Lifestyle Interventions Limit Gestational Weight Gain in Women with Overweight or Obesity: LIFE-Moms Prospective Meta-Analysis

Alan M Peaceman, Rebecca G Clifton, Suzanne Phelan, Dympna Gallagher, Mary Evans, Leanne M Redman, William C Knowler, Kaumudi Joshipura, Debra Haire-Joshu, Susan Z Yanovski, Kimberly A Couch, Kimberly L Drews, Paul W Franks, Samuel Klein, Corby K Martin, Xavier Pi-Sunyer, Elizabeth A Thom, Linda Van Horn, Rena R Wing, Alison G Cahill, LIFE‐Moms Research Group, Alan M Peaceman, Rebecca G Clifton, Suzanne Phelan, Dympna Gallagher, Mary Evans, Leanne M Redman, William C Knowler, Kaumudi Joshipura, Debra Haire-Joshu, Susan Z Yanovski, Kimberly A Couch, Kimberly L Drews, Paul W Franks, Samuel Klein, Corby K Martin, Xavier Pi-Sunyer, Elizabeth A Thom, Linda Van Horn, Rena R Wing, Alison G Cahill, LIFE‐Moms Research Group

Abstract

Objective: This study aimed to evaluate the effects of varied lifestyle intervention programs designed to ameliorate excess gestational weight gain (GWG) in pregnant women with overweight or obesity compared with standard care, including effects on pregnancy outcomes.

Methods: Seven clinical centers conducted separate randomized clinical trials to test different lifestyle intervention strategies to modify GWG in diverse populations. Eligibility criteria, specific outcome measures, and assessment procedures were standardized across trials. The results of the separate trials were combined using an individual-participant data meta-analysis.

Results: For the 1,150 women randomized, the percent with excess GWG per week was significantly lower in the intervention group compared with the standard care group (61.8% vs. 75.0%; odds ratio [95% CI]: 0.52 [0.40 to 0.67]). Total GWG from enrollment to 36 weeks' gestation was also lower in the intervention group (8.1 ± 5.2 vs. 9.7 ± 5.4 kg; mean difference: -1.59 kg [95% CI:-2.18 to -0.99 kg]). The results from the individual trials were similar. The intervention and standard care groups did not differ in preeclampsia, gestational diabetes, cesarean delivery, or birth weight.

Conclusions: Behavioral lifestyle interventions focusing primarily on diet and physical activity among women with overweight and obesity resulted in a significantly lower proportion of women with excess GWG. This modest beneficial effect was consistent across diverse intervention modalities in a large, racially and socioeconomically diverse US population of pregnant women.

Trial registration: ClinicalTrials.gov NCT01545934 NCT01616147 NCT01771133 NCT01631747 NCT01768793 NCT01610752 NCT01812694.

Conflict of interest statement

Disclosure

LMR and CKM reported one of the interventions being evaluated in the Expecting Success trial at Pennington Biomedical Research Center (the SmartMoms™ smartphone application) has a pending trademark and is available for licensure. The other writing group members declared no conflict of interest.

© 2018 The Obesity Society.

Figures

Figure 1
Figure 1
Participant flowchart
Figure 2
Figure 2
Forest plot for primary outcome

References

    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 Medicine. 2012;10:47–61.
    1. Hochner H, Friedlander Y, Calderon-Margalit R, et al. Weight gain with adult offspring cardiometabolic risk factors: the Jerusalem perinatal family follow-up study. Circulation. 2012;125:1381–9.
    1. Boney CM, Verma A, Tucker R, Vohr BR. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatrics. 2005;115:e290–6.
    1. Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database of Systematic Reviews. 2015;(6) doi: 10.1002/14651858.CD007145.pub3. Art. No.: CD007145.
    1. Institute of Medicine/National Research Council(Committee to Reexamine IOM Pregnancy Weight Guidelines, Food and Nutrition Board and Board on Children, Youth, and Families) Weight gain during pregnancy: reexamining the guidelines. Washington DC: National Academics Press; 2009.
    1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1998-2008. JAMA. 2010;303:235–41.
    1. Oken E, Kleinman KP, Belfort MB, Hammitt JK, Gillman MW. Associations of gestational weight gain with short- and longer-term maternal and child health outcomes. Am J Epidemiol. 2009;170:173–80.
    1. The LIFE-Moms Research Group. Design of lifestyle intervention trials to prevent excessive gestational weight gain in women with overweight or obesity. Obesity. 2016;24:305–313.
    1. Diabetes Prevention Program Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care. 2002;25:2165–2171.
    1. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. The New England journal of medicine. 2001;344:3–10.
    1. Redman LM, Gilmore LA, Breaux J, et al. Effectiveness of SmartMoms, a Novel eHealth Intervention for Management of Gestational Weight Gain: Randomized Controlled Pilot Trial. J Med Internet Res. 2017;13:e133.
    1. Gallagher D, Rosenn B, Toro-Ramos T, et al. Greater Neonatal Fat-Free Mass and Similar Fat Mass Following a Randomized Trial to Control Excess Gestational Weight Gain. Obesity. 2018;26:578–587.
    1. Cahill AG, Haire-Joshu D, Cade WT, et al. Weight Control Program and Gestational Weight Gain in Disadvantaged Women with Overweight or Obesity: A Randomized Clinical Trial. Obesity. 2018;26:485–491.
    1. Phelan S, Wing RR, Brannen A, et al. Randomized controlled clinical trial of behavioral lifestyle intervention with partial meal replacement to reduce excessive gestational weight gain. Am J Clin Nutr. 2018;107:183–194.
    1. Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstetrics and Gynecology. 1996;87:163–68.
    1. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization; 2006.
    1. Xu Z, Wen Z, Zhou Y, Li D, Luo Z. Inadequate weight gain in obese women and the risk of small for gestational age (SGA): a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2017;30:357–67.
    1. Kapadia MZ, Park CK, Beyene J, Giglia L, Maxwell C, McDonald SD. Weight loss instead of weight gain within the Guidelines in obese women during pregnancy: a systematic review and meta-analysis. PLoS One. 2015;10:e0132650. doi: 10.1371/journal.pone.0132650.
    1. Goldstein RF, Abell SK, Ranasinha S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317:2207–25.
    1. The 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 randomized trials. BMJ. 2017;358:3119. doi: 10.1136/bmj.3119.
    1. Broskey NT, Wang P, Li N, et al. Early pregnancy weight gain exerts the strongest effect on birth weight, posing a critical time to prevent childhood obesity. Obesity. 2017;25:1569–76.
    1. Oken E, Taveras EM, Kleinman KP, Rich-Edwards JW, Gillman MW. Gestational weight gain and child adiposity at age 3 years. Am J Obstet Gynecol. 2007;196:322.e1–8.
    1. Wrotniak BH, Shults J, Butts S, Stettler N. Gestational weight gain and risk of overweight in the offspring at age 7 y in a multicenter, multiethnic cohort study. Am J Clin Nutr. 2008;87:1818–24.
    1. Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008;359(1):61–73. doi: 10.1056/NEJMra0708473.
    1. Pettitt DJ, Baird HR, Aleck KA, Bennett PH, Knowler WC. Excessive obesity in offspring of Pima Indian women with diabetes during pregnancy. N Engl J Med. 1983;308:242–5.
    1. Lederman SA, Paxton A, Heymsfield SB, Wang J, Thornton J, Pierson RN. Body fat and water changes during pregnancy in women with different body weight and weight gain. Obstet Gynecol. 1997;90:483–8.
    1. Hull HR, Thornton JC, Paley C, et al. Higher infant body fat with excessive gestational weight gain in overweight women. Am J Obstet Gynecol. 2011;205:211.e1–7. doi: 10.1016/j.ajog.2011.04.004.
    1. Davenport MH, Ruchat SM, Giroux I, Sopper MM, Mottola MF. Timing of excessive pregnancy-related weight gain and offspring adiposity at birth. Obstet Gynecol. 2013;122:255–61. doi: 10.1097/AOG.0b013e31829a3b86.

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