81: An intensive behavioral intervention did not reduce gestational weight gain in overweight and obese gravidas

Abstract

More than half of overweight and obese women gain too much weight during pregnancy. This excessive weight gain increases risks of adverse perinatal outcomes, maternal postpartum weight retention, and childhood obesity. We aimed to evaluate the effectiveness of an antenatal intervention to target gestational weight gain (GWG) to current guidelines. We performed a prospective randomized clinical trial. Overweight and obese women with singleton gestations were recruited in the first trimester of pregnancy and randomized to usual care or a behavioral weight management intervention with financial incentives contingent upon meeting weight gain goals. The primary outcome was adherence to GWG guidelines. Group means were compared using ANOVA or ANCOVA and proportions were compared using chi-squared tests. 124 women were randomized and included in the analysis. The average BMI and % obese were similar between groups (32.3±5.7 vs 32.4±5.9 kg/m2 and 61% vs 60% intervention group vs usual care, respectively). Neither total GWG (21.4±1.6 vs 23.0±1.8 lbs; p=.52) nor GWG within/below guidelines (50.8% vs 47.7%; p=.73) differed between the intervention group and usual care. Results were unchanged when only obese women were included in the analysis. There was a trend towards fewer cases of large for gestational age neonates in the intervention group (11% vs 28%; p=.07) among obese women. An intensive behavioral intervention did not improve adherence to GWG guidelines in overweight and obese gravidas. These data suggest that antenatal modifications to GWG may be limited and highlights the importance of prepregnancy weight loss. Novel approaches are needed to optimize GWG in overweight and obese women.