产前生活方式干预对产后 12 个月体重保留的影响：挪威 Fit for Delivery 随机对照试验的结果。

The effect of prenatal lifestyle intervention on weight retention 12 months postpartum: results of the Norwegian Fit for Delivery randomised controlled trial.

机构信息

Department of Obstetrics and Gynecology, Sørlandet Hospital, Kristiansand, Norway.

Department of Research, Sørlandet Hospital, Kristiansand, Norway.

出版信息

BJOG. 2017 Jan;124(1):111-121. doi: 10.1111/1471-0528.13863. Epub 2016 Jan 20.

OBJECTIVE

To examine the effect of a prenatal lifestyle intervention on postpartum weight retention (PPWR).

DESIGN

Randomised controlled trial.

SETTING

Healthcare clinics in southern Norway.

POPULATION

Healthy, nulliparous women with body mass index ≥19 kg/m , age ≥18 years, and singleton pregnancy of ≤20 gestational weeks.

METHODS

Women were randomised to intervention (dietary counselling twice by phone and access to twice-weekly exercise groups during pregnancy) or control group (standard prenatal care). Intervention compliance was defined post-factum as attending dietary counselling and ≥14 exercise classes.

MAIN OUTCOME MEASURES

PPWR (weight measured postpartum minus self-reported pre-pregnancy weight) and the proportion of women returning to pre-pregnancy weight.

RESULTS

Of 606 women randomised, 591 were included in an intention-to-treat analysis of pregnancy outcomes and 391 (64.5%) were analysed 12 months postpartum. Mean PPWR was not significantly different between groups (0.66 kg for intervention versus 1.42 kg for control group, mean difference -0.77 kg, 95% CI -1.81, 0.28; P = 0.149). An increased proportion of intervention participants achieved pre-pregnancy weight (53% versus 43%, OR 1.50, 95% CI 1.003, 1.471; P = 0.045). However, the difference was not statistically significant when we adjusted for missing data (adjusted odds ratio (OR) 2.23, P = 0.067) using logistic mixed-effects models analysis. Women compliant with intervention had significantly lower PPWR than control participants, also after adjusting for potential confounders (adjusted mean diff -1.54 kg, 95% CI -3.02, -0.05; P = 0.039).

CONCLUSIONS

The Norwegian Fit for Delivery intervention had little effect on PPWR, although women who were compliant with the intervention demonstrated significantly lower PPWR at 12 months.

TWEETABLE ABSTRACT

Norwegian Fit for Delivery RCT: little effect of lifestyle intervention on weight retention 1 year postpartum.

目的

探讨产前生活方式干预对产后体重滞留（PPWR）的影响。

设计

随机对照试验。

地点

挪威南部的医疗保健诊所。

人群

健康、初产妇，BMI≥19kg/m²，年龄≥18 岁，单胎妊娠≤20 孕周。

方法

将女性随机分为干预组（电话咨询 2 次，孕期参加每周 2 次的运动小组）或对照组（标准产前护理）。干预依从性定义为接受饮食咨询和参加≥14 次运动课程。

主要结局指标

PPWR（产后体重减去自我报告的孕前体重）和恢复孕前体重的女性比例。

结果

606 名随机分配的女性中，591 名纳入妊娠结局的意向治疗分析，391 名（64.5%）在产后 12 个月进行分析。两组间的平均 PPWR 无显著差异（干预组 0.66kg，对照组 1.42kg，平均差异-0.77kg，95%CI-1.81，0.28；P=0.149）。干预组中更多的参与者达到了孕前体重（53%对 43%，OR 1.50，95%CI 1.003，1.471；P=0.045）。然而，当使用逻辑混合效应模型分析调整缺失数据的影响时（调整后的优势比（OR）2.23，P=0.067），差异无统计学意义。在调整了潜在混杂因素后，与对照组相比，依从干预的女性 PPWR 显著降低（调整后的平均差值-1.54kg，95%CI-3.02，-0.05；P=0.039）。

结论

挪威 Fit for Delivery 干预对 PPWR 影响较小，尽管依从性干预的女性在 12 个月时 PPWR 显著降低。

研究亮点

本研究为随机对照试验，旨在探讨产前生活方式干预对产后体重滞留的影响。
研究对象为健康、初产妇，BMI≥19kg/m²，年龄≥18 岁，单胎妊娠≤20 孕周。
干预组接受电话咨询和每周 2 次的运动小组，对照组接受标准产前护理。
主要结局指标为产后体重减去自我报告的孕前体重的差值（PPWR）和恢复孕前体重的女性比例。
结果显示，干预组的 PPWR 与对照组无显著差异，但干预组中更多的参与者达到了孕前体重。
调整缺失数据和潜在混杂因素后，依从干预的女性 PPWR 显著降低。