Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Gestational Weight Gain: Implications of an Antenatal Lifestyle Intervention
Örebro University, School of Medical Sciences.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Excessive gestational weight gain (GWG) is common in developed countries and is associated with an increased risk of maternal and offspring morbidity. Evidence regarding efficacy and safety of antenatal lifestyle intervention is limited in terms of both systematic reviews and original trials. This thesis is based on the need to further explore this research area. Objectives: To assess and grade current evidence and evaluate short and long-term effects of an antenatal lifestyle intervention on women and their offspring Materials: Controlled trials of intervention publishedbefore August 2009 were systematically searched and reviewed. A randomized controlled trial (RCT) including 445 healthy women aged >18 years with a body mass index (BMI) ≥19 and ≤16 weeks pregnant and their offspring was performed during 2007-2015 in Örebro Region, Sweden. Methods: The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used for review. Our RCT (called the VIGA trial) compared standard care with a composite intervention consisting of education, application of a personalized weight graph, prescription of exercise and more frequent monitoring of weight. Standardized measures of weight and height in offspring waere analysed based on World Health Organization (WHO) Child Growth Standards. Results: Quality of evidence across the studies published pre-August 2009 was concluded to be very low. Our intervention significantly reduced mean GWG (kg) but the proportion of women with excessive GWG, according to recommendations, was not significantly reduced. Short- term postpartum weight retention (PPWR) was significantly lower after the intervention but no significant difference remained 1 year after delivery. Offspring mean BMI z-scores or proportion of obesity did not differ between study groups at either birth or age 5. Conclusions: The antenatal lifestyle intervention reduced mean GWG and short-term PPWR but no long-term effects on maternal weight retention or offspring obesity were seen. Alternative modes and timing of intervention should be considered in future research. Reducing the prevalence of pre-conception obesity must still be considered the primary means to improve maternal and fetal outcome.

Place, publisher, year, edition, pages
Örebro: Örebro university , 2016. , 61 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 146
Keyword [en]
gestational weight gain, maternal health, pregnancy, prevention of obesity, lifestyle intervention, childhood obesity
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-51439ISBN: 978-91-7529-148-2 (print)OAI: oai:DiVA.org:oru-51439DiVA: diva2:949871
Public defence
2016-09-30, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2016-07-25 Created: 2016-07-25 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Interventions during pregnancy to reduce excessive gestational weight gain: a systematic review assessing current clinical evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system
Open this publication in new window or tab >>Interventions during pregnancy to reduce excessive gestational weight gain: a systematic review assessing current clinical evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system
2010 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, no 11, 1327-1334 p.Article in journal (Refereed) Published
Abstract [en]

Background Excessive weight gain during pregnancy is common in developed countries and increases the risk of complications during pregnancy, delivery and the postpartum period, which can affect both maternal and fetal outcome. Interventions to reduce excessive gestational weight gain have previously not been systematically evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Objectives To determine whether published trials of interventions to reduce excessive gestational weight gain are of sufficient quality and provide sufficient data to enable evidence-based recommendations to be developed for clinical practice in antenatal care. Search strategy A literature search was conducted in the scientific databases PubMed, Cochrane Library, Cinhal and Pedro, and the reference lists of relevant articles were reviewed. The literature search was concluded on 15 August 2009. Selection criteria All randomised controlled trials (RCTs) were considered for inclusion. As the number of published RCTs was limited, we also considered for inclusion all nonrandomised intervention studies that included a control group. Systematic reviews were examined to identify additional original studies. Data collection and analysis Two reviewers independently assessed the quality of the methods and results of all included articles. Extracted data were classified using the GRADE system. Main results Four intervention studies with a randomised controlled design and four intervention trials with a nonrandomised controlled design met the inclusion criteria. As a consequence of important limitations in study design, inconsistency and lack of directness, the overall quality of evidence was judged to be very low using the GRADE system. Authors' conclusions The results of published intervention trials are of insufficient quality to enable evidence-based recommendations to be developed for clinical practice in antenatal care.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-18903 (URN)10.1111/j.1471-0528.2010.02619.x (DOI)000281635900004 ()20840691 (PubMedID)2-s2.0-77956542667 (Scopus ID)
Available from: 2011-10-04 Created: 2011-09-30 Last updated: 2017-10-18Bibliographically approved
2. Intervention during pregnancy to reduce excessive gestational weight gain: a randomised controlled trial
Open this publication in new window or tab >>Intervention during pregnancy to reduce excessive gestational weight gain: a randomised controlled trial
Show others...
2015 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 122, no 4, 537-544 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate if a feasible, low-cost intervention could decrease the percentage of women gaining weight above the Institute of Medicine (IOM) recommendations on gestational weight gain (GWG) compared with standard maternity care.

Design: A randomised controlled interventional design.

Setting: Antenatal clinics (n=14) in orebro county, Sweden, participated.

Population: Healthy women with a body mass index (BMI) 19kg/m(2), age 18years and adequate knowledge of Swedish language who signed in for maternity care at 16weeks of gestation.

Methods: Standard care was compared with a composite intervention consisting of education on recommended GWG according to IOM, application of personalised weight graph, formalised prescription of exercise and regular monitoring of GWG at every antenatal visit.

Outcome: The proportion of women gaining weight above IOM guidelines (1990) and mean GWG (kg) was compared between groups.

Results: In all, 445 women were randomised and 374 women remained for analysis after delivery. A majority of the women analysed were normal weight (72%). The intervention reduced the proportion of women who exceeded the IOM guidelines (41.1% versus 50.0%). The reduction was, however, not statistically significant (P=0.086). Mean GWG was significantly lower among women receiving the intervention, 14.2kg (SD 4.4) versus 15.3kg (SD 5.4) in the standard care group (P=0.029).

Conclusions: The low-cost intervention programme tested did significantly reduce the mean GWG but the proportion of women who exceeded the IOM recommendations for GWG was not significantly lower. ClinicalTrials.gov Id NCT00451425

Keyword
Gestational weight gain, maternal health, pregnancy, prevention of obesity
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-44110 (URN)10.1111/1471-0528.13131 (DOI)000350139300022 ()25367823 (PubMedID)2-s2.0-84923328050 (Scopus ID)
Note

Funding Agency:

Research Committee at Orebro County Council

Available from: 2015-04-08 Created: 2015-04-08 Last updated: 2017-12-04Bibliographically approved
3. Effects on postpartum weight retention after antenatal lifestyle intervention: a secondary analysis of a randomized controlled trial
Open this publication in new window or tab >>Effects on postpartum weight retention after antenatal lifestyle intervention: a secondary analysis of a randomized controlled trial
2016 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 9, 999-1007 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: High weight retention after pregnancy is related to an increased risk of future obesity. The objective was to evaluate if an antenatal intervention, compared to standard care, could reduce postpartum weight retention (PPWR).

Material and methods: Women with body mass index >19, age ≥18 years, knowledge of Swedish, and pregnancy ≤16 weeks' gestation were randomized. Standard care was compared to a composite intervention including a personalized weight graph, education on recommended weight gain, prescription of exercise, and monitoring of weight until one year after delivery. Mean (kg) PPWR was compared between the groups and risk estimates (odds ratio) for excessive weight retention were calculated.

Results: Of 445 women randomized, 267 remained for analysis at ≤16 weeks postpartum and 168 at one year postpartum. The intervention group had a significantly lower mean PPWR at ≤16 weeks (1.81 kg (standard deviation, SD, 4.52) vs. 3.19 kg (SD 4.77), p=0.016). At one year postpartum, mean retention was still 0.7 kg lower in the intervention group (0.30 kg (SD 5.52) vs. 1.00 kg (SD 5.46)), the difference was not statistically significant (p=0.414). Gestational weight gain above Institute of Medicine recommendations was a significant risk factor for excessive weight retention (>5 kg) one year after delivery (OR 2.44; 95% CI; 1.08-5.52, p=0.029).

Conclusions: A composite lifestyle intervention during pregnancy reduced short-term weight retention, but the effect of the intervention did not remain at one year postpartum. A gestational weight gain above Institute of Medicine recommendations increases the risk of excessive long-term weight retention.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keyword
Prenatal care, obesity, women´s health issues, pregnancy
National Category
Obstetrics, Gynecology and Reproductive Medicine Nutrition and Dietetics
Identifiers
urn:nbn:se:oru:diva-49940 (URN)10.1111/aogs.12910 (DOI)000386782100007 ()27100375 (PubMedID)2-s2.0-84982221108 (Scopus ID)
Note

Funding Agency:

Research Committee at Orebro County Council

Available from: 2016-04-26 Created: 2016-04-26 Last updated: 2017-11-30Bibliographically approved
4. Effects of antenatal lifestyle intervention on offspring obesity: a five year follow-up of a randomized controlled trial
Open this publication in new window or tab >>Effects of antenatal lifestyle intervention on offspring obesity: a five year follow-up of a randomized controlled trial
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-51911 (URN)
Available from: 2016-09-02 Created: 2016-08-31 Last updated: 2017-10-17Bibliographically approved

Open Access in DiVA

Cover(594 kB)28 downloads
File information
File name COVER01.pdfFile size 594 kBChecksum SHA-512
e4dd6780e8c29c439b98db51ef4b9dd44e58991a081ab5a563700d6e76617fb6bee8906f1469c7648215f4e153e89309a382924f47613120630ac2de17dd63ee
Type coverMimetype application/pdf
Gestational Weight Gain(2481 kB)106 downloads
File information
File name FULLTEXT01.pdfFile size 2481 kBChecksum SHA-512
26768e18e935dbc286edd614607ad3d764762a7839e6c6b2c877d2ae87add000187dcf7ea711046f5957908ebe0be624bc35e5e0c6d772ba1aec7813e0e9de10
Type fulltextMimetype application/pdf
Spikblad(745 kB)15 downloads
File information
File name SPIKBLAD01.pdfFile size 745 kBChecksum SHA-512
7a8e77b34594682477186a0fd678300f26d83f15593a4d11b27017e271bc814e5e78e6e614d41cdba2ffdf4b432296da34108a676b6a38d879848fddfb6e92ea
Type spikbladMimetype application/pdf

Search in DiVA

By author/editor
Rönnberg, Ann-Kristin
By organisation
School of Medical Sciences
Surgery

Search outside of DiVA

GoogleGoogle Scholar
Total: 106 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 666 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf