Limiting excess weight gain in healthy pregnant women: importance of energy intakes, physical activity, and adherence to gestational weight gain guidelines

Tamara R Cohen, Kristine G Koski, Tamara R Cohen, Kristine G Koski

Abstract

Few studies have investigated if compliance with energy intakes, physical activity, and weight gain guidelines attenuate postpartum weight retention (PPWR) in mothers attending prenatal classes. We investigated whether (a) daily energy intakes within 300 kcal of estimated energy requirements (EERs), (b) walking more than 5000 steps/day, (c) targeting the recommended weight gain goals for prepregnancy BMI, and/or (d) achieving weekly or total gestational weight gain (GWG) recommendations minimized PPWR in 54 women attending prenatal classes in Montreal/Ottawa, Canada. Participants completed a validated pregnancy physical activity questionnaire (PPAQ), 3 telephone-validated 24-hr dietary recalls, and wore a pedometer for one week. PPWR was measured 6 weeks after delivery. Results showed that 72% had healthy prepregnancy BMIs. However, 52% consumed >300 kcal/day in excess of their EER, 54% exceeded recommended GWG, and more overweight (93%) than normal weight women (38%) cited nonrecommended GWG targets. Following delivery, 33% were classified as overweight, and 17% were obese. Multiple logistic regressions revealed that women targeting "recommended weight gain advice" were 3 times more likely to meet total GWG recommendations (OR: 3.2, P < 0.05); women who complied with weekly GWG goals minimized PPWR (OR: 4.2, P < 0.02). In conclusion, appropriate GWG targets, lower energy intakes, and physical activity should be emphasized in prenatal education programs.

Figures

Figure 1
Figure 1
Comparison of Individual Mother's Pre-Pregnancy with their Post-Partum BMI. The differences in the individual weight gains for our 54 mothers are described. The shaded box represents the normal BMI category (18.8–24.9 kg/m2).

References

    1. Davis EM, Stange KC, Horowitz RI. Childbearing, stress and obesity disparities in women: a public health perspective. Maternal and Child Health Journal. 2012;16:109–118.
    1. Yeh J, Shelton JA. Increasing prepregnancy body mass index: analysis of trends and contributing variables. American Journal of Obstetrics and Gynecology. 2005;193(6):1994–1998.
    1. Melzer K, Schutz Y. Pre-pregnancy and pregnancy predictors of obesity. International Journal of Obesity. 2010;34(2):S44–S52.
    1. Atkinson RL, Pietrobelli A, Uauy R, Macdonald IA. Are we attacking the wrong targets in the fight against obesity? The importance of intervention in women of childbearing age. International Journal of Obesity. 2012;36:1259–1260.
    1. Herring SJ, Nelson DB, Davey A, et al. Determinants of excessive gestational weight gain in urban, low-income women. Women's Health Issues. 2012;22(5):e439–e446.
    1. Stengel MR, Kraschnewski JL, Hwang SW, et al. What my doctor didn't tell me: examining health care provider advice to overweight and obese pregnant women on gestational weight gain and physical activity. Women's Health Issues. 2012;22(6):e535–e540.
    1. Bogaerts AFL, Devlieger R, Nuyts E, et al. Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial. International Journal of Obesity. 2012:1–8.
    1. Koepp UMS, Dahl-Jorgensen K, Stigum H, et al. The associations between maternal pre-pregnancy body mass index, gestational weight change during pregnancy and body mass index of the child at 3 years of age. International Journal of Obesity. 2012;36:1325–1331.
    1. Lowell H, Miller DC. Weight gain during pregnancy: adherence to Health Canada's guidelines. Health Reports. 2010;21(2) Statistics Canada, Component of Statistics Canada Catalogue no 82-003-XPE.
    1. Health Canada. Nutrition for a Healthy Pregnancy: National Guidelines for the Childbearing Years, Ottawa, Canada: Minister of Public Works and Government Services Canada; 1999.
    1. Kowal C, Kuk J, Tamim H. Characteristics of weight gain in pregnancy among Canadian women. Maternal and Child Health Journal. 2011:1–9.
    1. Health Canada. Canadian gestational weight gain recommendations. , 2010.
    1. Institute of Medicine. Weight gain during pregnancy: reexamining the guidelines. , 2009.
    1. Siega-Riz AM, Deierlein A, Stuebe A. Implementation of the new institute of medicine gestational weight gain guidelines. Journal of Midwifery and Women’s Health. 2010;55(6):512–519.
    1. Institute of Medicine. Nutrition During Pregnancy. Washington, DC, USA: National Academies of Sciences Press; 1990.
    1. Cogswell ME, Scanlon KS, Fein SB, Schieve LA. Medically advised, mother’s personal target, and actual weight gain during pregnancy. Obstetrics and Gynecology. 1999;94(4):616–622.
    1. Brawarsky P, Stotland NE, Jackson RA, et al. Pre-pregnancy and pregnancy-related factors and the risk of excessive or inadequate gestational weight gain. International Journal of Gynecology and Obstetrics. 2005;91(2):125–131.
    1. McDonald SD, Pullenayegum E, Taylor VH, et al. Despite 2009 guidelines, few women report being counseled correctly about weight gain during pregnancy. American Journal of Obstetrics and Gynecology. 2011;205(333):e1–e6.
    1. McDonald SD, Pullenayegum E, Bracken K, et al. Comparison of midwifery, family medicine, and obstetric patients' understanding of weight gain during pregnancy: a minority of women report correct counseling. Journal of Obstetrics and Gynaecology Canada. 2012;34(2):129–135.
    1. Stotland NE, Gilbert P, Bogetz A, Harper CC, Abrams B, Gerbert B. Preventing excessive weight gain in pregnancy: how do prenatal care providers approach counseling? Journal of Women’s Health. 2010;19(4):807–814.
    1. Stotland N, Teoh Y, Gerbert B. Prenatal weight gain: who is counseled? Journal of Women's Health. 2012;21(6):695–701.
    1. Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR. Practitioner advice and gestational weight gain. Journal of Women’s Health. 2011;20(4):585–591.
    1. Herring SJ, Platek DN, Elliott P, Riley LE, Stuebe AM, Oken E. Addressing obesity in pregnancy: what do obstetric providers recommend? Journal of Women’s Health. 2010;19(1):65–70.
    1. Cohen TR, Plourde H, Koski KG. Are Canadian women achieving a fit pregnancy? A pilot study. Canadian Journal of Public Health. 2010;101(1):87–91.
    1. Huberty J, Dinkel D, Beets MW, Coleman J. Describing the use of the internet for health, physical activity, and nutrition inormation in pregnant women. Maternal and Child Health Journal. 2012
    1. Sparud-Lundin C, Ranerup A, Berg M. Internet use, needs and expectations of web-based information and communication in childbearing women with type 1 diabetes. BMC Medical Informatics and Decision Making. 2011;11:49–55.
    1. Herman JA, Mock K, Blackwell D, Hulsey T. Use of a pregnancy support web site by low-income African American women. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2005;34(6):713–720.
    1. Brown MJ, Sinclair M, Liddle D, et al. A systematic review investigating healthy lifestyle interventions incorporating goal setting strategies for preventing excess gestational weight gain. PLOS One. 2012;7(7)e39503
    1. Skouteris H, Hartley-Clark L, McCabe M, et al. Preventing excessive gestational weight gain: a systematic review of interventions. Obesity Reviews. 2010;11(11):757–768.
    1. Streuling I, Beyerlein A, Rosenfeld E, Hofmann H, Schulz T, Von Kries R. Physical activity and gestational weight gain: a meta-analysis of intervention trials. BJOG. 2011;118(3):278–284.
    1. Wolfe LA, Mottola M. Physical Activity Readiness Medical Examination for Pregnancy [PARmed-X for pregnancy] Canadian Society for Exercise Physiologists, pp. 1-4, , 2002.
    1. Walker LO, Sterling BS, Timmerman GM. Retention of pregnancy-related weight in the early postpartum period: Implications for women’s health services. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2005;34(4):418–427.
    1. Montpetit AE, Plourde H, Cohen TR, Koski KG. Modeling the impact of prepregnancy BMI, physical activity, and energy intake on gestational weight gain, infant birth weight, and postpartum weight retention. Journal of Physical Activity and Health. 2012;9:1020–1029.
    1. Sohlstrom A, Forsum E. Changes in adipose tissue volume and distribution during reproduction in Swedish women as assessed by magnetic resonance imaging. American Journal of Clinical Nutrition. 1995;61(2):287–295.
    1. Tudor-Locke C, Bassett DR. How many steps/day are enough? preliminary pedometer indices for public health. Sports Medicine. 2004;34(1):1–8.
    1. Health Canada. Canadian Nutrient File. , 2010.
    1. Institute of Medicine (US) Panel on Macronutrients. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes., Dietary Reference Intakes For Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. xxv. Washington, DC, USA: National Academies Press; 2005.
    1. WHO. Human Energy Requirements Report of a Joint FAO/WHO/UNU Expert Consultation Food and Agriculture Organization. Rome, Italy: Energy Requirements of Pregnancy; 2004. (Food and Nutrition Technical Report Series).
    1. Begum F, Colman I, McCargar LJ, Bell RC. Gestational weight gain and early postpartum weight retention in a prospective cohort of Alberta women. Journal of Obstetrics and Gynaecology Canada. 2012;34(7):637–647.
    1. Cohen TR, Plourde H, Koski KG. Use of the pregnancy physical activity questionnaire (PPAQ) to identify behaviours associated with appropriate gestational weight gain during pregnancy. Journal of Physical Activity and Health. In press, .
    1. de Jersey SJ, Nicholson JM, Callaway LK, Daniels LA. A prospective study of pregnancy weight gain in Australian women. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2012;52(6):545–551.
    1. Downs DS, LeMasurier GC, DiNallo JM. Baby steps: pedometer-determined and self-reported leisure-time exercise behaviors of pregnant women. Journal of Physical Activity and Health. 2009;6(1):63–72.
    1. Harrison CL, Thompson RG, Teede HJ, Lombard CB. Measuring physical activity during pregnancy. International Journal of Behavioral Nutrition and Physical Activity. 2011;8(19) .

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren