Study Finds that Limiting Gestational Weight Gain in Overweight and Obese Women Did Not Improve Pregnancy Complications Essay

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LAS VEGAS (Jan. 23, 2017)—In a study to be presented Thursday, Jan. 26, in the oral plenary session at 8 a.m. PST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting™, researchers with Northwestern University in Chicago, Illinois, will present their findings for a study titled,  MOMFIT: A randomized clinical trial of an intervention to prevent excess gestational weight gain in overweight and obese women.

 It is now recognized that excess maternal weight gain during pregnancy is very common in the United States, and is associated with an increased risk of a number of pregnancy complications, especially in women who start pregnancy overweight or obese. These complications include gestational diabetes, maternal hypertension, excessive newborn size and cesarean delivery. Excess maternal weight gain has also been associated with higher rates of obesity in the child later in life. Some previous trials have had success with interventions to help women limit weight gain during pregnancy, but with mixed results as to whether subsequent complications were reduced.

This study performed a randomized trial with an intervention including intensive interaction with a dietician, recommendations for physical activity and internet-based self-monitoring of dietary adherence in overweight and obese women, and compared their outcomes to a similar group of women without this intervention. The intervention was successful in that average weight gain was reduced significantly, but no improvements in pregnancy outcomes were detected.

“While pregnant women should still be counseled against excess weight gain, additional measures may be required to reduce the associated complications,” stated Alan Peaceman, M.D. chief of maternal-fetal medicine in the department of obstetrics and gynecology at Northwestern Medicine in Chicago.  Peaceman will present the findings at the SMFM annual meeting.

Abstract #2     MOMFIT: A randomized clinical trial of an intervention to prevent excess gestational weight gain in overweight and obese women

Alan M. Peaceman, Mary J. Kwasny, Niki Gernhofer, Eileen Vincent, Jami L. Josefson, Linda Van Horn Northwestern University, Chicago, IL

OBJECTIVE: Excess gestational weight gain (GWG), especially in overweight and obese mothers, is associated with adverse pregnancy outcomes, and increased long term risks for the offspring including obesity and childhood diabetes. Previous intervention trials to help control GWG have had mixed results. We tested the effectiveness of a diet and lifestyle behavioral intervention designed to increase the proportion of participants whose GWG did not exceed 2009 IOM guidelines, and determined whether pregnancy outcomes improved.

STUDY DESIGN: Patients with BMI 25-40 were recruited before 16 weeks gestation and randomized to a lifestyle intervention or usual care. Exclusion criteria included multiple gestation, pre-gestational. diabetes, prior bariatric surgery, and IVF. The intervention included an individualized dietitian-prescribed calorie-specific DASH-type diet, physical activity, internet-based self-monitoring of diet adherence, and weekly coaching calls, with opportunities for group visits, webinars, and podcasts. Usual care participants were provided websites, electronic newsletters, and non-diet related pregnancy information. Obstetric providers and data collectors were not aware of patient group assignment.

RESULTS: 281 participants were randomized to the intervention or usual care, with complete data available for all but 2 patients. Baseline characteristics of maternal age, parity, gestational age at randomization, race, ethnicity, and pre-pregnancy BMI were similar. There were 4 pregnancy losses after randomization but before 24 weeks (data not included), and 1 fetal death after 24 weeks. The intervention group gained significantly less weight from enrollment to 36 weeks than the usual care group, and fewer participants exceeded the IOM recommendations (table). This did not result in fewer diagnoses of gestational diabetes, preeclampsia or gestational hypertension, or birth weight >4 kg; a higher rate of cesarean birth was observed in the intervention group.

CONCLUSION: The MOMFIT behaviorally adapted, nutrient-dense, energy-balanced diet and lifestyle intervention resulted in better adherence to IOM guidelines for gestational weight gain, but improvements in pregnancy outcomes were not observed.

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