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.

This study aims to determine whether the prescription of a detailed lifestyle programme in overweight/obese pregnant women influences the occurrence of gestational diabetes (GDM), and if this kind of prescription increases the adherence to a healthier lifestyle in comparison to standard care. The study was designed as a randomized controlled trial, with open allocation, enrolling women at 9-12 weeks of pregnancy with a BMI ≥ 25 kg/m . The women assigned to the Intervention group (I = 96) received a hypocaloric, low-glycaemic, low-saturated fat diet and physical activity recommendations. Those assigned to the Standard Care group (SC = 95) received lifestyle advices regarding healthy nutrition and exercise. Follow-up was planned at the 16 , 20 , 28 and 36 weeks. A total of 131 women completed the study (I = 69, SC = 62). The diet adherence was higher in the I (57.9%) than in the SC (38.7%) group. GDM occurred less frequently in the I (18.8%) than in the SC (37.1%, P = 0.019) group. The adherent women from either groups showed a lower GDM rate (12.5% vs. 41.8%, P < 0.001). After correcting for confounders, the GDM rate was explained by allocation into the I group (P = 0.034) and a lower BMI category (P = 0.039). The rates of hypertension, preterm birth, induction of labour, large for gestational age babies and birthweight > 4000 g were significantly lower in I group. The incidence of small for gestational age babies was not different. These findings demonstrate that the adherence to a personalized, hypocaloric, low-glycaemic, low-saturated fat diet started early in pregnancy prevents GDM occurrence, in women with BMI ≥ 25 kg/m .

No abstract

OBJECTIVE: To determine the influence of weight gain on the odds of cesarean delivery for obese women (as determined by pre-pregnancy body mass index [BMI]), specifically by class of obesity. STUDY DESIGN: This is a secondary data analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) in the United States (Centers for Disease Control and Prevention). The unadjusted odds ratios for cesarean delivery were determined for each class of BMI (underweight, normal weight, overweight, class I obesity, class II obesity, and class III obesity). These odds were then adjusted by demographic and prenatal care factors (maternal age, marital status, race, ethnicity, education) influencing either weight gain during pregnancy or risk of cesarean delivery on univariate analysis. The association of weight gain (insufficient <11 lbs, appropriate 11-20 lbs, and excessive >20 lbs) on the odds ratios of cesarean delivery in obese women was evaluated via multivariate logistic regression analysis. RESULTS: Thirty-two states contributed to the dataset (n¼57,866 women), (Figure 1). The adjusted odds ratios (aOR) of cesarean delivery by BMI were: underweight 0.92 (95% CI 0.83, 1.01), normal weight (referent group), overweight 1.38 (95% CI 1.32, 1.45), class I obesity 1.77 (95% CI 1.68, 1.88), class II obesity 2.17 (95% CI 2.02, 2.34), and class III obesity 3.07 (95% CI 2.82, 3.34). Class I and II obese women were more likely to have a cesarean with excessive weight gain, with class I OR 1.20 (95% CI 1.06, 1.36) and class II OR 1.24 (1.04,1.48) when compared to women in their same class of obesity with appropriate weight gain (Figure 2). CONCLUSION: Although obesity is a known risk factor for cesarean delivery, this risk is thought to be mitigatable by appropriate weight gain during the pregnancy. Weight gain of <20 pounds was associated with the least risk of cesarean delivery among obese (specifically Class I and II) individuals.