How to avoid excessive weight gain during pregnancy?

We will discuss “Lifestyle intervention to limit gestational weight gain: the Norwegian Fit for Delivery randomised controlled trial” by Sagedal and co-workers from 27 January 2016 for 7 days.

*This paper is now FREE-TO-VIEW

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Start date: 27 January 2016 (the discussion will open for 7 days between 27 January to 3 February 2016)

First hosted discussion session(s) starts at: GMT 8pm (UK time) *** NOTE: new start time for #BlueJC in 2016

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BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published manuscript)

Scenario

A nulliparous woman visits with her midwife at 13 week of her pregnancy. Her body mass index is 23 kg/m2 and she is healthy. Her dating ultrasound scan was normal. She is concerned about weight gain during pregnancy because her sister became overweight during pregnancy and struggled to lose weight after birth. She asks, “what can I do to avoid gaining too much weight during my pregnancy?”.

Description of research

Participants Healthy, non-diabetic, nulliparous women, ≥18 years, body mass index ≥19 kg/m2, with a singleton pregnancy of ≤20 gestational-weeks.
Intervention Dietary counselling twice by telephone and access to twice-weekly exercise groups
Comparison Standard prenatal care
Outcomes Primary outcomes: maternal gestational weight gain (GWG), weight of the newborn, maternal fasting serum glucose level, incidence of operative delivery, maternal body composition

Secondary outcomes: proportion of newborns with weight ≥90th percentile, the proportion of women with elevated 2-hour glucose tolerance tests, measurement of hormones related to glucose metabolism, the incidence of delivery complications and postpartum weight retention

Study design Randomised controlled trial (Trial registration number: NCT01001689)
Authors’ conclusion Despite a modest but significant decrease in GWG, lifestyle intervention had no measurable effect on obstetrical or neonatal outcomes.


Discussion Points

  • Which additional factors you may consider when you counsel this woman?
  • Which interventions have been used to maintain maternal weight during pregnancy? Are they effective? (See suggested reading)
  • Critically appraise this randomised controlled trial (RCT) using the Critical Appraisal Skill Programme (CASP; http://www.casp-uk.net/) checklist.
  • Based on your assessment, what are the strengths and weaknesses of this RCT?
  • Which parameter was used in the power calculation of this RCT? How does it impact on the design of this study?
  • How do the demographics of the study participants compare to women you encounter in your usual practice?
  • In this study how do the measured outcomes differ between women who had normal BMI (<25 kg/m2), women who were overweight (20-25 kg/m2) and obese (>25 kg/m2)
  • How would you advice the woman in the scenario?

Suggested reading

  • Sagedal LR, Øverby NC, Lohne-Seiler H, Bere E, Torstveit MK, Henriksen T, Vistad I. Study protocol: fit for delivery – can a lifestyle intervention in pregnancy result in measurable health benefits for mothers and newborns? A randomized controlled trial. BMC Public Health. 2013 Feb 13;13:132.
  • Thangaratinam S, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. BMJ. 2012 May 16;344:e2088.

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