Gestational Weight Gain
Implications of an Antenatal Lifestyle Intervention av
Ann-Kristin Rönnberg
Akademisk avhandling
Avhandling för medicine doktorsexamen i Obstetrik och Gynekologi,
som kommer att försvaras offentligt fredag den 30e September 2016 kl. 09.00, Hörsal HCS1, Campus USÖ, Örebro universitet
Opponent: Docent Marie Blomberg Linköpings Universitet
Örebro universitet
Institutionen för Medicinska Vetenskaper 701 82 ÖREBRO
© Ann-Kristin Rönnberg, 2016
Title: Gestational Weight Gain. Implications of an Antenatal Lifestyle Intervention.
Publisher: Örebro University 2016
www.oru.se/publikationer-avhandlingar
Print: Örebro University, Repro 08/2016
ISSN 1652-4063 ISBN 978-91-7529-148-2
Abstract
Ann-Kristin Rönnberg (2016): Gestational Weight Gain. Implications of an Antenatal Lifestyle Intervention. Örebro studies in Medicine 146.
Background: Excessive gestational weight gain (GWG) is common in developed
countries and is associated with an increased risk of maternal and offspring morbidity. Evidence regarding efficacy and safety of antenatal lifestyle intervention is limited in terms of both systematic reviews and original trials. This thesis is based on the need to further explore this research area. Objectives: To assess and grade current evi-dence and evaluate short and long-term effects of an antenatal lifestyle intervention on women and their offspring Materials: Controlled trials of intervention published before August 2009 were systematically searched and reviewed. A randomized con-trolled trial (RCT) including 445 healthy women aged >18 years with a body mass index (BMI) ≥19 and ≤16 weeks pregnant and their offspring was performed during 2007-2015 in Örebro Region, Sweden. Methods: The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used for review. Our RCT (called the VIGA trial) compared standard care with a composite interven-tion consisting of educainterven-tion, applicainterven-tion of a personalized weight graph, prescripinterven-tion of exercise and more frequent monitoring of weight. Standardized measures of weight and height in offspring waere analysed based on World Health Organization (WHO) Child Growth Standards. Results: Quality of evidence across the studies published pAugust 2009 was concluded to be very low. Our intervention significantly re-duced mean GWG (kg) but the proportion of women with excessive GWG, according to recommendations, was not significantly reduced. Short- term postpartum weight retention (PPWR) was significantly lower after the intervention but no significant difference remained 1 year after delivery. Offspring mean BMI z-scores or proportion of obesity did not differ between study groups at either birth or age 5. Conclusions: The antenatal lifestyle intervention reduced mean GWG and short-term PPWR but no long-term effects on maternal weight retention or offspring obesity were seen. Alternative modes and timing of intervention should be considered in future research. Reducing the prevalence of pre-conception obesity must still be considered the pri-mary means to improve maternal and fetal outcome.
Keywords: Gestational weight gain, maternal health, pregnancy, prevention of
obesi-ty, lifestyle intervention, childhood obesity.
Ann-Kristin Rönnberg, School of Health and Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden, ann-kristin.ronnberg@regionorebrolan.se
