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 prospective 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. ResultsThe 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. ConclusionThe intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome.

BackgroundAlthough studies have shown an association between anxiety and depression and obesity, psychological health among obese women during and after pregnancy has not been carefully studied. The aim of this study was to investigate psychological well-being using symptoms of depression and/or anxiety among obese pregnant women attending a weight gain restriction program and to then compare this group with a control group receiving traditional antenatal care.Methods151 obese pregnant women in an intervention group and 188 obese pregnant women in a control group answered the Beck Anxiety Inventory (BAI) and the Edinburgh Postnatal Depression Scale (EPDS). Group differences between the two groups were estimated by using the χ2 - test on categorical variables. The Student's t-test on continuous, normally distributed variables measuring changes in mean score on BAI and EPDS over time was used. To make a more comprehensive assessment of group differences, between as well as within the two groups, logistic regressions were performed with the BAI and EPDS as dependent variables, measured at gestational weeks 15 and 35 and 11 weeks postnatal. The grouping variable has been adjusted for socio-demographic variables and complications.ResultsThe prevalence of symptoms of anxiety during pregnancy varied between 24% and 25% in the intervention group and 22% and 23% in the control group. The prevalence of symptoms of anxiety postnatally was 9% in the intervention group and 11% in the control group. Five percent of the women in the intervention group and 4% of the women in the control group showed symptoms of anxiety during the course of pregnancy and at the postpartum assessment. The prevalence of symptoms of depression during pregnancy varied between 19% and 22% in the intervention group but was constant at 18% in the control group. Postnatal prevalence was 11% in both groups. Six percent of the women in the intervention group and 4% in the control group showed symptoms of depression during the course of pregnancy and at the postpartum assessment. We found no differences between the two groups as concerns demographic characteristics, weight gain in kg, or the distribution of scores on anxiety and depressive symptoms nor did we find differences in the fluctuation of anxiety and depressive symptoms over time between the women in the intervention group and in the control group.ConclusionObese pregnant women attending an intervention program seem to have the same risk of experiencing anxiety and/or depressive symptoms as do obese pregnant and postnatal women in general.

Objective: The objective of the study was to compare the differences in psychological wellbeing and quality of life during pregnancy and postpartum of obese physically active women and obese physically inactive women enrolled in a weight gain restriction program. We also wanted to explore whether physical activity influences weight change or health status during pregnancy.Design: A prospective intervention study. Setting: Antenatal care clinic.Participants: A total of 74 obese pregnant women in a physically active group and 79 obese women in a physically inactive group. Measurements:The women kept diaries of their physical activity during pregnancy and answered the Beck Anxiety Inventory, the Edinburgh Postnatal Depression Scale and Medical Study Short-Form Health Survey in gestational week 15 and 35 and 11 weeks postpartum.Physical activity was measured in metabolic equivalents. Findings:The physically active women experienced fewer depressive symptoms and estimated an improved quality of life during their pregnancies as measured by physical functioning, bodily pain, social functioning, role limitations due to emotional problems and general mental health as compared with the physically inactive women. There were no differences between the groups in gestational weight gain or weight change from early pregnancy to postpartum or in prevalence of complications.Key conclusions: Physical activity among obese pregnant women provides better psychological wellbeing and improved quality of life, but does not prevent weight change. Implications for practice:Staff at Antenatal Care Clinics that face obese pregnant women, should encourage and emphasize the benefits of being physically active throughout pregnancy.

BackgroundThe benefits of breastfeeding for the infant as well for the mother are well-known. It is recognized that obese (Body Mass Index ≥30 kg/m2) women may have less antenatal intention to breastfeed, and shortened duration of breastfeeding compared with normal-weight women. This may result in adverse short- and long-term health for both mother and child, such as a shortened lactational amenorrhoea and decreased protection against breast cancer for the women, and an increased risk for infectious diseases and overweight/obesity among the children. Therefore, it is important to gain more knowledge and understanding of obese women’s experiences of breastfeeding in order to attain good health care. Hence, the aim of this study was to identify and describe obese women’s experiences of breastfeeding.MethodsThis is an explorative study. Data was collected 2 – 18 months after childbirth through semi-structured face-to-face interviews with 11 obese women with breastfeeding experience. The interviews were recorded and transcribed verbatim. Thematic analysis was used.ResultsThree themes emerged from the data analysis: Breastfeeding - a part of motherhood, the challenges of breastfeeding, and support for breastfeeding. The women described an antenatal hope for breastfeeding, the body’s ability to produce milk fascinated them, and the breast milk was seen as the best way to feed the child and also as promoting the attachment between mother and child. Breastfeeding was described as a challenge even though it is natural. The challenges concerned technical difficulties such as the woman finding a good body position and helping the child to achieve an optimum grip of the nipple. Another challenge was the exposure of the body connected to public breastfeeding. Support of breastfeeding was described as the importance of being confirmed as an individual behind the obesity, rather than an individual with obesity, and to obtain enough professional breastfeeding support.ConclusionsBreastfeeding was experienced as a natural part of being a mother. There were practical challenges for obese women concerning how to manage breastfeeding and how to handle the public exposure of the body. There was a need for realistic information about breastfeeding concerning both the child and the woman.

Details of a female infant, who was born after 29 weeks gestation and who died within minutes of birth, are presented. The infant was hydropic, showed macroglossia and had very short limbs with normal sized hands and feet. Apart from a preductal aortic coarctation the pathological findings were confined to the skeleton. The radiographical and histological findings are described in detail; they differ from those of previous studies of similar conditions.

Objective: To investigate women's attitudes and satisfaction with a weight gain intervention programme during pregnancy.Design: Exploratory descriptive study. Data were collected via interviews. with the treatment and would attend the programme if they were pregnant again. Most of the women stated that they had changed their eating and exercise habits during pregnancy, and almost all of them had continued with these new habits. Even though the weight gain goal of maximum 6.9 kg was reached by less than half of the participants, most of the women were satisfied with their weight gain. 71.4 % of the women participated in a aqua aerobic class. They stated that the most satisfactory experience was the exercise form and that it also was a good social experience. Setting: University hospital Participants Key conclusions and implications for practice:A pregnant woman herself must be actively involved in setting her own goals to prevent an excessive weight gain during pregnancy. Considerable effort and support must be placed on discussing strategies, pitfalls and risks. In order for the woman to maintain the change in attitude and habits, she must probably be given continuous feedback and reinforcement over the long term.

Methods: Follow-up weight measurements were done at 12 and 24 months after childbirth. Main Outcome Measures:Weight change in kg at 12 and 24 months postpartum.Results: A greater percentage of women in the intervention group showed a weight loss 24 months after delivery than did women in the control group at that same time (p =0.034). Women in the intervention group who gained less than 7 kg during pregnancy had a significantly lower weight than the controls at the 24 months follow-up (p =0.018). The mean value of weight change in the intervention group was -2.2 kg compared to + 0.4 kg in the control group from early pregnancy to the follow-up 12 months after childbirth (p =0.046).Conclusions: An intervention program with weekly motivational support visits during pregnancy and every 6 months after childbirth seems to have an impact on weight gain up to 24 months after childbirth for those women in the intervention group who succeeded in restricting their gestational weight gain to less than 7 kg.Weight development two years after childbirth 3

BackgroundMaternal obesity is accompanied by maternal and fetal complications during and after pregnancy. The risks seem to increase with degree of obesity. Leptin has been suggested to play a role in the development of obesity related complications. Whether maternal leptin levels differ between obese and morbidly obese women, during and after pregnancy, have to our knowledge not been previously described. Neither has the association between maternal leptin levels and gestational weight gain in obese women. The aim was to evaluate if maternal plasma leptin levels were associated with different degrees of maternal obesity and gestational weight gain.MethodsProspective cohort study including women categorized as obesity class I-III (n = 343) and divided into three gestational weight gain groups (n = 304). Maternal plasma leptin was measured at gestational week 15, 29 and 10 weeks postpartum. Maternal Body Mass Index (BMI) was calculated from early pregnancy weight. Gestational weight gain was calculated using maternal weight in delivery week minus early pregnancy weight. The mean value and confidence interval of plasma-leptin were analysed with a two-way ANOVA model. Interaction effect between BMI and gestational weight gain group was tested with a two-way ANOVA model.ResultsThe mean maternal leptin concentrations were significantly higher in women with obesity class III compared to women in obesity class I, at all times when plasma leptin were measured. The mean leptin concentrations were also significantly higher in women with obesity class II compared to women in obesity class I, except in gestational week 29. There was no difference in mean levels of plasma leptin between the gestational weight gain groups. No significant interaction between BMI and gestational weight gain group was found.ConclusionsPlasma leptin levels during and after pregnancy were associated with obesity class but not with degree of gestational weight gain. These results are in concordance with epidemiological findings where the risk of obstetric complications increases with increased maternal obesity class. The effect on obstetric outcome by degree of gestational weight gain is less pronounced than the adverse effects associated with maternal obesity.