Obesity and Weight Gain in Pregnancy and Postpartum: an Evidence Review of Lifestyle Interventions to Inform Maternal and Child Health Policies

Abstract

Background: Maternal obesity, excessive gestational weight gain (GWG) and post-partum weight retention (PPWR) constitute new public health challenges, due to the association with negative short- and long-term maternal and neonatal outcomes. The aim of this evidence review was to identify effective lifestyle interventions to manage weight and improve maternal and infant outcomes during pregnancy and postpartum.Methods: A review of systematic reviews and meta-analyses investigating the effects of lifestyle interventions on GWG or PPWR was conducted (Jan 2009–2018) via electronic searches in the databases Medline, Pubmed, Web of Science and Cochrane Library using all keywords related to obesity/weight gain/loss, pregnancy or postpartum and lifestyle interventions;15 relevant reviews were selected.Results: In healthy women from all BMI classes, diet and physical activity interventions can decrease: GWG (mean difference −1.8 to −0.7 kg, high to moderate-quality evidence); the risks of GWG above the IOM guidelines (risk ratio [RR] 0.72 to 0.80, high to low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low to very low-quality evidence); cesarean section (RR 0.91 to 0.95; high to moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.56, high-quality evidence); without any maternal/fetal/neonatal adverse effects. In women with overweight/obesity, multi-component interventions can decrease: GWG (−0.91 to −0.63 kg, moderate to very low-quality evidence); pregnancy-induced hypertension (RR 0.30 to 0.66, low-quality evidence); macrosomia (RR 0.85, 0.73 to 1.0, moderate-quality evidence) and neonatal respiratory distress syndrome (RR 0.47, 0.26 to 0.85, moderate-quality evidence). Diet is associated with greater reduction of the risks of GDM, pregnancy-induced hypertension and preterm birth, compared with any other intervention. After delivery, combined diet and physical activity interventions reduce PPWR in women of any BMI (−2.57 to −2.3 kg, very low quality evidence) or with overweight/obesity (−3.6 to −1.22, moderate to very low-quality-evidence), but no other effects were reported.Conclusions: Multi-component approaches including a balanced diet with low glycaemic load and light to moderate intensity physical activity, 30–60 min per day 3–5 days per week, should be recommended from the first trimester of pregnancy and maintained during the postpartum period. This evidence review should help inform recommendations for health care professionals and women of child-bearing age.

Mothers’ views of health problems in the 12 months after childbirth: A concept mapping study

“…During pregnancy and the post‐childbirth period, women are prone to weight gain and weight retention (Nascimento, Pudwell, Surita, Adamo, & Smith, ). But while there are many practical guidelines for exercise during pregnancy (Farpour‐Lambert, Ells, Martinez de Tejada, & Scott, ), the post‐childbirth period is overlooked (Evenson, Mottola, Owe, Rousham, & Brown, ). Consistent with other studies, women in this study felt that getting information about exercise and getting fit after childbirth were important, but studies show that healthcare providers do not offer this information (Evenson, ; Ferrari et al, ).…”

Role of gestational weight gain, gestational diabetes, breastfeeding, and hypertension in mother-to-child obesity transmission

“…To avoid any additional maternal exposure to medications, most of protocols offered different models of lifestyle modifications (combinations of improved dietary habits and physical activity) commenced at different gestational age and in different populations at risk. 48,54 These interventions usually achieved a nonsignificant reduction in GDM prevalence, and (in DALI study) reduced gestational weight gain. 55 Recently, an increasing number of studies also reported results from randomized trials including medical prevention of maternal complications in different high-risk populations, mostly using an insulin-sensitizing agent, metformin, as a drug of choice for these interventions, either alone or in a combination with lifestyle modifications.…”

“…A recent meta-analysis summarizing available evidence on short-term maternal and neonatal outcomes noted differences in GWG reduction depending on the baseline maternal BMI. 48 The authors reported an overall beneficial influence of diet and lifestyle interventions to maintain a recommended GWG on reduced risk of gestational hypertension in mothers, and of macrosomia and respiratory distress syndrome in newborns. Interestingly, a post hoc analysis of data from DALI (Vitamin D and Lifestyle Intervention for GDM Prevention) study failed to confirm any correlation between smaller gestational weight gain and improvement in maternal glycemia, whereas a long--term follow-up of over 900 mother-child pairs recruited at one site within the HAPO study found that both excessive and insufficient gestational weight gain was associated with an increased risk of insulin resistance and hypertensive disorders in children at the age of 7 years.…”

Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

“…A review of systematic reviews and meta-analyses by Farpour-Lambert et al 195 examined evidence for an effect of postpartum interventions on postpartum weight retention. Fifteen systematic reviews were included: nine focused on pregnancy, three focused on postpartum and three covered both during and after pregnancy (the systematic review by Dodd et al 170 was not included).…”