Reducing Excessive Gestational Weight Gain
Excessive gestational weight gain is a prevalent problem and an independent predictor of future obesity in both mothers and offspring. Intervention research to prevent excessive gestational weight gain is still in its infancy but results to date have been quite modest. Research in weight control outside of pregnancy over the past 30 years has been more robust and identified several key components of effective programs, including use of caloric restriction, daily diet self-monitoring, self-weighing, behavior therapy and ongoing patient–provider contact. The aim of this article is to summarize intervention components shown to be effective in promoting successful weight control outside of pregnancy and explore potential applications in pregnancy. Available evidence suggests that the strategies shown to be effective for weight control outside of pregnancy may also promote better weight control in pregnancy, but several lines for future investigation remain.
The National Academy of Science Institute of Medicine (IOM) has reformulated specific weight gain recommendations for women during pregnancy in an effort to help prevent adverse maternal/neonatal outcomes associated with excessive gestational weight gain (GWG); however, approximately 35% of normal weight women and 60% of obese women gain more than recommended during pregnancy. Excessive GWG is an established independent risk factor for high postpartum weight retention and future weight gain, cardiovascular disease and Type 2 diabetes in women, and is also related to several more immediate adverse obstetrical outcomes, including gestational diabetes, c-section deliveries and stillbirths. The offspring of mothers with excessive GWG are also impacted and have higher rates of macrosomia and rapid early infant weight gain, future obesity and development of obesity-related comorbidities.
Unfortunately, the best strategies to prevent excessive GWG are unknown. Recent reviews and meta-analyses of the literature have concluded that dietary and physical activity interventions produce generally only small reductions in GWG. The reviews concurred that more research was needed examining mechanisms linking successful lifestyle interventions to reduced GWG. Interestingly, reviewers tended to diverge in recommendations for improving current treatment outcomes. Suggested strategies included greater emphasis on psychological factors, body image and motivational strategies, dietary, physical activity and weight monitoring strategies, attitudinal and motivational changes through education, cost-effective interventions, and interventions that considered the role of family, community and environmental supports. Thus, there remains a wide host of potential lines of research to pursue to improve lifestyle interventions in pregnancy. The most fruitful avenues for improving treatment remain unclear, but weight control research in nonpregnant populations may prove informative in this regard. In nonpregnant populations, rapid advances over the past 30 years have identified specific approaches that are most effective in altering energy balance in favor of long-term weight control (e.g., dietary, physical activity and behavioral strategies). Findings from this literature might inform treatment strategies for preventing excessive GWG in pregnancy.
The aim of this article is to summarize key components shown to be most effective in weight loss programs for nonpregnant populations and to explore potential applications in preventing excessive GWG in pregnancy. Given the magnitude of the research literature, our article focuses on effective strategies for promoting successful weight loss, defined as 5–10% of initial body weight, in overweight/obese individuals. This magnitude of weight loss has been shown to prevent diabetes and reduce several cardiovascular disease risk factors. However, it is important to note that the variables effective in promoting weight loss are the same key variables that have emerged as critical intervention targets for preventing weight gain and weight regain, as referenced in the sections that follow.
Abstract and Introduction
Abstract
Excessive gestational weight gain is a prevalent problem and an independent predictor of future obesity in both mothers and offspring. Intervention research to prevent excessive gestational weight gain is still in its infancy but results to date have been quite modest. Research in weight control outside of pregnancy over the past 30 years has been more robust and identified several key components of effective programs, including use of caloric restriction, daily diet self-monitoring, self-weighing, behavior therapy and ongoing patient–provider contact. The aim of this article is to summarize intervention components shown to be effective in promoting successful weight control outside of pregnancy and explore potential applications in pregnancy. Available evidence suggests that the strategies shown to be effective for weight control outside of pregnancy may also promote better weight control in pregnancy, but several lines for future investigation remain.
Introduction
The National Academy of Science Institute of Medicine (IOM) has reformulated specific weight gain recommendations for women during pregnancy in an effort to help prevent adverse maternal/neonatal outcomes associated with excessive gestational weight gain (GWG); however, approximately 35% of normal weight women and 60% of obese women gain more than recommended during pregnancy. Excessive GWG is an established independent risk factor for high postpartum weight retention and future weight gain, cardiovascular disease and Type 2 diabetes in women, and is also related to several more immediate adverse obstetrical outcomes, including gestational diabetes, c-section deliveries and stillbirths. The offspring of mothers with excessive GWG are also impacted and have higher rates of macrosomia and rapid early infant weight gain, future obesity and development of obesity-related comorbidities.
Unfortunately, the best strategies to prevent excessive GWG are unknown. Recent reviews and meta-analyses of the literature have concluded that dietary and physical activity interventions produce generally only small reductions in GWG. The reviews concurred that more research was needed examining mechanisms linking successful lifestyle interventions to reduced GWG. Interestingly, reviewers tended to diverge in recommendations for improving current treatment outcomes. Suggested strategies included greater emphasis on psychological factors, body image and motivational strategies, dietary, physical activity and weight monitoring strategies, attitudinal and motivational changes through education, cost-effective interventions, and interventions that considered the role of family, community and environmental supports. Thus, there remains a wide host of potential lines of research to pursue to improve lifestyle interventions in pregnancy. The most fruitful avenues for improving treatment remain unclear, but weight control research in nonpregnant populations may prove informative in this regard. In nonpregnant populations, rapid advances over the past 30 years have identified specific approaches that are most effective in altering energy balance in favor of long-term weight control (e.g., dietary, physical activity and behavioral strategies). Findings from this literature might inform treatment strategies for preventing excessive GWG in pregnancy.
The aim of this article is to summarize key components shown to be most effective in weight loss programs for nonpregnant populations and to explore potential applications in preventing excessive GWG in pregnancy. Given the magnitude of the research literature, our article focuses on effective strategies for promoting successful weight loss, defined as 5–10% of initial body weight, in overweight/obese individuals. This magnitude of weight loss has been shown to prevent diabetes and reduce several cardiovascular disease risk factors. However, it is important to note that the variables effective in promoting weight loss are the same key variables that have emerged as critical intervention targets for preventing weight gain and weight regain, as referenced in the sections that follow.