Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy

Abstract

IMPORTANCEThe prevalence of overweight and obesity is increasing among persons of childbearing age and pregnant persons. In 2015, almost half of all persons began pregnancy with overweight (24%) or obesity (24%). Reported rates of overweight and obesity are higher among Black, Alaska Native/American Indian, and Hispanic women and lower among White and Asian women. Excess weight at the beginning of pregnancy and excess gestational weight gain have been associated with adverse maternal and infant health outcomes such as a large for gestational age infant, cesarean delivery, or preterm birth.OBJECTIVE The USPSTF commissioned a systematic review to evaluate the benefits and harms of behavioral counseling interventions to prevent adverse health outcomes associated with obesity during pregnancy and to evaluate intermediate outcomes, including excess gestational weight gain. This is a new recommendation.POPULATION Pregnant adolescents and adults in primary care settings. EVIDENCE ASSESSMENTThe USPSTF concludes with moderate certainty that behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy have a moderate net benefit for pregnant persons.RECOMMENDATION The USPSTF recommends that clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. (B recommendation)

An interim analysis of a gestational weight gain intervention in military personnel and other TRICARE beneficiaries

“…Observed reductions in the prevalence of excessive GWG are consistent with other randomized controlled trials with similar behavioral interventions among civilians [ 36 , 38 , 39 ]. Additionally, the magnitude of the observed GWG difference is also similar to previous research [ 36 , 40 , 41 , 42 ], although it is larger than the mean GWG difference found in recent meta‐analyses (0.7 kg and 1 kg) [ 43 , 44 ]. Notably, these outcomes were achieved with 4.2 sessions, on average, provided to each participant and using the stepped‐care approach, which is substantially less than the 12 or more sessions that were associated with similar outcomes in the systematic review conducted by the US Preventive Services Task Force [ 44 ].…”

“…Additionally, the magnitude of the observed GWG difference is also similar to previous research [ 36 , 40 , 41 , 42 ], although it is larger than the mean GWG difference found in recent meta‐analyses (0.7 kg and 1 kg) [ 43 , 44 ]. Notably, these outcomes were achieved with 4.2 sessions, on average, provided to each participant and using the stepped‐care approach, which is substantially less than the 12 or more sessions that were associated with similar outcomes in the systematic review conducted by the US Preventive Services Task Force [ 44 ]. Nonetheless, this attenuation in GWG was not sufficient to significantly reduce negative maternal and neonatal health outcomes in the participants who received the intervention, consistent with previous analyses with larger samples [ 36 ].…”

The importance of nutrition in pregnancy and lactation: lifelong consequences

“…The recent evidence report and systematic review for the US Preventive Services Task Force (USPSTF) found that counseling and active behavioral interventions to limit GWG were associated with lower risk of GDM, macrosomia, LGA and emergency cesarean delivery and reduced GWG of −1.02 kg 172 The led the USPSTF to issue a new recommendation statement that clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excessive GWG in pregnancy (B recommendation). 173 …”

Pregnancy Care for Patients With Super Morbid Obesity

“…Some perceived benefits to limited weight gestational gain in these patients have been suggested, including decreased risk for cesarean section and decreased post-partum weight retention; however, secondary to the lack of proven benefit and the known increased risk of SGA infants, we recommend advising patients according to the IOM guidelines for gestational weight gain. The USPSTF has published a table of behavior counseling interventions to guide practitioners' discussion with pregnant patients who are at risk of adverse outcomes related to obesity ( 36 ). These recommendations include structured exercise classes, healthy eating habits, directed counseling and goal setting.…”