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Gestational Weight Gain and its Impact on Pregnant Women

Is weight control possible in pregnant women?

Gestational weight gain (GWG) is a key metric to consider when discussing obesity before, during and after pregnancy. Less GWG is connected with better maternal outcomes while increased GWG is connected with improvement in some infant health outcomes such as full-term birth and infant mortality. Implementation of the more rigorous criteria and earlier screening from the International Association of Diabetes and Pregnancy Study Groups (IADPSG) and WHO will provide a better prevalence of gestational diabetes mellitus (GDM). Goals of a successful pregnancy weight gain should be recognized by women planning to get pregnant on the basis of their pre-pregnancy BMI. GWG increases maternal stores rather than birth weight in obese women. In gestational obesity, the maternal health risks include backaches, leg pain, increased fatigue, gestational diabetes, pre-eclampsia, thromboembolism, slow labor process, high caesarean section, postpartum hemorrhage, maternal death and hypertension. Fetal risks connected with maternal obesity during pregnancy include miscarriage, congenital anomaly, macrosomia, shoulder dystocia, stillbirth and neonatal death. Other difficulties include low breastfeeding rates, caesarean wound infection and postpartum weight retention. A previous study found that obese women who took part in a dietary and lifestyle intervention gained 2.2 fewer kg than control women.

The purpose of this study is to find out if gestational weight control is possible, and its effect on the mother and the baby. It is a two-phase trial with phase 1 involving interviewing pregnant women (n=25) and postpartum (n=8). Phase 1 findings were integrated into phase 2 to help tailor results to unique circumstances of pregnancy and postpartum of African-American women. Recruited participants underwent a lifestyle intervention program, and inclusion criteria were being ≤ 18 weeks of gestation, African-American and a pre pregnancy BMI between 25.0 to 40.0 kg /m2. The women attended the same prenatal care clinics and also delivered in the same hospital. Telephone-based counseling, in-person counseling with routine obstetric visit, home-delivered interventions, group-based sessions and print or Internet delivered interventions are all conducted as a lifestyle intervention. Counseling continued through 36 weeks of gestation; they also received a home visit of 6-8 weeks postpartum. A registered dietician delivered all intervention materials. Frequent self-monitoring of physical activity, diet and weight was strongly encouraged. Physical activity level was based on sense wear; basic exercise information and recommendations for pregnant women were also provided. Interventional goals included moderate intensity physical activity, healthy eating of fruits, vegetables, whole grains, low saturated and trans fats. Interventions were measured at baseline ≤ 18 weeks, 32 weeks and 12 weeks postpartum with gestational weight gain being the primary outcome. A two-sided Fisher’s exact tests and paired t-tests were the statistical analyses used.

Recruited subjects into the interventional behavioral program were at 13.2± 2.5 weeks of gestation. 25.6±4.2 years with a mean prepregnancy BMI of 28.6± 3.5kg/m2. 56% attended college, 81.3% were not married and 56.3% were employed during pregnancy. Study participants gained less total weight on average and were less likely to exceed GWG recommendations. Participants had smaller weekly rate of weight gain in the 2nd and 3rd trimesters. Study participants at 12 weeks retained 2.6 Ibs from pregnancy weight. Of the study participants, half of them had their prepregnancy weight or lower and 35% of participants retained at least 5 Ibs postpartum weight. Adverse maternal and birth outcomes were similar for study participants and contemporary controls. No significant differences were found in infant’s birth weight, gestational ages, fetal growth, Apgar scores, C-section delivery, NICU admission and diagnosis of gestational diabetes. Offspring born to study participants had longer birth length than contemporary controls (P=0.0006). Weight retention at 32 weeks gestation was 94% and at 12 weeks postpartum had 88% of their weight still being retained.

In conclusion, these findings suggest we were able to decrease the degree of excessive gestational weight gain. For postpartum weight retention, half of the participants were able to return to pregnancy weight or lower and the mean net weight was 2.6 Ibs at 12 weeks. The weakness of this study is that it has a small sample size and used the contemporary controls as comparison group.

Practice Pearls:

  • Less GWG is connected with better maternal outcomes while increased GWG is connected with improvement in some infant health outcomes such as full-term birth and infant mortality.
  • Fetal risks connected with maternal obesity during pregnancy include miscarriage, congenital anomaly, macrosomia, shoulder dystocia, stillbirth and neonatal death.
  • We were able to decrease the degree of excessive gestational weight gain. For postpartum weight retention, half of the participants were able to return to pregnancy weight or lower and the mean net weight was 2.6 Ibs at 12 weeks.

 

Agha, Maliha, Riaz A. Agha, and Jane Sandell. “Interventions to Reduce and Prevent Obesity in Pre-Conceptual and Pregnant Women: A Systematic Review and Meta-Analysis.” Ed. Cheryl S. Rosenfeld. PLoS ONE 9.5 (2014): e95132. PMC. Web. 23 June 2016.

Liu, Jihong et al. “Preventing Excessive Weight Gain during Pregnancy and Promoting Postpartum Weight Loss: A Pilot Lifestyle Intervention for Overweight and Obese African American Women.” Maternal and child health journal 19.4 (2015): 840–849. PMC. Web. 23 June 2016.

Jurgen Harreiter et al. “IADPSG and WHO 213 Gestational Diabetes Mellitus Criteria Identify Obese Women With Marked Insulin Resistance in Early Pregnancy”. Diabetes Care 2016; 39:e90-e92. Web 23 June 2016.