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.
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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.
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.
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