Dietary and Lifestyle Advice for Pregnant Women Who Are Overweight or Obese: The LIMIT Randomized Trial

Abstract

Overweight and obesity during pregnancy are common and are associated with an increased risk of adverse health outcomes for both the mother and the infant. However, robust evidence about the effect of antenatal dietary and lifestyle interventions on health outcomes is lacking. We conducted a multicenter, randomized trial, recruiting 2,212 women (from 3 public maternity hospitals across South Australia) with a singleton pregnancy between 10⁺⁰ and 20⁺⁰ weeks' gestation and a BMI ≥25. The women were randomized to lifestyle advice (n = 1,108) or standard care (n = 1,104). Women randomized to lifestyle advice participated in a comprehensive dietary and lifestyle intervention over the course of their pregnancy (delivered by research staff), while women randomized to standard care received pregnancy care according to local guidelines, which did not include such information. Provision of the lifestyle intervention was associated with a significant 18% relative risk reduction in the chance of infants being born with a birth weight above 4 kg. No other significant differences were identified in maternal pregnancy and birth outcomes between the two treatment groups. Observational studies highlight the association between a high infant birth weight and the subsequent risk of childhood and adulthood obesity. Antenatal interventions that are effective in reducing high infant birth weights therefore represent a significant strategy to tackle obesity from a population health perspective, while ongoing interrogation of the biospecimens and measurements, including ongoing childhood follow-up, will provide a unique opportunity to evaluate the mechanistic pathways of maternal-to-infant/childhood obesity.

In overweight and obese women, fetal ultrasound biometry accurately predicts newborn measures

“…This secondary analysis includes women randomised to the Standard Care Group of the LIMITing weight gain in overweight and obese women during pregnancy to improve health outcomes: the LIMIT randomised controlled trial (ACTRN12607000161426) . Women in the Standard Care Group continued to receive their pregnancy care according to local hospital protocols, and did not include provision of dietary and lifestyle advice, or information relating to gestational weight gain in pregnancy .…”

“…the LIMIT randomised controlled trial (ACTRN12607000161426). [27][28][29][30][31] Women in the Standard Care Group continued to receive their pregnancy care according to local hospital protocols, and did not include provision of dietary and lifestyle advice, or information relating to gestational weight gain in pregnancy. 27,30 The ethics approval study number for LIMIT randomised controlled trial was 1839/6 (approved July 2006) and for the fetal growth ancillary study number was 2051/4 (approved April 2008).…”

Gestational weight gain

“…58 Unfortunately, most of the health behavior interventions either designed specifically for overweight or obese women or that included overweight and obese women in the study design among women of all BMI categories have not demonstrated a significant impact on GWG. 58–67 Notable exceptions include two more recent RCTs. The LiP (Lifestyle in Pregnancy) study offered dietary guidance, free membership in a fitness center, and personal coaching.…”

Behaviour change techniques to change the postnatal eating and physical activity behaviours of women who are obese: a qualitative study

“…Current literature suggests that women's knowledge in pregnancy tends to be low in terms of these behaviours, and health professionals feel uncomfortable discussing weight . There is no agreement on the effectiveness of dietary interventions on antenatal and postnatal weight gain and interpretation must be cautious because of the quality of studies . An ongoing systematic review should provide more insight …”