Subscribe to RSS
Download PDF
DOI: 10.1055/a-2558-2169
Reduction of Neonatal Macrosomia Rate of Infants Born to Overweight and Obese Women through Nutrition Counseling in Pregnancy – A One-arm Interventional Study
Article in several languages: English | deutschSupported by: Ministerium für Wirtschaft, Arbeit und Gesundheit Mecklenburg-Vorpommern
Abstract
Introduction
Because of fetal programming, neonatal macrosomia is associated with a higher long-term risk of metabolic disease. In 2020, the overall macrosomia rate of term-born singletons born to overweight or obese mothers in our center was approximately 30%. The aim of our study was to reduce the macrosomia rate with pregnancy-related nutrition counseling.
Methods
This is a single center, one-arm, interventional pilot study of 99 singleton pregnancies. The intervention took the form of three individual and group education sessions on pregnancy-relevant nutritional topics and exercise in the 10th to 14th, 20th to 24th and 30th to 34th weeks of gestation. The primary endpoint was the overall macrosomia rate born to overweight/obese mothers and birth ≥ 37 weeks of gestation. Macrosomia was defined as the presence of at least one of the following criteria: birth weight ≥ 4000 g, birth weight > 90th percentile, length-related birth weight > 90th percentile, birth weight > 90th percentile after adjustment for initial maternal weight and height. The results were compared with those of a non-interventional cohort from the same center.
Results
Ninety-one percent of pregnant women with a pre-pregnancy BMI ≥ 25 kg/m2 had a delivery at term (n = 77/85). The overall macrosomia rate of these children was 19.5% (95% CI: 11.3% to 30.1%, n = 15/77) and therefore lower than the expected BMI-corrected macrosomia rate of the comparison group of 31.3% (p = 0.026). In the total cohort, which included normal-weight women, a trend toward normalization of birth weights was observed (p = 0.083).
Conclusion
Professional nutrition counseling during pregnancy can reduce the neonatal macrosomia rate of infants born to women with a BMI ≥ 25 kg/m2. Relevant provision of counseling services in the context of antenatal care would be useful for affected women.
Publication History
Received: 12 August 2024
Accepted after revision: 09 March 2025
Article published online:
12 June 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References/Literatur
- 1 Plagemann A, Dudenhausen JW. Adipositas als Risiko in der Perinatalmedizin. München: Springer; 2010
- 2 OECD. Health at a Glance 2023: OECD Indicators. Paris: OECD Publishing; 2023.
- 3 IQTIG – Institut für Qualitätssicherung und Transparenz im Gesundheitswesen. Bundesauswertung Perinatalmedizin: Geburtshilfe EJ 2022. Accessed April 04, 2024 at: https://iqtig.org/veroeffentlichungen/bundesauswertung/DeQS_PM-GEBH_2022_BUAW_Bund_2023-07-20.pdf
- 4 IQTIG – Institut für Qualitätssicherung und Transparenz im Gesundheitswesen. Bundesauswertung Perinatalmedizin: Geburtshilfe EJ 2020. Accessed December 15, 2021 at: https://iqtig.org/downloads/auswertung/2020/16n1gebh/QSKH_16n1-GEBH_2020_BUAW_V01_2021-08-10.pdf
- 5 aQua – Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen. Bundesauswertung zum Erfassungsjahr 2014, 16/1 Geburtshilfe. Accessed October 22, 2017 at: https://web.archive.org/web/20220331014542/https:/sqg.de/downloads/Bundesauswertungen/2014/bu_Gesamt_16N1-GEBH_2014.pdf
- 6 Starling AP, Brinton JT, Glueck DH. et al. Associations of maternal BMI and gestational weight gain with neonatal adiposity in the Healthy Start study. Am J Clin Nutr 2015; 101: 302-309
- 7 Körber S, Bolz M, Gerber B. Gestationsdiabetes mellitus (GDM) – Aktuelle regionale Daten für ein überregionales Problem. Ärztbl Mecklenburg-Vorpommern 2017; 27: 15-19
- 8 Stubert J, Reister F, Hartmann S. et al. The Risks Associated With Obesity in Pregnancy. Dtsch Arztebl Int 2018; 115: 276-283
- 9 Schaefer-Graf U, Ensenauer R, Gembruch U. et al. Obesity and Pregnancy. Guideline of the German Society of Gynecology and Obstetrics (S3-Level, AWMF Registry No. 015–081, June 2019). Geburtshilfe Frauenheilkd 2021; 81: 279-303
- 10 Yogev, Chen, Hod. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. et al. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: preeclampsia. Am J Obstet Gynecol 2010; 202: 255.e1-255.e7
- 11 Sparano S, Ahrens W, De Henauw S. et al. Being macrosomic at birth is an independent predictor of overweight in children: results from the IDEFICS study. Matern Child Health J 2013; 17: 1373-1381
- 12 Plagemann A. Toward a unifying Concept on ‘perinatal Programming’: Vegetative Imprinting by environmentdependent biocybernetogenesis. In: Plagemann A. , ed. Perinatal Programming – The State of the Art. Boston: De Gruyter; 2010: 243-282
- 13 Shrestha N, Ezechukwu HC, Holland OJ. et al. Developmental programming of peripheral diseases in offspring exposed to maternal obesity during pregnancy. Am J Physiol Regul Integr Comp Physiol 2020; 319: R507-R516
- 14 Pirkola J, Pouta A, Bloigu A. et al. Risks of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus. Diabetes Care 2010; 33: 1115-1121
- 15 Tie HT, Xia YY, Zeng YS. et al. Risk of childhood overweight or obesity associated with excessive weight gain during pregnancy: a meta-analysis. Arch Gynecol Obstet 2014; 289: 247-257
- 16 Perng W, Gillman MW, Mantzoros CS. et al. A prospective study of maternal prenatal weight and offspring cardiometabolic health in midchildhood. Ann Epidemiol 2014; 24: 793-800.e1
- 17 Guo L, Liu J, Ye R. et al. Gestational Weight Gain and Overweight in Children Aged 3–6 Years. J Epidemiol 2015; 25: 536-543
- 18 Barker DJ, Osmond C, Golding J. et al. Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ 1989; 298: 564-567
- 19 Stupin JH, Arabin B. Overweight and Obesity before, during and after Pregnancy: Part 1: Pathophysiology, Molecular Biology and Epigenetic Consequences. Geburtshilfe Frauenheilkd 2014; 74: 639-645
- 20 Duewel AM, Doehmen J, Dittkrist L. et al. Antenatal risk score for prediction of shoulder dystocia with focus on fetal ultrasound data. Am J Obstet Gynecol 2022; 227: 753.e1-753.e8
- 21 Schäfer-Graf U, Laubner K, Hummel S. et al. S3 Leitlinie Gestationsdiabetes mellitus (GDM), Diagnostik, Therapie und Nachsorge, 2. Aufl. AWMF-Registernummer 057–008. 2018 Accessed February 01, 2022 at: https://register.awmf.org/assets/guidelines/057-008l_S3_Gestationsdiabetes-mellitus-GDM-Diagnostik-Therapie-Nachsorge_2019-06-abgelaufen.pdf
- 22 Kiserud T, Piaggio G, Carroli G. et al. The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight. PLoS Med 2017; 14: e1002220
- 23 Voigt M, Fusch C, Olbertz D. et al. Analyse des Neugeborenenkollektivs der Bundesrepublik Deutschland. Geburtshilfe Frauenheilkd 2006; 66: 956-970
- 24 Szwajcer E, Hiddink GJ, Maas L. et al. Nutrition awareness before and throughout different trimesters in pregnancy: a quantitative study among Dutch women. Fam Pract 2012; 29 (Suppl. 1) i82-i88
- 25 Rasmussen KM, Yaktine AL. , ed. Weight Gain during Pregnancy: Reexamining the Guidelines. Washington (DC): National Academies Press; 2009.
- 26 Metzger BE, Gabbe SG, Persson B. et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-682
- 27 Grobeisen-Duque O, Villavicencio-Carrisoza O, Mora-Vargas CD. et al. Impact of Pre-Gestational BMI and Gestational Weight Gain on Fetal Development Outcomes in Adolescent Pregnant Women. J Clin Med 2024; 13: 1839
- 28 Leddy MA, Power ML, Schulkin J. The impact of maternal obesity on maternal and fetal health. Rev Obstet Gynecol 2008; 1: 170-178
- 29 Ovesen P, Rasmussen S, Kesmodel U. Effect of prepregnancy maternal overweight and obesity on pregnancy outcome. Obstet Gynecol 2011; 118: 305-312
- 30 Corrales P, Vidal-Puig A, Medina-Gomez G. Obesity and pregnancy, the perfect metabolic storm. Eur J Clin Nutr 2021; 75: 1723-1734
- 31 Gomes D, von Kries R, Delius M. et al. Late-pregnancy dysglycemia in obese pregnancies after negative testing for gestational diabetes and risk of future childhood overweight: An interim analysis from a longitudinal mother-child cohort study. PLoS Med 2018; 15: e1002681
- 32 Brüll V, Hucklenbruch-Rother E, Ensenauer R. Programmierung von kindlichem Übergewicht durch perinatale Überflusssituation. Monatsschr Kinderheilkd 2016; 2: 99-105
- 33 Desoye G, Nolan CJ. The fetal glucose steal: an underappreciated phenomenon in diabetic pregnancy. Diabetologia 2016; 59: 1089-1094
- 34 Poston L, Bell R, Croker H. et al. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2015; 3: 767-777
- 35 Dodd JM, Deussen AR, Mohamad I. et al. The effect of antenatal lifestyle advice for women who are overweight or obese on secondary measures of neonatal body composition: the LIMIT randomised trial. BJOG 2016; 123: 244-253
- 36 Kunath J, Gunther J, Rauh K. et al. Effects of a lifestyle intervention during pregnancy to prevent excessive gestational weight gain in routine care – the cluster-randomised GeliS trial. BMC Med 2019; 17: 5
- 37 International Weight Management in Pregnancy (i-WIP) Collaborative Group. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomised trials. BMJ 2017; 358: j3119
- 38 Baroni NF, Baldoni NR, Alves GCS. et al. Do Lifestyle Interventions in Pregnant Women with Overweight or Obesity Have an Effect on Neonatal Adiposity? A Systematic Review with Meta-Analysis. Nutrients 2021; 13: 1903
- 39 Raab R, Michel S, Günther J. et al. Associations between lifestyle interventions during pregnancy and childhood weight and growth: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2021; 18: 8
- 40 Louise J, Poprzeczny AJ, Deussen AR. et al. The effects of dietary and lifestyle interventions among pregnant women with overweight or obesity on early childhood outcomes: an individual participant data meta-analysis from randomised trials. BMC Med 2021; 19: 128
- 41 Dodd JM, Deussen AR, Pena AS. et al. Effects of an antenatal dietary intervention in women with obesity or overweight on child outcomes at 8–10 years of age: LIMIT randomised trial follow-up. BMC Pediatr 2023; 23: 643
- 42 Hanson M, Barker M, Dodd JM. et al. Interventions to prevent maternal obesity before conception, during pregnancy, and post partum. Lancet Diabetes Endocrinol 2017; 5: 65-76
- 43 Louise J, Deussen AR, Dodd JM. Gestational Weight Gain-Re-Examining the Current Paradigm. Nutrients 2020; 12: 2314
- 44 Garnaes KK, Morkved S, Salvesen O. et al. Exercise Training and Weight Gain in Obese Pregnant Women: A Randomized Controlled Trial (ETIP Trial). PLoS Med 2016; 13: e1002079
- 45 Gunther J, Hoffmann J, Kunath J. et al. Effects of a Lifestyle Intervention in Routine Care on Prenatal Dietary Behavior-Findings from the Cluster-Randomized GeliS Trial. J Clin Med 2019; 8: 960
- 46 Gunther J, Hoffmann J, Spies M. et al. Associations between the Prenatal Diet and Neonatal Outcomes-A Secondary Analysis of the Cluster-Randomised GeliS Trial. Nutrients 2019; 11: 1889
- 47 Hoffmann J, Gunther J, Geyer K. et al. Associations between Prenatal Physical Activity and Neonatal and Obstetric Outcomes-A Secondary Analysis of the Cluster-Randomized GeliS Trial. J Clin Med 2019; 8: 1735