Mighty Mums - a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity

Karin Haby, Marie Berg, Hanna Gyllensten, Ragnar Hanas, Åsa Premberg, Karin Haby, Marie Berg, Hanna Gyllensten, Ragnar Hanas, Åsa Premberg

Abstract

Background: Obesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes.

Methods: The intervention was performed in a city in Sweden 2011-2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790).

Results: In the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG < 7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (- 0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population.

Conclusion: Pregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting.

Trial registration: The study has been registered at ClinicalTrials.gov, Identifier: NCT03147079. May 10 2017, retrospectively registered.

Keywords: Gestational weight gain; Lifestyle intervention; Obesity; Pregnancy.

Conflict of interest statement

The study was approved by the Regional Ethical Review Board, Gothenburg, Sweden (Regionala Etikprövningsnämnden i Göteborg). Approval number 505-10. All participants provided written informed consent prior to participating in the project and were informed of the right to withdraw from the study at any time.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of women in the study. ITT = intention-to-treat population; PP = per-protocol population. There is some overlap between reasons for exclusion from the PP population in the intervention group
Fig. 2
Fig. 2
Change in mothers’ weight during and after pregnancy, by group (PP)
Fig. 3
Fig. 3
Gestational weight gain

References

    1. Zeitlin J, Mohangoo A, Delnord M. European perinatal health report health and care of pregnant women and babies in Europe in 2010. Paris: INSERM Institut national de la santé et de la recherche médicale; 2010.
    1. Pregnancy register, yearly report 2016. Stockholm: Quality Register Center; 2016.
    1. Holowko N, Chaparro MP, Nilsson K, Ivarsson A, Mishra G, Koupil I, Goodman A. Social inequality in pre-pregnancy BMI and gestational weight gain in the first and second pregnancy among women in Sweden. J Epidemiol Community Health. 2015;69(12):1154–1161. doi: 10.1136/jech-2015-205598.
    1. Campbell EE, Dworatzek PD, Penava D, de Vrijer B, Gilliland J, Matthews JI, Seabrook JA. Factors that influence excessive gestational weight gain: moving beyond assessment and counselling. J Matern Fetal Neonatal Med. 2016;29(21):3527–3531.
    1. Drake AJ, Reynolds RM. Impact of maternal obesity on offspring obesity and cardiometabolic disease risk. Reproduction. 2010;140(3):387–398. doi: 10.1530/REP-10-0077.
    1. Stamnes Koepp UM, Frost Andersen L, Dahl-Joergensen K, Stigum H, Nass O, Nystad W. Maternal pre-pregnant body mass index, maternal weight change and offspring birthweight. Acta Obstet Gynecol Scand. 2012;91(2):243–249. doi: 10.1111/j.1600-0412.2011.01321.x.
    1. Marchi J, Berg M, Dencker A, Olander EK, Begley C. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Obes Rev. 2015;16(8):621–638. doi: 10.1111/obr.12288.
    1. Begum F, Colman I, McCargar LJ, Bell RC. Gestational weight gain and early postpartum weight retention in a prospective cohort of Alberta women. J Obstet Gynaecol Can. 2012;34(7):637–647. doi: 10.1016/S1701-2163(16)35316-6.
    1. Fraser A, Tilling K, Macdonald-Wallis C, Hughes R, Sattar N, Nelson SM, Lawlor DA. Associations of gestational weight gain with maternal body mass index, waist circumference, and blood pressure measured 16 y after pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC) Am J Clin Nutr. 2011;93(6):1285–1292. doi: 10.3945/ajcn.110.008326.
    1. Goldstein R, Teede H, Thangaratinam S, Boyle J. Excess gestational weight gain in pregnancy and the role of lifestyle intervention. Semin Reprod Med. 2016;34(2):e14–e21. doi: 10.1055/s-0036-1583531.
    1. Ludwig DS, Currie J. The association between pregnancy weight gain and birthweight: a within-family comparison. Lancet. 2010;376(9745):984–990. doi: 10.1016/S0140-6736(10)60751-9.
    1. Tie HT, Xia YY, Zeng YS, Zhang Y, Dai CL, Guo JJ, Zhao Y. Risk of childhood overweight or obesity associated with excessive weight gain during pregnancy: a meta-analysis. Arch Gynecol Obstet. 2014;289(2):247–257. doi: 10.1007/s00404-013-3053-z.
    1. Sridhar SB, Darbinian J, Ehrlich SF, Markman MA, Gunderson EP, Ferrara A, Hedderson MM. Maternal gestational weight gain and offspring risk for childhood overweight or obesity. Am J Obstet Gynecol. 2014;211(3):259 e251–259 e258. doi: 10.1016/j.ajog.2014.02.030.
    1. Leonard SA, Petito LC, Rehkopf DH, Ritchie LD, Abrams B. Weight gain in pregnancy and child weight status from birth to adulthood in the United States. Pediatr Obes. 2017;12(Suppl 1):18–25. doi: 10.1111/ijpo.12163.
    1. Amorim AR, Rossner S, Neovius M, Lourenco PM, Linne Y. Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI? Obesity (Silver Spring) 2007;15(5):1278–1286. doi: 10.1038/oby.2007.149.
    1. Walter JR, Perng W, Kleinman KP, Rifas-Shiman SL, Rich-Edwards JW, Oken E. Associations of trimester-specific gestational weight gain with maternal adiposity and systolic blood pressure at 3 and 7 years postpartum. Am J Obstet Gynecol. 2015;212(4):499 e491–499 e412. doi: 10.1016/j.ajog.2014.11.012.
    1. IOM American Institute of Medicine . Weight gain during pregnancy: reexamining the guidelines. Washington: National Academy Press; 2009.
    1. Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol. 2007;110(4):759–764. doi: 10.1097/01.AOG.0000279450.85198.b2.
    1. Blomberg M. Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations. Obstet Gynecol. 2011;117(5):1065–1070. doi: 10.1097/AOG.0b013e318214f1d1.
    1. Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database Syst Rev. 2015;6:CD007145.
    1. International Weight Management in Pregnancy (i-WIP) Collaborative Group Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ. 2017;j3119:358.
    1. Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, Kunz R, Mol BW, Coomarasamy A, Khan KS. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012;344:e2088. doi: 10.1136/bmj.e2088.
    1. Agha M, Agha RA, Sandall J. Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: a systematic review and meta-analysis. PLoS One. 2014;9(5):e95132. doi: 10.1371/journal.pone.0095132.
    1. Gardner B, Wardle J, Poston L, Croker H. Changing diet and physical activity to reduce gestational weight gain: a meta-analysis. Obes Rev. 2011;12(7):e602–e620. doi: 10.1111/j.1467-789X.2011.00884.x.
    1. Zhang S, Rattanatray L, Morrison JL, Nicholas LM, Lie S, McMillen IC. Maternal obesity and the early origins of childhood obesity: weighing up the benefits and costs of maternal weight loss in the periconceptional period for the offspring. Exp Diabetes Res. 2011;2011:585749. doi: 10.1155/2011/585749.
    1. Jeffries K, Shub A, Walker SP, Hiscock R, Permezel M. Reducing excessive weight gain in pregnancy: a randomised controlled trial. Med J Aust. 2009;191(8):429–433.
    1. Brownfoot FC, Davey MA, Kornman L. Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial. BJOG. 2016;123(2):254–261. doi: 10.1111/1471-0528.13735.
    1. Claesson IM, Sydsjo G, Brynhildsen J, Cedergren M, Jeppsson A, Nystrom F, Sydsjo A, Josefsson A. Weight gain restriction for obese pregnant women: a case-control intervention study. BJOG. 2008;115(1):44–50. doi: 10.1111/j.1471-0528.2007.01531.x.
    1. Haby K, Glantz A, Hanas R, Premberg A. Mighty Mums - an antenatal health care intervention can reduce gestational weight gain in women with obesity. Midwifery. 2015;31(7):685–692. doi: 10.1016/j.midw.2015.03.014.
    1. Jacobs G. “Take control or lean back?” barriers to practicing empowerment in health promotion. Health Promot Pract. 2011;12(1):94–101. doi: 10.1177/1524839909353739.
    1. Rollnick S, Butler CC, Kinnersley P, Gregory J, Mash B. Motivational interviewing. BMJ. 2010;340:c1900. doi: 10.1136/bmj.c1900.
    1. McCormack B, McCance TV. Development of a framework for person-centred nursing. J Adv Nurs. 2006;56(5):472–479. doi: 10.1111/j.1365-2648.2006.04042.x.
    1. Johansson K, Hutcheon JA, Stephansson O, Cnattingius S. Pregnancy weight gain by gestational age and BMI in Sweden: a population-based cohort study. Am J Clin Nutr. 2016;103(5):1278–1284. doi: 10.3945/ajcn.115.110197.
    1. Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes. 2008;32(3):495–501. doi: 10.1038/sj.ijo.0803710.
    1. Shirazian T, Monteith S, Friedman F, Rebarber A. Lifestyle modification program decreases pregnancy weight gain in obese women. Am J Perinatol. 2010;27(5):411–414. doi: 10.1055/s-0029-1243368.
    1. Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jorgensen JS. The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care. 2011;34(12):2502–2507. doi: 10.2337/dc11-1150.
    1. Bogaerts AF, Devlieger R, Nuyts E, Witters I, Gyselaers W, Van den Bergh BR. Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial. Int J Obes (Lond). 2013;37(6):814–21.
    1. Quinlivan JA, Lam LT, Fisher J. A randomised trial of a four-step multidisciplinary approach to the antenatal care of obese pregnant women. Aust N Z J Obstet Gynaecol. 2011;51(2):141–146. doi: 10.1111/j.1479-828X.2010.01268.x.
    1. Dencker A, Premberg A, Olander EK, McCourt C, Haby K, Dencker S, Glantz A, Berg M. Adopting a healthy lifestyle when pregnant and obese - an interview study three years after childbirth. BMC Pregnancy Childbirth. 2016;16(1):201. doi: 10.1186/s12884-016-0969-x.
    1. Tanentsapf I, Heitmann BL, Adegboye AR. Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth. 2011;11:81. doi: 10.1186/1471-2393-11-81.
    1. Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P. Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med. 2012;10:47. doi: 10.1186/1741-7015-10-47.
    1. Fieril DP, Olsen PF, Glantz D, Premberg DA. Experiences of a lifestyle intervention in obese pregnant women - a qualitative study. Midwifery. 2017;44:1–6. doi: 10.1016/j.midw.2016.10.011.
    1. Furness PJ, McSeveny K, Arden MA, Garland C, Dearden AM, Soltani H. Maternal obesity support services: a qualitative study of the perspectives of women and midwives. BMC Pregnancy Childbirth. 2011;11:69. doi: 10.1186/1471-2393-11-69.
    1. Dodd JM, Briley AL. Managing obesity in pregnancy - an obstetric and midwifery perspective. Midwifery. 2017;49:7–12. doi: 10.1016/j.midw.2017.03.001.
    1. Herring SJ, Platek DN, Elliott P, Riley LE, Stuebe AM, Oken E. Addressing obesity in pregnancy: what do obstetric providers recommend? J Women's Health (Larchmt) 2010;19(1):65–70. doi: 10.1089/jwh.2008.1343.
    1. Heslehurst N, Moore H, Rankin J, Ells LJ, Wilkinson JR, Summberbell CD. How can maternity services be developed to effectively address maternal obesity? A qualitative study. Midwifery. 2011;27(5):e170–e177. doi: 10.1016/j.midw.2010.01.007.
    1. Smith SA, Heslehurst N, Ells LJ, Wilkinson JR. Community-based service provision for the prevention and management of maternal obesity in the North East of England: a qualitative study. Public Health. 2011;125(8):518–524. doi: 10.1016/j.puhe.2011.05.004.
    1. Nyman VM, Prebensen AK, Flensner GE. Obese women's experiences of encounters with midwives and physicians during pregnancy and childbirth. Midwifery. 2010;26(4):424–429. doi: 10.1016/j.midw.2008.10.008.
    1. Kennen EM, Davis TC, Huang J, Yu H, Carden D, Bass R, Arnold C. Tipping the scales: the effect of literacy on obese patients’ knowledge and readiness to lose weight. South Med J. 2005;98(1):15–18. doi: 10.1097/01.SMJ.0000146617.21240.49.
    1. Tanvig M. Offspring body size and metabolic profile - effects of lifestyle intervention in obese pregnant women. Dan Med J. 2014;61(7):B4893.
    1. Wennberg A. Pregnant women and midwives are not in tune with each other about dietary counselling - studies in Swedish antenatal care. Umeå University. 2015.
    1. Mills A, Schmied VA, Dahlen HG. Get alongside us’, women’s experiences of being overweight and pregnant in Sydney, Australia. Matern Child Nutr. 2013;9(3):309–321. doi: 10.1111/j.1740-8709.2011.00386.x.
    1. Phelan S. Pregnancy: a “teachable moment” for weight control and obesity prevention. Am J Obstet Gynecol. 2010;202(2):135 e131–135 e138. doi: 10.1016/j.ajog.2009.06.008.
    1. Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR. Practitioner advice and gestational weight gain. J Women's Health (Larchmt) 2011;20(4):585–591. doi: 10.1089/jwh.2010.2316.
    1. Aquino MR, Edge D, Smith DM. Pregnancy as an ideal time for intervention to address the complex needs of black and minority ethnic women: views of British midwives. Midwifery. 2015;31(3):373–379. doi: 10.1016/j.midw.2014.11.006.
    1. Olander EK, Berg M, McCourt C, Carlstrom E, Dencker A. Person-centred care in interventions to limit weight gain in pregnant women with obesity - a systematic review. BMC Pregnancy Childbirth. 2015;15:50. doi: 10.1186/s12884-015-0463-x.
    1. Forsum E, Brantsaeter AL, Olafsdottir AS, Olsen SF, Thorsdottir I. Weight loss before conception: a systematic literature review. Food Nutr Res. 2013;57. 10.3402/fnr.v57i0.20522. Epub 2013 Mar 13.

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