Abstract
Background/ObjectivesWe previously reported results from a randomized trial showing that a behavioral intervention during pregnancy reduced excess gestational weight gain but did not impact maternal weight at 12 months. We now examine the longer-term effects of this prenatal intervention on maternal postpartum weight retention and toddler body-mass-index z scores (BMIz) over 36 months.Subjects/MethodsPregnant women (N = 264; 13.7 weeks’ gestation; 41.6% Hispanic) with overweight or obesity were randomized into usual care or prenatal intervention. Anthropometric assessments in mothers and toddlers occurred at baseline, 35 weeks’ gestation and after delivery at 6, 12, 18, 24, and 36 months.ResultsAt 36 months, prenatal intervention vs. usual care had no significant effect on the proportion of participants who returned to their early pregnancy weight or below (33.3% vs. 39.5%; p = 0.12) and had no effect on the magnitude of weight retained (2.8 [0.8, 4.8] vs 3.0 kg [1.0, 4.9], respectively; mean difference = 0.14 [−3.0, 2.7]). There was also no statistically significant intervention vs. usual care effect on infant BMIz or skinfold changes over time; toddler BMIz increased by 1.4 [−1.7, 1.0] units in the intervention group and 1.6 [−1.2, 1.8] units in the usual care group from delivery to 36 months (difference = 0.16 [−0.32. 0.63]). The proportion of toddlers at risk for obesity at 36 months was similar in intervention and usual care groups (28/77 [36.4%] vs 30/80 [37.5%]; p = 0.77).ConclusionsCompared with usual care, lifestyle intervention during pregnancy resulted in similar maternal and toddler anthropometric outcomes at 36-months postpartum in a diverse US sample of women with overweight and obesity. To sustain improved maternal weight management initiated during pregnancy, continued intervention during the postpartum years may be needed.
Highlights
Excess weight gain during pregnancy is a well-documented predictor of high postpartum weight retention in women [1, 2] and child obesity during infancy, toddlerhood, and adolescence [3]
It is unclear whether effective lifestyle interventions delivered during pregnancy have enduring impacts on maternal postpartum weight retention and child body mass index (BMI) beyond the first year, in women with overweight/obesity [6]
173/243 (71.2%) met additional eligibility criteria and were enrolled in this follow-up study (113 enrolled and provided anthropometric data at 18 months, an additional 18 at 24 months, and an additional 34 at 36 months; enrollment time includes those providing chart-abstracted anthropometric data at that time point; 8 participants enrolled at 18 months, but did not provide any data)
Summary
Excess weight gain during pregnancy is a well-documented predictor of high postpartum weight retention in women [1, 2] and child obesity during infancy, toddlerhood, and adolescence [3]. Lifestyle interventions during pregnancy can reduce excess gestational weight gain [4] and 12-month postpartum weight retention [5]. Interventions that continue during the postpartum year appear to have stronger effects on reducing 12month postpartum weight retention [5]. It is unclear whether effective lifestyle interventions delivered during pregnancy have enduring impacts on maternal postpartum weight retention and child body mass index (BMI) beyond the first year, in women with overweight/obesity [6]. Healthy Beginnings/Comienzos Saludables was a randomized clinical trial of lifestyle intervention with meal replacements to reduce excess gestational weight gain in Hispanic and non-Hispanic women with overweight and obesity [7]. Prior research has suggested that prenatal interventions might not affect child weight outcomes until later in life [9]
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