the same study period cared for at the same institution . The primary outcome evaluated was weight gain in pregnancy . Adverse pregnancy outcomes including preeclampsia , gestational diabetes , gestational hypertension , and various postpartum complications were evaluated between the two groups . Statistical analysis was performed using nonparametric methods , with p < 0.5 considered significant . Twenty-eight patients were recruited for this study and underwent the intervention . Patient compliance with the LMP was 75 % , two patients were lost to follow-up , one had a preterm delivery , and four had incomplete data due to various reasons . Twenty-one patients completed their pregnancy and were available for analysis . Twenty matched control patients were identified for analysis . Study participants gained significantly less weight in their pregnancies when compared with controls ( mean weight gain 17 versus 34 pounds , respectively ; p = 0.008 ) . Secondary outcomes of preeclampsia , gestational diabetes , cesarean section , as well as infant birth weight did not significantly differ between the groups . This study suggests an effective method of reducing prenatal weight gain in the obese population . This type of comprehensive intervention could be an important , cost-effective risk-reduction strategy In a cluster-r and omized trial , Riitta Luoto and colleagues find that counseling on diet and activity can reduce the birthweight of babies born to women at risk of developing  gestational diabetes mellitus ( GDM  ) , but fail to find an effect on GDM
Background Overweight and obesity pose a big challenge to pregnancy as they are associated with adverse maternal and perinatal outcome .
Evidence of lifestyle intervention result ing in improved pregnancy outcome is conflicting .
Hence the objective of this study is to determine the efficacy of antenatal dietary , activity , behaviour or lifestyle interventions in overweight and obese pregnant women to improve maternal and perinatal outcomes .