Current Obesity Reports

, Volume 7, Issue 2, pp 105–111 | Cite as

Prevention of Excessive Gestational Weight Gain and Postpartum Weight Retention

  • Nemencio A. NicodemusJr
Obesity Prevention (A Must, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Obesity Prevention

Abstract

Purpose of Review

The purpose of this review is to summarize the current evidence on the prevention of excessive gestational weight gain (GWG) and reduction of postpartum weight retention (PPWR) by lifestyle intervention and pharmacotherapy.

Recent Findings

Recent findings demonstrate that tailored nutrition counseling and adapting certain eating patterns, supervised exercise programs aiming at achieving at least moderate level of physical activity, and interactive and monitored behavior change interventions are effective in reducing excessive GWG and PPWR. Among the pharmacologic agents, Metformin has been shown to reduce GWG.

Summary

Excessive GWG and PPWR are associated with adverse maternal and neonatal outcomes. Recent evidence shows that weight during gestation and the postpartum period can be significantly reduced by more frequent nutrition counseling sessions on balanced diet focusing on healthier food choices and eating patterns, supervised moderate-intensity exercise for at least 30 min three times a week, and interactive behavior change interventions with regular feedback and follow-up. The benefits on weight are seen when these interventions are utilized together in a multimodality approach. Metformin is effective in preventing excessive GWG but has no impact on neonatal outcomes.

Keywords

Obesity Gestational weight gain Postpartum weight retention Dietary counseling Physical activity Behavior change Pharmacotherapy 

Notes

Compliance with Ethical Standards

Conflict of Interest

Nemencio A. Nicodemus, Jr. declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Rasmussen KM, Yaktine AL. Institute of Medicine (US) and National Research Council (US) committee to reexamine IOM pregnancy weight guidelines. Weight gain during pregnancy: reexamining the guidelines. Washington (DC): National Academies Press (US); 2009.Google Scholar
  2. 2.
    Warrington NM, for the Early Genetic Growth (EGG) Consortium, et al. Maternal and fetal genetic contribution to gestational weight gain. Int J Obes advance online publication, 21 November 2017;  https://doi.org/10.1038/ijo.2017.248.
  3. 3.
    Men Y, et al. The association between obesity-risk genes and gestational weight gain is modified by dietary intake in African American women. J Nutr Metab. 2018;2018:1–7.  https://doi.org/10.1155/2018/5080492.Google Scholar
  4. 4.
    Brunner S, Stecher L, Ziebarth S, Nehring I, Rifas-Shiman SL, Sommer C, et al. Excessive gestational weight gain prior to glucose screening and the risk of gestational diabetes: a meta-analysis. Diabetologia. 2015;58:2229–37.  https://doi.org/10.1007/s00125-015-3686-5.CrossRefPubMedGoogle Scholar
  5. 5.
    Rahman MM, abe SK, Kanda M, et al. Maternal body mass index and risk of birth and maternal health outcomes in low- and middle-income countries: a systematic review and meta-analysis. Obes Rev. 2015;16:758–70.CrossRefPubMedGoogle Scholar
  6. 6.
    Faucher MA, Hastings-Tolsma M, Song JJ, Willoughby DS, Gerding Bader S. Gestational weight gain and preterm birth in obese women: a systematic review and meta-analysis. BJOG. 2016;123:199–206.CrossRefPubMedGoogle Scholar
  7. 7.
    Aune D, Saugstad O, Henriksen T, Tonstad S. Maternal body mass index and the risk of fetal death, stillbirth, and infant death: a systematic review and meta-analysis. JAMA. 2014;311(15):1536–46.CrossRefPubMedGoogle Scholar
  8. 8.
    Lutsiv O, Mah J, Beyen J, McDonald SD. The effects of morbid obesity on maternal and neonatal health outcomes: a systematic review and meta-analyses. Obes Rev. 2015;16:531–46.CrossRefPubMedGoogle Scholar
  9. 9.
    Mamun AA, Mannan M, Doi AR. Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis. Obes Rev. 2014;15:338–47.CrossRefPubMedGoogle Scholar
  10. 10.
    Kapadia MZ, Park CK, Beyene J, Giglia L, Maxwell C, McDonald SD. Weight loss instead of weight gain within the guidelines in obese women during pregnancy: a systematic review and meta-analyses of maternal and infant outcomes. PLoS One. 2015;10(7):e0132650.  https://doi.org/10.1371/journal.pone.0132650.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    The GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.CrossRefGoogle Scholar
  12. 12.
  13. 13.
  14. 14.
    Food and Nutrition Research Institute. Philippine nutrition facts and figures 2013, 8th National Nutrition Survey Anthropometric Survey. Department of Science and Technology July 2015: 53–59Google Scholar
  15. 15.
    •• Abdel-Aziz SB, Hegazy IS, Mohamed DA, et al. Effect of dietary counseling on preventing excessive weight gain during pregnancy. Public Health. 2018;154:172–81. This randomized controlled trial showed that nutritional counselling which focused on having a regular meal pattern based on the five food groups of the food guide pyramid can effectively improve dietary practices of pregnant women to prevent excessive gestational weight gain. CrossRefPubMedGoogle Scholar
  16. 16.
    Thangaratinam S, Rogozonska E, Jolly K, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012;344:e2088.  https://doi.org/10.1136/bmj.e2088 (Published 17 May 2012).
  17. 17.
    Vesco KK, Karanja N, King JC, Gillman MW, Leo MC, Perrin N, et al. Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial. Obesity. 2014;22:1989–96.  https://doi.org/10.1002/oby.20831.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. For the DASH collaborative research group. A clinical trial of the effects of dietary patterns on blood pressure. N Engl J Med. 1997;336:1117–24.CrossRefPubMedGoogle Scholar
  19. 19.
    McCarthy EA, Walker SP, Ugoni A, Lappas M, Leong O, Shub A. Self-weighing and simple dietary advice for overweight and obese pregnant women to reduce obstetric complications without impact on quality of life: a randomised controlled trial. BJOG. 2016;123:965–73.CrossRefPubMedGoogle Scholar
  20. 20.
    Bisson M, Alméras N, Dufresne SS, Robitaille J, Rhéaume C, Bujold E, et al. A 12-week exercise program for pregnant women with obesity to improve physical activity levels: an open randomised preliminary study. PLoS One. 2015;10(9):e0137742.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    •• Wang C, Mei Y, Zhang X, et al. A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women. AJOG. 2017;216(4):340–51. This is a randomized controlled trial on the efficacy of regular exercise started in early pregnancy among overweight and obese women which showed significantly lower incidence of gestational diabetes, lesser GWG, and reduction in insulin resistance. CrossRefGoogle Scholar
  22. 22.
    Ruiz JR, Perales M, Pelaez M, Lopez C, Lucia A, Barakat R. Supervised exercise-based intervention to prevent excessive gestational weight gain: a randomized controlled trial. Mayo Clin Proc. 2013;88(12):1388–97.CrossRefPubMedGoogle Scholar
  23. 23.
    Agha M, Agha RA, Sandell J. Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: a systematic review and meta-analysis. PLoS One. 2014;9(5):e95132.  https://doi.org/10.1371/journal.pone.0095132.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Herring SJ, Cruice JF, Bennett GG, Rose MZ, Davey A, Foster GD. Preventing excessive gestational weight gain among African American women: a randomized clinical trial. Obesity. 2016;24:30–6.  https://doi.org/10.1002/oby.21240.CrossRefPubMedGoogle Scholar
  25. 25.
    Olson CM, Strawderman MS, Graham ML. Association between consistent weight gain tracking and gestational weight gain: secondary analysis of a randomized trial. Obesity (Silver Spring). 2017;25(7):1217–27.CrossRefGoogle Scholar
  26. 26.
    Graham ML, Strawderman MS, Demment M, Olson MC. Does usage of an eHealth intervention reduce the risk of excessive gestational weight gain? Secondary analysis from a randomized controlled trial. J Med Internet Res. 2017;19(1):e6.  https://doi.org/10.2196/jmir.6644.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Brownfoot FC, Davey M-A, Kornman L. Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial. BJOG. 2016;123:254–61.CrossRefPubMedGoogle Scholar
  28. 28.
    Skouteris H, McPhie S, Hill B, McCabe M, Milgrom J, Kent B, et al. Health coaching to prevent excessive gestational weight gain: a randomized-controlled trial. Br J Health Psychol. 2016;21:31–51.CrossRefPubMedGoogle Scholar
  29. 29.
    • Yeo S, Walker JS, Caughey MC, Ferraro AM, Asafu-Adjei JK. What characteristics of nutrition and physical activity interventions are key to effectively reducing weight gain in obese or overweight pregnant women? A systematic review and meta-analysis. Obes Rev. 2017;18(4):385–99.  https://doi.org/10.1111/obr.12511. This is a meta-analysis of 32 randomized trials among overweight and obese pregnant women which showed that nutrition and physical activity counseling was associated with greater reduction in GWG when delivered by pre-natal care providers. CrossRefPubMedGoogle Scholar
  30. 30.
    Rauh, et al. Safety and efficacy of a lifestyle \ intervention for pregnant women to prevent excessive maternalweight gain: a cluster-randomized controlled trial. BMC Pregnancy and Childbirth. 2013;13:151.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Bogaerts AFL, Devlieger R, Nuyts E. Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial. Int J Obes. 2013;37:814–21.CrossRefGoogle Scholar
  32. 32.
    Harrison CL, Lombard CB, Strauss BJ, Teede HJ. Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. Obesity. 2013;21:904–9.  https://doi.org/10.1002/oby.20163.CrossRefPubMedGoogle Scholar
  33. 33.
    •• Koivusalo SB, et al. Gestational diabetes mellitus can be prevented by lifestyle intervention: the Finnish Gestational Diabetes Prevention Study (RADIEL): a randomized controlled trial. Diabetes Care. 2016;39:24–30.  https://doi.org/10.2337/dc15-0511. This is a multicenter randomized control trial among obese pregnant women which showed that individualized counseling on diet, physical activity, and weight control from trained counselors led to lesser GWG and lower incidence of GDM. CrossRefPubMedGoogle Scholar
  34. 34.
    •• Simmons D, et al. Results from a European multicenter randomized trial of physical activity and/or healthy eating to reduce the risk of gestational diabetes mellitus: the DALI Lifestyle Pilot. Diabetes Care. 2015;38:1650–6. This is a multicenter randomized controlled trial done across 10 European centers in nine countries comparing three lifestyle approaches: healthy eating (HE), physical activity (PA), or both (HE+PA) and showed that HE led to lesser gestational weight gain and lower fasting blood glucose compared to PA. CrossRefPubMedGoogle Scholar
  35. 35.
    Vinter CA, Jørgensen JS, Ovesen P, Beck-Nielsen H, Skytthe A, Jensen DM. Metabolic effects of lifestyle intervention in obese pregnant women. Results from the randomized controlled trial ‘Lifestyle in Pregnancy’ (LiP). Diabet Med. 2014;31:1323–30.CrossRefPubMedGoogle Scholar
  36. 36.
    Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. N Engl J Med. 2002;346:393–403.CrossRefPubMedCentralGoogle Scholar
  37. 37.
    Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358:2003–15.CrossRefPubMedGoogle Scholar
  38. 38.
    •• Syngelaki A, et al. Metformin versus placebo in obese pregnant women without diabetes mellitus. N Engl J Med. 2016;374:434–43. This a double-blind, placebo-controlled trial of Metformin use among obese non-diabetic pregnant women which showed that Metformin reduced maternal gestational weight gain and rates of pre-eclampsia but had no effect on neonatal birth weight. CrossRefPubMedGoogle Scholar
  39. 39.
    Malin SK, Kashyap SR. Effects of metformin on weight loss: potential mechanisms. Curr Opin Endocrinol Diabetes Obes. 2014;21:323–9.CrossRefPubMedGoogle Scholar
  40. 40.
    • Lim S, O'Reilly S, Behrens H, Skinner T, Ellis I, Dunbar JA. Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis. Obesity reviews. 2015;16:972–87. This is a meta-analysis of 32 randomized controlled trials which showed that the combination of diet and physical activity, coupled with self-monitoring were effective in producing weight loss during the postpartum period. CrossRefPubMedGoogle Scholar
  41. 41.
    Nascimento SL, Pudwell J, Surita FG, Adamo KB, Smith GN. The effect of physical exercise strategies on weight loss in postpartum women: a systematic review and meta-analysis, Int J Obes. Accepted article preview 19 September 2013;  https://doi.org/10.1038/ijo.2013.183.
  42. 42.
    Vesco KK, et al. One-year postpartum outcomes following a weight management intervention in pregnant women with obesity. Obesity. 2016;24:2042–9.  https://doi.org/10.1002/oby.21597.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Horan MK, McGowan C, Gibney E, Donnelly J, McAuliffe F. Maternal diet and weight at 3 months postpartum following a pregnancy intervention with a low glycaemic index diet: results from the ROLO randomised control trial. Nutrients. 2014;6:2946–55.  https://doi.org/10.3390/nu6072946.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Haire-Joshu, et al. A group randomized controlled trial integrating obesity prevention and control for postpartum adolescents in a home visiting program. Int J Behav Nutr Phys Act. 2015;12:88.  https://doi.org/10.1186/s12966-015-0247-8.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Chang, et al. Results and lessons learned from a prevention of weight gain program for low-income overweight and obese young mothers: Mothers In Motion. BMC Public Health. 2017;17:182.  https://doi.org/10.1186/s12889-017-4109-y.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Nicklas JM, Zera CA, England LJ, Rosner BA, Horton E, Levkoff SE, et al. A web-based lifestyle intervention for women with recent gestational diabetes mellitus: a randomized controlled trial. Obstet Gynecol. 2014;124(3):563–70.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Harrison et al. Limiting postpartum weight retention through early antenatal intervention: the HeLP-her randomised controlled trial. Int J Behav Nutr Phys Act. 2014;11:134.CrossRefGoogle Scholar
  48. 48.
    Wilkinson SA, van der Pligt P, Gibbons KS, McIntyre HD. Trial for Reducing Weight Retention in New Mums: a randomised controlled trial evaluating a low intensity, postpartum weight management program. J Hum Nutr Diet. 2015;28(Suppl. 1):15–28.  https://doi.org/10.1111/jhn.12193.CrossRefPubMedGoogle Scholar
  49. 49.
    Ronnberg A, Hanson U, Ostlund I, Nilsson K. Effects on postpartum weight retention after antenatal lifestyle intervention—a secondary analysis of a randomized controlled trial. Acta Obstet Gynecol Scand. 2016;95:999–1007.  https://doi.org/10.1111/aogs.1291.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Nemencio A. NicodemusJr
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.College of MedicineUniversity of the PhilippinesManilaPhilippines
  2. 2.University of the Philippines-Philippine General HospitalManilaPhilippines
  3. 3.Philippine Association for the Study of Overweight and ObesityPasigPhilippines
  4. 4.Philippine Society of Endocrinology, Diabetes & MetabolismPasigPhilippines
  5. 5.ManilaPhilippines

Personalised recommendations