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Effects of maternal lifestyle intervention during pregnancy on untreated partner weight: Results from fit for delivery study.

ABSTRACT: To test the hypothesis that untreated partners of pregnant women receiving a prenatal lifestyle intervention (vs. standard care) would lose more weight during pregnancy and postpartum.Fit for Delivery was a study of 401 pregnant women with overweight/obesity (OW/OB) and normal weight (NW) randomized to prenatal lifestyle intervention or standard care. Mother's self-report of partners' weight was obtained at study entry (<16 weeks gestation), 30 weeks gestation, and 6 and 12 months postpartum.At study entry, 157 of 200 (78%) of intervention mothers and 144 of 201 (72%) of standard care mothers reported having a partner. In intent-to-treat analyses, there was no significant treatment × time effects on partner weight (P = 0.67). In secondary analyses, partners of OW/OB intervention women lost weight from study entry to 6 and 12 months postpartum (-0.5 ± 9.5 kg, -1.0 ± 9.3 kg; P < 0.05), while partners of standard care women gained weight during the same time frame (+2.5 ± 6.7 kg, +2.9 ± 7.4 kg; P < 0.05); adjusting for partner study entry BMI removed these effects.Lifestyle intervention delivered to pregnant women did not significantly reduce weight of untreated partners. Future research is needed to test prenatal interventions that engage partners and use objective measures of weight.

SUBMITTER: Hagobian TA

PROVIDER: S-EPMC4688135 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Effects of maternal lifestyle intervention during pregnancy on untreated partner weight: Results from fit for delivery study.

Hagobian Todd A TA Phelan Suzanne S Gorin Amy A AA Phipps Maureen G MG Abrams Barbara B Wing Rena R RR

Obesity (Silver Spring, Md.) 20151206 1

<h4>Objective</h4>To test the hypothesis that untreated partners of pregnant women receiving a prenatal lifestyle intervention (vs. standard care) would lose more weight during pregnancy and postpartum.<h4>Methods</h4>Fit for Delivery was a study of 401 pregnant women with overweight/obesity (OW/OB) and normal weight (NW) randomized to prenatal lifestyle intervention or standard care. Mother's self-report of partners' weight was obtained at study entry (<16 weeks gestation), 30 weeks gestation, ...[more]

PMID: 26637985

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Project description:The effectiveness of prenatal lifestyle intervention to prevent gestational diabetes and improve maternal glucose metabolism remains to be established. The Norwegian Fit for Delivery (NFFD) randomized, controlled trial studied the effect of a combined lifestyle intervention provided to a general population, and found significantly lower gestational weight gain among intervention participants but no improvement in obstetrical outcomes or the proportion of large infants. The aim of the present study is to examine the effect of the NFFD intervention on glucose metabolism, including an assessment of the subgroups of normal-weight and overweight/obese participants.Healthy, non-diabetic women expecting their first child, with pre-pregnancy body mass index (BMI) ?19 kg/m2, age ? 18 years and a singleton pregnancy of ?20 gestational-weeks were enrolled from healthcare clinics in southern Norway. Gestational weight gain was the primary endpoint. Participants (n = 606) were individually randomized to intervention (two dietary consultations and access to twice-weekly exercise groups) or control group (routine prenatal care). The effect of intervention on glucose metabolism was a secondary endpoint, measuring glucose (fasting and 2-h following 75-g glucose load), insulin, homeostatic assessment of insulin resistance (HOMA-IR) and leptin levels at gestational-week 30.Blood samples from 557 (91.9%) women were analyzed. For the total group, intervention resulted in reduced insulin (adj. Mean diff -0.91 mU/l, p = 0.045) and leptin levels (adj. Mean diff -207 pmol/l, p = 0.021) compared to routine care, while glucose levels were unchanged. However, the effect of intervention on both fasting and 2-h glucose was modified by pre-pregnancy BMI (interaction p = 0.030 and p = 0.039, respectively). For overweight/obese women (n = 158), intervention was associated with increased risk of at least one glucose measurement exceeding International Association of Pregnancy and Diabetes Study Group thresholds (33.7% vs. 13.9%, adj. OR 3.89, p = 0.004).The Norwegian Fit for Delivery intervention lowered neither glucose levels nor GDM incidence, despite reductions in insulin and leptin. Prenatal combined lifestyle interventions designed for a general population may be unsuited to reduce GDM risk, particularly among overweight/obese women, who may require earlier and more targeted interventions.ClinicalTrials.gov ID NCT01001689 , registered July 2, 2009, confirmed completed October 26, 2009 (retrospectively registered).

Project description:BACKGROUND: The global obesity epidemic has led to increased attention on pregnancy, a period when women are at risk of gaining excessive weight. Excessive gestational weight gain is associated with numerous complications, for both mother and child. Though the problem is widespread, few studies have examined the effect of a lifestyle intervention in pregnancy designed to limit maternal weight gain. The Fit for Delivery study will explore the effectiveness of nutritional counseling coupled with exercise classes compared with standard prenatal care. The aims of the study are to examine the effect of the intervention on maternal weight gain, newborn birth weight, glucose regulation, complications of pregnancy and delivery, and maternal weight retention up to 12 months postpartum. METHODS/DESIGN: Fit for Delivery is a randomized controlled trial that will include 600 women expecting their first child. To be eligible, women must be 18 years of age or older, of less than 20 weeks gestational age, with a singleton pregnancy, and have a Body Mass Index (BMI) ? 19 kg/m2. The women will be randomly allocated to either an intervention group or a control group. The control group will receive standard prenatal care. The intervention group will, in addition, receive nutritional counseling by phone, access to twice-weekly exercise sessions, and information on healthy eating and physical activity provided in pamphlets, evening meetings and an interactive website. Both groups will be monitored by weighing (including bioimpedance measurements of percent body fat), blood tests, self-report questionnaires and hospital record review. DISCUSSION: Weight gained in pregnancy affects the health of both the mother and her unborn child, and simple models for efficient intervention are in high demand. The Fit for Delivery intervention provides concrete advice on limiting energy intake and practical training in increasing physical activity. This lifestyle intervention is simple, reproducible, and inexpensive. The design of the study reflects the realities of clinical practice, where patients are free to choose whether or not they respond to health initiatives. If we find measurable health benefits associated with the intervention, it may be an easily adopted supplement to routine prenatal care, in the prevention of obesity. TRIAL REGISTRATION: ClinicalTrial.gov, NCT01001689.

Project description:BACKGROUND:To develop effective health promotional and preventive prenatal programs, it is important to understand perceived barriers to leisure-time physical activity during pregnancy, including exercise and sport participation. The aims of the present study was 1) to assess the effect of prenatal lifestyle intervention on the perceived barrier to leisure-time physical activity during pregnancy and the first year after delivery and 2) identify the most important perceived barriers to leisure-time physical activity at multiple time points during and after pregnancy. METHODS:This secondary analysis was part of the Norwegian Fit for Delivery study, a combined lifestyle intervention evaluated in a blinded, randomized controlled trial. Healthy, nulliparous women with singleton pregnancy of ?20 gestational weeks, age???18 years and body mass index ?19 kg/m2 were recruited via healthcare clinics in southern Norway, including urban and rural settings. Participants were randomized to either twice-weekly supervised exercise sessions and nutritional counselling (n?=?303) or standard prenatal care (n?=?303). The principal analysis was based on the participants who completed the standardized questionnaire assessing their perceived barriers to leisure-time physical activity at inclusion (gestational week 16, n?=?589) and following intervention (gestational week 36, n?=?509), as well as six months (n?=?470) and 12 months (n?=?424) postpartum. RESULTS:Following intervention (gestation week 35.4?±?1.0), a significant between-group difference in perceived barriers to leisure-time physical activity was found with respect to time constraints: "... I do not have the time" (intervention: 22 vs. control: 38, p?=?0.030), mother-child safety concerns: "... afraid to harm the baby" (intervention: 8 vs. control: 25, p?=?0.002) and self-efficacy: "... I do not believe/think that I can do it" (intervention: 3 vs. control: 10, p?=?0.050). No positive effect was seen at postpartum follow-up. Intrapersonal factors (lack of time, energy and interest) were the most frequently perceived barriers, and consistent over time among all participants. CONCLUSION:The intervention had effect on intrapersonal perceived barriers in pregnancy, but not in the postpartum period. Perceived barriers to leisure-time physical activity were similar from early pregnancy to 12 months postpartum. TRIAL REGISTRATION:ClinicalTrials.gov: NCT01001689 , registered July 2, 2009.

Project description:ObjectiveThe Action for Health in Diabetes (Look AHEAD) trial was a randomized controlled clinical trial to compare the effects of 10 years of intensive lifestyle intervention (ILI) with a control condition of diabetes support and education (DSE) on health outcomes in over 5,000 participants with type 2 diabetes. The ILI had significantly greater weight losses than DSE throughout the trial. The goal of this analysis is to describe the cost of delivering the intervention.MethodsThe ILI was designed to promote weight loss and increase physical activity. It involved a combination of group plus individual intervention sessions, with decreasing frequency of contact over the 10 years. The intervention incorporated a variety of strategies, including meal replacement products, to improve weight loss outcomes. The costs of intervention delivery were derived from staff surveys of effort and from records of intervention materials from the 16 US academic clinical trial sites. Costs were calculated from the payer perspective and presented in 2012 dollars.ResultsDuring the first year, when intervention delivery was most intensive, the annual cost of intervention delivery, averaged (standard deviation) across clinical sites, was $2,864.6 ($513.3) per ILI participant compared with $202.4 ($76.6) per DSE participant. As intervention intensity declined, costs decreased, such that from years 5 to 9 of the trial, the annual cost of intervention was $1,119.8 ($227.7) per ILI participant and $102.9 ($33.0) per DSE participant. Staffing accounted for the majority of costs throughout the trial, with meal replacements and materials to promote adherence accounting for smaller shares.ConclusionsThe sustained weight losses produced by the Look AHEAD intervention were supported by intervention costs that were within the range of other weight loss programmes. Future work will include an evaluation of the cost-effectiveness of the ILI and will contain additional follow-up data.

Project description:Excessive gestational weight gain (GWG) is associated with elevated weight retention in mothers and might be related to adiposity of their offspring. Little is known if lifestyle intervention during pregnancy has beneficial effects for mothers and children beyond gestation.A cluster-randomized controlled intervention trial was performed with 250 pregnant women in 8 gynaecological practices. Lifestyle intervention was carried out twice with individual counselling sessions on nutrition, physical activity and weight monitoring. Participants in the control group received routine prenatal care and an information leaflet. Follow-up data of women and their offspring were collected one year postpartum (pp) by phone call and/or via e-mail using a structured questionnaire. Maternal weight retention at 12 months pp and weight development of the children in their first year of life was compared between groups using linear regression. The association between energy and macronutrient intake during pregnancy with maternal weight retention and children weight development was also assessed.The intervention resulted in a trend towards lower mean weight retention 12 months pp (0.2 vs. 0.8 kg), but was not statistically significant (p = 0.321). Among women receiving lifestyle counselling, only 8% retained more than 5 kg weight while 17% in the control group retained >5 kg (OR: 0.40 (95% CI: 0.16, 0.97)). For the whole study cohort, an association between higher GWG and increased 12 month weight retention was found (0.4 kg weight retention per 1 kg increase in GWG, p < 0.001). Weight development of the infants did not differ between groups in the first months after birth. At the 10th-12th month weight measurement, infants born to mothers in the intervention group tended towards lower body weights. Both energy intake and macronutrient composition of the diet during pregnancy did not affect maternal weight retention and weight development of the infants.Lifestyle counselling during pregnancy to avoid GWG had a rather modest effect on maternal pp weight retention and weight development of the infants. However, larger intervention studies and longer follow-up are required to be able to draw definite conclusions.German Clinical Trials Register DRKS00003801.

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Effects of maternal lifestyle intervention during pregnancy on untreated partner weight: Results from fit for delivery study.

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Effects of maternal lifestyle intervention during pregnancy on untreated partner weight: Results from fit for delivery study.

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