Prevention of Excessive Gestational Weight Gain and Postpartum Weight Retention
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 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.
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.
KeywordsObesity Gestational weight gain Postpartum weight retention Dietary counseling Physical activity Behavior change Pharmacotherapy
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 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.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.
- 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
- 12.http://www.who.int/mediacentre/factsheets/fs311/en. Accessed 4 Apr 2018.
- 13.http://www.who.int/gho/ncd/risk_factors/obesity_text/en. Accessed 4 Apr 2018.
- 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.•• 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.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).
- 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
- 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
- 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
- 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.•• 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
- 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
- 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.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.
- 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
- 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