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An integrative review of interventions for limiting gestational weight gain in pregnant women who are overweight or obese

      Abstract

      Problem

      Excessive gestational weight gain in women who are overweight or obese puts them at risk of poor short- and long-term outcomes for maternal and neonatal health. Several interventions have been trialled to encourage women who are overweight or obese to limit gestational weight gain during pregnancy.

      Aim

      The aim of this review was to analyse the evidence on interventions to limit gestational weight gain in pregnant women who are overweight or obese.

      Method

      An integrative review guided by the Joanna Briggs Institute approach was conducted. An unlabeled search query of pregnancy, weight, and obesity was conducted in Medline, Scopus and CINAHL, limited to English language, 2010–2020 publications, and primary research on humans. Unlabeled search query of “((pregnancy outcome) OR (prenatal care) OR (pregnancy complications)) AND ((weight loss) OR (weight gain) OR (weight management)) AND (obesity) was used. Additional 9 records were identified through reference lists. Following a critical appraisal, 21 primary research articles were included in this review. A thematic synthesis was undertaken.

      Findings

      Four major themes were identified. These are (1) mixed findings of lifestyle interventions for weight management, (2) ineffectiveness of probiotics or metformin for weight management, (3) psycho-behavioural interventions for weight management, and (4) midwifery role as an integral component in multidisciplinary intervention for weight management.

      Conclusion

      The literature suggests a need for longer duration of behavioural lifestyle intervention sessions led by the same midwife trained in motivational interviewing to limit weight gain in pregnant women who are overweight or obese.

      Keywords

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      References

        • World Health Organization
        Obesity and Overweight.
        2020 (https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight)
        • Australian Bureau of Statistics
        National Health Survey: Overweight and Obesity.
        2018 (https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/latest-release (Accessed 27 September 2020))
      1. Australian Institute of Health and Welfare. Australia's Mothers and Babies 2016 – in Brief 2018. https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies-2016-in-brief/data.

        • Athukorala C.
        • Rumbold A.R.
        • Willson K.J.
        • Crowther C.A.
        The risk of adverse pregnancy outcomes in women who are overweight or obese.
        BMC Preg. Childbirth. 2010; 10
        • Callaway L.K.
        • Prins J.B.
        • Chang A.M.
        • McIntyre H.D.
        The prevalence and impact of overweight and obesity in an Australian obstetric population.
        Med. J. Aust. 2006; 184: 56-59
        • Godfrey K.M.
        • Reynolds R.M.
        • Prescott S.L.
        • Nyirenda M.
        • Jaddoe V.W.V.
        • Eriksson J.G.
        • Broekman B.F.P.
        Influence of maternal obesity on the long-term health of offspring.
        Lancet Diabetes Endocrinol. 2017; 5: 53-64
        • Goldstein F.R.
        • Abell K.S.
        • Ranasinha A.S.
        • Misso H.M.
        • Boyle J.J.
        • Black O.M.
        • Li H.N.
        • Hu H.G.
        • Corrado J.F.
        • Rode J.L.
        • Kim J.Y.
        • Haugen J.M.
        • Song J.W.
        • Kim J.M.
        • Bogaerts J.A.
        • Devlieger J.R.
        • Chung J.J.
        • Teede J.H.
        Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis.
        Obst. Gynecol. Surv. 2017; 72: 573-575
        • Kim Y.S.
        • Sharma J.A.
        • Sappenfield G.W.
        • Wilson M.H.
        • Salihu M.H.
        Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births.
        Obst. Gynecol. 2014; 123: 737-744
        • Nehring I.
        • Schmoll S.
        • Beyerlein A.
        • Hauner H.
        • Von Kries R.
        Gestational weight gain and long-term postpartum weight retention: a meta-analysis.
        Am. J. Clin. Nutr. 2011; 94: 1225-1231
        • Institute of Medicine, National Research Council
        Weight gain During Pregnancy: Reexamining the Guidelines.
        The National Academy Press, Washington2009
        • Furber C.M.
        • McGowan L.
        • Bower P.
        • Kontopantelis E.
        • Quenby S.
        • Lavender T.
        Antenatal interventions for reducing weight in obese women for improving pregnancy outcome.
        Cochrane Database Syst. Rev. 2013; : CD009334
        • Peaceman A.M.
        • Clifton R.G.
        • Phelan S.
        • Gallagher D.
        • Evans M.
        • Redman L.M.
        • Knowler W.C.
        • Joshipura K.
        • Haire-Joshu D.
        • Yanovski S.Z.
        • Couch K.A.
        • Drews K.L.
        • Franks P.W.
        • Klein S.
        • Martin C.K.
        • Pi-Sunyer X.
        • Thom E.A.
        • Van Horn L.
        • Wing R.R.
        • Cahill A.G.
        • LIFE-Moms Research Group
        Lifestyle interventions limit gestational weight gain in women with overweight or obesity: LIFE-Moms prospective meta-analysis.
        Obesity. 2018; 26: 1396-1404
        • Whittemore R.
        • Knafl K.
        The integrative review: updated methodology.
        J. Adv. Nurs. 2005; 52: 546-553
        • Long A.
        • Godfrey M.
        • Randall T.
        • Brettle A.
        • Grant M.
        Evaluation Tool for Quantitative Research Studies.
        2002 (https://www.usir.salford.ac.uk/id/eprint/12969/1/Evaluation_Tool_for_Quantitative_Research_Studies.pdf (Accessed 27 September 2020))
        • Daly N.
        • Farren M.
        • McKeating A.
        • O’Kelly R.
        • Stapleton M.
        • Turner M.J.
        • OʼKelly R.
        A medically supervised pregnancy exercise intervention in obese women: a randomized controlled trial.
        Obst. Gynecol. 2017; 130: 1001-1010
        • Lee A.
        • Karpavicius J.
        • Gasparini E.
        • Forster D.
        Implementing a diet and exercise program for limiting maternal weight gain in obese pregnant women: a pilot study.
        Aust. N. Z. J. Obst. Gynaecol. 2012; 52: 427-432
        • Mottola M.F.
        • Giroux I.
        • Gratton R.
        • Hammond J.
        • Hanley A.
        • Harris S.
        • McManus R.
        • Davenport M.H.
        • Sopper M.M.
        Nutrition and exercise prevent excess weight gain in overweight pregnant women.
        Med. Sci. Sports Exerc. 2010; 42: 265-272
        • Opie R.S.
        • Neff M.
        • Tierney A.C.
        A behavioural nutrition intervention for obese pregnant women: effects on diet quality, weight gain and the incidence of gestational diabetes.
        Aust. N. Z. J. Obstet. Gynaecol. 2016; 56: 364-373
        • Phelan S.
        • Phipps M.G.
        • Abrams B.
        • Darroch F.
        • Schaffner A.
        • Wing R.R.
        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
        • Raymond J.E.
        • Foureur M.J.
        • Davis D.L.
        Gestational weight change in women attending a group antenatal program aimed at addressing obesity in pregnancy in New South Wales, Australia.
        J. Midwifery Women's Health. 2014; 59: 398-404
        • Robertson N.
        • Ladlow B.
        Effect of individual dietetic intervention on gestational weight gain and associated complications in obese pregnant women.
        Aust. N. Z. J. Obst. Gynaecol. 2018; 58: 274-277
        • Seneviratne S.N.
        • Jiang Y.
        • Derraik J.G.B.
        • McCowan L.M.E.
        • Parry G.K.
        • Biggs J.B.
        • Craigie S.
        • Gusso S.
        • Peres G.
        • Rodrigues R.O.
        • Ekeroma A.
        • Cutfield W.S.
        • Hofman P.L.
        Effects of antenatal exercise in overweight and obese pregnant women on maternal and perinatal outcomes: a randomised controlled trial.
        BJOG Int. J. Obst. Gynaecol. 2016; 123: 588-597
        • Shirazian T.
        • Faris B.S.
        • Fox N.S.
        • Friedman Jr., F.
        • Rebarber A.
        The lifestyle modification project: limiting pregnancy weight gain in obese women.
        J. Matern. Fetal Neonatal Med. 2016; 29: 80-84
        • 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
        • Vesco K.K.
        • Karanja N.
        • King J.C.
        • Gillman M.W.
        • Leo M.C.
        • Perrin N.
        • McEvoy C.T.
        • Eckhardt C.L.
        • Smith K.S.
        • Stevens V.J.
        Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial.
        Obesity (19307381). 2014; 22: 1989-1996
        • Vinter C.A.
        • Jensen D.M.
        • Ovesen P.
        • Beck-Nielsen H.
        • Jørgensen J.S.
        The LiP (Lifestyle in Pregnancy) Study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women.
        Diabetes Care. 2011; 34: 2502-2507
        • Althuizen E.
        • van der Wijden C.L.
        • van Mechelen W.
        • Seidell J.C.
        • van Poppel M.N.
        The effect of a counselling intervention on weight changes during and after pregnancy: a randomised trial.
        BJOG Int. J. Obst. Gynaecol. 2013; 120: 92-99
        • Bogaerts A.F.L.
        • Devlieger R.
        • Nuyts E.
        • Witters I.
        • Gyselaers W.
        • Van den Bergh B.R.H.
        Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial.
        Int. J. Obes. 2013; 37: 814-821
        • Brownfoot F.C.
        • Davey M.A.
        • Kornman L.
        Routine weighing to reduce excessive antenatal weight gain: a randomised controlled trial.
        BJOG Int. J. Obst. Gynaecol. 2016; 123: 254-261
        • Claesson I.M.
        • Klein S.
        • Sydsjo G.
        • Josefsson A.
        Physical activity and psychological well-being in obese pregnant and postpartum women attending a weight-gain restriction programme.
        Midwifery. 2014; 30: 11-16
        • Dodd J.M.
        • Grivell R.M.
        • Owens J.A.
        Antenatal dietary and lifestyle interventions for women who are overweight or obese: outcomes from the LIMIT randomized trial.
        Curr. Nutr. Rep. 2014; 3: 392-399
        • Dodd J.M.
        • Louise J.
        • Deussen A.R.
        • Grivell R.M.
        • Dekker G.
        • McPhee A.J.
        • Hague W.
        Effect of metformin in addition to dietary and lifestyle advice for pregnant women who are overweight or obese: the GRoW randomised, double-blind, placebo-controlled trial.
        Lancet Diabetes Endocrinol. 2019; 7: 15-24
        • Garnæs K.K.
        • Mørkved S.
        • Salvesen Ø.
        • Moholdt T.
        Exercise training and weight gain in obese pregnant women: a randomized controlled trial (ETIP Trial).
        PLoS Med. 2016; 13: 1-18
        • 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
        • Haby K.
        • Berg M.
        • Gyllensten H.
        • Hanas R.
        • Premberg A.
        Mighty Mums – a lifestyle intervention at primary care level reduces gestational weight gain in women with obesity.
        BMC Obes. 2018; 5: 16
        • Haby K.
        • Glantz A.
        • Hanas R.
        • Premberg Å.
        Mighty Mums – an antenatal health care intervention can reduce gestational weight gain in women with obesity.
        Midwifery. 2015; 31: 685-692
        • Harrison C.L.
        • Teede H.J.
        • Lombard C.B.
        How effective is self-weighing in the setting of a lifestyle intervention to reduce gestational weight gain and postpartum weight retention?.
        Aust. N. Z. J. Obst. Gynaecol. 2014; 54: 382-385
        • Herring S.J.
        • Cruice J.F.
        • Bennett G.G.
        • Rose M.Z.
        • Davey A.
        • Foster G.D.
        Preventing excessive gestational weight gain among African American women: a randomized clinical trial.
        Obesity. 2016; 24: 30-36
        • Krukowski R.
        • West D.
        • DiCarlo M.
        • Shankar K.
        • Cleves M.
        • Tedford E.
        • Andres A.
        A behavioral intervention to reduce excessive gestational weight gain.
        Maternal Child Health J. 2017; 21: 485-491
        • Lindholm E.S.
        • Norman M.
        • Kilander C.P.
        • Altman D.
        Weight control program for obese pregnant women.
        Acta Obstet. Gynecol. Scand. 2010; 89: 840-843
        • McCarthy E.A.
        • Walker S.P.
        • Ugoni A.
        • Lappas M.
        • Leong O.
        • Shub A.
        • McCarthy E.A.
        • Walker S.P.
        Self-weighing and simple dietary advice for overweight and obese pregnant women to reduce obstetric complications without impact on quality of life: a randomised controlled trial.
        BJOG Int. J. Obst. Gynaecol. 2016; 123: 965-973
        • McGiveron A.
        • Foster S.
        • Pearce J.
        • Taylor M.A.
        • McMullen S.
        • Langley-Evans S.C.
        Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention.
        J. Human Nutr. Dietetics. 2015; 28: 29-37
        • Okesene-Gafa K.A.M.
        • Li M.
        • McKinlay C.J.D.
        • Taylor R.S.
        • Rush E.C.
        • Wall C.R.
        • Wilson J.
        • Murphy R.
        • Taylor R.
        • Thompson J.M.D.
        • Crowther C.A.
        • McCowan L.M.E.
        Effect of antenatal dietary interventions in maternal obesity on pregnancy weight-gain and birthweight: healthy Mums and babies (HUMBA) randomized trial.
        Am. J. Obstet. Gynecol. 2019; 221 (152.e1–152.e13)
        • Peccei A.
        • Blake-Lamb T.
        • Rahilly D.
        • Hatoum I.
        • Bryant A.
        Intensive prenatal nutrition counseling in a community health setting: a randomized controlled trial.
        Obst. Gynecol. 2017; 130: 423-432
        • Quinlivan J.A.
        • Lam L.T.
        • Fisher J.
        A randomised trial of a four-step multidisciplinary approach to the antenatal care of obese pregnant women.
        Aust. N. Zeal. J. Obst. Gynaecol. 2011; 51: 141-146
        • Renault K.M.
        • Nørgaard K.
        • Nilas L.
        • Carlsen E.M.
        • Cortes D.
        • Pryds O.
        • Secher N.J.
        The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women.
        Am. J. Obst. Gynecol. 2014; 210 (134.e1–134.e9)
        • Ronnberg A.
        • Ostlund I.
        • Fadl H.
        • Gottvall T.
        • Nilsson K.
        Intervention during pregnancy to reduce excessive gestational weight gain-a randomised controlled trial.
        BJOG Int. J. Obst. Gynaecol. 2015; 122: 537-544
        • Saldana J.
        The Coding Manual for Qualitative Researchers.
        3rd ed. Sage, London2016
        • Barwick M.A.
        • Bennett L.M.
        • Johnson S.N.
        • McGowan J.
        • Moore J.E.
        Training health and mental health professionals in motivational interviewing: a systematic review.
        Children Youth Serv. Rev. 2012; 34: 1786-1795
        • Donnolley N.
        • Butler-Henderson K.
        • Chapman M.
        • Sullivan E.
        The development of a classification system for maternity models of care.
        Health Inform. Manag. J. 2016; 45: 64-70
        • Sandall J.
        • Soltani H.
        • Gates S.
        • Shennan A.
        • Devane D.
        Midwife-led continuity models versus other models of care for childbearing women.
        Cochrane Database Syst. Rev. 2016; : 1-118
        • White C.
        • Davis D.
        Barriers and enablers in maintaining healthy gestational weight gain: a qualitative study.
        Women Birth. 2020;