Lifestyle Intervention for Overweight/Obese Pregnant Women with Polycystic Ovarian Syndrome: Lessons and Challenges

Abstract

<b><i>Introduction and Objective:</i></b> Polycystic ovary syndrome (PCOS) is the most common reproductive disorder in women of reproductive age, and overweight and obesity are highly prevalent in women with PCOS. This study aims to explore whether lifestyle intervention can improve gestational weight gain (GWG), glucolipid metabolism, and perinatal outcomes in overweight/obese pregnant women with PCOS. <b><i>Methods:</i></b> This study is a randomized controlled trial that included overweight and obese pregnant women with PCOS who met the inclusion criteria of 8–12 gestational weeks. They were randomly allocated to the intervention group and the control group. Women in the intervention group were given individualized counseling on diet and exercise from a trained dietitian and followed up regularly by a trained dietitian. Women in the control group received guidance on diet and exercise in the form of group education. <b><i>Results:</i></b> A total of 296 pregnant women were enrolled in the study, including 164 in the intervention group and 132 in the control group. GWG was 11.93 ± 5.67 kg in the intervention group and 11.86 ± 5.35 kg in the control group and did not differ between the 2 groups. According to the per-protocol analyses, women with good compliance had a lower weight gain (10.11 ± 5.56 vs. 12.70 ± 5.31, <i>p</i> = 0.0042). The incidence of gestational diabetes mellitus and other perinatal outcomes did not differ between the 2 groups. For the lipid profile, we did not find significant improvement in the intervention group. <b><i>Conclusions:</i></b> Our study showed that lifestyle intervention of diet and exercise did not affect GWG, glucolipid metabolism, and perinatal outcomes of overweight/obese pregnant women with PCOS. However, women with good compliance can benefit from the lifestyle intervention for GWG. We believe that future studies should focus on trial design and increasing compliance to improve the quality of the study.

Prepregnancy weight loss and maternal metabolic and inflammatory biomarkers during pregnancy: An analysis of National Health and Nutrition Examination Survey

“…15 Similarly, the few lifestyle weight loss interventions initiated after pregnancy also observed little or no change in lipid profiles. [28][29][30][31][32] Nonetheless, our finding of the lipidlowering effect of maternal weight loss prior to pregnancy was consistent with an animal study, which reported that preconception dietary restriction in obese mice led to decreased cholesterol and LDL-C levels in gestation. 33 The downtrend in levels of total cholesterol and LDL-C was accompanied by a parallel reduction in HDL-C levels, which is an unexpected finding as weight loss has historically been associated with improved HDL-C thus ameliorated cardiovascular risks.…”

“…Albeit a larger amount of weight loss in the intervention group, there was no between‐group difference in levels of triglycerides at 14 weeks' gestation 15 . Similarly, the few lifestyle weight loss interventions initiated after pregnancy also observed little or no change in lipid profiles 28–32 . Nonetheless, our finding of the lipid‐lowering effect of maternal weight loss prior to pregnancy was consistent with an animal study, which reported that preconception dietary restriction in obese mice led to decreased cholesterol and LDL‐C levels in gestation 33 …”

Research Trends of Lifestyle Intervention for Women With Obesity: A Text Network Analysis

“…It may be observed that it is common to provide lifestyle interventions, inclusive of nutrition and exercise, for changes in lifestyle for overweight and obese women. In overweight or obese pregnant women, lifestyle interventions were effective in the maintenance of stable weight gain and the control of fatigue and pregnancy stress [ 18 ], and were also effective in the reduction of weight and improvement of lipid levels [ 19 ]. In overweight and obese middle-aged women, it was effective in the increasing of health-promoting behaviors, reduction of psychological distress, weight loss, improvement of reproductive system symptoms [ 20 ], and increase in the pregnancy rate of obese and infertile women [ 21 ].…”

Effect of non-pharmacological interventions for overweight/obese women with polycystic ovary syndrome on ovulation and pregnancy outcomes: a protocol for a systematic review and network meta-analysis

“…First, non-pharmacological interventions in PCOS are an extensive research field, but we only focus on lifestyle interventions, acupuncture therapies and nutritional supplements, 11 which may lead to limitations of clinical practice. Second, considering that overweight/obese patients have an increased risk of metabolic disorders 32 and tend to benefit more from non-pharmacological interventions compared with normal weight patients, we will restrict the population to overweight/obese PCOS, which may limit the extrapolation of the conclusion. Third, the efficacy of different protocols of the same non-pharmacological intervention will not be investigated.…”