(a) Prenatal intervention studies using the 1990 IOM gestational weight gain recommendations
| Reference, sample characteristics | Treatment | Gestational weight gain (GWG) (kg) | Maternal weight retention postpartum (PP) (kg) | Infant birth weight (g) | |||||||
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| Control | Intervention | Control | Intervention | P value | Control | Intervention | P value | Control | Intervention | P value | |
| Gray-Donald et al. [64] Design: Time-series control trial N = 219 C = 107 I = 112 Country Canada Ethnicity Cree women Age C = 23.8 ± 5.86 I = 24.3 ± 6.29 SES NA Prepreg BMI C = 29.6 ± 6.45 I = 30.8 ± 6.85 Parity C = 73% nulliparous I = 31% nulliparous Gestational age at recruitment C = 18.5 ± 6.9 I = 17.1 ± 7.1 Duration of study until delivery |
Standard prenatal care |
Community-based intervention for specific population (Aboriginal Cree) Based on the social learning theory Nutrition Pamphlets about nutritional choices, supermarket tours and cooking demonstrations, individual counseling Physical activity Exercise/walking groups Other Advice to stay within GWG recommendations Delivered by dieticians and health workers |
At delivery
13.2 ± 8.3 Weekly GWG BMI ≤ 29: 0.63 ± 0.32 BMI > 29: 0.44 ± 0.30 Adherence to 1990 IOM NA |
At delivery
12.0 ± 6.4 Weekly GWG BMI ≤ 29: 0.62 ± 0.27 BMI > 29: 0.44 ± 0.24 Adherence to 1990 IOM NA |
0.29 NS NS |
At 6 weeks PP
7.4 ± 8.5 |
At 6 weeks PP
6.1 ± 6.7 |
>0.05 |
3,741 ± 523 <2,500 g n = 2 (2%) >4,000 g n = 31 (30%) |
3,686 ± 686 <2,500 g n = 3 (3%) >4,000 g n = 37 (35%) |
NS NS NS |
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Polley et al. [58] Design: RCT N = 110 C = 53 I = 57 Country United States Ethnicity 39% black 61% white, Age 25.5 ± 4.8 Parity 47% nulliparous SES low income Gestational age at recruitment 14.5 ± 3.1 Duration of study NA |
Standard prenatal care |
Nutrition
Bi-weekly newsletters on healthy eating Physical activity Bi-weekly newsletters on healthy exercise habits, increasing walking and developing a more active lifestyle Other Written and oral info about appropriate GWG, personalized graphs showing GWG Delivered by trained staff |
At 36–40 weeks
13.8 ± 5.4 |
At 36–40 weeks
14.5 ± 7.1 |
NS | NA | NA | — | NA | NA | — |
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Normal weight group C = 31 I = 30 Prepreg BMI C = 22.5 ± 2.0 I = 22.8 ± 1.9 |
At 36–40 weeks
16.4 ± 4.8 Adherence to 1990 IOM 42% did not exceed |
At 36–40 weeks
15.4 ± 7.1 Adherence to 1990 IOM 67% did not exceed |
NS <0.05 |
At 8 ± 7 w PP
6.2 ± 4.5 |
At 8 ± 7 w PP
4.4 ± 5.4 |
NS |
3,226 <2,500 g n = 3 (10%) >4,000 g n = 0 |
3,133 <2,500 g n = 4 (13%) >4,000 g n = 1 (3%) |
NS NS NS |
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Overweight group C = 22 I = 27 Prepreg BMI C = 34.1 ± 7.2 I = 31.4 ± 6.0 |
At 36–40 weeks
10.1 ± 6.2 Adherence to 1990 IOM 68% did not exceed |
At 36–40 weeks
13.6 ± 7.2 Adherence to 1990 IOM 41% did not exceed |
NS 0.09 |
At 8 ± 7 w PP
0.3 ± 7.0 |
At 8 ± 7 w PP
3.6 ± 5.6 |
NS |
3,349 <2,500 g n = 2 (9%) >4, 000 g n = 0 |
3,283 <2,500 g n = 1 (4%) >4,000 g n = 0 |
NS NS NS |
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Olson et al. [61] Design Historical cohort N = 560 C = 381 I = 179 Country United States Ethnicity 96% white Age: C = 94% 20–40 yr I = 94% 20–40 yr Parity C = 41% nulliparous I = 41% nulliparous SES C = 43% low income I = 37% low income Prepreg BMI 75% normal weight in early pregnancy Gestational age at recruitment <27 weeks Duration of study NA |
Standard prenatal care |
Nutrition
Tips and newsletters about healthy eating, “health checkbook” to help self-monitoring diet Physical activity Tips and newsletters about PA during pregnancy Other Guidance about self-monitoring of GWG, newsletters about GWG Delivered by healthcare providers |
At delivery
14.8 ± 4.7 Adherence to 1990 IOM 55% did not exceed Sub-group, Low SES Adherence to 1990 IOM NW 55% OW 28% did not exceed |
At delivery
14.1 ± 4.5 Adherence to 1990 IOM 59% did not exceed Sub-group, Low SES Adherence to 1990 IOM NW 71% OW 56% did not exceed |
0.09 0.30 0.05 0.04 |
At 1 year
1.3 ± 5.6 Sub-group, Low SES Weight retention ≥2.27 kg NW 40% OW 55% |
At 1 year
0.6 ± 4.8 Sub-group, Low SES Weight retention ≥2.27 kg NW 37% OW 25% |
0.14 >0.05 0.04 |
3,621 (2,060–5,486) <2,500 g n = 3 (1%) >4,000 g n = 83 (22%) |
3,610 (2,475–5,345) <2,500 g n = 2 (1%) >4,000 g n = 32 (18%) |
NS NS NS |
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Kinnunen et al. [63] Design non RCT N = 105 C = 56 I= 49 Country Finland Ethnicity Finish Age C = 28.8 ± 4.1 I = 27.6 ± 4.5 Parity 100% nulliparous SES C = 36% Basic/secondary education I = 57% Basic/secondary education Prepreg BMI C = 22.3 ± 2.1 I = 23.7 ± 3.9 Gestational age at recruitment 8-9 weeks Duration of study until 37 weeks of gestation |
Standard prenatal care |
Nutrition
4 individual counseling sessions on healthy diet Physical activity 5 counseling sessions to increase LTPA and design an individual activity plan. Possibility to join group exercise sessions once a week for 45–60 min Other Information on GWG recommendations Delivered by nurses |
At 36-37 weeks
14.3 ± 4.1 Adherence to 1990 IOM 70% did not exceed |
At 36-37 weeks
14.6 ± 5.4 Adherence to 1990 IOM 54% did not exceed |
0.77 0.053 |
NA | NA | — |
≥4,000 g n = 8 (15%) |
≥4,000 g n = 0 |
0.006 |
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Asbee et al. [55] Design RCT N = 100 C = 43 I = 57 Country United States Ethnicity mixed C = 55% Hispanic I = 58% Hispanic Age C = 26.4 ± 5.0 I = 26.7 ± 6.0 Parity C = 44% nulliparous I = 46% nulliparous SES C = 65% high school or < I = 68% high school or < Prepreg BMI C = 25.6 ± 5.1 I = 25.5 ± 6.0 Gestational age at recruitment C = 13.6 ± 3.6 I = 13.7 ± 3.6 Duration of study until delivery |
Standard prenatal care |
Nutrition
Nutrition plan containing 40% carbohydrate 30% protein 30% lipid Physical activity Recommendations Frequency 3–5/week Intensity moderate-intensity exercise Other Information about GWG guidelines Delivered by dieticians |
At delivery
16.2 ± 7.0 Adherence to 1990 IOM 49% did not exceed |
At delivery
13.0 ± 5.7 Adherence to 1990 IOM 61% did not exceed |
0.01
0.21 |
NA | NA | — | NA | NA | — |
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Mottola et al. [44] Design Case (historical cohort)-control matched design N = 325 C = 260 I = 65 Country Canada Ethnicity >50% aboriginal Age: C = 31.9 ± 3.5 I = 32.4 ± 4.0 Parity C = 38% nulliparous I = 38% nulliparous SES na Prepreg BMI C = 33.4 ± 6.3 I = 32.1 ± 6.2 Gestational age at recruitment 16–20 weeks Duration of study until 34–36 weeks of gestation |
Standard prenatal care |
Nutrition
Individualized nutrition plan with total energy intake of approx 2000 kcal/d 40%–55% of total energy intake from CHO Physical activity Supervised exercise program Frequency 3-4/week Intensity 30% heart rate reserve Duration 25–40 min Type walking Delivered by dieticians and kinesiologists |
NA |
6.8 ± 4.1* Adherence to 1990 IOM 80% *GWG during the intervention |
— — |
NA |
At 8 w PP
2.2 ± 5.6 53% within 2.0 kg of pre-pregnancy body weight |
— |
3,590 ± 500 <2,500 g OW 4% OB 3% 4,000–4,500 g OW 18% OB 13.3% |
3,564 ± 600 <2,500 g OW 0% OB 0% 4,000– 4,500 g OW 3.2% OB 26% |
NS NS NS 0.05 0.07 |
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| Guelinckx et al. [65] Design RCT Country Belgium Ethnicity Caucasians Prepreg BMI >29 Duration of study until 32 weeks of gestation |
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C = 43 PI = 37 Age C = 29.4 ± 4.4 PI = 28.7 ± 4.0 Parity C = 40% nulliparous PI = 41% nulliparous SES C = na PI = na Gestational age at recruitment C = 10.2 ± 2.4 PI = 10.2 ± 2.6 |
Standard prenatal care |
Passive Intervention:
Received a brochure designed for the study providing advice about nutrition, physical activity and tips to limit GWG |
At delivery
10.6 ± 6.9 Adherence to 1990 IOM 52% did not exceed |
At delivery
10.9 ± 5.6 Adherence to 1990 IOM 54% did not exceed |
NS NS |
NA | NA | — |
3,419 ± 425 >4,000 g n = 3 (7%) |
3,585 ± 398 >4,000 g n = 5 (14%) |
NS NS |
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C = 43 AI = 42 Age C = 29.4 ± 4.4 AI = 28.0 ± 3.6 Parity C = 40% nulliparous AI = 48% nulliparous SES C = na AI = na Gestational age at recruitment C = 10.2 ± 2.4 AI = 9.3 ± 2.8 |
Standard prenatal care |
Active Intervention:
Received the same brochure plus received 3 counseling group-sessions given by a dietician Delivered by dieticians |
At delivery
10.6 ± 6.9 Adherence to 1990 IOM 52% did not exceed |
At delivery
9.8 ± 7.6 Adherence to 1990 IOM 59% did not exceed |
NS NS |
NA | NA | — |
3,419 ± 425 >4,000 g n = 3 (7%) |
3,492 ± 468 >4,000 g n = 5 (12%) |
NS NS |
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Phelan et al. [59] Design RCT N = 401 C = 200 I = 201 Country United States Ethnicity C = 68% Caucasian I = 69% Caucasian Age C = 28.8 ± 5.2 I = 28.6 ± 5.2 Parity C = 77% nulliparous I = 76% nulliparous SES C = 19% unemployed I = 16% unemployed Prepreg BMI C = 26.5 ± 5.9 I = 26.3 ± 5.6 |
Standard prenatal care |
One face-to-face visit at study entry to discuss Nutrition Recommendations appropriate calorie goals (20 kcal/kg). Physical activity Recommendations appropriate PA (30 min walking most days of the week). Other Recommendations appropriate GWG. Food records, pedometers and body weight scale were provided, postcard about healthy eating and exercise habits |
At final visit
NW 16.2 ± 4.6 OW 15.1 ± 7.5 Adherence to 1990 IOM NW 48% OW 39% did not exceed |
At final visit
NW 15.3 ± 4.4 OW 14.7 ± 6.9 Adherence to 1990 IOM NW 60% OW 33% did not exceed |
>0.05 >0.05 0.003 NS |
At 6 months
NW 3.3 ± 3.5 OW 4.3 ± 6.2 at or below pre-pregnancy body weight NW 21% OW 17% |
At 6 months
NW 2.1 ± 4.7 OW 3.7 ± 5.9 at or below pre-pregnancy body weight NW 36% OW 26% |
OR = 2.1 P = 0.005 |
NW 3,271 ± 467 OW 3,442 ± 629 <2,500 g NW = 5 (5%) OW = 4 (5%) >4,000 g NW = 3 (3%) OW = 14 (16%) |
NW 3,367 ± 459 OW 3,430 ± 650 <2,500 g NW = 4 (4%) OW = 5 (6%) >4,000 g NW = 6 (7%) OW = 14 (17%) |
NS NS NS NS NS NS |
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Gestational age at recruitment
10–16 weeks Duration of study NA |
were mailed weekly. 3 brief phone calls from the dietician Personalized graph of GWG Delivered by dieticians |
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