Table IV.
Summary of completed and ongoing lifestyle intervention studies in relation to weight gain and/or obesity
| Authors | Design | Population and sample | Intervention | Outcome |
|---|---|---|---|---|
| Completed studies | ||||
| Gray-Donald et al. (2000) | Prospective intervention study | 219 aboriginal Cree women in Quebec, Canada | Intervention: several components, e.g. exercise groups and individual counselling | GWG: no effect |
| Control: not specified | Diet: caffeine intake decreased only | |||
| PA1: no effect | ||||
| Polley et al. (2002) | Randomized controlled trial | Low-income women (USA) 61 normal BMI, 49 overweight. Control: standard care | Stepped care intervention; healthy eating and exercise advice. Newsletters on diet, physical activity biweekly, telephone contact between visits | Intervention effective in preventing excessive weight gain (IOM, 1990) only in normal weight women. No effect on diet or physical activity |
| Olson et al. (2004) | Prospective cohort with historical control group | 421 normal BMI, 139 overweight rural, primarily white women (USA). Control; historical, care not specified | Healthcare provider monitoring of weight gain; newsletters by mail with return postcards for goal setting; booklet for self-monitoring of weight gain. No visits for dietary of physical activity counselling | Significant effect in preventing excessive weight gain (IOM, 1990) in low-income women only. Diet and physical activity not assessed |
| Kinnunen et al. (2007) | Selected intervention (n = 3) and control (n = 3) maternity clinics | 105 (all BMI) primiparous women, control, standard care | Individual counselling on diet and physical activity. Control: standard care. Visits: physical activity-one primary, four boosters; diet-one primary and three boosters | No effect on excessive weight gain (IOM, 1990). Diet; significantly improved fruit and vegetable intake. No effect on physical activity. Intervention group achieved better moderate or physical activity in 3rd trimester; 46% intervention v 30% in control |
| Claesson et al. (2008) | Prospective interventional study (intervention and comparison cities) | 348 obese (BMI > 30) Swedish women. Control; standard care | Motivational sessions with midwife (individual weekly 30 min). Aqua aerobics twice a week | Significant effect on weight gain <7 kg. Diet and PA not assessed |
| Wolff et al. (2008) | Randomized controlled trial | 50 obese (BMI > 30) non-diabetic, non-smoking Danish women. Control, routine antenatal care | 10 1 h consultations with dietician to achieve energy reduction according to Danish micronutrient guidelines. Weighed food records | Significant effect on weight gain (6.6 versus 13.3 kg in control). Diet; significant reduction in energy and % of energy as fat. Carbohydrate and protein as %energy increased. Physical activity not assessed |
| Asbee et al. (2009) | Randomized controlled trial | 100 (BMI 25.5) USA women | Initial consultation with dietician. Advised to exercise 3–5 times/week. Information on IOM GWG guidelines. Weighing and advice by healthcare provider at subsequent routine appointments | Effective reduction in weight gain (mean). Routine care group significantly more Caesarean sections. Women with higher BMI less likely to adhere to IOM guidelines. Diet not assessed, physical activity not assessed |
| Guelinckx et al., submitted for publication | Randomized controlled trial | 195 (BMI > 29 kg/m2) non-diabetic Belgian women. Control group routine antenatal care, passive group given detailed information leaflet and an active group | Three group sessions at 15, 20 and 32 weeks with dietician focusing on healthy eating habits, importance of physical activity and strategies to control eating behaviour | No reduction in GWG in passive or active arm. No impact on birthweight, macrosomia, hypertensive disorders of pregnancy or Caesarean section |
| Thornton et al. (2009 | Randomized controlled trial | 257 non-diabetic obese USA women. Control unmonitored routine antenatal care with prenatal dietary management | A balanced nutritional regimen, with women asked to record in a diary all of the foods eaten during each day | Significant reduction in GWG and post-partum weight. No impact on gestational hypertension |
| Ongoing studies | ||||
| Althuizen et al. (New Life study) | Randomized controlled trial | Healthy nulliparous women (7 months pregnant) n = 300 (the Netherlands) | Tailored advice on physical activity and diet | GWG in relation to IOM guidelines BMI and skin-fold thickness |
| Brand-Miller (the CHOPP study) | Randomized controlled trial | Pregnant women (n = 1650, Sydney, Australia) | Low glycemic index diet from 12 to 16 weeks until delivery | LGA delivery; childhood obesity |
| Chasan-Taber et al. (the B.A.B.Y. study) | Randomized controlled trial | Pregnant sedentary women with GDM in a prior pregnancy (n = 364, Western Massachusetts, USA) | Tailored advice on physical activity | Incidence of gestational diabetes, physical activity levels and circulating concentrations of glucose, insulin, leptin, TNF-α, resistin, CRP, adiponectin |
| Dodd et al. (the LIMIT trial) | Randomized controlled trial | Overweight and obese pregnant women (n = 2500, Australia) | Dietary package and lifestyle advice | GWG |
| Hauner | Randomized controlled trial | Pregnant and lactating women (n = 210, Munich, Germany) | n-3 fatty acids from 15 weeks gestation until 4 months post-partum | Body mass of newborn with follow-up until age 5 |
| Ko et al. | Randomized uncontrolled | Pregnant women receiving prenatal care (WA, USA) | Vigorous physical activity | Central adiposity 6–8 weeks post-partum |
| Krummel et al. | Randomized controlled trial | Obese pregnant women (Cincinnati USA) | Dietary docosahexanoic acid (DHA) supplements from 24 to 28 weeks gestation until term | Maternal insulin sensitivity |
| Louto et al. | Cluster randomized controlled trial | Women at risk of gestational diabetes (overweight, age 40 years or older, earlier macrosomic child, diabetic first degree relatives) (Finland) | Tailored diet and physical activity counselling, five visits to public health nurse. Monthly group session with physiotherapist | Primary; gestational diabetes, birthweight. Secondary; maternal weight gain, childhood weight at 1 year; requirement for insulin treatment in pregnancy |
| Ludwig et al. | Randomized controlled trial | Overweight and obese (BMI > 25, <45) pregnant women (Boston, USA) | Low glycaemic load | Birthweight z-score |
| Parat et al. | Randomized controlled trial | Overweight or obese women (Paris, France) | Counselling on healthy eating and modest exercise | 30% reduction in rapid infancy weight gain at 2 years |
| Fit for 2 study (Oostdam et al., 2009a, b) | Randomized controlled trial | Dutch women obese (BMI > 30) or overweight with a history of macrosomia or abnormal glucose tolerance in previous pregnancy or first grade relative with type 2 GDM 2 groups of 64 subjects | Intensive exercise program (2 days of week, 60 min each) | Maternal fasting plasma glucose and relative insulin resistance. Primary neonatal outcome birthweight, QUALY |
| Poston et al. (The UPBEAT Study) | Pilot trial followed by randomized controlled trial | 2700 obese pregnant women (UK) | Tailored advice on physical activity and diet. Group sessions | Pilot study; change in dietary and physical activity behaviours, QUALY and barriers to behavioural change. RCT; maternal insulin resistance. Primary neonatal outcome birthweight, QUALY |
| Shaheta et al. | (1) Observational Study; (2) Randomized controlled trial | (1) All pregnant women delivering in District General Hospital; (2) Women with a BMI > 40 | Measurement of waist circumference at booking & 20/40. Metformin plus exercise versus metformin | Macrosomia, pre-eclampsia and GDM |
| Shen et al. | Randomized controlled trial | All BMI pregnant women (Manitoba, USA) | Community-based lifestyle intervention package (diet and exercise) during and after pregnancy | Excessive GWG |
| Vintner et al. | Randomized controlled trial | Obese (BMI > 30) pregnant women (n = 360; Odense, Denmark) | Individualized counselling on diet and physical activity | Multiple obesity-related adverse pregnancy outcomes |