Gestational Weight Gain Interventions Research Articles

The Effects of Antenatal Interventions on Gestational Weight Gain in Low- and Middle-Income Countries: Protocol for a Systematic Review.

Gestational weight gain (GWG) is a crucial determinant of maternal and child outcomes yet remains an underused target for antenatal interventions in low- and middle-income countries (LMICs). This systematic review aims to identify and summarize educational, behavioral, nutritional, and medical interventions on GWG from randomized controlled trials conducted in LMICs. Randomized controlled trials that documented the effects of antenatal interventions on GWG in LMICs will be included. The interventions of interest will be educational, behavioral, nutritional, or medical. A systematic literature search will be conducted using PubMed, Embase, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from the inception of each database through October 2022 (with an updated search in January 2024). A total of 2 team members will independently perform the screening of studies and data extraction. A narrative synthesis of all the included studies will be provided. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The certainty of the evidence for each homogeneous group of interventions will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. A narrative synthesis of the included studies will be conducted to summarize mean differences (with 95% CIs) for continuous outcomes and risk ratios, rate ratios, hazard ratios, or odds ratios (with 95% CIs) for dichotomous or categorical outcomes. Available information on the costs of interventions will also be summarized to facilitate the adoption and scale-up of effective GWG interventions. The development of the research questions, search strategy, and search protocol was started on September 20, 2022. The database searches and the importation of the identified records into Covidence were performed on October 7, 2022. As of September 2023, the title and abstract screening was ongoing. The target completion time of this systematic review is April 2024. Without effective interventions to manage GWG, the potential to improve maternal and child health through optimal GWG remains unrealized in LMICs. This systematic review will inform the design and implementation of antenatal interventions to prevent inadequate and excessive GWG in resource-limited settings. PROSPERO (International Prospective Register of Systematic Reviews) CRD42022366354; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=366354. PRR1-10.2196/48234.

Gestational Weight Gain During the COVID-19 Pandemic.

Healthy gestational weight gain (GWG) is associated with improved pregnancy and delivery outcomes. The COVID-19 pandemic changed eating behaviours and physical activity, and thus may have impacted GWG. This study examines the impact of the COVID-19 pandemic on GWG. Participants (N = 371, 86% of the larger study) were part of a study focused on GWG among TRICARE beneficiaries (i.e., active-duty military personnel and other beneficiaries). Participants were randomized to two treatment groups (GWG intervention (n = 149 pre-COVID and n = 98 during COVID), and usual care condition (n = 76 pre-COVID and n = 48 during COVID). GWG was calculated as the difference between screening weight and at 36 weeks gestation. Participants who delivered prior to the COVID-19 pandemic (March 1, 2020, N = 225) were compared to participants whose pregnancies occurred during the pandemic (N = 146). We found no significant difference in GWG between those who delivered prior to the pandemic (11.2 ± 4.3kg) and those whose pregnancies occurred during COVID-19 (10.6 ± 5.4kg), with no effect of intervention arm. While excessive GWG was higher pre-COVID (62.8%) than during the pandemic (53.7%), this difference was not significant overall or by intervention arm. In addition, we found lower attrition during the pandemic (8.9%) than in the pre-COVID period (18.7%). In contrast to prior research that indicated challenges with engaging in health behaviors during the COVID-19 pandemic, we found that women did not have increased GWG or higher odds of excessive GWG. This research contributes to our understanding of how the pandemic impacted pregnancy weight gain and engagement in research.

Interest in an Instagram-delivered gestational weight gain intervention among pregnant women with pre-pregnancy overweight or obesity.

Barriers to attending in-person lifestyle interventions are common during pregnancy. The majority of young adults use Instagram, and pregnancy-related content abounds on this social media platform. The aims of this study were to assess interest in an Instagram-delivered gestational weight gain (GWG) intervention, examine characteristics associated with program interest, describe interest in specific program components, and to explore perceived advantages of and concerns about the proposed intervention. English-speaking pregnant women with pre-pregnancy overweight or obesity in the US who use Instagram completed a cross-sectional online survey (N=229). Participants reported interest in a proposed Instagram-delivered GWG intervention (very/quite a bit versus somewhat/a little bit/not at all interested), demographics, and Instagram use habits. Characteristics associated with program interest were examined using logistic regression models. Responses to open-ended questions about program likes and concerns were content-analyzed. Thirty-four percent were very or quite a bit interested in an Instagram-delivered GWG intervention, and women with children, those who were more extraverted, and those with greater engagement on Instagram were more likely to report interest. Among participants with high program interest, 63-95% were interested in specific intervention components and 52-82% were willing to engage in different aspects of the intervention. Participants liked the potential for information, peer support, convenience, and accountability, but reported concerns about privacy/confidentiality, social pressure, time required, and negative psychological consequences. Fostering a positive, supportive group culture may be key to leveraging Instagram to deliver a GWG intervention.

Management of gestational weight gain in obese or overweight women based on resting energy expenditure: A pilot cohort study

Resting energy expenditure (REE) comprises 60% of total energy expenditure and variations may be associated with gestational weight gain (GWG). This study aims to explore the usability and feasibility of REE guided intervention for GWG in obese and overweight women. We conducted a prospective cohort study in LuHe Hospital of Capital Medical University in Beijing, China between May 1, 2017 and May 31, 2018. Obese/overweight women who had routine prenatal care visit at 10 to 13 weeks of gestation, were recruited after written informed consent was obtained. The intervention group (those women who were recruited between January 1 and May 31, 2018) used REE calculated daily total energy to manage GWG, while the control group (those women who were recruited between May 1 and December 31, 2017) used prepregnancy body mass index calculated daily total energy to manage GWG. GWG and daily total energy between the 2 groups were recorded from 10 to 13 weeks of gestation to delivery. A total of 68 eligible women (35 in intervention group and 33 in control group) were included in the final analysis. Daily total energy in the intervention group increased less than the control group, especially from 2nd trimester to 3rd trimester (1929.54 kcal/d vs. 2138.33 kcal/d). The variation of daily total energy from 1st trimester to 3rd trimester in the intervention group was lower than the control group (226.17 kcal/d vs 439.44 kcal/d). Overall GWG of the intervention group (13.45 kg) was significantly lower than the control group (18.20 kg). The percentage of excess-GWG in the intervention group (31.42%) was also significantly lower than the control (57.57%). Findings from our pilot study suggest that diet recommendation basting on REE may improve management of GWG in obese/overweight women.

Incorporating Skills for Managing Mood, Stress, and Sleep into a Gestational Weight Gain Intervention

Incorporating Skills for Managing Mood, Stress, and Sleep into a Gestational Weight Gain Intervention

An interim analysis of a gestational weight gain intervention in military personnel and other TRICARE beneficiaries.

Despite military fitness regulations, women in the military frequently experience overweight/obesity, excessive gestational weight gain (GWG), and the postpartum implications. This interim analysis of the Moms Fit 2 Fight study examines GWG outcomes among active-duty personnel and other TRICARE beneficiaries who received a stepped-care GWG intervention compared with those who did not receive a GWG intervention. Participants (N=430; 32% identified with an underrepresented racial group, 47% were active duty) were randomized to receive a GWG intervention or the comparison condition, which did not receive a GWG intervention. Retention was 88% at 32 to 36 weeks' gestation. Participants who received the GWG intervention gained less weight compared with those who did not (mean [SD]=10.38 [4.58] vs. 11.80 [4.87] kg, p=0.0056). Participants who received the intervention were less likely to have excessive GWG compared with those who did not (54.6% vs. 66.7%, p=0.0241). The intervention effects were significant for participants who identified as White, but not for those of other racial identities. There were no significant differences between the conditions in maternal/neonatal outcomes. The intervention successfully reduced excessive GWG, particularly among participants who identified as White. Should this intervention be found cost-effective, it may be sustainably integrated throughout the military prenatal care system.

Lifestyle Intervention for Overweight/Obese Pregnant Women with Polycystic Ovarian Syndrome: Lessons and Challenges

Introduction and Objective: Polycystic ovary syndrome (PCOS) is the most common reproductive disorder in women of reproductive age, and overweight and obesity are highly prevalent in women with PCOS. This study aims to explore whether lifestyle intervention can improve gestational weight gain (GWG), glucolipid metabolism, and perinatal outcomes in overweight/obese pregnant women with PCOS. Methods: This study is a randomized controlled trial that included overweight and obese pregnant women with PCOS who met the inclusion criteria of 8–12 gestational weeks. They were randomly allocated to the intervention group and the control group. Women in the intervention group were given individualized counseling on diet and exercise from a trained dietitian and followed up regularly by a trained dietitian. Women in the control group received guidance on diet and exercise in the form of group education. Results: A total of 296 pregnant women were enrolled in the study, including 164 in the intervention group and 132 in the control group. GWG was 11.93 ± 5.67 kg in the intervention group and 11.86 ± 5.35 kg in the control group and did not differ between the 2 groups. According to the per-protocol analyses, women with good compliance had a lower weight gain (10.11 ± 5.56 vs. 12.70 ± 5.31, p = 0.0042). The incidence of gestational diabetes mellitus and other perinatal outcomes did not differ between the 2 groups. For the lipid profile, we did not find significant improvement in the intervention group. Conclusions: Our study showed that lifestyle intervention of diet and exercise did not affect GWG, glucolipid metabolism, and perinatal outcomes of overweight/obese pregnant women with PCOS. However, women with good compliance can benefit from the lifestyle intervention for GWG. We believe that future studies should focus on trial design and increasing compliance to improve the quality of the study.

Pregnant Women with Obesity Have Unique Perceptions About Gestational Weight Gain, Exercise, and Support for Behavior Change.

Prepregnancy obesity and excessive gestational weight gain (GWG) pose health risks to woman and fetus, yet gestational weight management interventions are largely unsuccessful. Little research examines the perceptions of women with obesity about weight gain and exercise. Although women with obesity have different body habitus and life experiences, most studies combine overweight and obese women into one group. We conducted 3 focus groups with pregnant women with obesity to determine perceptions of GWG, exercise, and a proposed behavioral intervention. Seventeen women participated in the focus groups including 6 at a birth center and 11 at a federally qualified health center. A key finding was that women with obesity felt stigmatized and perceived pregnancy as a refuge from fat shaming. Participants viewed risks associated with excessive GWG as exaggerated and instead deemed self-assessments of how they feel and look as more reliable measures of maternal and fetal health. Participants reported that quality rather than quantity of food promotes pregnancy health and that restrained eaters put their fetuses at risk. Knowledge gaps emerged related to dissatisfaction with counseling about weight gain guidelines. Although physical activity was endorsed, participants voiced safety concerns about exercise during pregnancy and instead favored walking and routine daily activity. Goal setting, positive messaging, and positive reinforcement were identified as favorable aspects of the proposed behavioral intervention. Pregnant women with obesity share other pregnant women's perceptions about weight gain and exercise in pregnancy but also have unique perceptions. Pregnant women with obesity in this study reported feeling stigmatized and fearful of being shamed by their health care providers but paradoxically eager for guidance. The findings offer implications for health care counseling and GWG interventions for this population.

Gestational Weight Gain Intervention Impacts Determinants of Healthy Eating and Exercise in Overweight/Obese Pregnant Women.

High gestational weight gain (GWG) in overweight/obese pregnant women increases maternal-fetal complications. We conducted a 6-week GWG intervention based on an energy balance model that includes theories of planned behavior (TPB) and self-regulation constructs to promote exercise and healthy eating motivation and behaviors. The purposes of this proof-of-concept feasibility study were to examine: (1) the energy balance model constructs over the intervention, and (2) pre-post intervention, weekly, and dose-response changes in study constructs. Methods. Overweight/obese pregnant women (N=17) were randomized to 1 of 6 conditions, increasing in intensity, and included varied combinations of components (exercise sessions, healthy eating demonstrations, etc.). Exercise and healthy eating TPB (attitude, subjective norm, perceived behavioral control, intention), and self-regulation (prospective, retrospective) constructs were collected weekly. Exercise behavior, energy intake, and GWG were collected daily. Results. We observed: (a) significant increases in exercise TPB constructs, healthy eating attitude (limit unhealthy foods), exercise/healthy eating retrospective self-regulation; (b) significant decrease in healthy eating subjective norm (limit unhealthy foods); (c) trending increases for healthy eating perceived behavioral control (limit unhealthy foods), healthy eating prospective self-regulation, and energy intake; (d) significantly higher active time, steps, and energy expenditure at W3 relative to other weeks; (e) no significant increase in GWG; and, (f) a dose response effect such that women in more intensive dosages had greater gains in exercise and healthy eating perceived behavioral control (eat healthy/limit unhealthy foods). Conclusion. Brief exposure to a theoretically-driven, GWG intervention resulted in changes to exercise and healthy eating TPB and self-regulation motivational determinants, no significant increase in GWG, and suggests intervention intensity can strengthen perceived ability to engage in exercise/healthy eating behaviors; offering initial proof-of-concept for the intervention to regulate GWG in overweight/obese pregnant women. Future research will test this intervention over the course of pregnancy to understand long-term impact on maternal-fetal health outcomes.

Supporting healthful lifestyles during pregnancy: a health coach intervention pilot study

BackgroundExcessive gestational weight gain (GWG) is associated with adverse health outcomes in both the mother and child. Many previous lifestyle interventions in women with excess weight during pregnancy encouraging appropriate GWG have been unsuccessful, and there remains no consensus about the content, format, or theoretical framework of GWG interventions. We assessed the feasibility and acceptability of a remote health coach intervention to promote healthful lifestyle behaviors and appropriate GWG among overweight pregnant women.MethodsAt one northeastern US clinic, we enrolled 30 overweight (pre-pregnancy BMI ≥ 25 kg/m2) pregnant women at a median gestation of 12.5 weeks (IQR: 11–15) into a one-arm trial. We connected participants with a health coach to provide behavioral support to help participants adopt healthful lifestyles during pregnancy. Health coaches contacted participants by phone every 2–3 weeks to monitor goals, and sent emails and text messages between calls. Participants completed baseline (N = 30) and follow-up (N = 26) surveys at the end of the intervention (36 weeks gestation), as well as follow-up phone interviews (N = 18).ResultsAmong 30 participants, median age was 32 years (IQR: 28–33), median self-reported pre-pregnancy BMI was 27.3 kg/m2 (IQR: 25.7–31.1), and 17/30 were white, 9/30 African-American, and 3/30 Asian. Three-quarters (22/29) of participants completed at least a college degree. Although 25/30 participants reported in baseline surveys that they worried about being able to lose the weight postpartum that they expected to gain during pregnancy, just 12/26 participants reported the same at follow-up (P < 0.001). In follow-up surveys, 21/26 participants reported that health coaches were helpful in keeping them motivated, and 22/26 thought the phone conversations helped them face problems and find solutions. Based on qualitative assessment, several themes emerged in follow-up interviews about the quality of the intervention including accountability and support from health coaches. Participants also expressed desire for more visual resources and integration with standard clinical care to improve the intervention.ConclusionsWe demonstrated feasibility and high participant satisfaction with our remote health coach intervention during pregnancy. We identified areas in which we could refine the intervention for inclusion in a full-scale RCT, such as integration with clinical care and additional visual resources.Trial RegistrationRetrospectively registered at ClinicalTrials.gov (NCT03080064, 3/14/2017).

Combined dietary-exercise intervention for gestational weight gain and birthweight: a meta-analysis.

Excessive gestational weight gain has been associated with higher risk for large for gestational age newborns. This systematic review and meta-analysis aims to assess whether an intensive diet and exercise intervention has an effect in reducing gestational weight gain and large for gestational age newborns. The search was conducted on PubMed and Cochrane database. Through PRISMA flow diagram, clinical trials which met the inclusion criteria were selected. Risk of bias, sensitivity analysis, and quality of evidence assessment were conducted using adequate statistical tests, and the quality of evidence was performed by GRADE method. A random-effect model was used to estimate the statistical significance of the meta- analysis. Ten clinical trials met the inclusion criteria. Using the random-effect model and a sensitivity analysis, it was found that an intensive patient-centered intervention reduced gestational weight gain when compared with standard prenatal care (Z=6.21 (p<0.00001); Tau²=0.00; Chi²=3.90, df=4 (p=0.42); I²=0%), and the quality of evidence was moderate. An intensive diet and exercise intervention decreased the number of large for gestational age newborns (Z=2.20 (p=0.03); Tau²=0.14; Chi²=7.84, df=4 (p=0.10); I²=49%), and the quality of evidence using the GRADE approach was moderate. The present review and meta-analysis indicates that an intensive diet and exercise intervention reduced gestational weight gain and large for gestational age newborns.

Effectiveness of SmartMoms, a Novel eHealth Intervention for Management of Gestational Weight Gain: Randomized Controlled Pilot Trial.

BackgroundTwo-thirds of pregnant women exceed gestational weight gain (GWG) recommendations. Because excess GWG is associated with adverse outcomes for mother and child, development of scalable and cost-effective approaches to deliver intensive lifestyle programs during pregnancy is urgent.ObjectiveThe aim of this study was to decrease the proportion of women who exceed the Institute of Medicine (IOM) 2009 GWG guidelines.MethodsIn a parallel-arm randomized controlled trial, 54 pregnant women (age 18-40 years) who were overweight (n=25) or obese (n=29) were enrolled to test whether an intensive lifestyle intervention (called SmartMoms) decreased the proportion of women with excess GWG, defined as exceeding the 2009 IOM guidelines, compared to no intervention (usual care group). The SmartMoms intervention was delivered through mobile phone (remote group) or in a traditional in-person, clinic-based setting (in-person group), and included a personalized dietary intake prescription, self-monitoring weight against a personalized weight graph, activity tracking with a pedometer, receipt of health information, and continuous personalized feedback from counselors.ResultsA significantly smaller proportion of women exceeded the IOM 2009 GWG guidelines in the SmartMoms intervention groups (in-person: 56%, 10/18; remote: 58%, 11/19) compared to usual care (85%, 11/13; P=.02). The remote intervention was a lower cost to participants (mean US $97, SD $6 vs mean US $347, SD $40 per participant; P<.001) and clinics (US $215 vs US $419 per participant) and with increased intervention adherence (76.5% vs 60.8%; P=.049).ConclusionsAn intensive lifestyle intervention for GWG can be effectively delivered via a mobile phone, which is both cost-effective and scalable.Trial RegistrationClinicaltrials.gov NCT01610752; https://clinicaltrials.gov/ct2/show/NCT01610752 (Archived by WebCite at http://www.webcitation.org/6sarNB4iW)

Impact of an Individualized Weight-Tracking Tool on Gestational Weight Gain Knowledge [37B

INTRODUCTION: Only ∼one-third of US women meet Institute of Medicine (IOM) gestational weight gain (GWG) guidelines. Whether women understand these body mass index (BMI)-specific guidelines and whether additional education could improve knowledge is unclear. We hypothesized that an individualized, GWG-tracking tool would improve patient knowledge about GWG guidelines and BMI. METHODS: Women with singleton pregnancies at one outpatient clinic were recruited for a clinical trial. Over eight weeks, women 15 0/7-22 6/7 weeks’ with at least one prior prenatal visit were enrolled in the control group. Women 6 0/7-14 6/7 weeks’ were enrolled in the intervention group at their first prenatal visit and received a GWG card from study staff who helped women record preconception weight, BMI, and BMI-specific GWG guidelines. Women were encouraged to record weight at each prenatal care visit. All women completed a GWG knowledge-based questionnaire at 15 0/7-22 6/7 weeks’. Groups were compared using bivariate analyses. RESULTS: Among 125 women, 45 (36%) comprised the intervention group. The intervention and control groups were similar in age, race/ethnicity, education, income, parity, and preconception BMI. Compared with control, intervention group women were not more likely to correctly define “BMI” (52% vs. 63%, p=0.5), correctly classify their preconception BMI (48% vs. 51%, p=0.9), recall their BMI-specific GWG guidelines (51% vs. 67%, p=0.1), or think they would meet GWG guidelines (58% vs. 50%, p=0.5). CONCLUSION: Our intervention did not improve GWG or BMI knowledge. These data underscore the deficit in fundamental knowledge among pregnant women, which may contribute to the limited success of GWG interventions.

Health coaching to prevent excessive gestational weight gain: A randomized-controlled trial.

The objectives of this study were to evaluate the efficacy of a health coaching (HC) intervention designed to prevent excessive gestational weight gain (GWG), and promote positive psychosocial and motivational outcomes in comparison with an Education Alone (EA) group. Randomized-controlled trial. Two hundred and sixty-one women who were <18 weeks pregnant consented to take part. Those allocated to the HC group received a tailored HC intervention delivered by a Health Coach, whilst those in the EA group attended two education sessions. Women completed measures, including motivation, psychosocial variables, sleep quality, and knowledge, beliefs and expectations concerning GWG, at 15 weeks of gestation (Time 1) and 33 weeks of gestation (Time 2). Post-birth data were also collected at 2 months post-partum (Time 3). There was no intervention effect in relation to weight gained during pregnancy, rate of excessive GWG or birth outcomes. The only differences between HC and EA women were higher readiness (b = 0.29, 95% CIs = 0.03-0.55, p < .05) and the importance to achieve a healthy GWG (b = 0.27, 95% CIs = 0.02-0.52, p < .05), improved sleep quality (b = -0.22, 95% CIs = -0.44 to -0.03, p < .05), and increased knowledge for an appropriate amount of GWG that would be best for their baby's health (b = -1.75, 95% CI = -3.26 to -0.24, p < .05) reported by the HC at Time 2. Whilst the HC intervention was not successful in preventing excessive GWG, several implications for the design of future GWG interventions were identified, including the burden of the intervention commitment and the use of weight monitoring. What is already known on the subject? Designing interventions to address gestational weight gain (GWG) continues to be a challenge. To date, health behaviour change factors have not been the focus of GWG interventions. What does this study add? Our health coaching (HC) intervention did not reduce GWG more so than education alone (EA). There was an intervention effect on readiness and importance to achieve healthy GWG. Yet there were no group differences regarding confidence to achieve healthy GWG post-intervention.

Psychological antecedents of excess gestational weight gain: a systematic review.

BackgroundExcess gestational weight gain (GWG), which has reached epidemic proportions, is associated with adverse outcomes during pregnancy and postpartum obesity in women and children. Psychological variables represent potentially modifiable factors. Moreover, previous systematic reviews on GWG interventions have called for the need for a clearer understanding of psychological factors affecting GWG. Hence, a systematic review was conducted to summarize the relation between psychological factors and GWG.MethodsEight databases were searched, and the guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Methodological quality of the included studies was assessed using a modified Newcastle-Ottawa scale. Two assessors independently reviewed titles, abstracts and full articles, extracted data and assessed quality.ResultsA total of 6198 titles and abstracts were reviewed of which 90 full text articles were retrieved. Thirty-five studies (25 cohort, eight cross-sectional and two case–control) met the inclusion criteria, assessing 26 different psychological constructs in affect, cognitions and personality. Negative affective states such as depression, anxiety and stress were not related to excess GWG. Among weight-related and dietary-related cognitions, risk factors for excess GWG included concern about weight gain, negative body image and attitude towards weight gain, inaccurate perceptions regarding weight, higher than recommended target weight gain, less knowledge about weight gain, higher levels of cognitive dietary restraint, and perceived barriers to healthy eating. Protective factors included an internal locus of control for weight gain, lower than recommended target weight gain and higher self-efficacy for healthy eating. Only one study examined the relation between personality and excess GWG.ConclusionIn this systematic review, a number of cognitive factors were identified that were associated with excess GWG. To address excess GWG, more high quality, adequately powered studies are required examining cognitions, motivation and personality factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0535-y) contains supplementary material, which is available to authorized users.

The effect of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women: a systematic review protocol.

Review question/objective What are the effects of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women? The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aimed at limiting gestational weight gain and postpartum weight retention in women. The second objective of this systematic review is to investigate included intervention components with respect to effect on weight-related outcomes. This may include, but is not limited to: length of intervention, use of face-to-face counselling, group or individual consultations, use of other interventions components including exercise, use of goals and use of support tools like food diaries, coaching , including email or text message support. Inclusion criteria Types of participants Participants of interest are pregnant or post-partum adult females (18 years and over), from all pre-pregnancy BMI categories. Women will be included if they have co-morbidities of gestational diabetes or diabetes; all other medical conditions will be excluded. Types of interventions Studies will be included if the weight management interventions include a dietary component and have an objective of determining the relationship with antenatal and/or postpartum weight change. The interventions must have been conducted across the antenatal or postpartum period, with intervention initiation at any point up to six weeks after delivery. Interventions will be compared with usual care, wait-list controls or alternative intervention component or intensity. Types of outcomes This review will consider studies that include body weight as the primary outcome, measured either during pregnancy and/or postpartum. Weight change outcomes reported as weight (kg or lb), Body Mass Index, waist or hip circumference and/or percentage body fat will be included. Adverse outcomes will be documented if reported.

The role of GPs in preventing excessive gestational weight gain among obese women early in pregnancy

Background: Gestational weight gain (GWG) interventions early in pregnancy are an important part of a comprehensive approach to addressing maternal obesity. Given that General Practitioners (GPs) are most likely to confirm pregnancies and to provide early antenatal care, understanding their role in managing maternal obesity is an important first step in designing interventions for GPs that assist them in providing support and preventive care to their obese patients. Aims: (1) To determine how GPs perceive their role in managing maternal obesity; (2) To explore GPs experiences in managing maternal obesity and GWG; (3) To explore possible intervention components that would help GPs to manage maternal obesity. Methods: A semi-structured interview was designed to address the three aims of the study. GPs participating in shared antenatal care in the Perth metropolitan area were invited to participate. Data from the semi-structured interview were analysed using thematic analysis. Results: Fifteen GPs completed an individual interview. In discussing how GPs perceive their role in managing maternal obesity and minimising GWG, all respondents agreed that GPs have a key role. Despite this, most GPs recognised that they lacked the skills and confidence. On the topic of current experiences in managing maternal obesity, two themes were identified: (1) variation in the scope, timing, and effectiveness of discussing the risks of maternal obesity; and (2) barriers to managing GWG in a GP setting (e.g. skills and time). In discussing components of an intervention, GPs suggested incorporating training, as well as practical strategies and information on GWG and weight management. Conclusions: GPs acknowledged that they have a vital role to play in the management of maternal obesity and GWG, however, their current practice and skills varied widely. This study suggests supporting GPs to deliver a GWG intervention is essential to managing maternal obesity in the primary care setting.

A Survey of Health Behaviors in Minority Women in Pregnancy: The Influence of Body Mass Index

BackgroundAn effective behavioral intervention for gestational weight gain in minority obese women needs to incorporate their baseline health behaviors and nutrition patterns. The objective of this study was to compare racial/ethnic differences in health behaviors and nutrition in pregnant obese and non-obese minorities. MethodsA face-to-face, 75-item survey was administered to 94 women (46% non-obese, 54% obese; 71% Black, 29% Hispanic) at a prenatal visit to an inner-city clinic. Television watching, exercise, and nutrition were compared between obese and non-obese women and racial/ethnic differences were compared within each body mass index (BMI) category using chi-square and Fisher's exact tests. Interactions between BMI category and race/ethnicity for each health behavior were examined. FindingsMore obese women described their nutrition as “fair” or “poor” (36% vs. 15%; p = .02) and missed more meals per day (21% vs. 6%; p = .03) compared with non-obese women. Obese Blacks were less likely to improve their nutrition during pregnancy compared with obese Hispanics (28% vs. 58%; p = .08). Non-obese Blacks watched more television (p = .03) and exercised less during pregnancy (p = .04) than non-obese Hispanics. Except for dairy products, there were no differences in daily nutrition (fruit, soda, vegetables, chips) among the BMI categories and racial/ethnic groups; however, fewer than 50% of all participants consumed fruits and vegetables every day. There was an interaction between BMI category and race/ethnicity: Obese Hispanics exercised less before pregnancy (p = .02), but exercised more during pregnancy (p = .01) compared with non-obese Hispanics. ConclusionsInterventions for gestational weight gain in obese women may have greater success if they considered racial/ethnic differences in health behaviors, especially related to exercise.

Preliminary outcomes from the PULSE randomised controlled trial—A multi-component type 2 diabetes prevention program for men

Limiting gestational weight gain (GWG) to recommended levels is important to optimize health outcomes for both mother and baby, including the prevention of maternal obesity and the development of childhood overweight and obesity. Currently, interventions designed to promote healthy GWG have reported limited effectiveness; addressing psychological factors and identifying useful behavior change techniques (BCTs) may help improve the effectivenes of such interventions. We extend current research by: (i) using a generalized health psychology perspective to systematically evaluate the theories of behavior change informing GWG interventions, and (ii) meta-analyzing BCTs reported in the interventions to identify areas of greater potential for successful intervention. Interventions designed to limit GWG were searched for using health, nursing, and psychology databases. Papers reporting an underpinning theory were identified and the CALO-RE taxonomy developed by Michie et al. was used to determine individual BCTs. Nineteen studies were identified for inclusion. Of these 19 studies, 8 were informed by a behavior change theory and 6 of these reported favorable effects on GWG. Overall, studies based on theory were found to be as effective as non-theory-based studies at limiting GWG. An average of 5.5 (range 1—12) BCTs were reported per intervention. In general, more techniques were reported in effective interventions. There was also a trend for interventions with a larger number of techniques to report greater differences in GWG between the intervention and control groups (r(n = 20) = .30, p = .10). There were 18 techniques that were not utilized in any intervention. Meta-analysis revealed the following BCTs to be key strategies for promoting healthy GWG in the reviewed studies: provision of information, motivational interviewing, behavioral self-monitoring, and providing rewards contingent on successful behavior. Future research should focus on determining the exact combination of BCTs and which underpinning theories are most useful for limiting GWG to healthy levels.

Interventions designed to limit gestational weight gain: a systematic review of theory and meta‐analysis of intervention components

Limiting gestational weight gain (GWG) to recommended levels is important to optimize health outcomes for mother and baby. Surprisingly, a recent review revealed that theory-based interventions to limit GWG were less effective than interventions that did not report a theory-base; however, strict criteria were used to identify theory-informed studies. We extended this review and others by systematically evaluating the theories of behaviour change informing GWG interventions using a generalized health psychology perspective, and meta-analysing behaviour change techniques reported in the interventions. Interventions designed to limit GWG were searched for using health, nursing and psychology databases. Papers reporting an underpinning theory were identified and the CALO-RE taxonomy was used to determine individual behaviour change techniques. Nineteen studies were identified for inclusion. Eight studies were informed by a behaviour change theory; six reported favourable effects on GWG. Overall, studies based on theory were as effective as non-theory-based studies at limiting GWG. Furthermore, the provision of information, motivational interviewing, behavioural self-monitoring and providing rewards contingent on successful behaviour appear to be key strategies when intervening in GWG. Combining these behaviour change techniques with dietary interventions may be most effective. Future research should focus on determining the exact combination of behaviour change techniques, or which underpinning theories, are most useful for limiting GWG.