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Weight gain restriction for obese pregnant women: An Intervention study
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Obesity is a growing global public health problem and is as prevalent among pregnant women as in the general population. It is well known that obese women have an increased risk for several complications during pregnancy and delivery and this is also true for the neonate. Excessive gestational weight gain among obese women seems to further increase these risks for adverse outcomes. It has not been known up to the time of this study whether a behavioral intervention program designed for obese pregnant women could result in a reduction of gestational weight gain.

Aim: The overall aim of the present thesis was to study the effect of an intervention program designed to control weight gain among obese pregnant women during pregnancy and to then observe the outcomes of their pregnancies. In addition we wanted to learn if this behavioral intervention program could result in a weight gain of less than seven kilograms.

Material and methods: The intervention group consisted of 155 obese (BMI >30 kg/m2) pregnant women at the antenatal care clinic (ANC) in Linköping; the control group consisted of 193 obese pregnant women in two other cities. The women in the intervention group were offered, in addition to regular care at the ANC, motivational interviewing in weekly visits to support them in making this behavioral change. They were also offered aqua aerobic class once or twice a week. The women in the control group attended the routine antenatal program in their respective ANCs. Outcome measures were: weight in kg, pregnancy-, delivery and neonatal outcomes, prevalence of anxiety- and depressive symptoms and attitudes and experiences of participating in an intervention program.

Results: The women in the intervention group had a significantly lower gestational weight gain and also had a lower postnatal weight than the women in the control group. The percentage of women in the intervention group who gained <7 kg was greater than the percentage in the control group. There were no differences between the two groups in pregnancy-, delivery- and neonatal outcomes. In addition, there was no difference in prevalence of symptoms of anxiety and depressions between the intervention- and control group and the gestational weight gain did not have any effect on symptoms of depression or anxiety. The women in the intervention group with gestational weight gain <7 kg, weighed less at the two years follow-up than the women in the control group. Most of the women who participated in the intervention program expressed positive attitudes and were positive towards their experiences with the intervention program and their efforts to manage the gestational weight gain.

Conclusion: The intervention program was effective in controlling weight gain during pregnan-cy and did not change the pregnancy, delivery or neonatal outcomes or the prevalence of anxie-ty- and depressive symptoms. The group with a gestational weight gain <7 kg showed the same distribution of complications as the group with a higher weight gain. The intervention program seems to influence the development of weight in a positive direction up to two years after childbirth. The women were also satisfied with their participation in the intervention program.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2010. , 75 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1186
Keyword [en]
Obesity, pregnancy, weight gain, intervention, outcome, anxiety, depression, postnatal/postpartum
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-56390ISBN: 978-91-7393-386-5 (print)OAI: oai:DiVA.org:liu-56390DiVA: diva2:319602
Public defence
2010-06-04, Berzeliussalen, Ingång 65, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-05-25 Created: 2010-05-09 Last updated: 2010-05-25Bibliographically approved
List of papers
1. Weight gain restriction for obese pregnant women: A case-control intervention study
Open this publication in new window or tab >>Weight gain restriction for obese pregnant women: A case-control intervention study
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2008 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 115, no 1, 44-50 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To minimise obese women's total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome. Design: A prospective case-control intervention study. Setting: Antenatal care clinics in the southeast region of Sweden. Population: One hundred fifty-five pregnant women in an index group and one hundred ninety-three women in a control group. Methods: An intervention programme with weekly motivational talks and aqua aerobic classes for obese pregnant women. Main outcome measures: Weight gain in kilograms, delivery and neonatal outcome. Results: The index group had a significantly lower weight gain during pregnancy compared with the control group (P < 0.001). The women in the index group weighed less at the postnatal check-up compared with the weight registered in early pregnancy (P < 0.001). The percentage of women in the index group who gained less than 7 kg was greater than that of women in the control group who gained less than 7 kg (P = 0.003). The percentage of nulliparous women in this group was greater than that in the control group (P = 0.018). In addition, the women in the index group had a significantly lower body mass index at the postnatal check-up, compared with the control group (P < 0.001). There were no differences between the index group and the control group regarding birthweight, gestational age and mode of delivery. Conclusion: The intervention programme was effective in controlling weight gain during pregnancy and did not affect delivery or neonatal outcome.

Keyword
Delivery, intervention, neonatal, obesity, pregnancy, weight gain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-42955 (URN)10.1111/j.1471-0528.2007.01531.x (DOI)70184 (Local ID)70184 (Archive number)70184 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2013-09-10
2. Weight gain restriction during pregnancy is safe for both the mother and neonate.
Open this publication in new window or tab >>Weight gain restriction during pregnancy is safe for both the mother and neonate.
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2009 (English)In: Acta obstetricia et gynecologica Scandinavica, ISSN 1600-0412, Vol. 88, no 10, 1158-1162 p.Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to investigate whether pregnancy, delivery, and neonatal outcome among obese pregnant women who took part in an intervention study for weight restriction differed from a group of obese pregnant women attending regular antenatal care. The intervention group consisted of 155 obese pregnant women and 193 obese pregnant women who formed a control group. We found that a weight gain restriction of less than 7 kg during pregnancy is safe for both the mother and the neonate.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-51405 (URN)10.1080/00016340903214916 (DOI)19711205 (PubMedID)
Note
Original Publication: Ing-Marie Claesson, Jan Brynhildsen, Marie Cedergren, Annika Jeppsson, Adam Sydsjö and Ann Josefsson, Weight gain restriction during pregnancy is safe for both the mother and neonate., 2009, Acta obstetricia et gynecologica Scandinavica, (88), 10, 1158-1162. http://dx.doi.org/10.1080/00016340903214916 Copyright: Taylor and Francis http://www.tandf.co.uk/journals/default.asp Available from: 2009-10-30 Created: 2009-10-30 Last updated: 2011-04-04
3. Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study.
Open this publication in new window or tab >>Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study.
2010 (English)In: BMC Public Health, ISSN 1471-2458, Vol. 10, 766- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although studies have shown an association between anxiety and depression and obesity, psychological health among obese women during and after pregnancy has not been carefully studied. The aim of this study was to investigate psychological well-being using symptoms of depression and/or anxiety among obese pregnant women attending a weight gain restriction program and to then compare this group with a control group receiving traditional antenatal care.

METHODS: 151 obese pregnant women in an intervention group and 188 obese pregnant women in a control group answered the Beck Anxiety Inventory (BAI) and the Edinburgh Postnatal Depression Scale (EPDS). Group differences between the two groups were estimated by using the χ2 - test on categorical variables. The Student's t-test on continuous, normally distributed variables measuring changes in mean score on BAI and EPDS over time was used. To make a more comprehensive assessment of group differences, between as well as within the two groups, logistic regressions were performed with the BAI and EPDS as dependent variables, measured at gestational weeks 15 and 35 and 11 weeks postnatal. The grouping variable has been adjusted for socio-demographic variables and complications.

RESULTS: The prevalence of symptoms of anxiety during pregnancy varied between 24% and 25% in the intervention group and 22% and 23% in the control group. The prevalence of symptoms of anxiety postnatally was 9% in the intervention group and 11% in the control group. Five percent of the women in the intervention group and 4% of the women in the control group showed symptoms of anxiety during the course of pregnancy and at the postpartum assessment. The prevalence of symptoms of depression during pregnancy varied between 19% and 22% in the intervention group but was constant at 18% in the control group. Postnatal prevalence was 11% in both groups. Six percent of the women in the intervention group and 4% in the control group showed symptoms of depression during the course of pregnancy and at the postpartum assessment. We found no differences between the two groups as concerns demographic characteristics, weight gain in kg, or the distribution of scores on anxiety and depressive symptoms nor did we find differences in the fluctuation of anxiety and depressive symptoms over time between the women in the intervention group and in the control group.

CONCLUSION: Obese pregnant women attending an intervention program seem to have the same risk of experiencing anxiety and/or depressive symptoms as do obese pregnant and postnatal women in general.

Place, publisher, year, edition, pages
BMC, 2010
Keyword
Depression, anxiety, pregnancy, obesity, weight gain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-56582 (URN)10.1186/1471-2458-10-766 (DOI)000285890000001 ()
Note
Original Publication: Ing-Marie Claesson, Ann Josefsson and Gunilla Sydsjö, Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study., 2010, BMC Public Health, (10), 766. http://dx.doi.org/10.1186/1471-2458-10-766 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2010-05-25 Created: 2010-05-25 Last updated: 2011-04-04
4. Weight after childbirth: A 2-year follow-up of obese women in a weight-gain restriction program
Open this publication in new window or tab >>Weight after childbirth: A 2-year follow-up of obese women in a weight-gain restriction program
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2011 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 1, 103-110 p.Article in journal (Other academic) Published
Abstract [en]

Objective: To investigate the effects of a weight gain restriction program on weight development or weight maintenance two years after childbirth.

Methods: The intervention group consisted of 155 obese pregnant women who participated in a weight gain restriction program with weekly support duringpregnancy. The control group consisted of 193 obese pregnant women. Follow-up weight measurements were done at 12 and 24 months postpartum.

Results: The mean value of weight change in the intervention group was -2.2 kg compared to + 0.4 kg in the control group from early pregnancy to the follow-up 12 months after childbirth (p = .046). A greater percentage of women in the intervention group showed a weight loss 24 months after delivery than did women in the control group at that same time (p = .034). Women in the intervention group who gained less than 7 kg during pregnancy had a significantly lower weight than the controls at the 24 months follow-up (p = .018).

Conclusion: An intervention program with weekly motivational support visits during pregnancy and every 6 months after childbirth seems to have an impact on weight gain up to 24 months after childbirth for those women in the intervention group who succeeded in restricting their gestational weight gain to less than 7 kg.

Place, publisher, year, edition, pages
Informa Healthcare, 2011
Keyword
Pregnancy, obesity, postnatal/postpartum, weight gain, intervention
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-56583 (URN)10.1111/j.1600-0412.2010.01016.x (DOI)000287103300016 ()
Note
Original Publication: Ing-Marie Claesson, Gunilla Sydsjö, Jan Brynhildsen, Maria Blomberg, Annika Jeppsson, Adam Sydsjö and Ann Josefsson, Weight after childbirth: A 2-year follow-up of obese women in a weight-gain restriction program, 2011, Acta Obstetricia et Gynecologica Scandinavica, (90), 1, 103-110. http://dx.doi.org/10.1111/j.1600-0412.2010.01016.x Copyright: Informa Healthcare http://informahealthcare.com/ Available from: 2010-05-25 Created: 2010-05-25 Last updated: 2012-02-21
5. Consumer satisfaction with a weight-gain intervention programme for obese pregnant women.
Open this publication in new window or tab >>Consumer satisfaction with a weight-gain intervention programme for obese pregnant women.
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2008 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, no 2, 163-167 p.Article in journal (Refereed) Published
Abstract [en]

Objective: to investigate women's attitudes and satisfaction with a weight-gain intervention programme during pregnancy.

Design: exploratory, descriptive study. Data were collected via interviews.

Setting: University hospital.

Participants: 56 obese pregnant women who attended antenatal care at the University Hospital of Linköping's obstetrical department and took part in an intervention programme aimed at reducing weight gain during pregnancy, between November 2003 and August 2004.

Findings: the interviews comprised several questions concerning attitudes and opinions of the programme. Most of the women expressed positive experiences with the treatment and would attend the programme if they became pregnant again. Most of the women stated that they had changed their eating and exercise habits during pregnancy, and almost all of them had continued with these new habits. Even though the weight gain goal of a maximum 6.9 kg was reached by less than half of the participants, most of the women were satisfied with their weight gain. A total of 71.4% of the women participated in aqua aerobics classes. They stated that they were most satisfied with this form of exercise, and that it also was a good social experience.

Key conclusions and implications for practice: a pregnant woman herself must be actively involved in setting her own goals to prevent excessive weight gain during pregnancy. Considerable effort and support must be placed on discussing strategies, pitfalls and risks. In order for the woman to maintain the change in attitude and habits, she must probably be given continuous feedback and reinforcement over the long term.

Keyword
obesity, pregnancy, intervention
Identifiers
urn:nbn:se:liu:diva-15902 (URN)10.1016/j.midw.2006.10.007 (DOI)17316933 (PubMedID)
Note
Original Publication:Ing-Marie Claesson, Ann Josefsson, Marie Cedergren, Jan Brynhildsen, Annika Jeppsson, Fredrik Nyström, Adam Sydsjö and Gunilla Sydsjö, Consumer satisfaction with a weight-gain intervention programme for obese pregnant women, 2008, Midwifery, (24), 163-7.http://dx.doi.org/10.1016/j.midw.2006.10.007Copyright: Elsevier Science B.V., Amsterdamhttp://www.elsevier.com/Available from: 2008-12-15 Created: 2008-12-12 Last updated: 2013-09-10Bibliographically approved

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