Effect of individualized weight management intervention on excessive gestational weight gain and perinatal outcomes: a randomized controlled trial

Abstract

It is unclear whether weight management is still effective for pregnant women with excessive weight gain in the second or third trimester in China. This study adopted individualized weight management intervention for pregnant women with abnormal weight gain in the second or third trimester, to analyze the effect of intervention by observing the gestational weight gain and perinatal outcomes. This randomized controlled trial was performed at Aerospace Center Hospital. The obstetrician determined whether the pregnant women gained too much weight in the second or third trimester according to the Institute of Medicine guidelines, and randomly divided the pregnant women who gained too much weight in the second or third trimester into the intervention group or the control group according to the inclusion and exclusion criteria. The pregnant women in the intervention group and in the control group all received routine prenatal examination and diet nutrition education by the doctors in the Department of Obstetrics and Gynecology. The intervention group underwent individualized weight management, including individualized diet, exercise, psychological assessment, cognitive intervention and continuous communication, the whole process is tracked and managed by professional nutritionists. The obstetrician collected the prenatal examination data and pregnancy outcome data of all enrolled pregnant women. The primary outcome measure was weight gain during pregnancy. A generalized linear model and a logistic regression model were used to compare the outcomes between the two groups. In total, 348 pregnant women participated in this study with 203 in the intervention group and 145 in the control group. The whole gestational weight gain in the intervention group (15.8 ± 5.4 Kg) was lower than that in the control group (17.5 ± 3.6 Kg; adjusted β = - 1.644; 95% CI [-2.660--0.627]; P = 0.002). The percent of pregnant women with excessive weight gainbefore delivery was 54.2% (110/203) in the intervention group, which was lower than 69.7% (101/145) in the control group (adjusted RR = 0.468; 95% CI [0.284-0.769] P = 0.003). The pregnant women given the individualized weight management intervention from the second to the third trimester experienced less weight gain than that from the third trimester (15.5 ± 5.6 Kg vs. 16.2 ± 5.2 Kg), but without significant difference (P = 0.338). Lower rates of GDM, preeclampsia and gestational hypertension, higher rates of fetal distress and puerperal infection were observed in the intervention group than in the control group (all P < 0.05). Individualized weight management during the second or third trimesters is still beneficial for pregnant women who gain excessive weight and can decrease the associated adverse outcomes.

Keywords: Excessive gestational weight gain; GDM; Hypertension; Individualized weight management.

Conflict of interest statement

The authors declare there are no competing interests.

©2022 Xu et al.

Figures

Figure 1. A flow diagram of the pregnant women in the study.

Figure 2. The percent of individuals in the intervention and control groups with the various pregnancy outcomes and the risk ratios of the intervention group for the pregnancy outcomes.

The risk ratio and 95% confidence interval were estimated by a logistic regression model when adjusted for age, pre-pregnancy BMI, parity and gravidity. SD, standard deviation; BMI, body mass index.

Figure 3. The percent of pregnancy outcomes when starting the intervention during the second and third trimester groups and the risk ratios of the second trimester group compared to the third trimester.

The risk ratio and 95% confidence interval were estimated by a logistic regression model and adjusted for age, pre-pregnancy BMI, parity and gravidity. SD, standard deviation; BMI, body mass index.

Figure 4. A comparison of the gestational weight gain between the intervention and control groups and between the second and third trimester groups within the various BMI groups in China.

(A) Comparison of the gestational weight gain between the intervention and control groups. (B) Comparison of the gestational weight gain between the second and third trimester groups. (C) The β and 95% confidence interval were estimated by the generalized regression model and adjusted for age, pre-pregnancy BMI, parity and gravidity. SD, standard deviation; BMI, body mass index; GWG, gestational weight gain. The blue represents the intervention and control groups, and the pink represents the second and third trimester groups.