Lifestyle Modification Program Decreases Pregnancy Weight Gain in Obese Women

ABSTRACT

We assessed the impact of a lifestyle modification program (LMP) on weight gain in pregnancy and evaluated its effect on adverse pregnancy outcomes. A prospective matched controlled study design was employed. Inclusion criteria consisted of pregnant women with singleton gestations and body mass index (BMI) ≥30 without underlying medical conditions. In the study group, patients were prospectively enrolled in the first trimester. Through the LMP, women participated in a comprehensive program on nutrition, exercise, and weight control in pregnancy. The control group consisted of matched patients by starting BMI, parity, and socioeconomic status during the same study period cared for at the same institution. The primary outcome evaluated was weight gain in pregnancy. Adverse pregnancy outcomes including preeclampsia, gestational diabetes, gestational hypertension, and various postpartum complications were evaluated between the two groups. Statistical analysis was performed using nonparametric methods, with p < 0.5 considered significant. Twenty-eight patients were recruited for this study and underwent the intervention. Patient compliance with the LMP was 75%, two patients were lost to follow-up, one had a preterm delivery, and four had incomplete data due to various reasons. Twenty-one patients completed their pregnancy and were available for analysis. Twenty matched control patients were identified for analysis. Study participants gained significantly less weight in their pregnancies when compared with controls (mean weight gain 17 versus 34 pounds, respectively; p = 0.008). Secondary outcomes of preeclampsia, gestational diabetes, cesarean section, as well as infant birth weight did not significantly differ between the groups. This study suggests an effective method of reducing prenatal weight gain in the obese population. This type of comprehensive intervention could be an important, cost-effective risk-reduction strategy.

KEYWORDS

Obesity and pregnancy - lifestyle modification - weight limitation

REFERENCES

• 1 Obesity: Preventing and Managing a Global Epidemic. WHO Technical Support Series 894. Geneva, Switzerland; World Health Organization 2000
• 2 Ogden C L, Carroll M D, McDowell M A, Flegal K M. Obesity among adults in the United States— no change since 2003–2004. NCHS data brief no 1. Hyattsville, MD; National Center for Health Statistics 2007
• 3 Rasmussen S A, Chu S Y, Kim S Y, Schmid C H, Lau J. Maternal obesity and risk of neural tube defects: a metaanalysis.  Am J Obstet Gynecol. 2008;  198 611-619
• 4 Sarwer D B, Allison K C, Gibbons L M, Markowitz J T, Nelson D B. Pregnancy and obesity: a review and agenda for future research.  J Womens Health (Larchmt). 2006;  15 720-733
• 5 Chu S Y, Kim S Y, Lau J et al.. Maternal obesity and risk of stillbirth: a metaanalysis.  Am J Obstet Gynecol. 2007;  197 223-228
• 6 Nutrition During Pregnancy Part I. Weight Gain; Part II: Nutrient Supplements. Committee on Nutritional Status During Pregnancy and Lactation, Institute of Medicine. Washington DC; National Academy Press 1990
• 7 Kuehn B M. Guideline for pregnancy weight gain offers targets for obese women.  JAMA. 2009;  302 241-242
• 8 Polley B A, Wing R R, Sims C J. Randomized controlled trial to prevent excessive weight gain in pregnant women.  Int J Obes Relat Metab Disord. 2002;  26 1494-1502
• 9 Mayer J P, Hawkins B, Todd R. A randomized evaluation of smoking cessation interventions for pregnant women at a WIC clinic.  Am J Public Health. 1990;  80 76-78
• 10 Smith S A, Hulsey T, Goodnight W. Effects of obesity on pregnancy.  J Obstet Gynecol Neonatal Nurs. 2008;  37 176-184
• 11 Olson C M, Strawderman M S, Reed R G. Efficacy of an intervention to prevent excessive gestational weight gain.  Am J Obstet Gynecol. 2004;  191 530-536
• 12 Asbee S M, Jenkins T R, Butler J R, White J, Elliot M, Rutledge A. Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial.  Obstet Gynecol. 2009;  113(2 Pt 1) 305-312