Lifestyle intervention to prevent excessive maternal weight gain: mother and infant follow-up at 12 months postpartum

Kathrin Rauh, Julia Günther, Julia Kunath, Lynne Stecher, Hans Hauner, Kathrin Rauh, Julia Günther, Julia Kunath, Lynne Stecher, Hans Hauner

Abstract

Background: Excessive gestational weight gain (GWG) is associated with elevated weight retention in mothers and might be related to adiposity of their offspring. Little is known if lifestyle intervention during pregnancy has beneficial effects for mothers and children beyond gestation.

Methods: A cluster-randomized controlled intervention trial was performed with 250 pregnant women in 8 gynaecological practices. Lifestyle intervention was carried out twice with individual counselling sessions on nutrition, physical activity and weight monitoring. Participants in the control group received routine prenatal care and an information leaflet. Follow-up data of women and their offspring were collected one year postpartum (pp) by phone call and/or via e-mail using a structured questionnaire. Maternal weight retention at 12 months pp and weight development of the children in their first year of life was compared between groups using linear regression. The association between energy and macronutrient intake during pregnancy with maternal weight retention and children weight development was also assessed.

Results: The intervention resulted in a trend towards lower mean weight retention 12 months pp (0.2 vs. 0.8 kg), but was not statistically significant (p = 0.321). Among women receiving lifestyle counselling, only 8% retained more than 5 kg weight while 17% in the control group retained >5 kg (OR: 0.40 (95% CI: 0.16, 0.97)). For the whole study cohort, an association between higher GWG and increased 12 month weight retention was found (0.4 kg weight retention per 1 kg increase in GWG, p < 0.001). Weight development of the infants did not differ between groups in the first months after birth. At the 10th-12th month weight measurement, infants born to mothers in the intervention group tended towards lower body weights. Both energy intake and macronutrient composition of the diet during pregnancy did not affect maternal weight retention and weight development of the infants.

Conclusions: Lifestyle counselling during pregnancy to avoid GWG had a rather modest effect on maternal pp weight retention and weight development of the infants. However, larger intervention studies and longer follow-up are required to be able to draw definite conclusions.

Trial registration: German Clinical Trials Register DRKS00003801.

Figures

Fig. 1
Fig. 1
Study scheme of the FeLIPO study with follow-up
Fig. 2
Fig. 2
Mean weight change of the women in relation to pre-pregnancy weight. Body weight change (± s.d.) between pre-pregnancy and the last obstetric visit prior to delivery and body weight change until 4 and 12 months postpartum are displayed. The number of women providing data in the control group was 83, 74, 72 and 65 pre-pregnancy and at the mentioned time points respectively, and 167, 152, 152 and 148 in the intervention group
Fig. 3
Fig. 3
Mean weight of the infants (± s.d.) at each time point according to group

References

    1. World Health Organization: WHO | Obesity and overweight: Fact Sheet N°311 [].
    1. Kurth B. Erste Ergebnisse aus der “Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS). Bundesgesundheitsbl, 2012:980–990.
    1. Mensink GBM, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C. Übergewicht und Adipositas in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) Bundesgesundhbl Gesundheitsforsch Gesundheitsschutz. 2013;56:786–94. doi: 10.1007/s00103-012-1656-3.
    1. Catalano PM, Ehrenberg HM. The short- and long-term implications of maternal obesity on the mother and her offspring. BJOG. 2006;113:1126–33. doi: 10.1111/j.1471-0528.2006.00989.x.
    1. Guelinckx I, Devlieger R, Beckers K, Vansant G. Maternal obesity: pregnancy complications, gestational weight gain and nutrition. Obes Rev. 2008;9:140–50. doi: 10.1111/j.1467-789X.2007.00464.x.
    1. Davies GAL, Maxwell C, McLeod L, Gagnon R, Basso M, Bos H, et al. SOGC clinical practice guidelines: obesity in pregnancy. No. 239, February 2010. Int J Gynaecol Obstet. 2010;110:167–73. doi: 10.1016/j.ijgo.2010.03.008.
    1. Nelson SM, Matthews P, Poston L. Maternal metabolism and obesity: modifiable determinants of pregnancy outcome. Hum Reprod Update. 2010;16:255–75. doi: 10.1093/humupd/dmp050.
    1. Adamo KB, Ferraro ZM, Brett KE. Can we modify the intrauterine environment to halt the intergenerational cycle of obesity? Int J Environ Res Publ Health. 2012;9:1263–307. doi: 10.3390/ijerph9041263.
    1. Gaudet L, Ferraro ZM, Wen SW, Walker M. Maternal obesity and occurrence of fetal macrosomia: a systematic review and meta-analysis. BioMed Res Int. 2014;2014:640291. doi: 10.1155/2014/640291.
    1. Viswanathan M, Siega-Riz AM, Moos MK, Deierlein A, Mumford S, Knaack J, et al. Outcomes of maternal weight gain. Evid Rep Technol Assess. 2008;1–223.
    1. Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol. 2010;115:597–604. doi: 10.1097/AOG.0b013e3181cfce4f.
    1. Margerison-Zilko CE, Rehkopf D, Abrams B. Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. Am J Obstet Gynecol. 2010;202:574.e1-8.
    1. Durie DE, Thornburg LL, Glantz JC. Effect of second-trimester and third-trimester rate of gestational weight gain on maternal and neonatal outcomes. Obstet Gynecol. 2011;118:569–75. doi: 10.1097/AOG.0b013e3182289f42.
    1. Jang DG, Jo YS, Lee GS. Effect of pre-pregnancy body mass index and weight gain during pregnancy on the risk of emergency cesarean section in nullipara. Arch Gynecol Obstet. 2011;284:1389–97. doi: 10.1007/s00404-011-1868-z.
    1. Gibson KS, Waters TP, Catalano PM. Maternal weight gain in women who develop gestational diabetes mellitus. Obstet Gynecol. 2012;119:560–5. doi: 10.1097/AOG.0b013e31824758e0.
    1. Liu Y, Dai W, Dai X, Li Z. Prepregnancy body mass index and gestational weight gain with the outcome of pregnancy: a 13-year study of 292,568 cases in China. Arch Gynecol Obstet. 2012;286:905–11. doi: 10.1007/s00404-012-2403-6.
    1. Linné Y, Dye L, Barkeling B, Rössner S. Long-term weight development in women: a 15-year follow-up of the effects of pregnancy. Obes Res. 2004;12:1166–78. doi: 10.1038/oby.2004.146.
    1. Nehring I, Schmoll S, Beyerlein A, Hauner H, Von Kries R. Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr. 2011;94:1225–31. doi: 10.3945/ajcn.111.015289.
    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;34:637–47.
    1. Rode L, Kjærgaard H, Ottesen B, Damm P, Hegaard HK. Association between gestational weight gain according to body mass index and postpartum weight in a large cohort of Danish women. Matern Child Health J. 2012;16:406–13. doi: 10.1007/s10995-011-0775-z.
    1. Gunderson EP, Abrams B, Selvin S. The relative importance of gestational gain and maternal characteristics associated with the risk of becoming overweight after pregnancy. Int J Obes Relat Metab Disord. 2000;24:1660–8. doi: 10.1038/sj.ijo.0801456.
    1. Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol. 2002;100:245–52. doi: 10.1016/S0029-7844(02)02125-7.
    1. Mamun AA, Kinarivala M, O’Callaghan MJ, Williams GM, Najman JM, Callaway LK. Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: evidence from 21 y postpartum follow-up. Am J Clin Nutr. 2010;91:1336–41. doi: 10.3945/ajcn.2009.28950.
    1. DeVader SR, Neeley HL, Myles TD, Leet TL. Evaluation of gestational weight gain guidelines for women with normal prepregnancy body mass index. Obstet Gynecol. 2007;110:745–51. doi: 10.1097/01.AOG.0000284451.37882.85.
    1. Ferraro ZM, Barrowman N, Prud’homme D, Walker M, Wen SW, Rodger M, et al. Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index. J Matern Fetal Neonatal Med. 2012;25:538–42. doi: 10.3109/14767058.2011.638953.
    1. Lee JM, Kim MJ, Kim MY, Han JY, Ahn HK, Choi JS, et al. Gestational weight gain is an important risk factor for excessive fetal growth. Obstet Gynecol Sci. 2014;57:442–7. doi: 10.5468/ogs.2014.57.6.442.
    1. Moreira P, Padez C, Mourão-Carvalhal I, Rosado V. Maternal weight gain during pregnancy and overweight in Portuguese children. Int J Obes (Lond) 2007;31:608–14. doi: 10.1038/sj.ijo.0803582.
    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. Olson CM, Strawderman MS, Dennison BA. Maternal weight gain during pregnancy and child weight at age 3 years. Matern Child Health J. 2009;13:839–46. doi: 10.1007/s10995-008-0413-6.
    1. von Kries R, Ensenauer R, Beyerlein A, Amann-Gassner U, Hauner H, Rosario AS. Gestational weight gain and overweight in children: Results from the cross-sectional German KiGGS study. Int J Pediatr Obes. 2011;6:45–52. doi: 10.3109/17477161003792564.
    1. Beyerlein A, Nehring I, Rzehak P, Heinrich J, Müller MJ, Plachta-Danielzik S, et al. Gestational weight gain and body mass index in children: results from three german cohort studies. PloS One. 2012;7 doi: 10.1371/journal.pone.0033205.
    1. Margerison-Zilko CE, Shrimali BP, Eskenazi B, Lahiff M, Lindquist AR, Abrams BF. Trimester of maternal gestational weight gain and offspring body weight at birth and age five. Matern Child Health J. 2012;16:1215–23. doi: 10.1007/s10995-011-0846-1.
    1. Dello Russo M, Ahrens W, De Vriendt T, Marild S, Molnar D, Moreno LA, et al. Gestational weight gain and adiposity, fat distribution, metabolic profile, and blood pressure in offspring: the IDEFICS project. Int J Obes Relat Metab Disord. 2013;37:914–9. doi: 10.1038/ijo.2013.35.
    1. Ensenauer R, Chmitorz A, Riedel C, Fenske N, Hauner H, Nennstiel-Ratzel U, et al. Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: results from a retrospective cohort study. Int J Obes (Lond) 2013;37:505–12. doi: 10.1038/ijo.2012.226.
    1. Oken E, Rifas-Shiman SL, Field AE, Frazier AL, Gillman MW. Maternal gestational weight gain and offspring weight in adolescence. Obstet Gynecol. 2008;112:999–1006. doi: 10.1097/AOG.0b013e31818a5d50.
    1. Mamun AA, O’Callaghan M, Callaway L, Williams G, Najman J, Lawlor DA. Associations of gestational weight gain with offspring body mass index and blood pressure at 21 years of age: evidence from a birth cohort study. Circulation. 2009;119:1720–7. doi: 10.1161/CIRCULATIONAHA.108.813436.
    1. Reynolds RM, Osmond C, Phillips DIW, Godfrey KM. Maternal BMI, parity, and pregnancy weight gain: influences on offspring adiposity in young adulthood. J Clin Endocrinol Metab. 2010;95:5365–9. doi: 10.1210/jc.2010-0697.
    1. Schack-Nielsen L, Michaelsen KF, Gamborg M, Mortensen EL, Sørensen TIA. Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood. Int J Obes (Lond) 2010;34:67–74. doi: 10.1038/ijo.2009.206.
    1. Laitinen J, Jääskeläinen A, Hartikainen A, Sovio U, Vääräsmäki M, Pouta A, et al. Maternal weight gain during the first half of pregnancy and offspring obesity at 16 years: a prospective cohort study. BJOG. 2012;119:716–23. doi: 10.1111/j.1471-0528.2012.03319.x.
    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 (Lond) 2008;32:495–501. doi: 10.1038/sj.ijo.0803710.
    1. Streuling I, Beyerlein A, von Kries R. Can gestational weight gain be modified by increasing physical activity and diet counseling? A meta-analysis of interventional trials. Am J Clin Nutr. 2010;92:678–87. doi: 10.3945/ajcn.2010.29363.
    1. Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR. Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study. Am J Clin Nutr. 2011;93:772–9. doi: 10.3945/ajcn.110.005306.
    1. Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jørgensen JS. The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care. 2011;34:2502–7. doi: 10.2337/dc11-1150.
    1. Ronnberg A, Ostlund I, Fadl H, Gottvall T, Nilsson K. Intervention during pregnancy to reduce excessive gestational weight gain-a randomised controlled trial. BJOG. 2014.
    1. Rauh K, Gabriel E, Kerschbaum E, Schuster T, von Kries R, Amann-Gassner U, et al. Safety and efficacy of a lifestyle intervention for pregnant women to prevent excessive maternal weight gain: a cluster-randomized controlled trial. BMC Pregnancy Childbirth. 2013;13:151. doi: 10.1186/1471-2393-13-151.
    1. Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, et al. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr. 1991;45:569–81.
    1. Hronek M, Zadak Z, Hrnciarikova D, Hyspler R, Ticha A. New equation for the prediction of resting energy expenditure during pregnancy. Nutrition. 2009;25:947–53. doi: 10.1016/j.nut.2009.02.011.
    1. Craig CL, Marshall AL, Sjöström M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381–95. doi: 10.1249/01.MSS.0000078924.61453.FB.
    1. Gunderson EP, Abrams B. Epidemiology of gestational weight gain and body weight changes after pregnancy. Epidemiol Rev. 1999;21:261–75. doi: 10.1093/oxfordjournals.epirev.a018001.
    1. Ohlin A, Rössner S. Maternal body weight development after pregnancy. Int J Obes. 1990;14:159–73.
    1. Claesson I, Sydsjö G, Brynhildsen J, Blomberg M, Jeppsson A, Sydsjö A, et al. Weight after childbirth: a 2-year follow-up of obese women in a weight-gain restriction program. Acta Obstet Gynecol Scand. 2011;90:103–10. doi: 10.1111/j.1600-0412.2010.01016.x.
    1. Huang T, Yeh C, Tsai Y. A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial. Midwifery. 2011;27:257–64. doi: 10.1016/j.midw.2009.06.009.
    1. Phelan S, Phipps MG, Abrams B, Darroch F, Grantham K, Schaffner A, et al. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Am J Clin Nutr. 2014;99:302–11. doi: 10.3945/ajcn.113.070151.
    1. Olson CM, Strawderman MS, Reed RG. Efficacy of an intervention to prevent excessive gestational weight gain. Am J Obstet Gynecol. 2004;191:530–6. doi: 10.1016/j.ajog.2004.01.027.
    1. Althuizen E, van der Wijden CL, van Mechelen W, Seidell JC, van Poppel MNM. The effect of a counselling intervention on weight changes during and after pregnancy: a randomised trial. BJOG. 2013;120:92–9. doi: 10.1111/1471-0528.12014.
    1. Butte NF, Ellis KJ, Wong WW, Hopkinson JM, Smith EO. Composition of gestational weight gain impacts maternal fat retention and infant birth weight. Am J Obstet Gynecol. 2003;189:1423–32. doi: 10.1067/S0002-9378(03)00596-9.
    1. Nohr EA, Vaeth M, Baker JL, Sørensen TI, Olsen J, Rasmussen KM. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr. 2008;87:1750–9.
    1. Huang T, Wang H, Dai F. Effect of pre-pregnancy body size on postpartum weight retention. Midwifery. 2010;26:222–31. doi: 10.1016/j.midw.2008.05.001.
    1. Haugen M, Brantsæter AL, Winkvist A, Lissner L, Alexander J, Oftedal B, et al. Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study. BMC Pregnancy Childbirth. 2014;14:201. doi: 10.1186/1471-2393-14-201.
    1. Amorim AR, Rössner S, Neovius M, Lourenço PM, Linné Y. Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI? Obesity (Silver Spring) 2007;15:1278–86. doi: 10.1038/oby.2007.149.
    1. Maddah M, Nikooyeh B. Weight retention from early pregnancy to three years postpartum: a study in Iranian women. Midwifery. 2009;25:731–7. doi: 10.1016/j.midw.2008.01.004.
    1. Ng S, Cameron CM, Hills AP, McClure RJ, Scuffham PA. Socioeconomic disparities in prepregnancy BMI and impact on maternal and neonatal outcomes and postpartum weight retention: the EFHL longitudinal birth cohort study. BMC Pregnancy Childbirth. 2014;14:314. doi: 10.1186/1471-2393-14-314.
    1. Gore SA, Della Brown M, West DS. The role of postpartum weight retention in obesity among women: a review of the evidence. Ann Behav Med. 2003;26:149–59. doi: 10.1207/S15324796ABM2602_07.
    1. Fraser A, Tilling K, Macdonald-Wallis C, Hughes R, Sattar N, Nelson SM, et al. 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;93:1285–92. doi: 10.3945/ajcn.110.008326.
    1. Mannan M, Doi, Suhail AR, Mamun AA. Association between weight gain during pregnancy and postpartum weight retention and obesity: a bias-adjusted meta-analysis. Nutr Rev. 2013;71:343–52. doi: 10.1111/nure.12034.
    1. McClure CK, Catov JM, Ness R, Bodnar LM. Associations between gestational weight gain and BMI, abdominal adiposity, and traditional measures of cardiometabolic risk in mothers 8 y postpartum. Am J Clin Nutr. 2013;98:1218–25. doi: 10.3945/ajcn.112.055772.
    1. Wilkinson SA, van der Pligt P, Gibbons KS, McIntyre HD. Trial for Reducing Weight Retention in New Mums: a randomised controlled trial evaluating a low intensity, postpartum weight management programme. J Hum Nutr Diet. 2015;28(Suppl 1):15–28. doi: 10.1111/jhn.12193.
    1. Arenz S, Rückerl R, Koletzko B, Von Kries R. Breast-feeding and childhood obesity--a systematic review. Int J Obes Relat Metab Disord. 2004;28:1247–56. doi: 10.1038/sj.ijo.0802758.
    1. Harder T, Bergmann R, Kallischnigg G, Plagemann A. Duration of breastfeeding and risk of overweight: a meta-analysis. Am J Epidemiol. 2005;162:397–403. doi: 10.1093/aje/kwi222.
    1. Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115:1367–77. doi: 10.1542/peds.2004-1176.
    1. Beyerlein A, Von Kries R. Breastfeeding and body composition in children: will there ever be conclusive empirical evidence for a protective effect against overweight? Am J Clin Nutr. 2011;94:1772S–5. doi: 10.3945/ajcn.110.000547.
    1. Zhu Y, Hernandez LM, Dong Y, Himes JH, Hirschfeld S, Forman MR. Longer breastfeeding duration reduces the positive relationships among gestational weight gain, birth weight and childhood anthropometrics. J Epidemiol Community Health. 2015;69:632–8. doi: 10.1136/jech-2014-204794.
    1. Nehring I, Lehmann S, von Kries R. Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: a meta-analysis. Pediatr Obes. 2013;8:218–24. doi: 10.1111/j.2047-6310.2012.00110.x.
    1. Mamun AA, Mannan M, Doi SAR. Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2014;15:338–47. doi: 10.1111/obr.12132.
    1. Ebbeling CB, Pawlak DB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet. 2002;360:473–82. doi: 10.1016/S0140-6736(02)09678-2.
    1. Lawlor DA, Lichtenstein P, Fraser A, Långström N. Does maternal weight gain in pregnancy have long-term effects on offspring adiposity? A sibling study in a prospective cohort of 146,894 men from 136,050 families. Am J Clin Nutr. 2011;94:142–8. doi: 10.3945/ajcn.110.009324.
    1. Dodd JM, Grivell RM, Crowther CA, Robinson JS. Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials. BJOG. 2010;117:1316–26. doi: 10.1111/j.1471-0528.2010.02540.x.
    1. Lederman SA, Paxton A. Maternal reporting of prepregnancy weight and birth outcome: consistency and completeness compared with the clinical record. Matern Child Health J. 1998;2:123–6. doi: 10.1023/A:1022996924094.
    1. Tanentsapf I, Heitmann BL, Adegboye ARA. 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. Rauh K, Kunath J, Rosenfeld E, Kick L, Ulm K, Hauner H. Healthy living in pregnancy: a cluster-randomized controlled trial to prevent excessive gestational weight gain - rationale and design of the GeliS study. BMC Pregnancy Childbirth. 2014;14:119. doi: 10.1186/1471-2393-14-119.

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