Download PDF
Semin Reprod Med 2016; 34(02): e14-e21
DOI: 10.1055/s-0036-1583531
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Excess Gestational Weight Gain in Pregnancy and the Role of Lifestyle Intervention

Rebecca Goldstein
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
2   Diabetes and Endocrinology Units, Monash Health, Monash Medical Centre, Clayton, Victoria, Australia
,
Helena Teede
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
2   Diabetes and Endocrinology Units, Monash Health, Monash Medical Centre, Clayton, Victoria, Australia
,
Shakila Thangaratinam
3   Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
,
Jacqueline Boyle
1   Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
4   Obstetrics and Gynaecology Unit, Monash Health, Clayton, Victoria, Australia
› Author Affiliations
Further Information

Publication History

Publication Date:
24 May 2016 (online)

   Permissions and Reprints

Abstract

With increasingly adverse lifestyles, young women in many countries have rapid weight gain and rising obesity. In keeping with this, most pregnant women exceed recommended gestational weight gain (GWG) and then retain weight postpartum. The consequences of excess GWG include maternal risks during pregnancy, neonatal risks and maternal obesity and chronic disease longer term, presenting a significant public health and economic burden worldwide. This article discusses the adverse maternal and infant risks with excess GWG apparent from observational studies, summarizes the existing guidelines for optimal GWG and highlights the need for further research to identify optimal GWG recommendations across the different ethnicities and weight ranges.

We also review the evidence for lifestyle interventions in pregnancy to prevent excess GWG and highlighting the work underway to integrate large scale meta-analyses of individual patient data from lifestyle intervention studies to inform clinical practice beyond current observational data. Finally, we address the need to implement lifestyle interventions into routine pregnancy care to improve short and long term maternal health outcomes.

Keywords

gestational weight gain (GWG) - outcomes - intervention - body mass index (BMI)
 

  • References

  • 1 Apovian CM, Aronne LJ, Bessesen DH , et al; Endocrine Society. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015; 100 (2) 342-362
    Google Scholar
  • 2 Wadden TA, Butryn ML, Wilson C. Lifestyle modification for the management of obesity. Gastroenterology 2007; 132 (6) 2226-2238
    Google Scholar
  • 3 Hill JO. Understanding and addressing the epidemic of obesity: an energy balance perspective. Endocr Rev 2006; 27 (7) 750-761
    CrossrefPubMedGoogle Scholar
  • 4 Lombard CB, Deeks AA, Teede HJ. A systematic review of interventions aimed at the prevention of weight gain in adults. Public Health Nutr 2009; 12 (11) 2236-2246
    CrossrefPubMedGoogle Scholar
  • 5 World Health Organisation 2013–2020 action plan for the global strategy for the prevention and control of noncommunicable diseases: prevent and control cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Geneva: WHO; 2014
    Google Scholar
  • 6 Teede H, Harrison C, Lombard C, Boyle J, East C, Brown W. Case for Action proposal: Obesity prevention through preventing excess weight gain during pregnancy and postpartum. National Health and Medical Research Council; 2015: 20 wwwnhmrcgovau/research/research-translation/research-translation-faculty/ . Accessed May 10, 2016
    Google Scholar
  • 7 Colditz GA, Willett WC, Stampfer MJ , et al. Weight as a risk factor for clinical diabetes in women. Am J Epidemiol 1990; 132 (3) 501-513
    CrossrefPubMedGoogle Scholar
  • 8 Willett WC, Manson JE, Stampfer MJ , et al. Weight, weight change, and coronary heart disease in women. Risk within the ‘normal’ weight range. JAMA 1995; 273 (6) 461-465
    CrossrefPubMedGoogle Scholar
  • 9 Winett RA, Tate DF, Anderson ES, Wojcik JR, Winett SG. Long-term weight gain prevention: a theoretically based Internet approach. Prev Med 2005; 41 (2) 629-641
    CrossrefPubMedGoogle Scholar
  • 10 Harrison CL, Lombard CB, Strauss BJ, Teede HJ. Optimizing healthy gestational weight gain in women at high risk of gestational diabetes: a randomized controlled trial. Obesity (Silver Spring) 2013; 21 (5) 904-909
    CrossrefPubMedGoogle Scholar
  • 11 Chu SY, Callaghan WM, Bish CL, D'Angelo D. Gestational weight gain by body mass index among US women delivering live births, 2004-2005: fueling future obesity. Am J Obstet Gynecol 2009; 200 (3) 271.e1-271.e7
    CrossrefPubMedGoogle Scholar
  • 12 Fraser A, Tilling K, Macdonald-Wallis C , et al. 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: 599-600
    CrossrefPubMedGoogle Scholar
  • 13 Rasmussen K, Yaktine AL , Eds. Institute of Medicine and National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight Gain During Pregnancy: Reexamining the Guidelines. Washington DC: National Academic Press; 2009
    Google Scholar
  • 14 Amorim AR, Rössner S, Neovius M, Lourenço PM, Linné Y. Does excess pregnancy weight gain constitute a major risk for increasing long-term BMI?. Obesity (Silver Spring) 2007; 15 (5) 1278-1286
    CrossrefPubMedGoogle Scholar
  • 15 World Health Organisation. 2008–2013 action plan for the global strategy for the prevention and control of noncommunicable diseases: prevent and control cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. Geneva: WHO; 2008
    Google Scholar
  • 16 Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol 2007; 110 (4) 759-764
    CrossrefPubMedGoogle Scholar
  • 17 Black MH, Sacks DA, Xiang AH, Lawrence JM. The relative contribution of prepregnancy overweight and obesity, gestational weight gain, and IADPSG-defined gestational diabetes mellitus to fetal overgrowth. Diabetes Care 2013; 36 (1) 56-62
    CrossrefPubMedGoogle Scholar
  • 18 Institute of Medicine/National Research Council. Committee to Reexamine IOM Pregnancy Weight Guidelines, Food and Nutrition Board and Board on Children, Youth, and Families. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press; 2009
    Google Scholar
  • 19 Dodd J, Thangaratinam S ; i–WIP collaborative network. Researchers' position statement on tackling obesity in pregnancy: the International Weight Management in Pregnancy (i-WIP) collaboration pleads for public health intervention. BJOG 2016; 123 (2) 163-164
    CrossrefPubMedGoogle Scholar
  • 20 Skouteris H, Huang T, Millar L , et al. A systems approach to reducing maternal obesity: The Health in Preconception, Pregnancy and Postbirth (HIPPP) Collaborative. Aust N Z J Obstet Gynaecol 2015; 55 (4) 397-400
    CrossrefPubMedGoogle Scholar
  • 21 Thangaratinam S, Rogozińska 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-e2093
    CrossrefPubMedGoogle Scholar
  • 22 Muktabhant B, Lumbiganon P, Ngamjarus C, Dowswell T. Interventions for preventing excessive weight gain during pregnancy. Cochrane Database Syst Rev 2012; 4: CD007145
    PubMedGoogle Scholar
  • 23 Hill B, Skouteris H, Fuller-Tyszkiewicz M. Interventions designed to limit gestational weight gain: a systematic review of theory and meta-analysis of intervention components. Obes Rev 2013; 14 (6) 435-450
    CrossrefPubMedGoogle Scholar
  • 24 van der Pligt P, Willcox J, Hesketh KD , et al. Systematic review of lifestyle interventions to limit postpartum weight retention: implications for future opportunities to prevent maternal overweight and obesity following childbirth. Obes Rev 2013; 14 (10) 792-805
    CrossrefPubMedGoogle Scholar
  • 25 Biro MA, Cant R, Hall H, Bailey C, Sinni S, East C. How effectively do midwives manage the care of obese pregnant women? A cross-sectional survey of Australian midwives. Women Birth 2013; 26 (2) 119-124
    CrossrefPubMedGoogle Scholar
  • 26 Stewart ZA, Wallace E, Allan C. Weight gain in pregnancy: a survey of current practices in a teaching hospital. Aust N Z J Obstet Gynaecol 2012; 52 (2) 208-210
    CrossrefPubMedGoogle Scholar
  • 27 Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR. Practitioner advice and gestational weight gain. J Womens Health (Larchmt) 2011; 20 (4) 585-591
    CrossrefPubMedGoogle Scholar
  • 28 Arslan Ozkan I, Mete S. Pregnancy planning and antenatal health behaviour: findings from one maternity unit in Turkey. Midwifery 2010; 26 (3) 338-347
    CrossrefPubMedGoogle Scholar
  • 29 Edvardsson K, Ivarsson A, Eurenius E , et al. Giving offspring a healthy start: parents' experiences of health promotion and lifestyle change during pregnancy and early parenthood. BMC Public Health 2011; 11: 936
    CrossrefPubMedGoogle Scholar
  • 30 Ruifrok AE, Rogozinska E, van Poppel MNM , et al; i-WIP (International Weight Management in Pregnancy) Collaborative Group. Study protocol: differential effects of diet and physical activity based interventions in pregnancy on maternal and fetal outcomes—individual patient data (IPD) meta-analysis and health economic evaluation. Syst Rev 2014; 3: 131-137
    CrossrefPubMedGoogle Scholar
  • 31 Opray N, Grivell RM, Deussen AR, Dodd JM. Directed preconception health programs and interventions for improving pregnancy outcomes for women who are overweight or obese. Cochrane Database Syst Rev 2015; 7: CD010932
    PubMedGoogle Scholar
  • 32 Kurukulasuriya LR, Stas S, Lastra G, Manrique C, Sowers JR. Hypertension in obesity. Med Clin North Am 2011; 95 (5) 903-917
    CrossrefPubMedGoogle Scholar
  • 33 Reaven GM. Insulin resistance: the link between obesity and cardiovascular disease. Med Clin North Am 2011; 95 (5) 875-892
    CrossrefPubMedGoogle Scholar
  • 34 Mehra R, Redline S. Sleep apnea: a proinflammatory disorder that coaggregates with obesity. J Allergy Clin Immunol 2008; 121 (5) 1096-1102
    CrossrefPubMedGoogle Scholar
  • 35 Hillemeier MM, Downs DS, Feinberg ME , et al. Improving women's preconceptional health: findings from a randomized trial of the Strong Healthy Women intervention in the Central Pennsylvania women's health study. Womens Health Issues 2008; 18 (6, Suppl) S87-S96
    CrossrefPubMedGoogle Scholar
  • 36 Weisman CS, Hillemeier MM, Downs DS , et al. Improving women's preconceptional health: long-term effects of the Strong Healthy Women behavior change intervention in the central Pennsylvania Women's Health Study. Womens Health Issues 2011; 21 (4) 265-271
    CrossrefPubMedGoogle Scholar
  • 37 Weisman CS, Hillemeier MM, Downs DS, Chuang CH, Dyer AM. Preconception predictors of weight gain during pregnancy: prospective findings from the Central Pennsylvania Women's Health Study. Womens Health Issues 2010; 20 (2) 126-132
    CrossrefPubMedGoogle Scholar
  • 38 National Institute for Health and Clinical Excellence (NICE). Dietary interventions and physical activity interventions for weight management before, during and after pregnancy. 2010, London, UK
    PubMedGoogle Scholar
  • 39 Thangaratinam S, Jolly K. Obesity in pregnancy: a review of reviews on the effectiveness of interventions. BJOG 2010; 117 (11) 1309-1312
    CrossrefPubMedGoogle Scholar
  • 40 Viswanathan M, Siega-Riz AM, Moos MK , et al. Outcomes of maternal weight gain. Evid Rep Technol Assess (Full Rep) 2008; (168) 1-223
    PubMedGoogle Scholar
  • 41 Margerison Zilko CE, Rehkopf D, Abrams B. Association of maternal gestational weight gain with short- and long-term maternal and child health outcomes. Am J Obstet Gynecol 2010; 202 (6) 574.e1-574.e8
    CrossrefPubMedGoogle Scholar
  • 42 Haugen M, Brantsæter AL, Winkvist A , et al. Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study. BMC Pregnancy Childbirth 2014; 14: 201-205
    CrossrefPubMedGoogle Scholar
  • 43 Nohr EA, Vaeth M, Baker JL, Sørensen TIa, Olsen J, Rasmussen KM. Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy. Am J Clin Nutr 2008; 87 (6) 1750-1759
    PubMedGoogle Scholar
  • 44 Li N, Liu E, Guo J , et al. Maternal prepregnancy body mass index and gestational weight gain on pregnancy outcomes. PLoS ONE 2013; 8 (12) e82310
    CrossrefPubMedGoogle Scholar
  • 45 Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol 2010; 115 (3) 597-604
    CrossrefPubMedGoogle Scholar
  • 46 Yu Z, Han S, Zhu J, Sun X, Ji C, Guo X. Pre-pregnancy body mass index in relation to infant birth weight and offspring overweight/obesity: a systematic review and meta-analysis. PLoS ONE 2013; 8 (4) e61627
    CrossrefPubMedGoogle Scholar
  • 47 Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol 2002; 100 (2) 245-252
    CrossrefPubMedGoogle Scholar
  • 48 Fraser A, Tilling K, Macdonald-Wallis C , et al. Associations of gestational weight gain with maternal body mass index, waist circumference, and blood pressure measured 16 y after pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC). Am J Clin Nutr 2011; 93 (6) 1285-1292
    CrossrefPubMedGoogle Scholar
  • 49 Rooney BL, Schauberger CW, Mathiason MA. Impact of perinatal weight change on long-term obesity and obesity-related illnesses. Obstet Gynecol 2005; 106 (6) 1349-1356
    CrossrefPubMedGoogle Scholar
  • 50 Oken E, Kleinman KP, Belfort MB, Hammitt JK, Gillman MW. Associations of gestational weight gain with short- and longer-term maternal and child health outcomes. Am J Epidemiol 2009; 170 (2) 173-180
    CrossrefPubMedGoogle Scholar
  • 51 Gaillard R, Welten M, Oddy WH , et al. Associations of maternal prepregnancy body mass index and gestational weight gain with cardio-metabolic risk factors in adolescent offspring: a prospective cohort study. BJOG 2016; 123 (2) 207-216
    CrossrefPubMedGoogle Scholar
  • 52 Hrolfsdottir L, Rytter D, Olsen SF , et al. Gestational weight gain in normal weight women and offspring cardio-metabolic risk factors at 20 years of age. Int J Obes 2015; 39 (4) 671-676
    CrossrefPubMedGoogle Scholar
  • 53 Shi P, Yang W, Yu Q , et al. Overweight, gestational weight gain and elevated fasting plasma glucose and their association with macrosomia in chinese pregnant women. Matern Child Health J 2014; 18 (1) 10-15
    CrossrefPubMedGoogle Scholar
  • 54 Potti S, Sliwinski CS, Jain NJ, Dandolu V. Obstetric outcomes in normal weight and obese women in relation to gestational weight gain: comparison between Institute of Medicine guidelines and Cedergren criteria. Am J Perinatol 2010; 27 (5) 415-420
    Article in Thieme ConnectPubMedGoogle Scholar
  • 55 Beyerlein A, Schiessl B, Lack N, von Kries R. Optimal gestational weight gain ranges for the avoidance of adverse birth weight outcomes: a novel approach. Am J Clin Nutr 2009; 90 (6) 1552-1558
    CrossrefPubMedGoogle Scholar
  • 56 Ee TX, Allen Jr JC, Malhotra R, Koh H, Østbye T, Tan TC. Determining optimal gestational weight gain in a multiethnic Asian population. J Obstet Gynaecol Res 2014; 40 (4) 1002-1008
    CrossrefPubMedGoogle Scholar
  • 57 Scott C, Andersen CT, Valdez N , et al. No global consensus: a cross-sectional survey of maternal weight policies. BMC Pregnancy Childbirth 2014; 14: 167
    CrossrefPubMedGoogle Scholar
  • 58 Abrams B, Selvin S. Maternal weight gain pattern and birth weight. Obstet Gynecol 1995; 86 (2) 163-169
    CrossrefPubMedGoogle Scholar
  • 59 Harrison CL, 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
    CrossrefPubMedGoogle Scholar
  • 60 Women's Weight: Findings From the Australian Longitudinal Study on Women's Health . Australian Government Department of Health & Ageing. June 2007. at http://www.alswh.org.au/Reports/OtherReportsPDF/ALSWHMajorReportB310707_final.pdf . Accessed May 10, 2016
    PubMed
  • 61 Jeffries K, Shub A, Walker SP, Hiscock R, Permezel M. Reducing excessive weight gain in pregnancy: a randomised controlled trial. Med J Aust 2009; 191 (8) 429-433
    PubMedGoogle Scholar
  • 62 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
    CrossrefPubMedGoogle Scholar
  • 63 Lombard CB, Harrison CL, Kozica SL, Zoungas S, Keating C, Teede HJ. Effectiveness and implementation of an obesity prevention intervention: the HeLP-her Rural cluster randomised controlled trial. BMC Public Health 2014; 14: 608
    CrossrefPubMedGoogle Scholar
  • 64 Harrison CL, Lombard CB, Teede HJ. Limiting postpartum weight retention through early antenatal intervention: the HeLP-her randomised controlled trial. Int J Behav Nutr Phys Act 2014; 11: 134
    CrossrefPubMedGoogle Scholar
  • 65 Stephens J, Allen J. Mobile phone interventions to increase physical activity and reduce weight: a systematic review. J Cardiovasc Nurs 2013; 28 (4) 320-329
    CrossrefPubMedGoogle Scholar
  • 66 Artinian NT, Fletcher GF, Mozaffarian D , et al; American Heart Association Prevention Committee of the Council on Cardiovascular Nursing. Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults: a scientific statement from the American Heart Association. Circulation 2010; 122 (4) 406-441
    CrossrefPubMedGoogle Scholar
  • 67 Wadden TA, Butryn ML, Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res 2004; 12 (Suppl): 151S-162S
    CrossrefPubMedGoogle Scholar
  • 68 Briley AL, Barr S, Badger S , et al. A complex intervention to improve pregnancy outcome in obese women; the UPBEAT randomised controlled trial. BMC Pregnancy Childbirth 2014; 14: 74
    CrossrefPubMedGoogle Scholar
  • 69 Poston L, Bell R, Croker H , et al; UPBEAT Trial Consortium. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2015; 3 (10) 767-777
    PubMedGoogle Scholar
  • 70 Dodd JM, Turnbull D, McPhee AJ , et al; LIMIT Randomised Trial Group. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ 2014; 348: g1285
    CrossrefPubMedGoogle Scholar
  • 71 Callaway LK, O'Callaghan MJ, McIntyre HD. Barriers to addressing overweight and obesity before conception. Med J Aust 2009; 191 (8) 425-428
    PubMedGoogle Scholar
  • 72 Cogswell ME, Scanlon KS, Fein SB, Schieve LA. Medically advised, mother's personal target, and actual weight gain during pregnancy. Obstet Gynecol 1999; 94 (4) 616-622
    CrossrefPubMedGoogle Scholar
  • 73 Power ML, Cogswell ME, Schulkin J. Obesity prevention and treatment practices of U.S. obstetrician-gynecologists. Obstet Gynecol 2006; 108 (4) 961-968
    CrossrefPubMedGoogle Scholar
  • 74 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: 47
    CrossrefPubMedGoogle Scholar
  • 75 Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330 (7494) 765
    CrossrefPubMedGoogle Scholar