Mackeen Awathif Dhanya, Young Amanda J, Lutcher Shawnee, Hetherington Vonda, Mowery Jacob W, Savage Jennifer S, Symons Downs Danielle, Bailey-Davis Lisa
Department of Obstetrics and Gynecology Geisinger Danville Pennsylvania USA.
Department of Population Health Sciences Geisinger Danville Pennsylvania USA.
Obes Sci Pract. 2021 Sep 22;8(3):261-271. doi: 10.1002/osp4.565. eCollection 2022 Jun.
Excessive gestational weight gain (GWG) can increase pregnancy morbidity and is particularly problematic for women with pregestational obesity. A lifestyle modification intervention was introduced to gravida with obesity to decrease excessive GWG as compared to usual care (UC).
A randomized controlled trial was conducted to improve healthy lifestyle behaviors to manage appropriate GWG. Consenting participants with prepregnancy obesity and singletons ≤17 weeks were randomized to (1) : usual written educational materials and counseling by obstetric provider or (2) : UC plus (a) personalized letter from physician detailing appropriate GWG; (b) access to individualized GWG chart; (c) ongoing counseling with registered dietitian/nutritionist (RDN). The primary outcome was proportion with GWG ≤9.1 kg, as this is upper limit recommended by Institute of Medicine (IOM). Total GWG and GWG as less than/within/greater than IOM recommendations (in aggregate and stratified by obesity class), and pregnancy/neonatal outcomes were evaluated as secondary outcomes.
Analyses included 105 participants in EC and 109 in UC arms. The groups had similar demographics: 46% with class I obesity, 26% class II, and 28% class III. There were no group differences for any GWG, pregnancy, or neonatal outcomes when analyzed in aggregate. As compared to those randomized to the EC arm, participants in UC arm with class I obesity gained 1.4 kg less and those with class II obesity were significantly more likely to gain within IOM guidelines (14.8% vs. 40.0%, adjusted = 0.04). Participants with class III obesity randomized to EC arm were more likely to gain within IOM guidelines as compared to participants randomized to UC arm (29.0% vs. 6.7%, adjusted = 0.02).
There were no differences in GWG observed between groups when analyzing participants in aggregate. However, a physician's letter detailing appropriate GWG, patient portal access to a personalized GWG chart, and RDN consultation were helpful for encouraging GWG within IOM guidelines for women with prepregnancy class III obesity. Women with class I or II obesity had better GWG outcomes without these additional interventions.
孕期体重增加过多（GWG）会增加妊娠并发症的发生风险，对于孕前肥胖的女性而言问题尤为突出。与常规护理（UC）相比，针对肥胖孕妇引入了一种生活方式改善干预措施，以减少过多的GWG。
开展了一项随机对照试验，以改善健康生活方式行为，从而控制适当的GWG。符合条件的孕前肥胖且单胎妊娠≤17周的参与者被随机分为两组：（1）常规书面教育材料并由产科医生进行咨询指导；（2）常规护理加（a）医生详细说明适当GWG的个性化信件；（b）获取个性化GWG图表；（c）由注册营养师/营养学家（RDN）进行持续咨询指导。主要结局是GWG≤9.1kg的比例，因为这是医学研究所（IOM）推荐的上限。总GWG以及GWG低于/在/IOM推荐范围之内/高于IOM推荐范围（总体以及按肥胖类别分层），以及妊娠/新生儿结局作为次要结局进行评估。
分析纳入了强化护理组（EC）的105名参与者和常规护理组（UC）的109名参与者。两组的人口统计学特征相似：46%为I级肥胖，26%为II级肥胖，28%为III级肥胖。总体分析时，任何GWG、妊娠或新生儿结局在两组之间均无差异。与随机分配到强化护理组的参与者相比，常规护理组中I级肥胖的参与者体重增加少1.4kg，II级肥胖的参与者更有可能在IOM指南范围内增加体重（14.8%对40.0%，校正后P = 0.04）。与随机分配到常规护理组的参与者相比，随机分配到强化护理组的III级肥胖参与者更有可能在IOM指南范围内增加体重（29.0%对6.7%，校正后P = 0.02）。
总体分析参与者时，两组之间未观察到GWG存在差异。然而，医生详细说明适当GWG的信件、患者通过门户网站获取个性化GWG图表以及RDN咨询有助于鼓励孕前III级肥胖女性的GWG在IOM指南范围内。I级或II级肥胖女性在没有这些额外干预措施的情况下GWG结局更好。
