Limiting antenatal weight gain improves maternal health outcomes in severely obese pregnant women: findings of a pragmatic evaluation of a midwife-led intervention

Abstract

Background: Antenatal obesity in pregnancy is associated with complications of pregnancy and poor obstetric outcomes. Although most guidance on pregnancy weight is focused on the pre-pregnancy period, pregnancy is widely viewed as a period where women are open to lifestyle change to optimise their health. Method: The hospital-based Bumps and Beyond intervention invited all pregnant women with a BMI of over 35 kg/m2 to take part in a programme of health education around diet and exercise, accompanied by one-to-one guidance and monitoring of dietary change. This service evaluation compares 89 women who completed at a programme of 7 sessions with healthy lifestyle midwives and advisors (intervention) with a group of 89 women who chose not to attend (non-intervention). Results: Weight gain in the intervention group (4.5±4.6 kg) was less than in the non-intervention group (10.3±4.4 kg) between antenatal booking and 36 weeks gestation (<0.001). This was associated with a 95% reduction in the risk of gestational hypertension during pregnancy and a general reduction in pregnancy complications. There was no effect of the intervention upon gestational diabetes or complications in labour other than post-partum haemorrhage (reduced 55%). The impact of the intervention on gestational weight gain was greater in women with BMI over 40 kg/m2 at booking. There were no adverse effects of the intervention, even though 21% of the intervention group lost weight during their pregnancy. Conclusion: Intensive, personalised weight management intervention may be an effective strategy for prevention of hypertensive disorders during pregnancy