Background
Women with elevated body mass index are encouraged to lose weight before pregnancy,
but no trials have tested the effects of prepregnancy weight loss on health outcomes.
Objective
This study aimed to determine whether prepregnancy weight loss reduces gestational
weight gain and improves pregnancy outcomes.
Study Design
Pragmatic randomized clinical trial was conducted between May 2015 and October 2019
at Kaiser Permanente Northwest, an integrated health system. Data collection was blind
to condition assignment. Eligible participants were women aged 18 to 40 years with
a body mass index of ≥27 kg/m2 who were planning pregnancy within 2 years. Recruitment contacts were sent to 27,665
health system members who met age and body mass index criteria; 329 women attended
screening visits, and 326 were randomized. They were randomized to either a behavioral
weight loss intervention or usual care control. The intervention consisted of health
coaching phone sessions weekly for 6 months and then monthly for 18 months or until
end of pregnancy. We used logistic regression to examine the a priori primary hypothesis
that participants in the intervention would be less likely to exceed National Academy
of Medicine guidelines for gestational weight gain during each trimester and overall.
Secondary and exploratory outcomes included absolute weight gain before and during
pregnancy and perinatal and newborn outcomes.
Results
Of the 326 participants, 169 had singleton pregnancies lasting ≥14 weeks (analytical
cohort: intervention, 89; control, 80). At baseline, mean age was 31.3±3.5 years,
and body mass index was 34.8±5.8 kg/m2. Participants in the intervention group lost more weight before pregnancy than those
in the control group (−0.25±0.51 vs −0.03±0.21 kg/wk; P<.001). However, participants in the intervention group gained more weight than those
in the control group in the second trimester (0.42±0.26 vs 0.33±0.28 kg/wk; P=.04) and third trimester (0.56±0.37 vs 0.43±0.33 kg/wk; P=.02) and overall (13.2±8.20 vs 10.3±7.41 kg; P=.03). Nevertheless, arms did not differ in rates of exceeding gestational weight
gain guidelines at any time point. Spontaneous pregnancy loss was less common in the
intervention arm than in the control arm (8 [4.9%] vs 19 [11.8%]; odds ratio, 0.39
[0.16–0.92]), but we found no other differences in the secondary or exploratory outcomes.
Conclusion
Participation in the prepregnancy weight loss intervention had no effect on women’s
likelihood of exceeding gestational weight gain guidelines. Although the intervention
group successfully lost weight before conception, the intervention group was associated
with greater weight gain in late pregnancy. To effectively reduce weight throughout
pregnancy and improve maternal and child outcomes, prepregnancy weight loss interventions
may need to be combined with intensive weight management that continues throughout
delivery.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Risk factors for gestational diabetes: an umbrella review of meta-analyses of observational studies.PLoS One. 2019; 14e0215372
- Association of gestational weight gain with adverse maternal and infant outcomes.JAMA. 2019; 321: 1702-1715
- Prevalence and trends in prepregnancy normal weight - 48 states, New York City, and District of Columbia, 2011–2015.MMWR Morb Mortal Wkly Rep. 2018; 66: 1402-1407
- Setting the stage for revising pregnancy weight guidelines: conceptual framework.in: Rasmussen K.M. Yaktine A.L. Weight gain during pregnancy: reexamining the guidelines. National Academies Press, Washington, DC2009: 1-13
- Directed preconception health programs and interventions for improving pregnancy outcomes for women who are overweight or obese.Cochrane Database Syst Rev. 2015; 7: CD010932
- Prepare, a randomized trial to promote and evaluate weight loss among overweight and obese women planning pregnancy: study design and rationale.Contemp Clin Trials. 2016; 49: 174-180
- The current understanding of gestational weight gain among women with obesity and the need for future research.(Available at:)https://doi.org/10.31478/202001a(Accessed Aug. 31, 2020)Date: 2019
- Adherence to a DASH-style diet and risk of coronary heart disease and stroke in women.Arch Intern Med. 2008; 168: 713-720
- The Harris Benedict equation reevaluated: resting energy requirements and the body cell mass.Am J Clin Nutr. 1984; 40: 168-182
- Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis.JAMA. 2017; 317: 2207-2225
- Pregnancy outcomes with weight gain above or below the 2009 Institute of Medicine guidelines.Obstet Gynecol. 2013; 121: 969-975
- The effect of new antepartum weight gain guidelines and prepregnancy body mass index on the development of pregnancy-related hypertension.Am J Perinatol. 2011; 28: 285-292
- Gestational weight gain as a risk factor for hypertensive disorders of pregnancy.Am J Obstet Gynecol. 2013; 209: 327.e1-327.e17
- Weight gain in pregnancy: does the Institute of Medicine have it right?.Am J Obstet Gynecol. 2015; 212: 362.e1-362.e8
- Association between gestational weight gain and perinatal outcomes.Obstet Gynecol. 2018; 132: 875-881
- Gestational weight gain and risk of gestational diabetes mellitus.Obstet Gynecol. 2010; 115: 597-604
- Maternal weight gain in women who develop gestational diabetes mellitus.Obstet Gynecol. 2012; 119: 560-565
- New equations for estimating body fat mass in pregnancy from body density or total body water.Am J Clin Nutr. 1988; 48: 24-29
- Associations of trimester-specific gestational weight gain with maternal adiposity and systolic blood pressure at 3 and 7 years postpartum.Am J Obstet Gynecol. 2015; 212: 499.e1-499.e12
- Trimester-specific gestational weight gain and infant size for gestational age.PLoS One. 2016; 11e0159500
- A nearly continuous measure of birth weight for gestational age using a United States national reference.BMC Pediatr. 2003; 3: 6
- Validity and usefulness of medical chart weights in the long-term evaluation of weight loss programs.Addict Behav. 1988; 13: 171-175
- Validity of clinical body weight measures as substitutes for missing data in a randomized trial.Obes Res Clin Pract. 2008; 2: 277-281
- Medical record versus researcher measures of height and weight.Biol Res Nurs. 2006; 8: 15-23
- Accuracy of height and weight data from child health records.Arch Dis Child. 2009; 94: 950-954
- Validity of medical chart weights and heights for obese pregnant women.EGEMS (Wash DC). 2014; 2: 1051
- The accuracy of self-reported pregnancy-related weight: a systematic review.Obes Rev. 2017; 18: 350-369
- Comparison of self-reported and measured pre-pregnancy weight: implications for gestational weight gain counseling.Matern Child Health J. 2017; 21: 1469-1478
- Validity of self-reported pre-pregnancy weight and body mass index classification in an integrated health care delivery system.Paediatr Perinat Epidemiol. 2016; 30: 314-319
- Prepregnancy weight and the risk of adverse pregnancy outcomes.N Engl J Med. 1998; 338: 147-152
- Prepregnancy weight status and the risk of adverse pregnancy outcome.Acta Obstet Gynecol Scand. 2008; 87: 953-959
- Effect of prepregnancy maternal overweight and obesity on pregnancy outcome.Obstet Gynecol. 2011; 118: 305-312
- Gestational Diabetes Mellitus.Diabetes Care. 2003; 26: s103-s105
- Modified intention to treat reporting in randomised controlled trials: systematic review.BMJ. 2010; 340: c2697
- Post-randomisation exclusions: the intention to treat principle and excluding patients from analysis.BMJ. 2002; 325: 652-654
- 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
- The International Federation of Gynecology and Obstetrics (FIGO) recommendations on adolescent, preconception, and maternal nutrition: “Think Nutrition First”.Int J Gynaecol Obstet. The International Federation of Gynecology and Obstetrics. 2015; 131: S213-S253
- SOGC clinical practice guidelines: obesity in pregnancy. No. 239, February 2010.Int J Gynaecol Obstet. 2010; 110: 167-173
- Weight management before, during and after pregnancy. 2010.(Available at:) (Accessed Aug. 31, 2020)
- An association between maternal weight change in the year before pregnancy and infant birth weight: ELFE, a French national birth cohort study.PLoS Med. 2019; 16e1002871
- Prevention of gestational diabetes with a prepregnancy lifestyle intervention—findings from a randomized controlled trial.Int J Womens Health. 2018; 10: 493-501
- Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial.JAMA. 2008; 299: 1139-1148
- Characterizing the pattern of weight loss and regain in adults enrolled in a 12-week Internet-based weight management program.Obesity (Silver Spring). 2018; 26: 318-323
- NIH working group report: innovative research to improve maintenance of weight loss.Obesity (Silver Spring). 2015; 23: 7-15
- Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: an updated systematic review for the U.S. Preventive Services Task Force.Agency for Healthcare Research and Quality (US), Rockville, MD2018
- The defence of body weight: a physiological basis for weight regain after weight loss.Clin Sci (Lond). 2013; 124: 231-241
- The expectant brain: adapting for motherhood.Nat Rev Neurosci. 2008; 9: 11-25
- How pregnant African American women view pregnancy weight gain.J Obstet Gynecol Neonatal Nurs. 2012; 41: 798-808
- “If she wants to eat…and eat and eat…fine! It’s gonna feed the baby”: pregnant women and partners’ perceptions and experiences of pregnancy with a BMI >40kg/m2.Midwifery. 2017; 49: 87-94
- Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement.JAMA. 2018; 320: 1163-1171
- Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: updated evidence report and systematic review for the US Preventive Services Task Force.JAMA. 2018; 320: 1172-1191
- Rapid weight loss vs. slow weight loss: which is more effective on body composition and metabolic risk factors?.Int J Endocrinol Metab. 2017; 15: e13249
- Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review.Semin Reprod Med. 2011; 29: 507-513
- Perinatal risk factors for childhood obesity and metabolic dysregulation.Am J Clin Nutr. 2009; 90: 1303-1313
Article Info
Publication History
Published online: July 17, 2020
Accepted:
July 15,
2020
Received in revised form:
July 13,
2020
Received:
May 26,
2020
Footnotes
The authors report no conflict of interest.
This study was supported, in part, by a grant ( R01/R56 DK099882 ) from the National Institute of Diabetes and Digestive and Kidney Diseases . The sponsor had no role in any of the following: design or conduct of the study; collection management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
This study was registered on January 26, 2015, on ClinicalTrails.gov (identifier number: NCT02346162) (https://clinicaltrials.gov/ct2/show/NCT02346162), before initial participant enrollment in May 2015.
Cite this article as: LeBlanc ES, Smith NX, Vesco KK, et al. Weight loss prior to pregnancy and subsequent gestational weight gain: Prepare, a randomized clinical trial. Am J Obstet Gynecol 2021;224:99.e1-14.
Identification
Copyright
© 2020 Published by Elsevier Inc.
