Limiting postpartum weight retention through early antenatal intervention: the HeLP-her randomised controlled trial

International Journal of Behavioral Nutrition and Physical Activity

Helena J Teede²  Catherine B Lombard¹  Cheryce L Harrison¹ 

[1] Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia;Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia

关键词: Gestational diabetes;    Self-management;    Lifestyle intervention;    Pregnancy;    Gestational weight gain;    Postpartum weight retention;   

Others  :  1136134
DOI  :  10.1186/s12966-014-0134-8

 received in 2014-03-26, accepted in 2014-10-15,  发布年份 2014

【 摘 要 】

Background

Pregnancy is a recognised high risk period for excessive weight gain, contributing to postpartum weight retention and obesity development long-term. We aimed to reduce postpartum weight retention following a low-intensity, self-management intervention integrated with routine antenatal care during pregnancy.

Methods

228 women at increased risk of gestational diabetes, <15 weeks gestation were randomised to intervention (4 self-management sessions) or control (generic health information). Outcomes, collected at baseline and 6 weeks postpartum, included anthropometrics (weight and height), physical activity (pedometer) and questionnaires (health behaviours).

Results

Mean age (32.3 ± 4.7 and 31.7 ± 4.4 years) and body mass index (30.4 ± 5.6 and 30.3 ± 5.9 kg/m²) were similar between intervention and control groups, respectively at baseline. By 6 weeks postpartum, weight change in the control group was significantly higher than the intervention group with a between group difference of 1.45 ± 5.1 kg (95% CI: −2.86,-0.02; p < 0.05) overall, with a greater difference in weight found in overweight, but not obese women. Intervention group allocation, higher baseline BMI, GDM diagnosis, country of birth and higher age were all independent predictors of lower weight retention at 6 weeks postpartum on multivariable linear regression. Other factors related to weight including physical activity, did not differ between groups.

Conclusions

A low intensity intervention, integrated with standard antenatal care is effective in limiting postpartum weight retention. Implementation research is now required for scale-up to optimise antenatal health care.

Trial registration

Australian New Zealand Clinical Trial Registry Number: ACTRN12608000233325 webcite. Registered 7/5/2008.

【 授权许可】

   
2014 Harrison et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Cameron AJ, Welborn TA, Zimmet PZ, Dunstan DW, Owen N, Salmon J, Dalton M, Jolley D, Shaw JE: Overweight and obesity in Australia: the 1999–2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). MJA 2003, 178(9):427-432.
• [2]Rennie KL, Jebb SA: Prevalence of obesity in Great Britian. Obes Rev 2005, 6(1):11-12.
• [3]Flegal KMCM, Ogden CL, Curtin LR: Prevalence and trends in obesity among us adults, 1999–2008. JAMA 2010, 303(3):235-241.
• [4]Kopelman PG: Obesity as a medical problem. Nature 2000, 404(6778):635-643.
• [5]Adamson L, Brown W, Byles J, Chojenta C, Dobson A, Fitzgerald D, Hockey R, Loxton D, Powers J, Spallek M, Waters B, Watson M: Women’s Weight: Findings from the Australian Longitudinal Study on Women’s Health.Aus Govt Dept of Health Ageing 2007.
• [6]Weight Gain during Pregnancy: Re-examining the Guidelines. National Academies Press, Washington, DC; 2009.
• [7]Teede HJ, Harrison CL, Teh WT, Paul E, Allan CA: Gestational Diabetes: development of an early risk prediction tool to facilitate opportunities for prevention. Aust N Z J Obstet Gynaecol 2011, 51(6):499-504.
• [8]Park S, Sappenfield W, Bish C, Salihu H, Goodman D, Bensyl D: Assessment of the Institute of Medicine Recommendations for Weight Gain During Pregnancy: Florida, 2004–2007. Matern Child Healt J 2011, 15(3):289-301.
• [9]Geulinckx I, Devlieger R, Beckers K, Vansant G: Maternal Obesity: pregnancy complications, gestational weight gain and nutrition. Obes Rev 2008, 9:140-150.
• [10]Amorim AR, Rossner S, Neovius M, Lourenco PM, Linne Y: Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI? Obesity 2007, 15(5):1278-1286.
• [11]Gore S, Brown DM, West DS: The role of postpartum weight retention in obesity among women: A review of the evidence. Ann Behav Med 2003, 26(2):149-159.
• [12]van der Pligt P, Wilcox J, Hesketh KD, Ball K, Wilkinson S, Crawford D, Campbell K: Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent materna overweight and obesity following childbirth. Obes Rev 2013, 14(10):792-805.
• [13]Muktabhant B, Lumbiganon P, Ngamjarus C, Dowswell T: Interventions for preventing excessive weight gain during pregnancy. Cochrane Database Syst Rev 2012, 4:CD007145.
• [14]Phelan S: Pregnancy: a “teachable moment” for weight control and obesity prevention. Am J Obstet Gynecol 2010, 202(2):135. e131-135.e138
• [15]Oteng-Ntim E, Varma R, Croker H, Poston L, Doyle P: Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis. BMC Med 2012, 10(1):47. BioMed Central Full Text
• [16]Dodd JM, Turnbull D, McPhee AJ, Deussen AR, Grivell RM, Yelland LN, Crowther CA, Wittert G, Owens JA, Robinson JS: Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ 2014, 348:g1285.
• [17]Harrison C, 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(5):904.
• [18][http://www.wpro.who.int/nutrition/documents/Redefining_obesity/en/] webcite WHO/IASO/IOTF: The Asia-Pacific perspective: re-defining obesity and its treatment. Melbourne: Health Communications Australia; 2000. Avaiable from: .
• [19][[https://www.nhmrc.gov.au/guidelines/publications/n55]] webcite Dietary Guidelines For Australian Adults
• [20]Lombard C, Deeks A, Jolley D, Ball K, Teede H: A low intensity, community based lifestyle programme to prevent weight gain in women with young children: cluster randomised controlled trial. BMJ 2010, 341:c3215.
• [21]Institute of Medicine and National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines: Weight Gain during Pregnancy: Reexamining the Guidelines. National Academic Press, Washington DC; 2009.
• [22]Engstrom JL, Paterson SA, Doherty A, Trabulsi M, Speer KL: Accuracy of Self-Reported Height and Weight in Women: An Integrative Review of the Literature. J Midwifery Wom Health 2003, 48(5):338-345.
• [23]Harrison CL, Thompson RG, Teede HJ, Lombard CB: Measuring physical activity during pregnancy. Int J Behav Nutr Phys Act 2011, 8(19):114-130.
• [24]Tudor-Locke C, Burkett L, Reis JP, Ainsworth BE, Macera CA, Wilson DK: How many days of pedometer monitoring predict weekly physical activity in adults? Prev Med 2005, 40(3):293-298.
• [25]Hoffmann L, Nolan C, Wilson JD, Oats JJN, Simmons D: Gestational Diabetes Mellitus: Management Guidelines. MJA 1998, 169:93-97.
• [26]Althuizen E, van Poppel MNM, Seidell JC, van der Wijden C, van Mechelen W: Design of the New Life(style) study: a randomised controlled trial to optimise maternal weight development during pregnancy. [ISRCTN85313483]. BMC Public Health 2006, 6:168. BioMed Central Full Text
• [27][http://www.abs.gov.au/ausstats/abs@.nsf/mf/2039.0/] webcite Australian Bureau of Statistics, ABS: Information Paper: Introduction to Socio-Economic Indexes for Areas (SEIFA) 2006. Canberra: 2008. Available from: .
• [28]Schmitt N, Nicholson WK, Schmitt J: The association of pregnancy and the development of obesity - results of a systematic review and meta-analysis on the natural history of postpartum weight retention. Int J Obes (Lond) 2007, 31(11):1642-1651.
• [29][[http://www.alswh.org.au/publications-and-reports/major-reports]] webcite Women’s Weight: Findings From the Australian Longitudinal Study on Women’s Health
• [30]Fraser A, Tilling K, Macdonald-Wallis C, Hughes R, Sattar N, Nelson S, Lawlor DA: Associations of Gestational Weight Gain with Maternal Body Mass Index, Waist Circumference, and Blood Pressure Measured 16 Years after Pregnancy: The Avon Longitudinal Study of Parents and Children. Obstet Gynecol Surv 2011, 66(10):599-610.
• [31]Willett WC, Manson JE, Stampfer MJ, Colditz GA, Rosner B, Speizer FE, Hennekens CH: Weight, weight change, and coronary heart disease in women. Risk within the ‘normal’ weight range. JAMA 1995, 273(6):461-465.
• [32]Colditz GA, Willett WC, Stampfer MJ, Manson JE, Hennekens CH, Arky RA, Speizer FE: Weight as a risk factor for clinical diabetes in women. Am J Epidemiol 1990, 132(3):501-513.
• [33]Teh WT, Teede HJ, Paul E, Harrison CL, Wallace EM, Allan C: Risk factors for gestational diabetes mellitus: Implications for the application of screening guidelines. Aust N Z J Obstet Gynaecol 2011, 51(1):26-30.
• [34]Polley B, Wing RR, Sims CJ: Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obes (Lond) 2002, 26:1494-1502.
• [35]Gray-Donald K, Robinson E, Collier A, David K, Renaud L, Rodrigues S: Intervening to reduce weight gain in pregnancy and gestational diabetes mellitus in Cree communities: an evaluation. Can Med Assoc J 2000, 163(10):1247-1251.
• [36]Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR: Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study. Am J Clin Nutr 2011, 93(4):772-779.
• [37]Kac G, Benício M, Velásquez-Meléndez G, Valente JG, Struchiner CJ: Gestational Weight Gain and Prepregnancy Weight Influence Postpartum Weight Retention in a Cohort of Brazilian Women. J Nutr 2004, 134(3):661-666.
• [38]Wolff S, Legarth J, Vangsgaard K, Toubro S, Astrup A: A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes 2008, 32(3):495-501.
• [39]Dodd JM, Grivell RM, Crowther CA, Robinson JS: Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials. BJOG 2010, 117(11):1316-1326.
• [40]Harrison C, Lombard CB, Teede HJ: Understanding health behaviours in a cohort of pregnant women at risk of gestational diabetes mellitus: an observational study. BJOG 2012, 119(6):731-738.
• [41]Bandyopadhyay M, Small R, Davey M-A, Oats JJN, Forster DA, Aylward A: Lived experience of gestational diabetes mellitus among immigrant South Asian women in Australia. Aust New Zeal J Obstet Gynaecol 2011, 51(4):360-364.