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Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial

International Journal of Obesity volume 37, pages 814–821 (2013)Cite this article

Abstract

Objective:

Lifestyle intervention could help obese pregnant women to limit their weight gain during pregnancy and improve their psychological comfort, but has not yet been evaluated in randomized controlled trials. We evaluated whether a targeted antenatal lifestyle intervention programme for obese pregnant women influences gestational weight gain (GWG) and levels of anxiety or depressed mood.

Design and subjects:

This study used a longitudinal interventional design. Of the 235 eligible obese pregnant women, 205 (mean age (years): 29±4.5; body mass index (BMI, kg m−2): 34.7±4.6) were randomized to a control group, a brochure group receiving written information on healthy lifestyle and an experimental group receiving an additional four antenatal lifestyle intervention sessions by a midwife trained in motivational lifestyle intervention. Anxiety (State and Trait Anxiety Inventory) and feelings of depression (Edinburgh Depression Scale) were measured during the first, second and third trimesters of pregnancy. Socio-demographical, behavioural, psychological and medical variables were used for controlling and correcting outcome variables.

Results:

We found a significant reduction of GWG in the brochure (9.5 kg) and lifestyle intervention (10.6 kg) group compared with normal care group (13.5 kg) (P=0.007). Furthermore, levels of anxiety significantly decreased in the lifestyle intervention group and increased in the normal care group during pregnancy (P=0.02); no differences were demonstrated in the brochure group. Pre-pregnancy BMI was positively related to levels of anxiety. Obese pregnant women who stopped smoking recently showed a significant higher GWG (β=3.04; P=0.01); those with concurrent gestational diabetes mellitus (GDM) (β=3.54; P=0.03) and those who consumed alcohol on a regular base (β=3.69; P=0.04) showed significant higher levels of state anxiety. No differences in depressed mood or obstetrical/neonatal outcomes were observed between the three groups.

Conclusions:

A targeted lifestyle intervention programme based on the principles of motivational interviewing reduces GWG and levels of anxiety in obese pregnant women.

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References

  1. Guelinckx I, Devlieger R, Beckers K, Vansant G . Maternal obesity: pregnancy complications, gestational weight gain and nutrition. Obes Rev 2008; 9: 140–150.

    Article  CAS  Google Scholar 

  2. Heslehurst N, Simpson H, Ells LJ, Rankin J, Wilkinson J, Lang R et al. The impact of maternal BMI status on pregnancy outcomes with immediate short-term obstetric resource implications: a meta-analysis. Obes Rev 2008; 9: 635–683.

    Article  CAS  Google Scholar 

  3. Briese V, Voigt M, Wisser J, Borchardt U, Straube S . Risks of pregnancy and birth in obese primiparous women: an analysis of German perinatal statistics. Arch Gynecol Obstet 2010; 283: 249–253.

    Article  Google Scholar 

  4. Heslehurst N, Rankin J, Wilkinson JR, Summerbell CD . A nationally representative study of maternal obesity in England, UK: trends in incidence and demographic inequalities in 619 323 births, 1989–2007. Int J Obes 2010; 34: 420–428.

    Article  CAS  Google Scholar 

  5. Vansant G, Guelinckx I, Mullie P, Devlieger R . Prevalence of overweight and obesity in pregnant women in Belgium. Int J Obes 2008; 32 (Suppl S1): S104.

    Google Scholar 

  6. Callaway LK, Prins JB, Chang AM, McIntyre HD . The prevalence and impact of overweight and obesity in an Australian obstetric population. Med J Aust 2006; 184: 56–59.

    PubMed  Google Scholar 

  7. Sarwer DB, Allison KC, Gibbons LM, Markowitz JT, Nelson DB . Pregnancy and obesity: a review and agenda for future research. J Womens Health 2006; 15: 720–733.

    Article  Google Scholar 

  8. Amir LH, Donath S . A systematic review of maternal obesity and breastfeeding intention, initiation and duration. BMC Pregnancy Childbirth 2007; 7: 9.

    Article  Google Scholar 

  9. Guelinckx I, Devlieger R, Bogaerts A, Pauwels S, Vansant G . The effect of pre-pregnancy BMI on intention, initiation and duration of breast-feeding. Public Health Nutr 2012; 15: 840–848.

    Article  Google Scholar 

  10. Nelson SM, Matthews P, Poston L . Maternal metabolism and obesity: modifiable determinants of pregnancy outcome. Hum Reprod Update 2010; 16: 255–275.

    Article  Google Scholar 

  11. Cedergren M . Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet 2006; 93: 269–274.

    Article  CAS  Google Scholar 

  12. Nohr EA, Vaeth M, Baker JL, Sorensen TI, 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: 1750–1759.

    Article  CAS  Google Scholar 

  13. Institute of Medicine. Weight Gain During Pregnancy: Re-Examining the Guidelines. National Academy Press: Washington (DC), 2009.

  14. Tarry-Adkins JL, Ozanne SE . Mechanisms of early life programming: current knowledge and future directions. Am J Clin Nutr 2011; 94: 1765S–1771SS.

    Article  CAS  Google Scholar 

  15. Rasmussen KM, Abrams B, Bodnar LM, Butte NF, Catalano PM, Maria Siega-Riz A . Recommendations for weight gain during pregnancy in the context of the obesity epidemic. Obstet Gynecol 2010; 116: 1191–1195.

    Article  Google Scholar 

  16. Olson CM . Achieving a healthy weight gain during pregnancy. Annu Rev Nutr 2008; 28: 411–423.

    Article  CAS  Google Scholar 

  17. Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR . Practitioner advice and gestational weight gain. J Womens Health 2011; 20: 585–591.

    Article  Google Scholar 

  18. 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: 1316–1326.

    Article  CAS  Google Scholar 

  19. Skouteris H, Hartley-Clark L, McCabe M, Milgrom J, Kent B, Herring SJ et al. Preventing excessive gestational weight gain: a systematic review of interventions. Obes Rev 2010; 11: 757–768.

    Article  CAS  Google Scholar 

  20. Asbee SM, Jenkins TR, Butler JR, White J, Elliot M, Rutledge A . Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial. Obstet Gynecol 2009; 113: 305–312.

    Article  Google Scholar 

  21. Claesson IM, Sydsjo G, Brynhildsen J, Cedergren M, Jeppsson A, Nystrom F et al. Weight gain restriction for obese pregnant women: a case-control intervention study. BJOG 2008; 115: 44–50.

    Article  Google Scholar 

  22. Shirazian T, Monteith S, Friedman F, Rebarber A . Lifestyle modification program decreases pregnancy weight gain in obese women. Am J Perinatol 2010; 27: 411–414.

    Article  Google Scholar 

  23. 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: 772–779.

    Article  CAS  Google Scholar 

  24. Laraia BA, Siega-Riz AM, Dole N, London E . Pregravid weight is associated with prior dietary restraint and psychosocial factors during pregnancy. Obesity 2009; 17: 550–558.

    Article  Google Scholar 

  25. Bodnar LM, Wisner KL, Moses-Kolko E, Sit DK, Hanusa BH . Prepregnancy body mass index, gestational weight gain, and the likelihood of major depressive disorder during pregnancy. J Clin Psychiatry 2009; 70: 1290–1296.

    Article  Google Scholar 

  26. Webb JB, Siega-Riz AM, Dole N . Psychosocial determinants of adequacy of gestational weight gain. Obesity 2009; 17: 300–309.

    Article  Google Scholar 

  27. Hurley KM, Caulfield LE, Sacco LM, Costigan KA, Dipietro JA . Psychosocial influences in dietary patterns during pregnancy. J Am Diet Assoc 2005; 105: 963–966.

    Article  Google Scholar 

  28. Rifas-Shiman SL, Rich-Edwards JW, Kleinman KP, Oken E, Gillman MW . Dietary quality during pregnancy varies by maternal characteristics in Project Viva: a US cohort. J Am Diet Assoc 2009; 109: 1004–1011.

    Article  Google Scholar 

  29. Guelinckx I . Pregnancy and Obesity: Clinical Approach and Nutritional Management. KU Leuven: Leuven, 2010.

  30. Guelinckx I, Devlieger R, Mullie P, Vansant G . Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial. Am J Clin Nutr 2010; 91: 373–380.

    Article  CAS  Google Scholar 

  31. Lodewijckx K, Peeters G, Spitz B, Blot S, Temmerman M, Zhang W et al. Nationale richtlijn prenatale zorg. Een basis voor een klinisch pad voor de opvolging van zwangerschappen. KCE Reports 6A (D/2004/10.273/13). Federaal Kenniscentrum voor de gezondheidszorg (KCE): Brussel, 2004.

    Google Scholar 

  32. Hoge Gezondheidsraad. Voedingsaanbevelingen voor België, herziening 2009. HRG dossiernummer: 8309. Hoge Gezondheidsraad: Belgium, 2009.

  33. Johnson SS, Paiva AL, Cummins CO, Johnson JL, Dyment SJ, Wright JA et al. Transtheoretical model-based multiple behavior intervention for weight management: effectiveness on a population basis. Prev Med 2008; 46: 238–246.

    Article  Google Scholar 

  34. DiMarco ID, Klein DA, Clark VL, Wilson GT . The use of motivational interviewing techniques to enhance the efficacy of guided self-help behavioral weight loss treatment. Eat Behav 2009; 10: 134–136.

    Article  Google Scholar 

  35. Miller WR, Rollnick SP . Motivational Interviewing, Preparing People for Change 2nd edn. The Guilford Press: New York, 2002.

    Google Scholar 

  36. Tilton SR . Review of the state-trait anxiety inventory (STAI). Newsnotes 2008; 48: 1–3.

    Google Scholar 

  37. Spielberger CD, Gorsuch RL, Lushene RE . STAI Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press: Palo Alto, CA, 1970.

    Google Scholar 

  38. Grant KA, McMahon C, Austin MP . Maternal anxiety during the transition to parenthood: A prospective study. J Affect Disord 2008; 108: 101–111.

    Article  Google Scholar 

  39. Britton JR . Maternal anxiety: course and antecedents during the early postpartum period. Depress Anxiety 2008; 25: 793–800.

    Article  Google Scholar 

  40. Cox JL, Holden JM, Sagovsky R . Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150: 782–786.

    Article  CAS  Google Scholar 

  41. Pop VJ, Komproe IH, van Son MJ . Characteristics of the Edinburgh Post Natal Depression Scale in The Netherlands. J Affect Disord 1992; 26: 105–110.

    Article  CAS  Google Scholar 

  42. Murray D, Cox JL . Screening for depression during pregnancy with the edinburgh depression scale (EDDS). J Reprod Infant Psychol 1990; 8: 99–107.

    Article  Google Scholar 

  43. Polit DE, Beck CT . Nursing Research, Generating and Assessing Evidence for Nursing Practice.. Lippincott Williams & Wilkins: Philadelphia, 2008.

    Google Scholar 

  44. Brown MA, Lindheimer MD, de SM, Van AA, Moutquin JM . The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertens Pregnancy 2001; 20: IX–XIV.

    Article  CAS  Google Scholar 

  45. Hoffman L, Nolan C, Wilson JD, Oats JJ, Simmons D . Gestational diabetes mellitus--management guidelines. The Australasian Diabetes in Pregnancy Society. Med J Aust 1998; 169: 93–97.

    Article  CAS  Google Scholar 

  46. 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: 495–501.

    Article  CAS  Google Scholar 

  47. Kinnunen TI, Pasanen M, Aittasalo M, Fogelholm M, Hilakivi-Clarke L, Weiderpass E et al. Preventing excessive weight gain during pregnancy - a controlled trial in primary health care. Eur J Clin Nutr 2007; 61: 884–891.

    Article  CAS  Google Scholar 

  48. Polley BA, Wing RR, Sims CJ . Randomized controlled trial to prevent excessive weight gain in pregnant women. Int J Obes Relat Metab Disord 2002; 26: 1494–1502.

    Article  CAS  Google Scholar 

  49. Olson CM, Strawderman MS, Reed RG . Efficacy of an intervention to prevent excessive gestational weight gain. Am J Obstet Gynecol 2004; 191: 530–536.

    Article  Google Scholar 

  50. Campbell F, Johnson M, Messina J, Guillaume L, Goyder E . Behavioural interventions for weight management in pregnancy: a systematic review of quantitative and qualitative data. BMC Public Health 2011; 11: 491.

    Article  Google Scholar 

  51. World Health Organisation. Adherence to Long-Term Therapies: Evidence for Action. WHO: Geneva, 2003.

  52. Claesson IM, Josefsson A, Sydsjo G . Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study. BMC Public Health 2010; 10: 766.

    Article  Google Scholar 

  53. Pedersen P, Baker JL, Henriksen TB, Lissner L, Heitmann BL, Sorensen TI et al. Influence of psychosocial factors on postpartum weight retention. Obesity 2011; 19: 639–646.

    Article  Google Scholar 

  54. Waterland RA . Is epigenetics an important link between early life events and adult disease? Horm Res 2009; 71 (Suppl 1): 13–16.

    CAS  Google Scholar 

  55. Junien C, Nathanielsz P . Report on the IASO Stock Conference 2006: early and lifelong environmental epigenomic programming of metabolic syndrome, obesity and type II diabetes. Obes Rev 2007; 8: 487–502.

    Article  CAS  Google Scholar 

  56. Simmons D . Diabetes and obesity in pregnancy. Best Pract Res Clin Obstet Gynaecol 2011; 25: 25–36.

    Article  Google Scholar 

  57. Van den Bergh BR, Mulder EJ, Mennes M, Glover V . Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neurosci Biobehav Rev 2005; 29: 237–258.

    Article  Google Scholar 

  58. Raikkonen K, Seckl JR, Pesonen AK, Simons A, Van den Bergh BR . Stress glucocorticoids and liquorice in human pregnancy: programmers of the offspring brain. Stress 2011; 14: 590–603.

    Article  CAS  Google Scholar 

  59. Tanentsapf I, Heitmann BL, Adegboye AR . Systematic review of clinical trials on dietary interventions to prevent excessive weight gain during pregnancy among normal weight, overweight and obese women. BMC Pregnancy Childbirth 2011; 11: 81.

    Article  Google Scholar 

  60. Ludwig DS, Currie J . The association between pregnancy weight gain and birthweight: a within-family comparison. Lancet 2010; 376: 984–990.

    Article  Google Scholar 

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Acknowledgements

We thank all the pregnant women for their participation and the gynaecologists and midwives from St Janshospital Genk, Jessa Hospital Hasselt and St Franciscus Hospital Heusden-Zolder, Belgium, for their co-operation in enrolment of the women. We also thank M. Mead for the conscious reading of the manuscript. AB was supported by a PWO project from Flanders. RD is senior clinical researcher for FWO Vlaanderen (2010–2015), and BVDB is funded by a grant of the European Science Foundation (EuroSTRESS programme ‘Stress and Mental Health’;2008–2011), by the Netherlands Organization for Scientific Research (NWO; Brain and Cognition Programme; 2008–2012), and by European Commission’s seventh Framework Programme (FP7/ 2007–2013; BrainAGE; 2012–2017).

Author contributions

AB, RD, IW and BVdB designed the study and wrote the protocol. AB managed the literature searches, the intervention sessions and the analyses. EN undertook the statistical analysis. AB wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Author information

Authors and Affiliations

  1. Department of Healthcare Research, PHL University College, Limburg Catholic University College, Hasselt, Belgium

    A F L Bogaerts & E Nuyts

  2. Division of Mother and Child, Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium

    R Devlieger

  3. Center of Human Genetics, University Hospitals KU Leuven, Leuven, Belgium

    I Witters

  4. Department of Obstetrics, East Limburg Hospital, Genk, Belgium

    W Gyselaers

  5. Department of Physiology, Hasselt University, Diepenbeek, Belgium

    W Gyselaers

  6. Department of Psychology, Tilburg University, Tilburg, The Netherlands

    B R H Van den Bergh

  7. Department of Psychology; KU Leuven,

    B R H Van den Bergh

  8. KU Leuven, Leuven, Belgium

    B R H Van den Bergh

  9. Department of Welfare, Public Health and Family, Flemish Government, Brussels, Belgium

    B R H Van den Bergh

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  1. A F L Bogaerts
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  2. R Devlieger
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  4. I Witters
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  6. B R H Van den Bergh
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Corresponding author

Correspondence to R Devlieger.

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The authors declare no conflict of interest.

Additional information

Presented at the 59th Annual Meeting of the Society for Gynecologic Investigation in San Diego, CA, USA, 21–24 March 2012, and the 19th European Congress on Obesity (ECO 2012), Lyon, France, 9–12 May 2012.

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Bogaerts, A., Devlieger, R., Nuyts, E. et al. Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial. Int J Obes 37, 814–821 (2013). https://doi.org/10.1038/ijo.2012.162

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