Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial

Abstract

Objective To examine whether a lifestyle intervention in pregnancy limits gestational weight gain (GWG) and provides measurable health benefits for mother and newborn.Design Randomised controlled trial.Setting Healthcare clinics of southern Norway.Population Healthy, non-diabetic, nulliparous women, aged ≥18 years, with a body mass index of ≥19 kg/m 2 , and with a singleton pregnancy at ≤20 weeks of gestation.Methods Women were randomised to an intervention group (with dietary counselling twice by telephone and access to twiceweekly exercise groups) or to a control group (with standard prenatal care). Participants were measured three times during pregnancy and at delivery, and newborns were measured at delivery. Hospital records were reviewed for outcomes of pregnancy and delivery. Assessors were blinded to group allocation. Analysis was performed by intention to treat, assessing GWG using the Student's t-test and linear mixed models, and comparing proportions using the chi-square test.Main outcome measures GWG, rates of pregnancy complications and operative deliveries, and newborn birthweight.Results A total of 606 women were randomised. Of these, 591 were analysed, with 296 in the intervention group and 295 in the control group. At term, the mean GWG from pre-pregnancy was 14.4 kg for the intervention group and 15.8 kg for the control group (mean difference 1.3 kg; 95% confidence interval, 95% CI 0.3-2.3 kg; P = 0.009). There was no significant difference between groups in the frequency of pregnancy complications or operative deliveries. The intervention demonstrated no effect on the mean birthweight of term infants, or on the proportion of large newborns.Conclusions The Norwegian Fit for Delivery lifestyle intervention in pregnancy had no measurable effect on obstetrical or neonatal outcomes, despite a modest but significant decrease in GWG.Keywords Birthweight, diet, intervention, lifestyle, physical activity, pregnancy, weight gain.Tweetable abstract Norwegian Fit for Delivery RCT: reduced gestational weight gain, unchanged birthweight and obstetric outcomes.

Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials

“…We identified 58 trials published up to June 2015, of which 36 studies (62%) provided individual participant data (IPD),1617343536373839404142434445464748495051525354555657585960616263646566 that accounted for data from 80% of the participants (12 526/15 541); 22 studies (3015 women) did not provide IPD (fig 1). 67686970717273747576777879808182838485868788 A further 45 trials (9945 women)8990919293949596979899100101102103104105106107108109110111112113114115116117118119120121122…”

“…Twenty two studies17343637383941424748515253565758596061626367 were from Europe, four each from North America,44546566 Australia,16434550 and Brazil,35495564 and one study each from Egypt40 and Iran 46. Twenty three IPD studies included women of any body mass index (BMI),3435363738424445464748525455565859606164656667 seven included only obese women,17394041506263 and six included obese and overweight women 164349515357. The interventions included those mainly based on diet (four IPD studies)47616264 or physical activity (16 IPD studies),3536374246495051525558596566…”

“…Twenty three IPD studies included women of any body mass index (BMI),3435363738424445464748525455565859606164656667 seven included only obese women,17394041506263 and six included obese and overweight women 164349515357. The interventions included those mainly based on diet (four IPD studies)47616264 or physical activity (16 IPD studies),353637424649505152555859656669 and those based on a mixed approach of diet, physical activity, or behaviour modifying techniques, or all three together (15 IPD studies) 161734394041434445485354566063. One study had a three arm design with intervention arms being physical activity only and a mixed approach 57.…”

Effectiveness of exercise interventions in the prevention of excessive gestational weight gain and postpartum weight retention: a systematic review and meta-analysis

“…Similarly, Phelan et al reported no effect of prenatal exercise + co-intervention (diet and behavioural intervention) on the odds of returning to pre-pregnancy weight at 12 months postpartum (OR 1.6, 95% CI 0.92 to 2.7) 72. In contrast, Sagedal et al 63 reported higher odds of returning to pre-pregnancy weight at 12 months postpartum (OR 1.50, 95% CI 1.01 to 2.24) in women who participated in an exercise + diet intervention. Similarly, Rauh et al reported lower odds of PPWR >5 kg at 4 months postpartum (OR 0.5, 95% CI 0.2 to 0.9, adjusted for several potential confounding factors)55 and at 12 months postpartum (OR 0.40, 95% CI 0.16 to 0.97, adjusted for age, pre-pregnancy BMI, time of 12-month follow-up and practice)77 with a prenatal exercise + diet intervention compared with no intervention.…”

Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women

“…Of 1610 nulliparous women, 606 were included into the study [26], and 575 participated in the present sub study (Fig. 1).…”