For women attempting pregnancy, obesity reduces fertility and is an independent risk factor for obstetric and neonatal complications. The aim of this evaluator-blinded, randomized controlled trial was to evaluate a weight loss intervention on pregnancy rates in obese women undertaking fertility treatment. Forty-nine obese women, aged ≤ 37 years, presenting for fertility treatment were randomized to either a 12-week intervention (n = 27) consisting of a very-low-energy diet for the initial 6 weeks followed by a hypocaloric diet, combined with a weekly group multidisciplinary programme; or a control group (n = 22) who received recommendations for weight loss and the same printed material as the intervention. Anthropometric and reproductive parameters were measured at baseline and at 12 weeks. The 22 women who completed the intervention had greater anthropometric changes (-6.6 ± 4.6 kg and -8.7 ± 5.6 cm vs. -1.6 ± 3.6 kg and -0.6 ± 6.3 cm) compared with the control group (n = 17; P < 0.001). The intervention group achieved a pregnancy rate of 48% compared with 14% (P = 0.007), took a mean two fertility treatment cycles to achieve each pregnancy compared with four in the control group (P = 0.002), and had a marked increase in the number of live births (44% vs. 14%; P = 0.02). A group weight loss programme, incorporating dietary, exercise and behavioural components, is associated with a significant improvement in pregnancy rates and live births in a group of obese women undergoing fertility treatment.

SummaryThis systematic review assessed the effect of weight loss in overweight and/or obese women undergoing assisted reproductive technology (ART) on their subsequent pregnancy outcome. Weight losses achieved by diet and lifestyle changes, very--low--energy diets, non--surgical medical interventions and bariatric surgery translated into significantly increased pregnancy rates and/or live birth in overweight and/or obese women undergoing ART in 8 of the 11 studies reviewed. In addition, regularization of the menstrual pattern, a decrease in cancellation rates, an increase in the number of embryos available for transfer, a reduction in the number of ART cycles required to achieve pregnancy and a decrease in miscarriage rates were reported. There were also a number of natural conceptions in five of the six studies that reported this outcome. Non--surgical medical weight loss procedures and bariatric surgery induced the greatest weight losses, but their use, as well as that of very--low--energy diets, for weight loss prior to ART requires careful consideration. While the overall quality of the studies included in this review was poor, these results support the clinical recommendation of advising overweight and/or obese women to lose weight prior to ART. Prospective randomized controlled trials are required to establish efficacious evidence--based guidelines for weight loss interventions in overweight and/or obese women prior to ART treatment. Introduction Obesity has numerous health implications relating to fertility and is now the most common clinical risk factor encountered in obstetric practice [1]. Infertility in natural menstrual cycles has been shown to be almost three times higher in obese women (i.e. those with a body mass index [BMI] ≥ 30 kg m−2) [2, 3]. The positive relationship between BMI and time to pregnancy has been established in overweight and obese women with anovulation as well as in those with a regular menstrual cycle [4,5]. With the increasing prevalence of obesity worldwide, the number of obese women who are seeking assisted reproductive technology (ART) as a treatment for infertility is on the rise [6].Not only is it more difficult for overweight or obese women to conceive, pregnancy in overweight and obese women is associated with an increased risk of complications for both the mother and the fetus [7--9]. In addition to problems apparent during pregnancy or in the perinatal period, pre--pregnancy and gestational obesity may lead to a self--reinforcing vicious cycle of excessive weight gain and adiposity that is passed on from mother to successive offspring [10--12]. While the underlying mechanisms of such maternal obesity--induced programming remain unclear (and are possibly epigenetic), the hypothesis is a potentially important explanation for the rapid rise in obesity [11].While an increasing number of obese women are seeking ART, it is by no means an optimum solution for infertility in this population. Obesity has been found to impair ART outcomes in most, but not all studies, as recent...

In women at risk of gestational diabetes mellitus, a low-GI diet influences offspring birth weight, birth length, and arterial wall thickness in early childhood, but not adiposity or growth trajectory during the first year of life. This trial was registered at anzctr.org.au as ACTRN12610000681055.

BackgroundExcess gestational weight gain (GWG) leads to adverse short- and long-term consequences for women and their offspring. Evidence suggests that excess GWG in early pregnancy may be particularly detrimental, contributing to the intergenerational cycle of obesity. The primary outcome was to investigate the prevalence and predictors of excess GWG in early pregnancy, and if women understand the risks to themselves and their offspring stratified by maternal body mass index (BMI).MethodsThis was a secondary analysis (n = 2131) of a cross-sectional study (n = 2338) conducted over 6 months in 2015 of pregnant women attending antenatal clinics at four maternity hospitals across Sydney, Australia before 22 completed weeks gestation An self-completed questionnaire was used to investigate knowledge of expected weight gain in pregnancy, understanding of risks associated with excess GWG, self-reported anthropometric measures and socio-demographic data.ResultsOne third (34.2%) of women gained weight in excess of the recommendations by 22 completed weeks gestation. Women who were overweight (OR: 1.69, 95% CI: 1.33–2.14) or obese (OR: 1.64, 95% CI: 1.20–2.24) pre-pregnancy were more likely to gain excess weight in early pregnancy compared to normal weight women; as were women from lower socio-economic areas (OR: 1.89, 95% CI: 1.49–2.41). Half (51%) the women were unsure about the effect of excess GWG on their baby; 11% did not believe that excess GWG would affect the weight of the baby and 14% did not believe that excess GWG would affect longer term outcomes for their baby. Women who gained weight above the recommendations were significantly more likely to believe that excessive GWG in pregnancy would not have any adverse future effect on health outcomes or weight of their baby.ConclusionsThe women at particular risk of excess early GWG are those who are overweight and obese and/or residing in lower socio-economic areas. These women need to be targeted for appropriate counselling preconception or in early pregnancy. Given the significant adverse outcomes associated with excess GWG in early pregnancy, preconception or early pregnancy counselling with respect to GWG and intervention research regarding best approach remains a public health priority.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1482-6) contains supplementary material, which is available to authorized users.

ObjectiveTo review the literature on nutrition interventions and identify which work to improve diet-related and health outcomes in Australian Aboriginal and Torres Strait Islander people.Study designSystematic review of peer-reviewed literature.Data sourcesMEDLINE, PubMed, Embase, Science Direct, CINAHL, Informit, PsychInfo and Cochrane Library, Australian Indigenous Health InfoNet.Study selectionPeer-reviewed article describing an original study; published in English prior to December 2017; inclusion of one or more of the following outcome measures: nutritional status, food/dietary/nutrient intake, diet-related biomedical markers, anthropometric or health measures; and conducted with Australian Aboriginal and Torres Strait Islander people.Data extraction and synthesisTwo independent reviewers extracted data and applied the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project. A purpose designed tool assessed community engagement in research, and a framework was applied to interventions to report a score based on numbers of settings and strategies. Heterogeneity of studies precluded a meta-analysis. The effect size of health outcome results were estimated and presented as forest plots.ResultsThirty-five articles (26 studies) met inclusion criteria; two rated moderate in quality; 12 described cohort designs; 18 described interventions in remote/very remote communities; none focused solely on urban communities; and 11 reported moderate or strong community engagement. Six intervention types were identified. Statistically significant improvements were reported in 14 studies of which eight reported improvements in biochemical/haematological markers and either anthropometric and/or diet-related outcomes.ConclusionsStore-based intervention with community health promotion in very remote communities, fiscal strategies and nutrition education and promotion programmes show promise. Future dietary intervention studies must be rigorously evaluated, provide intervention implementation details explore scale up of programmes, include urban communities and consider a multisetting and strategy approach. Strong Aboriginal and Torres Strait Islander community engagement is essential for effective nutrition intervention research and evaluation.PROSPERO registration numberCRD42015029551.