Clinical Research

One-year postpartum anthropometric outcomes in mothers and children in the LIFE-Moms lifestyle intervention clinical trials



Excess gestational weight gain (GWG) is a risk factor for maternal postpartum weight retention and excessive neonatal adiposity, especially in women with overweight or obesity. Whether lifestyle interventions to reduce excess GWG also reduce 12-month maternal postpartum weight retention and infant weight-for-length z score is unknown. Randomized controlled trials from the LIFE-Moms consortium investigated lifestyle interventions that began in pregnancy and tested whether there was benefit through 12 months on maternal postpartum weight retention (i.e., the difference in weight from early pregnancy to 12 months) and infant-weight-for-length z scores.


In LIFE-Moms, women (N = 1150; 14.1 weeks gestation at enrollment) with overweight or obesity were randomized within each of seven trials to lifestyle intervention or standard care. Individual participant data were combined and analyzed using generalized linear mixed models with trial entered as a random effect. The 12-month assessment was completed by 83% (959/1150) of women and 84% (961/1150) of infants.


Compared with standard care, lifestyle intervention reduced postpartum weight retention (2.2 ± 7.0 vs. 0.7 ± 6.2 kg, respectively; difference of −1.6 kg (95% CI −2.5, −0.7; p = 0.0003); the intervention effect was mediated by reduction in excess GWG, which explained 22% of the effect on postpartum weight retention. Lifestyle intervention also significantly increased the odds (OR = 1.68 (95% CI, 1.26, 2.24)) and percentage of mothers (48.2% vs. 36.2%) at or below baseline weight at 12 months postpartum (yes/no) compared with standard care. There was no statistically significant treatment group effect on infant anthropometric outcomes at 12 months.


Compared with standard care, lifestyle interventions initiated in pregnancy and focused on healthy eating, increased physical activity, and other behavioral strategies resulted in significantly less weight retention but similar infant anthropometric outcomes at 12 months postpartum in a large, diverse US population of women with overweight and obesity.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Kirkegaard H, Stovring H, Rasmussen KM, Abrams B, Sorensen TI, Nohr EA. How do pregnancy-related weight changes and breastfeeding relate to maternal weight and BMI-adjusted waist circumference 7 y after delivery? Results from a path analysis. Am J Clin Nutr. 2014;99:312–9.

  2. 2.

    Mamun AA, Kinarivala M, O'Callaghan MJ, Williams GM, Najman JM, Callaway LK. Associations of excess weight gain during pregnancy with long-term maternal overweight and obesity: evidence from 21 y postpartum follow-up. Am J Clin Nutr. 2010;91:1336–41.

  3. 3.

    Mamun AA, Mannan M, Doi SA. Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis. Obesity Rev. 2014;15:338–47.

  4. 4.

    Nehring I, Lehmann S, von Kries R. Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: a meta-analysis. Pediatric obesity. 2013;8:218–24.

  5. 5.

    International Weight Management in Pregnancy Collaborative, G. 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.

  6. 6.

    Peaceman AM, Clifton RG, Phelan S, Gallagher D, Evans M, Redman LM, et al. Lifestyle interventions limit gestational weight gain in women with overweight or obesity: a prospective meta-analysis. Obesity. 2018;0:1–9.

  7. 7.

    Linne Y, Dye L, Barkeling B, Rossner S. Long-term weight development in women: a 15-year follow-up of the effects of pregnancy. Obes Res. 2004;12:1166–78.

  8. 8.

    Rooney BL, Schauberger CW, Mathiason MA. Impact of perinatal weight change on long-term obesity and obesity-related illnesses. Obstet Gynecol. 2005;106:1349–56.

  9. 9.

    Zheng M, Lamb KE, Grimes C, Laws R, Bolton K, Ong KK, et al. Rapid weight gain during infancy and subsequent adiposity: a systematic review and meta-analysis of evidence. Obes Rev. 2018;19:321–32.

  10. 10.

    Althuizen E, van der Wijden CL, van Mechelen W, Seidell JC, van Poppel MN. The effect of a counselling intervention on weight changes during and after pregnancy: a randomised trial. BJOG. 2013;120:92–9.

  11. 11.

    Vesco KK, Leo MC, Karanja N, Gillman MW, McEvoy CT, King JC, et al. One-year postpartum outcomes following a weight management intervention in pregnant women with obesity. Obesity (Silver Spring). 2016;24:2042–9.

  12. 12.

    Phelan S, Phipps MG, Abrams B, Darroch F, Grantham K, Schaffner A, et al. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Am J Clin Nutr. 2014;99:302–11.

  13. 13.

    Dodd JM, Turnbull D, McPhee AJ, Deussen AR, Grivell RM, Yelland LN, et al. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ. 2014;348:g1285.

  14. 14.

    Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Tanvig M, Lamont RF, et al. Postpartum weight retention and breastfeeding among obese women from the randomized controlled Lifestyle in Pregnancy (LiP) trial. Acta Obstet Gynecol Scand. 2014;93:794–801.

  15. 15.

    Vesco KK, Karanja N, King JC, Gillman MW, Leo MC, Perrin N, et al. Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial. Obesity (Silver Spring). 2014;22:1989–96.

  16. 16.

    Patel N, Godfrey KM, Pasupathy D, Levin J, Flynn AC, Hayes L, et al. Infant adiposity following a randomised controlled trial of a behavioural intervention in obese pregnancy. Int J Obes (Lond). 2017;41:1018–26.

  17. 17.

    O'Brien EC, Geraghty AA, O'Sullivan EJ, Riordan JA, Horan MK, Larkin E, et al. Five-year follow up of a low glycaemic index dietary randomised controlled trial in pregnancy-no long-term maternal effects of a dietary intervention. BJOG. 2019;126:514–24.

  18. 18.

    Dodd, JM, Louise, J, Deussen, AR, McPhee, AJ, Owens, JA & Robinson, JS. Prenatal diet and child growth at 18 months. Pediatrics 2018;142:pii: e20180035.

  19. 19.

    Vinter CA, Jensen DM, Ovesen P, Beck-Nielsen H, Jorgensen JS. The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women. Diabetes Care. 2011;34:2502–7.

  20. 20.

    Rong K, Yu K, Han X, Szeto IM, Qin X, Wang J, et al. Pre-pregnancy BMI, gestational weight gain and postpartum weight retention: a meta-analysis of observational studies. Public Health Nutr. 2015;18:2172–82.

  21. 21.

    Tanvig M, Vinter CA, Jorgensen JS, Wehberg S, Ovesen PG, Beck-Nielsen H, et al. Effects of lifestyle intervention in pregnancy and anthropometrics at birth on offspring metabolic profile at 2.8 years: results from the Lifestyle in Pregnancy and Offspring (LiPO) study. J Clin Endocrinol Metab. 2015;100:175–83.

  22. 22.

    Clifton RG, Evans M, Cahill AG, Franks PW, Gallagher D, Phelan S, et al. Design of lifestyle intervention trials to prevent excessive gestational weight gain in women with overweight or obesity. Obesity (Silver Spring). 2016;24:305–13.

  23. 23.

    Phelan S, Wing RR, Brannen A, McHugh A, Hagobian TA, Schaffner A, et al. Randomized controlled clinical trial of behavioral lifestyle intervention with partial meal replacement to reduce excessive gestational weight gain. Am J Clin Nutr. 2018;107:183–94.

  24. 24.

    Gallagher D, Rosenn B, Toro-Ramos T, Paley C, Gidwani S, Horowitz M, et al. Greater neonatal fat-free mass and similar fat mass following a randomized trial to control excess gestational weight gain. Obesity (Silver Spring). 2018;26:578–87.

  25. 25.

    Trak-Fellermeier, MA, Campos, M, Meléndez, M, Pomeroy, J, Palacios, C, Rivera-Viñas, J et al. PEARLS randomized lifestyle trial in pregnant hispanic women with overweight/obesity: gestational weight gain, and offspring birthweight. Diabetes Metab Syndr Obes. 2019;12:225–238.

  26. 26.

    Van Horn, L, Peaceman, A, Kwasny, M, Vincent, E, Fought, A, Josefson, J et al. Dietary approaches to stop hypertension diet and activity to limit gestational weight: maternal offspring metabolics family intervention trial, a technology enhanced randomized trial. Am J Prev Med. 2018;55:603–614.

  27. 27.

    Cahill AG, Haire-Joshu D, Cade WT, Stein RI, Woolfolk CL, Moley K, et al. Weight control program and gestational weight gain in disadvantaged women with overweight or obesity: a randomized clinical trial. Obesity (Silver Spring). 2018;26:485–91.

  28. 28.

    Rasmussen, KM, Yaktine, AL & Institute of Medicine (U.S.). Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. (National Academies Press, 2009).

  29. 29.

    Headen I, Cohen AK, Mujahid M, Abrams B. The accuracy of self-reported pregnancy-related weight: a systematic review. Obes Rev. 2017;18:350–69.

  30. 30.

    World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. (World Health Organization, 2006).

  31. 31.

    Truesdale KP, Stevens J, Lewis CE, Schreiner PJ, Loria CM, Cai J. Changes in risk factors for cardiovascular disease by baseline weight status in young adults who maintain or gain weight over 15 years: the CARDIA study. Int J Obes (Lond). 2006;30:1397–407.

  32. 32.

    Phelan S, Hagobian T, Brannen A, Hatley KE, Schaffner A, Munoz-Christian K, et al. Effect of an internet-based program on weight loss for low-income postpartum women: a randomized clinical trial. JAMA. 2017;317:2381–91.

  33. 33.

    Leermakers EA, Anglin K, Wing RR. Reducing postpartum weight retention through a correspondence intervention. Int J Obes Relat Metab Disord. 1998;22:1103–9.

  34. 34.

    Huseinovic E, Bertz F, Leu Agelii M, Hellebo Johansson E, Winkvist A, Brekke HK. Effectiveness of a weight loss intervention in postpartum women: results from a randomized controlled trial in primary health care. Am J Clin Nutr. 2016;104:362–70.

  35. 35.

    Evenson KR, Aytur SA, Borodulin K. Physical activity beliefs, barriers, and enablers among postpartum women. J Womens Health (Larchmt). 2009;18:1925–34.

  36. 36.

    Insana SP, Montgomery-Downs HE. Sleep and sleepiness among first-time postpartum parents: a field- and laboratory-based multimethod assessment. Dev Psychobiol. 2013;55:361–72.

  37. 37.

    Barkin JL, Bloch JR, Hawkins KC, Thomas TS. Barriers to optimal social support in the postpartum period. J Obstet Gynecol Neonatal Nurs. 2014;43:445–54.

  38. 38.

    Luoto R, Kalliomaki M, Laitinen K, Isolauri E. The impact of perinatal probiotic intervention on the development of overweight and obesity: follow-up study from birth to 10 years. Int J Obes (Lond). 2010;34:1531–7.

  39. 39.

    Horan, MK, McGowan, CA, Gibney, ER, Byrne, J, Donnelly, JM & McAuliffe, FM. Maternal nutrition and glycaemic index during pregnancy impacts on offspring adiposity at 6 months of age–analysis from the ROLO randomised controlled trial. Nutrients 2016;8:820 pii: E7.

  40. 40.

    Dyer JS, Rosenfeld CR. Metabolic imprinting by prenatal, perinatal, and postnatal overnutrition: a review. Sem Reprod Med. 2011;29:266–76.

  41. 41.

    Karachaliou M, Georgiou V, Roumeliotaki T, Chalkiadaki G, Daraki V, Koinaki S, et al. Association of trimester-specific gestational weight gain with fetal growth, offspring obesity, and cardiometabolic traits in early childhood. Am J Obstet Gynecol. 2015;212:502 e501–514.

  42. 42.

    Crume TL, Ogden L, Daniels S, Hamman RF, Norris JM, Dabelea D. The impact of in utero exposure to diabetes on childhood body mass index growth trajectories: the EPOCH study. J Pediatr. 2011;158:941–6.

  43. 43.

    Dabelea D, Crume T. Maternal environment and the transgenerational cycle of obesity and diabetes. Diabetes. 2011;60:1849–55.

  44. 44.

    Gunderson EP. Childbearing and obesity in women: weight before, during, and after pregnancy. Obstet Gynecol Clin North Am. 2009;36:317–32.

Download references


We thank the LIFE-Moms consortium members for their contributions to the development and oversight of the common measures and procedures shared across the trials. The following individuals and institutions are members of the LIFE-Moms Research Group (asterisks indicate principal investigators): California Polytechnic State University & Brown University: S. Phelan*, R.R. Wing, T.A. Hagobian, A. Schaffner, C. Hart, E.K. Yin, M.G. Phipps, B. Abrams, T.O. Scholl, D.A. Savitz St. Luke’s-Roosevelt Hospital and Columbia University: D. Gallagher*, X. Pi-Sunyer*, J. Thornton, B. Rosenn, C. Paley, S. Gidwani, M. Horowitz University of Puerto Rico: K. Joshipura*, P.W. Franks*, C. Palacios, M. Campos, J. Rivera, W.C. Willett, C. Zorrilla, S. Soltero, F. Hu, J. Cordero, M.A. Trak, M. Meléndez Washington University in St. Louis: A.G. Cahill*, S. Klein*, D. Haire-Joshu*, R. Stein, A. Mathur, W.T. Cade, K. Moley Northwestern University: A.M. Peaceman*, L. Van Horn*, M. Kwasny, J.L. Josefson, L. Neff, B. Spring Pennington Biomedical Research Center: L.M. Redman*, C.K. Martin, K. Elkind-Hirsh, J. Breaux, W. Johnson, E.A. Frost NIDDK/Phoenix Indian Medical Center: W.C. Knowler*, K.A. Couch*, J.M. Curtis, D.L. Dunnigan, R.L. Hanson, M. Hoskin, K. Kavena, G.Y. Kishi, C. Moffett, S. Murphy (deceased), R.G. Nelson, J. Pomeroy, L. Shovestull, Rachel Williams Research Coordinating Unit, George Washington University Biostatistics Center: R.G. Clifton*, E.A. Thom*, K. Drews, T. Boekhoudt NIH: M. Evans (NIDDK), S.Z. Yanovski (NIDDK), S. Arteaga (NHLBI), D.L. Alekel (NCCIH, now at NIAMS).


Research reported in this publication was supported by the National Institutes of Health through The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK, U01 DK094418, U01 DK094463, U01 DK094416, 5U01 DK094466 (RCU)), The National Heart, Lung, and Blood Institute (NHLBI, U01 HL114344, U01 HL114377), and The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD, U01 HD072834). In addition, the National Center for Complementary and Integrative Health (NCCIH), the NIH Office of Research in Women’s Health (ORWH), the Office of Behavioral and Social Science Research (OBSSR), the NIH Office of Disease Prevention (ODP), the Indian Health Service, the Intramural Research Program of the NIDDK, and the Office of the Director, National Institutes of Health (OD) contributed support. Additional support was received from the NIDDK Obesity Nutrition Research Centers (P30 DK026687, P30 DK072476, P30 DK56341), National Center for Advancing Translational Sciences Clinical and Translational Science Awards (U54 GM104940, U54 MD007587, UL1 RR024992), National Institute on Minority Health and Health Disparities (S21MD001830) and EXODIAB-Excellence of diabetes research in Sweden. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Correspondence to Suzanne Phelan.

Ethics declarations

Conflict of interest

SP reports a grant from Weight Watchers International, outside the submitted work. LMR and CKM reported one of the interventions being evaluated in the Expecting Success trial at Pennington Biomedical Research Center (the SmartMoms™ smartphone application) has a pending trademark and is available for licensure. The authors have no other conflicts of interest to report.


The content is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI, NIDDK, NCCIH, now at NIAMS, NICHD, and the National Institutes of Health.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark