Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial

Abstract

Objective To determine the effect of antenatal dietary and lifestyle interventions on health outcomes in overweight and obese pregnant women.Design Multicentre randomised trial. We utilised a central telephone randomisation 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 randomised to a comprehensive dietary and lifestyle intervention delivered by research staff; 1104 were randomised to standard care and received pregnancy care according to local guidelines, which did not include such information.

Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL)

“…On the other hand, if overweight women or women with previous macrosomia had been recruited to the trial, the heterogeneity of the study group would have been increased markedly. This could also have had effects on the intervention results (24,26,28,29). We believe that in the RADIEL we have been able to identify a real high-risk group that is also the most likely to benefit from a lifestyle intervention during pregnancy.…”

“…One possible explanation is the high-risk status of the women recruited to the study. In several previous GDM and other lifestyle intervention studies during pregnancy (21)(22)(23)(24)26,28,29), the women recruited were only at a modest risk for the development of GDM. This kind of study setting would need a bigger sample size to reveal the effect of a lifestyle intervention.…”

“…Adherence to a healthy lifestyle before pregnancy is, however, associated with reduced GDM risk (20). Several lifestyle intervention trials targeted at limiting gestational weight gain or preventing obesity-related perinatal complications, including GDM, have been performed (21)(22)(23)(24)(25)(26)(27)(28)(29). However, the results have been inconsistent; some studies (22,25,27,28) have been successful in reducing gestational weight gain, but the effect on GDM incidence has been minor (23)(24)(25)(26)(27)(28)(29).…”

Risk factors for gestational diabetes: is prevention possible?

“…Second, interventions in most of the studies were implemented late, in the second or third trimester, which might not have allowed sufficient time for the intervention to be effective. The latter was true even for the relatively large-scale intervention studies published recently [28][29][30].…”

“If she wants to eat…and eat and eat…fine! It's gonna feed the baby”: Pregnant women and partners' perceptions and experiences of pregnancy with a BMI >40 kg/m 2

“…A number of randomised-controlled trials have sought to examine the efficacy of pregnancy intervention approaches such as diet and exercise programmes, cognitive behavioural therapy (CBT), and social (cognitive) learning theory, on maternal weight gain and fetal growth (Dodd et al, 2010;Smith and Lavender 2011;Thangaratinam et al, 2012). However, recent RCTs of behaviour change interventions have experienced low uptake (Dodd et al, 2014;Poston et al, 2015), indicating poor acceptability. Multiple systematic reviews (Dodd et al, 2010;Campbell et al, 2011) and meta-analyses (Oteng-Ntim et al, 2012;Agha et al, 2014) have concluded that behaviour change interventions to date which have focused on limiting GWG via a combination of dietary counselling, weight monitoring, and exercise programmes for all categories of women with a BMI > 30 kg/m 2 have had moderate to no influence on GWG, and no effect on other perinatal outcomes.…”