Gestational Weight Gain Management Research Articles

Association between Gestational Weight Gain and Maternal and Birth Outcomes in Northern Ghana.

Although inappropriate gestational weight gain is considered closely related to adverse maternal and birth outcomes globally, little evidence was found in low- and middle-income countries. Study Objectives. This study is aimed at identifying the determinants of gestational weight gain and examine the association between gestational weight gain and maternal and birth outcomes in the Northern Region of Ghana. Study Methods. The study used a facility-based cross-sectional study design involving 611 antenatal and delivery records in Tatale district, Tamale west, and Gushegu municipal hospitals. A two-stage sampling method involving cluster and simple random sampling was employed. Descriptive statistical analysis and measures of central tendency were used to describe the sample. The multinomial logistic regression model was used to determine the determinants of gestational weight gain and its association with maternal and birth outcomes. Among the 611 women included in the study, 516 (84.45%) had inadequate gestational weight gain, and 19 (3.11%) had excessive gestational weight gain. The gestational weight gain ranged from 2 kg to 25 kg with a mean of 7.26 ± 3.70 kg. The risk factor for inadequate gestational weight gain was low prepregnancy BMI (adjusted odds ratio (AOR) = 1.33, 95% CI = 1.18 - 2.57, P = 0.002). Pregnant women who had inadequate gestational weight gain were significantly less likely to deliver through caesarean section (AOR = 0.27, 95% CI = 0.12 - 0.61, P = 0.002), and those who had excessive weight gain were more likely to undergo caesarean section (AOR = 19.81, 95% CI = 5.38 - 72.91, P = 0.001). The odds of premature delivery (birth < 37 weeks) among pregnant women with inadequate weight gain were 2.88 (95% CI = 1.27 - 6.50, P = 0.011). Furthermore, subjects who had excessive weight gain were 43.80 times more likely to give birth to babies with macrosomia (95% CI = 7.07 - 271.23, P = 0.001). Inappropriate gestational weight gain is prevalent in Ghana, which is associated with caesarean section, preterm delivery, delivery complications, and macrosomia. Urgent policy interventions are needed to improve on the frequent monitoring and management of gestational weight gain of pregnant women till term.

Factors associated with gestational weight gain in women with morbid obesity

Background Women with obesity are at increased risk of excessive gestational weight gain. Women with a body mass index (BMI) of 40 kg/m2 or more are known to have different patterns of weight gain than women with lower levels of obesity. This study therefore aimed to determine the characteristics associated with gestational weight gain (GWG) among women with a BMI of 40 kg/m2 or more. Methods Secondary analysis was undertaken on a retrospective cohort of women with a BMI of 40 kg/m2 or more, with a singleton pregnancy referred to an antenatal healthy lifestyle service between 2009 and 2015 (n = 735). GWG was calculated by subtracting weight at the first antenatal appointment from final recorded weight in pregnancy provided the final weight was recorded from at least 34 + 0 weeks gestation. Univariable and multiple linear regression analyses were employed to determine the association between GWG and different maternal and infant characteristics. Results Average GWG among women with a BMI of 40 kg/m2 or more was 6.0 (±7.1)kg. Multiple regression showed GWG decreased with increasing BMI and increasing parity. Other socio-demographic factors were also significantly associated with GWG, with higher GWG seen among those with high levels of deprivation, where the highest household occupation was of a manual nature, in older women and women of non-White British ethnicity. Conclusion GWG in this cohort of women with a BMI of 40 kg/m2 or more was within Institute of Medicine recommendations. Using a systems approach to GWG management that incorporates biological, psychological and socio-ecological factors is important.

Digital Self-Monitoring Tools for the Management of Gestational Weight Gain: Protocol for a Systematic Review.

Gestational weight gain (GWG) exceeding the recommendations of the Institute of Medicine (in the United States) is associated with numerous adverse maternal and infant health outcomes. While many behavioral interventions targeting nutrition and physical activity have been developed to promote GWG within the Institute of Medicine guidelines, engagement and results are variable. Technology-mediated interventions can potentially increase the feasibility, acceptability, and reach of interventions, particularly for pregnant women, for whom integration of interventions into daily life may be critical to retention and adherence. Previous reviews highlight GWG self-monitoring as a common intervention component, and emerging work has begun to integrate digital self-monitoring into technology-mediated interventions. With rapid advances in technology-mediated interventions, a focused synthesis of literature examining the role of digital self-monitoring tools in managing GWG is warranted to guide clinical practice and inform future studies. The proposed review aims to synthesize the emerging research base evaluating digital GWG self-monitoring interventions, primarily focusing on whether the intervention is effective in managing GWG. Depending on the characteristics of the included research, secondary focus areas will comprise intervention recruitment and retention, feasibility, acceptability, and differences between stand-alone and multicomponent interventions. This protocol was developed following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines for systematic review protocols. The proposed review would use a planned and systematic approach to identify, evaluate, and synthesize relevant and recent empirical quantitative studies (reported in English) examining the use of digital weight self-monitoring tools in the context of technology-mediated interventions to manage GWG in pregnant US adults, with at least 2 instances of data collection. Literature eligible for inclusion will have a publication date between January 2010 and July 2020. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies will be used to assess the methodological quality of included studies across various domains, and results will be synthesized and summarized per the synthesis without meta-analysis guidelines. The initial queries of 1150 records have been executed and papers have been screened for inclusion. Data extractions are expected to be finished by December 2023. Results are expected in 2024. The systematic review that will be generated from this protocol will offer evidence for the use of digital self-monitoring tools in the management of GWG. The planned, focused synthesis of relevant literature has the potential to inform the use of digital weight self-monitoring tools in the context of future technology-mediated interventions to manage GWG. In addition, the planned review has the potential to contribute as part of a broader movement in research toward empirically supporting the inclusion of specific components within more extensive, multicomponent interventions to balance parsimony and effectiveness. PROSPERO CRD42020204820; https://tinyurl.com/ybzt6bvr. PRR1-10.2196/50145.

Simultaneous selection and incorporation of consistent external aggregate information.

Interest has grown in synthesizing participant level data of a study with relevant external aggregate information. Several efficient and flexible procedures have been developed under the assumption that the internal study and the external sources concern the same population. This homogeneity condition, albeit commonly being imposed, is hard to check due to limitedly available external information in aggregate data forms. Bias may be introduced when the assumption is violated. In this article, we propose a penalized likelihood approach that avoids undesirable bias by simultaneously selecting and synthesizing consistent external aggregate information. The proposed approach provides a general framework which incorporate consistent external information from heterogeneous study populations as long as the conditional distribution of the dependent variable under investigation is same and differences in the independent variable distributions are properly accounted for via a semi-parametric density ratio model. The proposed approach also properly accounts for the sampling errors in the external information. A two-step estimator and an optimization algorithm are proposed for computation. We establish the selection and estimation consistency and the asymptotic normality of the two-step estimator. The proposed approach is illustrated with an analysis of gestational weight gain management studies.

1385-P: Maternal Gestational Weight Gain and Children’s Genetic Susceptibility on Childhood Adiposity—A Longitudinal Cohort Study

Few studies have assessed the association of early-life environmental and genetic factors with the risk of childhood adiposity. The aim of the present study was to investigate the interaction between maternal gestational weight gain (GWG) and children’s genetic susceptibility on childhood adiposity. The present study included 1038 mother-child pairs. Body mass index (BMI) for age Z-score (BMI-Z) and childhood overweight were evaluated according to the World Health Organization (WHO) growth reference. Genetic risk score (GRS) was established by aggregating alleles of 10 BMI susceptibility single-nucleotide polymorphisms identified from a recent study. Children born to mothers with excessive GWG had higher BMI-Z (P&amp;lt;0.001), percentage of body fat (P&amp;lt;0.001), and prevalence of overweight (28.4% vs 15.9%, P&amp;lt;0.001) than those born to mothers with adequate GWG. Children’s BMI GRS was significantly and positively associated with BMI-Z, percentage of body fat and overweight risk (all P&amp;lt;0.05). Stratified analyses showed the positive association of children’s BMI GRS with adiposity risk was especially concentrated among mothers with pre-pregnancy normal weight but excessive GWG. The present study identified an interactive effect between maternal GWG and children’s genetic susceptibility on childhood adiposity risk. The findings provided new insight into the etiology of childhood obesity and highlighted the importance of GWG management. Disclosure H.Liu: None. W.Li: None. L.Wang: None. S.Zhang: None. W.Li: None. X.Yang: None. J.Leng: None. G.Hu: None. S.Wang: None. Funding European Foundation for the Study of Diabetes/Chinese Diabetes Society/Lilly Programme for Collaborative Research between China and Europe; National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100790, R01DK132011); National Institute of General Medical Sciences (U54GM104940)

Association between gestational weight gain and preterm birth and post-term birth: a longitudinal study from the National Vital Statistics System database

BackgroundTo evaluate the association between gestational weight gain (GWG) and preterm birth and post-term birth.MethodsThis longitudinal-based research studied singleton pregnant women from the National Vital Statistics System (NVSS) (2019). Total GWG (kg) was converted to gestational age-standardized z scores. The z-scores of GWG were divided into four categories according to the quartile of GWG, and the quantile 2 interval was used as the reference for the analysis. Univariate and multivariate logistic regression analyses were performed to investigate the association between GWG and preterm birth, post-term birth, and total adverse outcome (preterm birth + post-term birth). Subgroup analysis stratified by pre-pregnancy body mass index (BMI) was used to estimate associations between z-scores and outcomes.ResultsOf the 3,100,122 women, preterm birth occurred in 9.45% (292,857) population, with post-term birth accounting for 4.54% (140,851). The results demonstrated that low GWG z-score [odds ratio (OR): 1.04, 95% confidence interval (CI): 1.03 to 1.05, P < 0.001], and higher GWG z-scores (quantile 3: OR: 1.42, 95% CI: 1.41 to 1.44, P < 0.001; quantile 4: OR: 2.79, 95% CI: 2.76 to 2.82, P < 0.001) were positively associated with preterm birth. Low GWG z-score (OR: 1.18, 95% CI: 1.16 to 1.19, P < 0.001) was positively associated with an increased risk of post-term birth. However, higher GWG z-scores (quantile 3: OR: 0.84, 95% CI: 0.83 to 0.85, P < 0.001; quantile 4: 0.59, 95% CI: 0.58 to 0.60, P < 0.001) was associated with a decreased risk of post-term birth. In addition, low GWG z-score and higher GWG z-scores were related to total adverse outcome. A subgroup analysis demonstrated that pre-pregnancy BMI, low GWG z-score was associated with a decreased risk of preterm birth among BMI-obesity women (OR: 0.96, 95% CI: 0.94 to 0.98, P < 0.001).ConclusionOur result suggests that the management of GWG may be an important strategy to reduce the number of preterm birth and post-term birth.

Pattern of weight gain during pregnancy among pregnant women attending antenatal clinics

Background Excessive and inadequate weight gain during pregnancy is associated with adverse maternal and neonatal outcomes. The aim of this study was to assess the pattern of weight gain among pregnant women attending antenatal clinics. Design A descriptive research design was adopted to describe how weight pattern changes during pregnancy. Sample A convenience sample of 400 pregnant women was included in the study. Setting The study was conducted at the antenatal outpatient clinic of El-Kasr El Aini University Hospital, Cairo University, Egypt. Tools Two tools were used: (a) maternal structured interviewing and (b) assessment and follow-up. Results Approximately 36% had normal weight, 34.3% were overweight, 26% were obese, and only 3.8% were underweight at recruitment. Appropriate weight gain was observed in 81.0% of underweight pregnant women and 75.5% of normal weight women. However, 61.5% of overweight women and 72% of obese women gained weight above the recommendation range by the Institute of Medicine. The mean total weight gain at the time of delivery among underweight women was 13.5 kg, normal weight women was 12.43 kg, overweight women was 12.05 kg, and obese women was 10.43 kg. Conclusion Overweight and obese women had excessive weight gain during pregnancy, whereas underweight and normal weight women gained weight within the Institute of Medicine recommendations. Recommendation Counseling during early pregnancy toward adequate gestational weight gain management should be required for pregnant women at the outpatient clinic.

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.

“Help me fight my constant battle”: A focus group study of overweight and obese women's mHealth app experiences to manage gestational weight gain

ObjectivesTo understand and describe overweight and obese pregnant women’s mHealth app experiences in managing gestational weight gain (GWG) for optimal weight goals. DesignA focus group study. SettingWe identified and invited pregnant women from a prenatal outpatient clinic in a metropolitan city in Northern Taiwan. ParticipantsThe participants were women whose pre-pregnancy BMI≥25 Kg/m2 at antenatal booking, and have experience using smartphone apps for pregnancy e-information. A total of 13 overweight and obese women were agreed to participate, their gestation weeks from 11 to 38 weeks. MethodsThree focus group of six sessions were conducted from July to October of 2019. Thematic analysis was employed to inductively analyze the qualitative data. FindingsOverweight and obese pregnant women...s major concern was to safely deliver a healthy baby. Main themes identified included: planning to know more and wanting to do right, feeling like a failure and having low self-expectations, struggling with life and desiring peace of mind, yearning to be supported and hoping to be seen, adjusting for the future and embracing new technology to engage in GWG management. Key conclusions and implications for practiceThe core theme was presented as high BMI pregnant women...s shared need to be well-equipped to fight their constant weight battle, reflecting these women...s mixed feelings and barriers toward GWG control and body image during pregnancy. Experiences with a GWG addressing mHealth APP seemed to be positive and further facilitated healthy eating and physical activities, participants... self-efficacy may be increased along with satisfactory APP adherence to prevent excessive GWG for women with obesity.

Body Composition in Preschool Children and the Association With Prepregnancy Weight and Gestational Weight Gain: An Ambispective Cohort Study.

ObjectiveTo describe the body composition in preschool children and to evaluate the association with prepregnancy BMI and gestational weight gain (GWG).MethodsChildren were recruited in their first year in kindergarten (3 years old) and followed up for the next 2 years. Information during pregnancy and birth was retrieved from medical records. Height, weight, fat mass, fat-free mass, and percentage of body fat (FM%) were measured through a bioelectrical impedance analysis for each child visit, and BMI, fat mass index (FMI), and fat-free mass index (FFMI) were calculated. Generalized linear mixed models (GLMMs) were used to evaluate the associations between prepregnancy weight, GWG, and adiposity indicators.ResultsA total of 3,329 single-birth 3-year-old children were recruited as the baseline population and were followed at 4 and 5 years old. During the 3 years of follow-up, the mean (±SD) values of BMI, FMI, FFMI, and FM% of the children were 15.6 (±1.6) kg/m2, 2.8 (±1.3) kg/m2, 12.8 (±0.7) kg/m2, and 17.2% (±5.8%), respectively. The prevalence rates of overweight and obesity in mothers before pregnancy were 16.6 and 3.2%, respectively. Mothers were divided into three groups based on GWG: appropriate (1,233, 37.0%), excessive (767, 23.0%), and insufficient (1,329, 39.9%). GLMMs analyses showed that the preschool children’s BMI, FMI, FFMI, and FM% were all significantly positively related to maternal prepregnancy BMI and GWG (all P < 0.001); the children of mothers who were overweight/obese before pregnancy were more likely to be overweight/obese, high FMI, high FFMI, and high FM% at preschool age (all P < 0.001); although maternal excessive GWG was not correlated with offspring’s overweight/obese (P = 0.156), the children of mothers with excessive GWG are more likely to have higher FMI, but not to be with a higher FFMI status than the children of mothers with appropriate GWG. For prepregnancy overweight/obese women, compared with the GWG-appropriate group, maternal excessive GWG was related to the risk of high FMI (coefficient = 0.388, 95% CI: 0.129–0.647) and high FM% (coefficient = 0.352, 95% CI: 0.097–0.607), but was not related to the risk of overweight/obese or high FFMI of the offspring at preschool age.ConclusionFat mass index decreased with age, while FFMI increased with age among 3- to 5-year-old children. It is necessary to optimize maternal weight prior to conception and GWG management to improve the health outcomes of the offspring.

A Review of the Clinician's Role in Women's Weight Management and Implications for Women's Health and Pregnancy Outcomes.

Ten years have passed since the Institute of Medicine (IOM) released its recommendations for gestational weight gain (GWG), based on a woman's prepregnancy body mass index. Despite this, the majority of women do not gain the appropriate gestational weight; most women gain too much weight, and a small but substantial number gain too little. We review the literature concerning GWG, the opinions and practices of clinicians in managing their patients' weight, and how these practices are perceived by patients. We also review several randomized control trials that investigate the efficacy of clinical intervention in managing GWG. A literature review search was conducted with no limitations on the number of years searched. The number of clinicians who are aware of and use the IOM recommendations has increased, but the prevalence of inappropriate GWG has not decreased. Clinicians report feeling less than confident in their ability to have an impact on their patients' weight gain, and there are discrepancies between what clinicians and patients report regarding counseling. Many randomized control trials demonstrate a beneficial impact of clinical intervention, highlighting the importance of collaboration and technology to provide educational information and support throughout a pregnancy. Pregnancy provides an opportunity for clinicians to have open and direct conversations with their patients about their weight. Providing clinicians with the tools, skillset, and confidence to assist in the management of GWG is essential to the health of women and their children, and warrants further investigation.

A Personalized Bayesian Approach for Early Intervention in Gestational Weight Gain Management Toward Pregnancy Care

Pre-pregnancy body mass index and weight gain management are associated with pregnancy outcomes in expecting women. Poor gestational weight gain (GWG) management could increase the risk of adverse complications. These risks can be alleviated by lifestyle based interventions if undesired GWG trend is detected early on in the pregnancy. Current literature lacks analysis of gestational weight gain data and tracking the pregnancy over time. In this work, we collected longitudinal gestational weight gain data from women during their pregnancy and model their weight measurements to predict the end-of-pregnancy weight gain and classify it in accordance with the medically recommended guidelines. The measurement frequency of the weights is often very variable such that segments of data can be missing and the need to predict early utilising few data points complicates data modelling. We propose a Bayesian approach to forecast weight gain while effectively dealing with the limited data availability for early prediction. We validate on diverse populations from Europe and China. We show that utilising individual’s data only up to mid-way through the pregnancy, our approach produces mean absolute errors of 2.45 kgs and 2.82 kgs in forecasting end-of-pregnancy weight gain on these populations respectively, whereas the best of state-of- the-art yields 8.17 and 6.60 kgs on respective populations. The proposed method can serve as a tool to keep track of individual’s pregnancy and achieve GWG goals, thus supporting the prevention of excessive or insufficient weight gain during pregnancy.

Current Practice of Maternal-Fetal Medicine Specialists Regarding the Prevention and Management of Preterm Birth in Twin Gestations.

To investigate the current practices of maternal-fetal medicine (MFM) specialists regarding the prevention and management of preterm birth (PTB) in twin pregnancies. This was a cross-sectional study of Canadian MFM specialists. Participants responded to an anonymous survey regarding the prevention and management of PTB in twins, including lifestyle and gestational weight gain recommendations, cervical length screening, PTB prevention, and labour and delivery practices. Of 137 MFM specialists surveyed, 95 (69%) responded. Most MFM specialists recommend against activity restriction (77.9%), avoidance of sexual activity (96.7%), routine progesterone (97.8%), routine prophylactic cerclage (98.9%), and routine administration of antenatal corticosteroids (95.6%). There were considerable inconsistencies with respect to gestational weight gain management. Despite lack of support by guidelines, most MFM specialists reported using routine cervical length screening (97.8%) and progesterone for short cervix (92.3%). Over half (52.7%) of MFM specialists recommend cervical cerclage when the cervix is <15mm. In cases of PTB, most MFM specialists recommend vaginal delivery when twins are in vertex presentation (63%-75%). MFM specialists are less likely to recommend vaginal delivery when twin B is non-vertex (35%-41%). There is a considerable variation among MFM specialists regarding the prevention and management of PTB in twins, and the practice of many MFM specialists differs from that recommended by professional societies' guidelines. These findings underscore the necessity for high-quality studies and up-to-date recommendations.

The Design of a Randomized Clinical Trial to Evaluate a Pragmatic and Scalable eHealth Intervention for the Management of Gestational Weight Gain in Low-Income Women: Protocol for the SmartMoms in WIC Trial.

BackgroundLess than one-third of women gain an appropriate amount of weight during pregnancy, which can influence the long-term health of both the mother and the child. Economically disadvantaged women are the most vulnerable to maternal obesity, excessive weight gain during pregnancy, and poor birth outcomes. Effective and scalable health care strategies to promote healthy weight gain during pregnancy specifically tailored for these women are lacking.ObjectiveThis paper presents the design and protocol of a biphasic, community-based eHealth trial, SmartMoms in WIC, to increase the adherence to healthy gestational weight gain (GWG) recommendations in low-income mothers receiving women, infant, and children (WIC) benefits.MethodsPhase 1 of the trial included using feedback from WIC mothers and staff and participants from 2 community peer advisory groups to adapt an existing eHealth gestational weight management intervention to meet the needs of women receiving WIC benefits. The health curriculum, the format of delivery, and incentive strategies were adapted to be culturally relevant and at an appropriate level of health literacy. Phase 2 included a pragmatic randomized controlled trial across the 9 health care regions in Louisiana with the goal of enrolling 432 women. The SmartMoms in WIC intervention is an intensive 24-week behavioral intervention, which includes nutrition education and exercise strategies, and provides the technology to assist with weight management, delivered through a professionally produced website application.ResultsPhase 1 of this trial was completed in July 2019, and recruitment for phase 2 began immediately thereafter. All data are anticipated to be collected by Spring 2023.ConclusionsThe SmartMoms in WIC curriculum was methodically developed using feedback from community-based peer advisory groups to create a culturally relevant, mobile behavioral intervention for mothers receiving WIC benefits. The randomized clinical trial is underway to test the effectiveness of a sustainable eHealth program on the incidence rates of appropriate GWG. SmartMoms in WIC may be able to offer an innovative, cost-effective, and scalable solution for GWG management in women served by WIC.Trial RegistrationClinicalTrials.gov NCT04028843; https://clinicaltrials.gov/ct2/show/NCT04028843International Registered Report Identifier (IRRID)DERR1-10.2196/18211

Impact of binge eating during pregnancy on gestational weight gain and postpartum weight retention among women with gestational diabetes mellitus: LINDA-Brasil.

Binge eating (BE) is associated with gestational weight gain, which is a risk factor for gestational diabetes (GDM). Little is known about this association in women with GDM. To evaluate the relationship of BE in pregnancy with gestational weight gain, BE at postpartum and postpartum weight retention in women with GDM. Lifestyle INtervention for Diabetes prevention After pregnancy (LINDA-Brasil) is a multicenter cohort study with 1,958 women with GDM. BE was assessed by interview during recruitment in pregnancy and at a phone interview at ~4 months postpartum. Gestational weight gain was classified according to the 2009 Institute of Medicine (IOM) recommendations. Poisson regression with robust variance was used to estimate adjusted relative risks (RR). Prevalence of BE was 31.6% (95% confidence interval [CI] 29.5-33.6%) during pregnancy and 30.0% (95% CI 28.0-32.1%) at postpartum. The risk of exceeding the IOM's recommendation for gestational weight gain was 45% higher (RR 1.45, 95% CI 1.29-1.63) in women who had BE during pregnancy compared to those who did not. The risk of having postpartum weight retention above the 75th percentile was 33% higher (RR 1.33, 95% CI 1.10-1.59) among those with BE compared to those without. Among these women with GDM, BE was frequent and was associated with excessive gestational weight gain and weight retention at postpartum. Thus, given the vulnerability of these periods of the life cycle, tracking this eating behavior is important for the management of gestational weight gain and for the prevention of excessive postpartum retention.

Healthy Mom Zone: A Gestational Weight Gain Management Intervention

Healthy Mom Zone: A Gestational Weight Gain Management Intervention

General practitioners and gestational weight management

This study aimed to explore the knowledge and practice of New Zealand (NZ) general practitioners (GPs) regarding gestational weight gain (GWG), and identify the current level of involvement NZ GPs have in early pregnancy care. In NZ, the majority of antenatal care is carried out by a midwife lead maternity carer (LMC), with government funding for one first trimester appointment with the woman’s GP. A mixed methods survey was conducted on a randomly selected sample of 470 NZ GPs. Survey responses were analysed using descriptive statistics and a general inductive approach for free text data. A total of 200 GPs (42.5%) responded. Half of the GPs regularly saw women in their early pregnancy, but the discussion of recommended GWG was uncommon. The knowledge and practice regarding GWG was not in keeping with the national guidance. Free text analysis identified time pressures, funding issues, loss of skill and a poor communication with LMCs as the barriers to care. Education, promotion of guidance, appropriate funding and improved communication between carers are critical to address the current shortfalls.Impact statementWhat is already known on this subject? Excess gestational weight gain (GWG) is a modifiable risk factor for the vast majority of obstetric complications. It is more likely in pregnant women who overestimate the appropriate GWG. Current literature suggests that the antenatal advice on GWG is insufficient. In New Zealand (NZ), there is provision for one funded general practitioner (GP) appointment in the first trimester, in addition to that provided by the lead maternity carer (LMC). GPs are expected to provide a range of services at this appointment including health information and education on nutrition.What the results of this study add? The results demonstrate that while GPs are seeing women in early pregnancy, specific GWG discussion is uncommon. The results suggest knowledge gaps are partially responsible for this along with GP self-reported frustrations at lack of time, funding issues, loss of relevant skills, and minimal contact with LMCs.What the implications are of these findings for clinical practice and/or further research? Mediocre gestational weight management is not acceptable in our current obesity climate. This research identifies a need to improve GP knowledge on the management of GWG as part of the wider maternity healthcare team, address GP concerns regarding funding for their provision of maternity care, and aid communication between GPs and LMCs.

Improving the effectiveness of lifestyle interventions for gestational diabetes prevention: a meta-analysis and meta-regression.

Diet and exercise during pregnancy have been used to prevent gestational diabetes mellitus (GDM) with some success. To examine the effectiveness of lifestyle intervention on GDM prevention and to identify key effectiveness moderators to improve the prevention strategy. Pubmed, Scopus, Cochrane, and cross-references were searched. Randomised controlled trials (RCTs) evaluating lifestyle interventions during pregnancy for GDM prevention. Two independent reviewers extracted data. A random-effects model was used to analyse the relative risk (RR) and 95% confidence interval (95%CI). Meta-regressions and subgroup analyses were used to investigate important moderators of effectiveness. Forty-seven RCTs involving 15745 participants showed that diet and exercise during pregnancy were preventive of GDM (RR0.77, 95%CI 0.69-0.87). Four key aspects were identified to improve the preventive effect: targeting the high-risk population; an early initiation of the intervention; the correct intensity and frequency of exercise; and gestational weight gain management. Although 24 RCTs targeted women who were overweight or obese, body mass index (BMI) failed to predict the effectiveness of an intervention. Instead, interventions are most effective in high-incidence populations rather than simply in women who are overweight or obese. Furthermore, exercise of moderate intensity for 50-60minutes twice a week could lead to an approximately 24% reduction in GDM. The best strategy to prevent GDM is to target the high-risk population predicted by risk evaluation models and to control the gestational weight gain of women through intensified diet and exercise modifications early in their pregnancy. Four key effectiveness moderators of lifestyle interventions for GDM prevention.

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)

Managing Gestational Weight Gain: Obstetricians' Perceived Barriers and Interventions.

To support optimal health outcomes during pregnancy, understanding obstetricians' (OBs) recommendations for and barriers to managing gestational weight gain (GWG) can benefit childbirth educators. This mailed survey examined OBs' practices (n = 63) for managing GWG along with perceived barriers. The most frequent recommendations were (a) increase activity (76.2%), (b) aerobic activity (63.5%), (c) patient education about weight management (61.9%), (d) increase fiber intake (61.3%), and (e) use of guidelines for weight gain (58.7%). Self-tracking weight gain charts were the least used. Greatest barriers to GWG management were (a) patients not interested in changing behavior (77.8%), (b) high relapse rates (66.7%), (c) lack of community resources (60.3%), (d) patients cannot afford referrals (58.7%), and (e) lack of time (53.9%).