A Multidisciplinary Approach of Lifestyle in Overweight/Obese Pregnant Women: A Case-Control Study

Abstract

Objective: To determine whether an early lifestyle change program (consisting of customized nutritional advices and a constant moderate physical activity) can reduce the incidence of unfavorable maternal and neonatal outcomes among overweight/obese women. Research design and methods: This is a case-control study: women included in a lifestyle change program were labeled as cases; controls were randomly selected from the next three women delivering after one case and not undergoing any specific lifestyle change program, but only referred by the obstetrics of the National Health System. Cases attended a multidisciplinary counselling (by both the dietitian and the gynecologist) from enrollment (9th-12th week) until delivery (with four follow-up visits), consisting of a hypocaloric, low-glycemic index diet and a moderate physical activity program. Results: Three-hundred seventy-five women were included: 95 cases and 275 controls. Overall gestational weight gain and the rate of women remaining within the Institute of Medicine recommendations was similar between groups. The occurrence of gestational diabetes mellitus was lower in cases (21.5%) than in controls (32.7%; p = 0.041), and remained statistically significant after correcting for confounding factors (BMI ≥30 kg/m2, a family history of diabetes, age ≥35 y and ethnicity; p = 0.005). Pre-term births were significantly lower in cases (1.1%) than in controls (10.2%; p = 0.004). A higher number of controls developed hypertensive disorders (p = 0.024), in particular pregnancy-induced hypertension (1.1% in cases vs. 11.6% in controls, p = 0.0007). The frequency of macrosomic or large-for-gestational-age babies was significantly lower among cases (vedi prima) (p = 0.015 and p = 0.003 respectively). Conclusion: An early behavioral intervention among overweight/obese pregnant women (an individualized counseling by a dietician, a physical activity program and a close follow-up) reduces the preterm birth, the hypertensive disorders and the gestational diabetes mellitus, thus the occurrence of macrosomic and large-forgestational- age babies, while it doesn’t affect the occurrence of small-for-gestational-age.