College of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Sheffield, United Kingdom.
Women Birth. 2024 Feb;37(1):197-205. doi: 10.1016/j.wombi.2023.08.010. Epub 2023 Sep 9.
Women with obesity are more likely to gain excessive gestational weight; with both obesity and excessive weight gain linked to adverse outcomes for mothers and their infant. Provision of antenatal healthy lifestyle services is currently variable, with uncertainty over the most effective gestational healthy lifestyle interventions.
To compare pregnancy and birth outcomes among women who experienced an antenatal health lifestyle service with a cohort who did not receive this service.
A retrospective comparative cohort study was undertaken in women with a BMI ≥ 40 kg/m² attending maternity care in two NHS Trusts. One Trust provided an antenatal healthy lifestyle service, while the comparison Trust provided routine maternity care. Data was collected from medical records.
No differences were observed between the antenatal healthy lifestyle service and comparison cohorts for average gestational weight gain [adjusted mean difference (aMD) - 0.70 kg (95%CI -2.33, 0.93)], rate of weight gain [aMD - 0.02 kg/week (95%CI -0.08, 0.04)] or weight gain in accordance with recommendations. The proportion of women breastfeeding at discharge was higher for the antenatal healthy lifestyle service than the comparison cohort (42.4% vs 29.8%). No other clinical outcomes were enhanced with the antenatal healthy lifestyle service.
Internal audit had suggested the antenatal healthy lifestyle service was successful at managing gestational weight gain in women with a BMI ≥ 40 kg/m². However, no benefit on gestational weight gain was evident once the service was evaluated against a comparison cohort with adequate adjustment for confounders. It is essential that future services are evaluated against a relevant comparison group.
肥胖女性更容易在孕期体重增加过多；肥胖和体重过度增加都与母亲及其婴儿的不良后果有关。目前，产前健康生活方式服务的提供存在差异，对于最有效的妊娠期健康生活方式干预措施存在不确定性。
比较接受产前健康生活方式服务的女性与未接受该服务的女性的妊娠和分娩结局。
对在两家 NHS 信托机构接受产科护理的 BMI≥40kg/m²的女性进行回顾性比较队列研究。一家信托机构提供产前健康生活方式服务，而对照组信托机构则提供常规产科护理。数据从病历中收集。
在平均孕期体重增加方面，产前健康生活方式服务组与对照组之间没有差异[调整后的平均差异（aMD）-0.70kg（95%CI-2.33，0.93）]，体重增加率[aMD-0.02kg/周（95%CI-0.08，0.04）]或按建议增加体重方面也没有差异。接受产前健康生活方式服务的女性在出院时母乳喂养的比例高于对照组（42.4%比 29.8%）。产前健康生活方式服务并没有改善其他临床结局。
内部审计表明，产前健康生活方式服务成功地控制了 BMI≥40kg/m²的女性的孕期体重增加。然而，一旦针对具有充分混杂因素调整的对照组进行评估，就没有明显证据表明该服务对孕期体重增加有获益。未来的服务必须针对相关的对照组进行评估。
