Polley B A, Wing R R, Sims C J
University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Int J Obes Relat Metab Disord. 2002 Nov;26(11):1494-502. doi: 10.1038/sj.ijo.0802130.
The Institute of Medicine (IOM) recommends that normal-weight women (BMI (body mass index) of 19.8-26.0) gain 25-35 lb (11.4-15.9 kg) during pregnancy, and that overweight women (BMI of 26.1-29.0) gain 15-25 lbs (6.8-11.4 kg). A significant number of normal-weight women and an even greater proportion of overweight women exceed these guidelines, which increases postpartum weight retention and may contribute to the development of obesity.
To determine whether a stepped care, behavioral intervention will decrease the percentage of women who gain more than the IOM recommendation.
Randomized controlled trial comparing a stepped-care behavioral intervention with usual care. Women (n=120) who had a BMI>19.8, age>18 and <20 weeks gestation were recruited from a hospital-based clinic serving low-income women and randomized by race and BMI category to the intervention or control group. The intervention group received education about weight gain, healthy eating, and exercise and individual graphs of their weight gain. Those exceeding weight gain goals were given more intensive intervention. Women were followed through pregnancy to their first postpartum clinic visit. The main outcome measure was weight gain during pregnancy categorized as above the IOM recommendations vs below or within the IOM recommendations.
The intervention significantly decreased the percentage of normal-weight women who exceeded the IOM recommendations (33 vs 58%, P<0.05). There was a non-significant (P=0.09) effect in the opposite direction among overweight women (59% of intervention and 32% of control gained more than recommended). Postpartum weight retention was strongly related to weight gain during pregnancy (r=0.89).
The intervention reduced excessive weight gain during pregnancy among normal weight women.
美国医学研究所（IOM）建议，体重正常的女性（体重指数（BMI）为19.8 - 26.0）孕期增重25 - 35磅（11.4 - 15.9千克），超重女性（BMI为26.1 - 29.0）增重15 - 25磅（6.8 - 11.4千克）。相当数量的体重正常女性以及更大比例的超重女性超出了这些指南范围，这增加了产后体重滞留，可能促使肥胖的发生。
确定分级护理行为干预是否会降低孕期增重超过IOM建议值的女性比例。
一项随机对照试验，比较分级护理行为干预与常规护理。从一家为低收入女性服务的医院诊所招募BMI>19.8、年龄>18岁且妊娠<20周的女性（n = 120），并根据种族和BMI类别随机分为干预组或对照组。干预组接受了关于体重增加、健康饮食和运动的教育以及其体重增加的个人图表。那些超出体重增加目标的人接受了更强化的干预。女性在孕期接受随访直至她们的首次产后诊所就诊。主要结局指标是孕期体重增加情况，分为超过IOM建议值与低于或在IOM建议值范围内。
干预显著降低了体重正常且超出IOM建议值的女性比例（33%对58%，P<0.05）。超重女性中存在相反方向的非显著效应（干预组59%，对照组32%增重超过建议值，P = 0.09）。产后体重滞留与孕期体重增加密切相关（r = 0.89）。
该干预减少了体重正常女性孕期的过度体重增加。
