Table 2.

Characteristics of the antenatal/postnatal interventions.

Author/Year Trial Name Country	Aims	Timing of Intervention	Reported Primary/Secondary Outcomes	Study Population	Intervention
Pregnancy only
Phelan et al. 2013 [35] Fit for Delivery USA	To determine if a behavioural intervention initiated during pregnancy could decrease the proportion of women who exceeded the recommendations for GWG and increase the proportion of women who returned to pre-pregnancy weight by 6-month PP	Commenced 10–16 weeks gestation Ended at birth	Proportion of women at or below pre-pregnancy weight at 6 months PP Secondary outcome: Proportion of women who exceeded 1990 IOM recommended GWG	N = 401 all BMI I: n = 201 26.32 ± 5.6 kg/m2 C: n = 200 26.48 ± 5.9 kg/m2 Subgroup analysis was provided for women with BMI ≥25.0 kg/m2: n = 200	I: Diet and physical activity -Standard care plus a behavioural lifestyle intervention which involved one face-to-face visit with an interventionist; weekly mailed materials that promoted appropriate weight gain, healthy eating (20 kcal/kg) and exercise (30 min of walking most days/week); individual graphs of weight gain; and telephone-based feedback C: Usual care included nutrition counselling in line with the WIC program
Vesco et al. 2016 [36] Healthy Moms Trial USA	To determine if women who received a weight management intervention during pregnancy weighed less at 1-year PP	Commenced <20 weeks gestation Ended at birth	Weight change at 1-year PP, defined as weight at 12-months PP minus weight at randomisation	N = 114 OB women only I: n = 56 BMI 36.7 ± 5.2 kg/m2 C: n = 58 BMI 36.8 ± 5.2 kg/m2	I: Diet and physical activity -Two individual dietary counseling sessions with an interventionist -Weekly group meetings -Daily food and activity diaries (reviewed weekly) -Target: Maintain weight within 3% of randomisation weight by 12 months pp -Keep calorie intake within an individual goal and adopt a sodium-restricted diet -Exercise daily (goal of 30 min moderate activity per day or 10,000 steps per day on pedometer) C: Usual care included a single dietary advice session with a dietitian.
Vinter et al. 2014 [37] LiP study Denmark	To determine the effect of a lifestyle intervention in pregnancy on PPWR at 6 months and the association between breastfeeding and PPWR	Commenced <14 weeks gestation Ended at birth	PPWR, defined as 6-month PP weight minus weight at study inclusion	304 OB women only I: n = 150 33.4 kg/m2 (31.7–36.5) C: n = 154 33.3 kg/m2 (31.7–36.9)	I: Diet and physical activity -Four individual dietary counselling sessions with a dietitian -Counselling on postpartum diet, nutritional requirements during breastfeeding and weight loss -1 h/week aerobic classes -Free fitness membership C: Usual care
Pregnancy and postpartum
Ferrara et al. 2011 [38] DEBI study USA	To evaluate the feasibility of a prenatal/postpartum intervention to modify diet and physical activity	Commenced at diagnosis of GDM Ended 12 months PP	Proportion of women who reached their weight goal by 12 months PP, (reduction to 5% below their pre-pregnancy weight)	N = 197 all BMI Subgroup analysis was provided for women with BMI ≥25.0 kg/m2 n = 114 I: n = 96 All BMI OW = 24% (n = 23) OB = 35% (n = 34) C: n = 101 OW = 22% (n = 22) OB = 35% (n = 35)	I: Diet and physical activity 3 intervention phases delivered by dietitians Prenatal: GDM diagnosis to 6 weeks PP -1 in-person session, 2 telephone calls -Encouraged to follow the ADA diet -Engage in moderate intensity physical activity for 150 min/week. -Advice on breastfeeding for 6 months Postpartum: 6 weeks to 7 months PP -Goal of a 5% reduction in pre-pregnancy weight by 12 months PP -2 individualised in-person sessions and telephone calls -150 min of moderate or vigorous physical activity/week. -Consume 25% or less of total calories from fat per day. Maintenance phase: 7 to 12 months PP -3 telephone calls to reinforce the behavioral changes and address relapses. C: Usual care received materials on GDM, infant safety and general health
Herring et al. 2017 [39] USA	To determine whether an early pregnancy behavioral intervention could increase the proportion of obese African American women who were at or below their early pregnancy weights by 6- and 12-months PP	Commenced <20 weeks gestation Ended 6 months PP	Number of women at or below their early pregnancy weights by 6- and 12-months PP	N = 66 OW/OB African American women I: n = 33 BMI 33.5 ± 5.8 kg/m2 C: n = 33 BMI 32.2 ± 5.4 kg/m2	I: Diet and physical activity Behavioural lifestyle intervention designed to: (1) Prevent excessive GWG (delivered from baseline to 36 weeks’ gestation) (2) Promote weight loss postpartum (delivered between 10 weeks and 6 months PP) Behaviour change goals included ‘limit junk and high fat foods to no more than 1 per day’, ‘walk 5000 steps daily’ and ‘weigh yourself weekly’. Delivered via three mechanisms: -Daily text messages tailored to a behavioural goal -Weekly Facebook posts with links to websites and videos -Weekly to monthly scripted calls with a health coach -Participants were provided with digital scales, pedometers, water bottles and portion plates. C: Usual care
Peccei et al. 2017 [40] USA	To assess the effect of a culturally-appropriate nutritional intervention on GWG and PPWR	Commenced <16 weeks gestation Ended 6 months PP	Weight retention at 6 months PP from baseline	N = 300 OW/OB women I: n = 200 n = 85 OW n = 115 OB White: 36%, Black: 8%, Hispanic: 49%, Other: 7% C: n = 100 n = 43 OW n = 57 OB White: 46%, Black: 3%, Hispanic: 43%, Other: 8%	I: Diet only -Pregnancy: culturally appropriate, 10–30 min bi-monthly counselling on a low carbohydrate diet with a dietitian either in person or by phone -Pregnancy-specific individualised meal plans, weight gain trajectory assessments, counselling on food labels, shopping for healthy foods, calorie comparisons and supplement advice -Postpartum (6 weeks to 6 months): nutritional assessment and individualised meal plans for postpartum period; adjusted according to breastfeeding C: Standard prenatal and postnatal care
Postpartum only
Bertz et al. 2012 [41] Sweden	To evaluate whether a 12-week dietary, physical exercise or combined dietary and physical exercise behaviour modification reduces body weight in lactating women	Commenced 10–14 weeks PP Duration 12 weeks	To measure changes (by DXA scan) from baseline in body weight and body composition	N = 68 OW/OB women (calculated from pre-pregnancy weight) I: n = 51 Diet only: n = 17 BMI 30.0 ± 2.6 kg/m2 Exercise only: n = 18 BMI 30.4 ± 3.1 kg/m2 Diet and exercise: n = 16 BMI 29.9 ± 2.2 kg/m2 C: n = 17 BMI 30.2 ± 3.4 kg/m2 BMI data from baseline	I: Diet and physical activity Individual behaviour modification face to face counseling totaling 5 h. D: Reduction of 500 kcal/day -Limit sweets and snacks to 100 g/week -Substitute low-fat and low-sugar alternatives for regular foods -Cover one-half of the plate with vegetables at lunch -Reduce portion sizes E: 45-min brisk walk 4 day/week at 60–70% of the maximum heart rate. Women were contacted biweekly with text messages. C: Usual care
Colleran et al. 2012 [42] USA	An intervention examining the effects of energy restriction and exercise on body composition in overweight/obese lactating women	Commenced < 4 weeks PP Ended 20 weeks after recruitment	Primary outcome: To improve total diet or overall pattern of food consumptionAdditional outcomes: Changes in anthropometric and body composition, including BMI	N = 31 OW/OB (calculated at baseline) Data available for n = 27 I: n = 14 BMI 29.7 ± 3.6 kg/m2 C: n = 13 BMI: 28.0 ± 3.3 kg/m2	I: Diet and physical activity -A 16-week intervention using MyPyramid to estimate energy needs based on age, weight, height, and lactation status. -Printout generated which graphically displayed their recommended energy needs and food group servings Research assistants travelled to participants’ homes up to three times/week to facilitate the exercise session and dietary counselling C: Usual care group were asked not to participate in structured exercise or decrease their energy intake during the 16-week intervention
Craigie et al. 2011 [43] WeighWell UK	To evaluate the feasibility of a weight loss intervention in socially disadvantaged women	Commenced 6–18 months PP Duration 12 weeks	To assess changes in body composition (weight, WC and skinfolds), dietary intake and physical activity	Socially disadvantaged women. N = 52 OW/OB calculated at baseline I: n = 29 BMI 31.6 ± 4.7 kg/m2 C: n = 23 BMI 31.6 ± 5.4 kg/m2	I: Diet and physical activity -3 × monthly face-to-face consultations with a trained lifestyle counselor -3 structured telephone calls -500 kcal/day reduction -150 min of moderate-vigorous activity per week C: Written information on weight loss and usual care
Falciglia et al. 2017 [44] USA	To evaluate the effectiveness of a dietary intervention to increase target vegetable intake in OW PP women	Commenced 6 weeks PP Duration 12 months	Primary outcome: Maternal dietary intake Additional outcomes: Changes in body composition, including BMI	N = 104 OW/OB calculated at baseline I: n = 52 C: n = 52	I: Diet only -Mothers received 4 × 60 min education sessions with a nutrition professional and 8-month follow-up phone calls. -Sessions were tailored to SES of the participant and included advice on vegetable intake for the mother and her infant -Dietary guidelines were based on MyPyramid C: Usual care with standard educational material on MyPyramid
Gilmore et al. 2017 [45]	E-Moms: A personalized mHealth intervention for health and weight loss in postpartum women	Commenced <8 weeks PP Duration 16 weeks	Primary outcomes: Change in weight Additional outcome: Changes in body fat percentage, waist circumference, hip circumference and waist-to-hip ratio	N = 40 OW/OB Calculated at baseline Data available for n = 35 I: n = 19 BMI 31.3 ± 3.2 kg/m2 C: n = 16 BMI 32.7 ± 2.8 kg/m2	I: Diet and physical activity -The participants were given access to the SmartLoss phone application and an iPhone -The application included real-time weight and activity monitoring, scheduled delivery of health information, and interventionist feedback -To track weight and activity, participants were provided a BodyTrace scale and a Fitbit Zip accelerometer. Weight and steps were plotted on a weight and step graph found in the SmartLoss App and interventionist web portal once daily Target goals included weight loss of 10 ± 3% of enrolment weight at 16 weeks. An initial step goal was 500 steps/day which increased by 500 steps per day each week. 16 SmartTips were automatically sent each week and included tips on diet, physical activity and behaviour modification C: Standardised advice and services for postpartum nutrition and weight management through their WIC clinic
Herring et al. 2014 [46] Healthy4Baby USA	To examine the feasibility, acceptability, and efficacy of a technology-based weight loss intervention for urban, low-income mothers	Commenced 2 weeks–12 months PP Duration 14 weeks	Change in body weight from baseline to the end of the intervention	N = 18 OW/OB calculated from pre-pregnancy weight I: n = 9 BMI 36.9 ± 6.1 kg/m2 C: n = 9 BMI 36.9 ± 6.1 kg/m2	I: Diet and physical activity Daily text messages and biweekly calls on energy deficit, setting personal goals around behaviour change strategies -Limit sugary drinks to no more than 1 per day -Limit junk and high fat foods to no more than 1 per day -Aim for 1200–1500 kcal/day, -Walk 30 min or 5000 steps every day -Self-monitoring texts 3/4 × week to probe about adherence to behavioral strategies -Calls conducted biweekly C: Usual care
Huseinovic et al. 2016 [47] LEVA in Real Life Study Sweden	To evaluate short and long-term effectiveness of diet behaviour modification for weight loss in women	Commenced 6–15 weeks PP Duration 12 weeks	Change in body weight from baseline. Additional outcomes include BMI, WC, HC, body fat %, dietary intake and physical activity at the end of the intervention and 1-year PP	N = 110 OW/OB Baseline BMI ≥ 27 kg/m2 I: n = 54 BMI 31.8 ± 4.0 kg/m2 C: n = 56 BMI 31.6 ± 3.4 kg/m2	I: Diet only -1.5 h face-to-face visit with the dietitian -Reduction of 500 kcal/day -Limit sweets, salty snacks, and caloric drinks to 1 day/week and a max of 100 g/week -Substitute regular foods with low-fat and/or low-sugar alternatives -Cover one-half of the plate with vegetables -Reduce portion sizes -Phone calls and text messages were used throughout the trial to keep in contact -Weight loss goal of 0.5 kg/week; final loss of 6 kg after 12 weeks C: Usual care and a brochure on healthy eating
Lovelady et al. 2000 [48] USA	To determine whether weight loss by women during lactation affects the growth of their infants	Commenced 4 weeks PP Duration 10 weeks	Primary outcome: growth of infant. Additional outcomes include: maternal weight, BMI, body fat % and skinfolds	N = 40 OW only Baseline BMI 25–30 kg/m2 I: n = 27 27.6 ± 2.4 kg/m2 C: n = 21 28.0 ± 2.1 kg/m2	I: Diet and physical activity -Energy intake reduction of 500 kcal/d -Aerobic exercise (4×/week of 45-min sessions at 65–80% maximal heart-rate) -Weight loss goal: 0.5 to 1.0 kg/ week C: Instructed to: -Not restrict energy intake -Not perform vigorous aerobic exercise more than once per week All women were given a multivitamin supplement to take which contained at least 50 percent of the recommended dietary allowances for lactating women
Nicklas et al. 2014 [49] Balance after Baby USA	To test the feasibility and effectiveness of a web-based lifestyle intervention for women with recent GDM to reduce weight retention	Commenced 6 weeks PP Duration 24 weeks	Change in body weight at 12 months from (a) baseline visit and (b) self-reported pre-pregnancy weight	N = 75 OW/OB I: n = 36 31.2 ± 5.8 kg/m2 C: n = 39 31.6 ± 5.5 kg/m2	I: Diet and physical activity Web-based lifestyle modification program, including advice on how to achieve the following: -Lower glycemic index -Higher fibre -Controlled portion sizes -Gradually increasing physical activity to ≥150 min/week -Weight goal: return to pre-pregnancy weight C: Usual care plus distribution of a handout
Østbye et al. 2009 [50] Active mothers postpartum USA	To promote a reduction in BMI up to 24-months PP via sustainable lifestyle changes	Commenced 6 weeks PP Duration 9 month	Changes from baseline to 1-month post-intervention in: diet, physical activity and weight	N = 450 OW/OB at baseline I: n = 225 BMI 33.1 ± 6.7 kg/m2 C: n = 225 BMI 32.9 ± 6.0 kg/m2	I: Diet and physical activity -8 healthy-eating classes -10 physical-activity classes Delivered by a health counsellor 6 telephone-counseling sessions covering: -Reducing total caloric intake (decrease in calorie-dense foods) -An increase in fruit and vegetable consumption -Increasing physical activity to 30 min/day × 5/week 6-months postpartum, a sport stroller was provided to encourage walking for exercise outside of class and after the end of the intervention. C: Received biweekly newsletters with general tips for postpartum mothers
Wilkinson et al. 2015 [51] TRiM Australia	To evaluate a PP weight management programme on weight loss	Commenced 6-weeks PP Ended 6 months PP	Weight loss from pre-pregnancy to 6 months PP and from 6 weeks PP to 6 months PP	N = 81 OW/OB I: n = 40 BMI 33.5 ± 5.9 kg/m2 C: n = 41 BMI 33.5±x6.4 kg/m2	I: Diet only 6-month intervention 36 weeks gestation: 1-h face-to-face nutrition assessment with a dietitian, goal-setting introduction and counselling session regarding nutrition post-pregnancy 6 weeks until 3 months postpartum: Every 2 weeks information and goal-setting sheets posted 3 months until 6 months postpartum: monthly information and goal-setting sheets posted C: Usual care, at 36 weeks gestation received nutrition for breastfeeding resource
Wiltheiss et al. 2013 [52] KAN-DO USA	To improve diet and physical activity habits of mothers, to promote PP weight loss	Commenced 2–7 months PP Duration 10 months	Primary outcomes: Changes in diet quality and reduced energy intake from baseline Secondary outcomes: weight loss from baseline	n = 392 OW/OB calculated from pre-pregnancy BMI Available for analysis: I: n = 131 C: n = 145 weight: 87.5 kg ± 15.7	I: Diet only -8 monthly educational kits via mail -Kits focused specifically on changing dietary habits, appropriate portion size, ways to increase fruit and vegetable intake, ideas for nutritious snacks, how to read food labels and sample grocery lists with meal plans -Participants received a 20–30 min phone call with a health coach to discuss the content and address motivations and barriers C: Participants in the control arm received monthly newsletters focusing on reading skills and enjoyment of the preschooler.

Abbreviations: %: percentage; ADA: American Diabetes Association; BMI: body mass index; C: control; DXA; dual energy X-ray absorptiometry; E: exercise; GDM: gestational diabetes mellitus; HC; hip circumference; GWG: gestational weight gain; I: intervention; IOM; Institute of Medicine; kcal: kilocalories; n: number; kg: kilograms; OB: obese; OW: overweight; PP: postpartum; PPWR: postpartum weight retention; SES: socioeconomic status; WC: waist circumference; WIC: Women, Infant and Children; wk: week.