Editorial: The importance of gestational weight gain

Goldstein, Rebecca F.; Harrison, Cheryce L.; Teede, Helena

doi:10.1111/obr.13073

Cited by 9 publications

(7 citation statements)

References 12 publications

(13 reference statements)

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“…Gestational weight gain that exceeds the recommendations occurs in approximately half of pregnancies and has been associated with adverse maternal and neonatal health outcomes. [5][6][7]45 Antenatal lifestyle interventions were associated with reduced GWG by 0.7 kg in a previous systematic review and individual patient-level data meta-analysis, with similar efficacy regardless of the mother's body mass index, age, parity, race and ethnicity, or preexisting medical conditions. 10 In another systematic review and meta-analysis of 68 studies, 9 lifestyle interventions were associated with 1.02 kg less GWG with a significant interaction with study intensity.…”

Section: Discussionmentioning

confidence: 95%

“…2 Preconception and pregnancy are priority life stages for healthy lifestyles and obesity prevention, 3,4 with excess weight being associated with adverse pregnancy outcomes, long-term noncommunicable disease in women, and epigenetic consequences across generations. [4][5][6] In metaanalyses of more than 1.3 million pregnancies worldwide, gestational weight gain (GWG) that exceeds international recommendations affected approximately half of pregnancies 6,7 and was an independent risk factor in adverse maternal and neonatal pregnancy outcomes. 5,6,8 The US Preventive Services Task Force has prioritized antenatal lifestyle interventions to limit excessive GWG, 9 yet the optimal intervention type and specific associations with maternal and neonatal outcomes remain unclear.…”

mentioning

confidence: 99%

“…9 Further insights into different intervention types are now needed. 7 We aimed to evaluate the association of different types of diet and physical activity-based antenatal lifestyle interventions with GWG and maternal and neonatal outcomes. We classified the interventions into structured diet, structured physical activity, and diet with physical activity with at least 1 structured component.…”

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Association of Antenatal Diet and Physical Activity–Based Interventions With Gestational Weight Gain and Pregnancy Outcomes

et al. 2022

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IMPORTANCE Excessive gestational weight gain (GWG) is common and associated with adverse pregnancy outcomes. Antenatal lifestyle interventions limit GWG; yet benefits of different intervention types and specific maternal and neonatal outcomes are unclear. OBJECTIVE To evaluate the association of different types of diet and physical activity-based antenatal lifestyle interventions with GWG and maternal and neonatal outcomes.DATA SOURCES A 2-stage systematic literature search of MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database was conducted from February 1, 2017, to May 31, 2020. Search results from the present study were integrated with those from a previous systematic review from 1990 to February 2017. STUDY SELECTION Randomized trials reporting GWG and maternal and neonatal outcomes.DATA EXTRACTION AND SYNTHESIS Data were extracted for random-effects meta-analyses to calculate the summary effect estimates and 95% CIs. MAIN OUTCOMES AND MEASURESOutcomes were clinically prioritized, with mean GWG as the primary outcome. Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy, cesarean section, preterm delivery, large or small for gestational age neonates, neonatal intensive care unit admission, or fetal death.RESULTS A total of 117 randomized clinical trials of antenatal lifestyle interventions (involving 34 546 women) were included. Overall lifestyle intervention was associated with reduced GWG (−1.15 kg; 95% CI, −1.40 to −0.91), risk of gestational diabetes (odds ratio [OR], 0.79; 95% CI, 0.70-0.89), and total adverse maternal outcomes (OR, 0.89; 95% CI, 0.84-0.94) vs routine care. Compared with routine care, diet was associated with less GWG (−2.63 kg; 95% CI, −3.87 to −1.40) than physical activity (−1.04 kg; 95% CI, −1.33 to −0.74) or mixed interventions (eg, unstructured lifestyle support, written information with weight monitoring, or behavioral support alone) (−0.74 kg; 95% CI, −1.06 to −0.43). Diet was associated with reduced risk of gestational diabetes (OR, 0.61; 95% CI, 0.45-0.82), preterm delivery (OR, 0.43; 95% CI, 0.22-0.84), large for gestational age neonate (OR, 0.19; 95% CI, 0.08-0.47), neonatal intensive care admission (OR, 0.68; 95% CI, 0.48-0.95), and total adverse maternal (OR, 0.75; 95% CI, 0.61-0.92) and neonatal outcomes (OR, 0.44; 95% CI, 0.26-0.72). Physical activity was associated with reduced GWG and reduced risk of gestational diabetes (OR, 0.60; 95% CI, 0.47-0.75), hypertensive disorders (OR, 0.66; 95% CI, 0.48-0.90), cesarean section (OR, 0.85; 95% CI, 0.75-0.95), and total adverse maternal outcomes (OR, 0.78; 95% CI, 0.71-0.86). Diet with physical activity was associated with reduced GWG (−1.35 kg; 95% CI, −1.95 to −0.75) and reduced risk of gestational diabetes (OR, 0.72; 95% CI, 0.54-0.96) and total adverse maternal outcomes (OR, 0.81; 95% CI, 0.69-0.95). Mixed interventions were associated with reduced GWG on...

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Section: Discussionmentioning

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Association of Antenatal Diet and Physical Activity–Based Interventions With Gestational Weight Gain and Pregnancy Outcomes

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“…Overall, lifestyle intervention reduced GWG (mean difference −1.15 kg; 95%CI: −1.40 to −0.91; 99 studies; 29,247 women), gestational diabetes (odds ratio (OR) 0.79; 95% CI: 0.70 to 0.89; 67 studies; 24,371 women) and total adverse maternal outcomes (OR 0.89; 95% CI: 0.84 to 0.94; I2=28%) [66]. With Level 1 evidence demonstrating the efficacy of lifestyle interventions alongside cost-effectiveness and potential cost savings [67], there is now a strong mandate for the translation and implementation of effective interventions into policy and practice [63,68]. Strategies to generate knowledge and public health impact for the prevention of weight gain in this critical window offers potential for major benefits to reproductive, cardiometabolic and psychological health in women of reproductive age and their families.…”

Section: Intervention Studies Addressing Lifestyle During Pregnancymentioning

confidence: 99%

Addressing Obesity in Preconception, Pregnancy, and Postpartum: A Review of the Literature

et al. 2022

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Purpose of Review Reproductive-aged women (aged 19 to 50 years) are a key population warranting focused research for the prevention of overweight and obesity. This review highlights the importance of addressing weight before, during and after pregnancy. Recent Findings Obesity decreases fertility during the preconception period; increases the risk of adverse pregnancy outcomes including gestational diabetes, pre-eclampsia and caesarean section and postpartum weight retention; and increases the long-term health risks for both the mother and offspring. Despite overwhelming efficacy evidence on solutions, there are significant implementation gaps in translating this evidence into pragmatic models of care and real-world solutions. Interventions during preconception, pregnancy and postpartum are likely to be cost-effective or cost-saving, with future investigation needed in the preconception and postpartum period. Summary International clinical guidelines and public health policies are needed for a concerted effort to prevent unhealthy weight gain in these life stages and to reverse the significant adverse health outcomes for women and the next generation.

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“…Interventions designed to improve healthy lifestyle, limit gestational weight gain and improve maternal and infant outcomes are effective, supported by level I evidence from a large meta-analysis [9]. The priority and remaining challenge is to implement these programs used in randomised controlled trials (RCTs) into usual maternal care [10,11]. Successful programs require dedicated, well-trained health professionals that can educate, empower and support women to make changes [12].…”

Section: Introductionmentioning

confidence: 99%

Facilitators and barriers to behaviour change within a lifestyle program for women with obesity to prevent excess gestational weight gain: a mixed methods evaluation

Goldstein

Boyle

et al. 2021

BMC Pregnancy Childbirth

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Background Maternal obesity is associated with health risks for women and their babies and is exacerbated by excess gestational weight gain. The aim of this study was to describe women’s experiences and perspectives in attending a Healthy Pregnancy Service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity. Methods An explanatory sequential mixed methods study design utilised two questionnaires (completed in early and late pregnancy) to quantify feelings, motivation and satisfaction with the service, followed by semi-structured interviews that explored barriers and enablers of behaviour change. Data were analysed separately and then interpreted together. Results Overall, 49 women attending the service completed either questionnaire 1, 2 or both and were included in the analysis. Fourteen women were interviewed. Prior to pregnancy, many women had gained weight and attempted to lose weight independently, and reported they were highly motivated to achieve a healthy lifestyle. During pregnancy, diet changes were reported as easier to make and sustain than exercise changes. Satisfaction with the service was high. Key factors identified in qualitative analysis were: service support enabled change; motivation to change behaviour, social support, barriers to making change (intrinsic, extrinsic and clinic-related), post-partum lifestyle and needs. On integration of data, qualitative and quantitative findings aligned. Conclusions The Healthy Pregnancy service was valued by women. Barriers and enablers to the delivery of an integrated model of maternity care that supported healthy lifestyle and recommended gestational weight gain were identified. These findings have informed and improved implementation and further scale up of this successful service model, integrating healthy lifestyle into routine antenatal care of women with obesity. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (no.12620000985987). Registration date 30/09/2020, retrospectively registered. http://www.anzctr.org.au/

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Editorial: The importance of gestational weight gain

Cited by 9 publications

References 12 publications

Association of Antenatal Diet and Physical Activity–Based Interventions With Gestational Weight Gain and Pregnancy Outcomes

Association of Antenatal Diet and Physical Activity–Based Interventions With Gestational Weight Gain and Pregnancy Outcomes

Addressing Obesity in Preconception, Pregnancy, and Postpartum: A Review of the Literature

Facilitators and barriers to behaviour change within a lifestyle program for women with obesity to prevent excess gestational weight gain: a mixed methods evaluation

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