Effects of a lifestyle intervention in routine care on prenatal physical activity – findings from the cluster-randomised GeliS trial

Abstract

BackgroundExcessive gestational weight gain (GWG) is associated with an increased risk of pregnancy and obstetric complications. The “healthy living in pregnancy” (GeliS) study was performed in a routine care setting with the aim of limiting excessive GWG. The purpose of this secondary analysis is to evaluate the effect of the intervention on physical activity (PA) behaviour and to assess the impact of PA intensities on GWG.MethodsThe cluster-randomised, multicentre GeliS trial was performed in a routine care setting alongside scheduled prenatal visits. Pregnant women with a pre-pregnancy BMI between 18.5 and 40.0 kg/m2 were either assigned to the control group receiving usual care or to the intervention group. Participants in the intervention group attended three antenatal counselling sessions on diet and PA and one additional postpartum session. Data on PA behaviour were collected twice, before the end of the 12th (baseline) and after the 29th week of gestation using the Pregnancy Physical Activity Questionnaire.ResultsPA data were available for 1061 (93%) participants in the intervention and 1040 (93%) in the control group. Women in the intervention group reported significant improvements in the levels of total PA (p < 0.001), total PA of light intensity and above (p < 0.001), moderate-intensity (p = 0.024) and vigorous-intensity activities (p = 0.002) as well as sport activities (p < 0.001) in late pregnancy compared to the control group. The proportion of women meeting the international PA recommendations in late pregnancy was significantly higher in the intervention (64%) versus the control group (49%, p < 0.001). Activities of light-intensity and above (p = 0.006), light-intensity (p = 0.002) and vigorous-intensity (p = 0.014) in late pregnancy were inversely associated with total GWG.ConclusionWe found significant evidence of improvements in the PA pattern of pregnant women receiving lifestyle counselling within the framework of routine care. Most PA intensities were inversely associated with total GWG which indicates that PA across different intensities should be promoted.Trial registrationNCT01958307, ClinicalTrials.gov, retrospectively registered 9 October, 2013.

Associations between Prenatal Physical Activity and Neonatal and Obstetric Outcomes—A Secondary Analysis of the Cluster-Randomized GeliS Trial

“…The intervention yielded some improvements in the PA behavior [21] but no major between-group differences in primary and secondary maternal, neonatal, and obstetric outcomes except for infants’ birth weight and height [19]. Therefore, we made the post-hoc decision to pool data from the IV and C for the present analysis and adjusted for the group assignment.…”

“…The GeliS intervention was not successful in reducing the incidence of excessive gestational weight gain [19]. However, it led to some improvements in maternal antenatal dietary [20], and PA behavior [21]. Moreover, some minor but likely clinically irrelevant benefits in maternal postpartum weight development and breastfeeding behavior were observed [22].…”

Evaluation of antenatal risk factors for postpartum depression: a secondary cohort analysis of the cluster-randomised GeliS trial

“…The GeliS intervention was neither successful in reducing the proportion of women with excessive GWG [24], nor influenced the maternal postpartum weight development substantially [25]. However, the intervention resulted in small to moderate improvements in maternal dietary [26] and physical activity behaviour [27]. Further, the GeliS study included a large sample of pregnant women with extensive data on maternal health and used a validated tool for assessing PPD.…”

Effects of a Lifestyle Intervention in Routine Care on Short- and Long-Term Maternal Weight Retention and Breastfeeding Behavior—12 Months Follow-up of the Cluster-Randomized GeliS Trial

“…The primary aim of the GeliS study was to reduce the proportion of women with excessive GWG according to the weight gain recommendations of the Institute of Medicine (IOM) [24] by offering a comprehensive lifestyle intervention alongside antenatal routine visits [25]. Although the intervention was not effective in limiting excessive GWG [26], it yielded some improvements in dietary (manuscript under revision) and physical activity behavior (manuscript under revision) [27,28]. The long-term influence on maternal health remains to be investigated.…”