Abstract
The management of pregnancy and delivery is facing a major issue as the prevalence of overweight and obesity during pregnancy rises globally. Compared to women with a body mass index in the optimal range (20–24.99 kg m–2), those with a pre-pregnancy BMI greater than 25 kg m–2 are more likely to experience difficulties conceiving and to be at higher risk of miscarriage and stillbirth. Overweight, obesity, and excessive gestational weight gain increase the risk of all pregnancy problems, including those that seriously endanger the lives of expectant mothers and their unborn children. Obesity and overweight worsen pregnancies, increasing the likelihood of labor difficulties. Women are more receptive to messages regarding their lifestyle and health during pregnancy. They also have more opportunities to interact with medical professionals at this period. Although several studies have shown that appropriate interventions centered around dietary changes can be effective in controlling weight gain and lowering the risk of pregnancy complications, management of pregnancy weight gain and the impact of overweight is currently generally poor. The development of individualized and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care.
Introduction
For women in developed nations, pregnancy and delivery are now generally safe because to modern medical care. In the Global North, the rates of stillbirth and late fetal death range from four to six per 1000 births, while the maternal mortality rate is fewer than one per 10,000 births. One A number of factors, including as improved nutrition and high levels of sanitation and cleanliness, have contributed to improvements in outcomes since the 1960s, but women’s control over reproduction has been the most significant. Given that over 60% of pregnancies are now scheduled in advance, women and their partners have the chance to modify their lifestyles to improve pregnancy health and lower the risk of unfavorable pregnancy outcomes.
One of the main advantages of the medicalization of pregnancy, which is typified by antenatal observation and intervention, is the relative safety of pregnancy and childbirth for women in high-income nations. Naturally, this is not the case in the Global South, where problems associated to pregnancy and childbirth continue to be the leading cause of death for young women. In cases when women gain from improvements in obstetric care, there are worries that the medical control of pregnancy has become overly invasive and that the advantages of careful monitoring and prompt intervention—especially during labor—do not outweigh the related expenses and the loss of women’s autonomy. In light of this, it is unexpected that weight control and dietary modifications are not standard components of prenatal treatment. Dietary recommendations are vague; women are only told to eat a healthy, “balanced” diet, along with a list of foods to avoid (possible food pathogen sources, liver, fatty fish, alcohol, and caffeine). This strategy is unlikely to be effective given the current prevalence of overweight and obesity and the poor quality of the western diet. Many women do not receive weight-gain guidance until they are pregnant, and even then, the information is of poor quality.
Both maternal and fetal components contribute to gestational weight increase (GWG). To build the placenta, amniotic fluid, and fetal tissues, mass is laid down on the fetal side. Additionally, women gain weight due to the growth of the uterus, the deposition of fat in stores, the deposition of tissue in the breasts in preparation for postpartum nursing, and an increase in body water and blood volume to promote placenta perfusion. Pregnant women’s BMI determines the appropriate ranges of weight increase. Obese women should limit their weight gain to prevent excessive GWG, while underweight women should gain more weight before becoming pregnant in order to prevent the problems linked to insufficient GWG.
Obesity and Fertility
The primary lifestyle factor that affects women’s reproductive health is body fatness. Menstrual cycle disorders, such as anovulation, amenorrhea, and oliogorrhea, are linked to both underweight and obesity. Adipose tissue produces the hormone leptin, which mediates this link. The quantity of adipose tissue in the body is closely correlated with leptin levels, which also have a permissive influence on the pituitary’s and hypothalamus’s release of luteinizing hormone and follicle-stimulating hormone as well as gonadotrophin-releasing hormone. Women who are obese experience cycle abnormalities as a result of leptin resistance. According to Rich-Edwards et al., there is a U-shaped correlation between BMI and ovulatory abnormalities, with obesity accounting for 25% of these diseases in the US population. Obesity and overweight prevent women who are attempting to conceive from getting pregnant, even if they do not have any overt menstrual cycle abnormalities. Women who have bariatric surgery to address their weight experience improved fertility and successful pregnancies. Obesity decreases the effectiveness of assisted reproductive therapies (ART) in women receiving them. The odds of a live birth were considerably lower for women with a BMI > 30 kg m–2 compared to those with a BMI between 18.5 and 24.9 kg m–2 (relative risk [RR] = 0.85, 95% CI = 0.82–0.87). Before starting ART, obese women are typically recommended to lose weight.
Obesity is the primary risk factor for polycystic ovarian syndrome (PCOS), in addition to leptin-resistant infertility. One of the more prevalent fertility problems among women is PCOS, which is linked to irregular menstrual periods and anovulation. Although insulin resistance is the primary cause of PCOS-related reproductive issues, increased androgen concentrations are also a contributing factor. Although PCOS is more prevalent in obese women, it can also affect non-obese women, and visceral fat accumulation is a risk factor. PCOS and related menstrual cycle abnormalities can be easily managed by losing about 5% of body weight or by taking metformin to increase insulin sensitivity. Standard weight loss techniques (exercise and energy restriction) seem to be the most efficient and straightforward method, despite the fact that several research have assessed whether low-carb diets or similarly restricted approaches have specific efficacy in restoring fertility in PCOS.
Miscarriage, Stillbirth and Maternal Death
One established predictor of the likelihood of spontaneous miscarriage during the first trimester of pregnancy is the mother’s body mass index (BMI). Although the literature may provide stronger evidence of the negative effects of underweight than overweight, both extremes of the BMI range are thought to raise risk. Because leptin is involved in fetal implantation and placenta establishment, both low levels of the hormone and leptin resistance may contribute to miscarriage. Large studies of Asian populations show a low but considerable incidence of miscarriage, despite the fact that Bracken and Langhe found no link between fat and miscarriage. Pan et al. examined nearly half a million pregnancies in China and discovered that while being overweight did not increase the chance of miscarriage, having a BMI greater than 28 kg m–2—the Asian cut-off for obesity—was linked to a 16% higher risk. Haque et al. found that being overweight increased risk by 8% and being obese increased risk by 26%. Obesity increases the risk of miscarriage in women receiving ART.
Maternal BMI, GWG, and stillbirth risk have a more complicated relationship than is frequently stated. Although it has been shown that either inadequate weight gain or loss during pregnancy increases the chance of stillbirth, moderate weight loss during the second trimester decreased the risk by 14% in women who were extremely obese before becoming pregnant. Johansson et al. found that high GWG increased the probability of stillbirth, but only in women who had normal weight before becoming pregnant. According to other research, pregnancies complicated by overweight or obesity may have a higher risk of stillbirth. Obesity significantly raised risk in South Asian women (OR = 1.46, 95% CI = 1.27–1.67). In the Yao et al. study, women who were obese had a twofold greater risk of stillbirth due to excessive GWG, and the risk of obesity increased significantly for women whose pregnancies lasted longer than 39 weeks. According to a systematic review and meta-analysis that included more than 16,000 stillbirths from 38 studies, the risks of stillbirth rose by 24% for each 5 kg m–2 increase in BMI over the optimal range (OR = 1.24, 95% CI = 1.18–1.30).
Pregnancy Complications
Obese or overweight women are more likely to experience any pregnancy difficulties. GDM and PE are the two main complications, and both pose a serious risk of death for both the mother and the unborn child. Many pregnant women endure less serious issues, such as symphysis pubis dysfunction (SPD) and heartburn. Both illnesses are chronic and burdensome during pregnancy, but neither poses a threat to a live baby’s successful delivery. One modifiable risk factor for SPD and maybe a pelvic girdle syndrome that lasts after the baby is delivered is obesity. According to Denison et al., the incidence of heartburn increased by 2.65 times and the risk of SPD was nearly four times greater for women with a BMI over 30 kg m–2 compared to those with a BMI under 25 kg m–2.
Hypertensive disorders of pregnancy
Pregnancy-related elevated blood pressure is a common occurrence and is usually not regarded as an issue. Pregnant women’s renal function changes to manage a larger amount of blood and to perfuse the placenta, which raises blood pressure. If there is no pre-existing hypertension prior to conception and the condition develops no earlier than 20 weeks of gestation, gestational hypertension (GHT) is defined as a blood pressure increase that exceeds the typical cut-offs for hypertension (systolic 140 mmHg/diastolic 90 mmHg) in the final trimester of pregnancy. Although GHT is usually not a serious issue, it must be continuously watched in order to identify any progression to PE (frequent proteinuria screening and additional prenatal checkups). A blood pressure reading of more than 160/110 mmHg is considered an obstetric emergency, endangering the lives of the mother and the unborn child. Additionally, women with GHT are more likely to experience any postpartum problems, including hemorrhage. Along with anti-hypertensive drugs, lifestyle changes such as controlling weight and consuming less sodium in the diet serve to treat GHT. Higher adherence to the DASH eating pattern was linked to decreased mean arterial blood pressure and diastolic blood pressure in a cohort of women who were mostly overweight and obese. After delivering delivery, GHT usually goes away in three months, but if persistent hypertension appears, follow-up monitoring is recommended.
Obesity and overweight are known risk factors for GHT. Although only 2.6% of women of normal weight developed the syndrome, Ralph et al. found that the prevalence was 4.7% in overweight women, 7.8% in obese women, and more than 10% in severely obese women in their very large cohort.
PE is an extremely dangerous condition that threatens the lives of both mother and fetus. It is characterized by the development of hypertension after 20 weeks of gestation and urinary protein excretion in excess of 300 mg/24 h. PE is caused by the development of arterial dysfunction in the placenta, which involves oxidative injury and an inflammatory response spreading beyond the placenta to impact upon all major organs in the mother. PE is a progressive condition that cannot be reversed or controlled and, without intervention, women are at risk of developing eclampsia.
GDM
Changes to insulin signaling pathways during pregnancy cause the mother’s muscles and liver to become less able to absorb glucose, resulting in an insulin-resistant condition. This facilitates the movement of glucose into the fetal compartment as a growth substrate when the animal is fed. Women mobilize additional triglycerides, free fatty acids, and ketones for fetal metabolism when they fast. Given this metabolic backdrop, some women develop gestational diabetes mellitus (GDM), which can have a range of negative long-term and in-utero effects on the unborn child. The most frequent result is macrosomia. Macrosomic babies weigh greater than 4.5 kg at birth, which typically leads to more caesarean sections since normal labor raises the risk of shoulder dystocia, bone fractures, and subconjunctival hemorrhage during transit through the birth canal. 73 Congenital cardiac abnormalities are more likely to occur in people with GDM. 74 and children born to mothers with GDM are more likely to grow up to be obese.
It is commonly known that obesity and GDM are related. Excess visceral and central adiposity are more risk factors than general obesity, according to systematic reviews and meta-analyses of case-control and cohort studies. Obesity also increases risk by more than three times. Excessive GWG and pre-pregnancy and early pregnancy BMI are linked to the risk of GDM. Among more than 700,000 Canadian women, Relph et al.20 discovered that the risk of GDM rose when BMI rose across the board. 12.4% of women with a BMI of ≥ 50 kg m–2 developed the condition, compared to 2.8% of women with a BMI of less than 18.5 kg m–2.
Excessive GWG was linked to a higher risk of GDM, according to a retrospective analysis of 4512 births in Lagos (OR = 4.8, 95% CI = 1.93–12.62). 80 Excessive GWG during the second trimester of pregnancy nearly tenfold elevated the risk of GDM in Malaysian women who experienced food insecurity.
Labour Complications
Both directly and indirectly, obesity and high GWG raise the risk of problems before, during, and after labor. Indirectly, weight-related diseases like PE and GDM raise the risk of caesarean sections and preterm deliveries. In practical terms, medical practitioners’ caution while managing the labors of obese women and uterine malfunction make labor more difficult.
Obese or overweight women are less likely to start and continue spontaneous labor than women of normal weight. According to research on animals, this is a result of decreased uterine contractile protein expression and labor-inducing prostaglandin synthesis. These women are therefore more prone to need labor induction. Obese women are more than three times as likely as normal-weight women to need an emergency caesarean section following induction, and induction is less likely to be successful.
Obese women are often more likely to require labor intervention, and they are less likely to give birth naturally than women of optimal weight. Both elective and emergency cesarean sections are the most likely intervention. and this is partially motivated by medical professionals’ desire to reduce the mother’s and baby’s danger. Compared to women of ideal weight, obese women whose labor is not advancing are less likely to be permitted to attempt a vaginal delivery with the use of forceps or a vacuum cap (ventouse); but, when permitted, they seem to have better results. Obesity increases the risk of surgical complications and slows recovery from cesarean sections.
Up to 5% of women experience postpartum hemorrhage, which is characterized by either significant blood loss during delivery (more than 500 ml after vaginal delivery or 1 l after cesarean) or in the days that follow (due to placental retention, uterine atony, or rupture). One of the main risk factors for postpartum hemorrhage is obesity. Thies-Lagergren et al. examined information from the Swedish Birth Registry on almost 400,000 pregnancies. Women with a BMI more than 25 kg m–2.92 had a higher chance of losing more than 1 liter of blood in the two hours following delivery. Similarly, a study by Dalbye et al. revealed that obese women had a more than twofold increased risk of postpartum hemorrhage. Babies born to fat mothers have a higher birthweight and head circumference, which increases the risk of ripping.
LONG-TERM IMPLICATIONS FOR THE INFANT
Being obese during pregnancy does not only increase the danger of the pregnancy’s outcome. An increasing amount of data points to maternal obesity as the cause of the developing fetus’s long-term health and wellbeing programming. Those exposed to maternal obesity or gestational diabetes mellitus during pregnancy are at an increased risk of obesity, type-2 diabetes, and cardiovascular disease-related death as adults.
THE ANTENATAL PERIOD AS A TEACHABLE MOMENT
In general, the target population’s lack of engagement hinders health promotion initiatives aimed at older individuals and children. Even though some important diet and nutrition-related signals can get deeply ingrained in both children’s and adults’ consciousness, there may be very little adherence to these messages. For instance, the 5-a-day message about eating more fruits and vegetables is nearly universally understood, but it has little effect on behavior in any age group. Similarly, less than 40% of UK women of reproductive age take folic acid supplements as recommended, despite the fact that the majority are aware of the need to do so in order to prevent neural tube abnormalities should they get pregnant. Even while about 40% of pregnancies are unplanned, which helps to explain part of this, a sizable percentage of women obviously disregard the rules even when they are aware of them. There are several reasons why some pregnant women may not follow lifestyle recommendations, especially those related to weight. particularly if those modifications are necessary without the promise of helping the developing embryo. In a qualitative investigation of the causes of pregnant women’s alcohol consumption. Many women who did so either did not understand the risk or lived in environments where healthy behaviors were not the norm, according to Meurk et al. (2019). The desire to continue their typical social behaviors was more desirable than changing their way of life. The same considerations probably hold true for other poor choices made before and during pregnancy.
Pregnancy has been referred to as a “teachable moment” and may be the time in a woman’s life when she is most open to health messages and ready to make lifestyle changes. Women are motivated to change when they realize that certain behaviors could endanger their own health and, more importantly, the health of their unborn child. Their function in their family and in society must be reevaluated throughout pregnancy. Additionally, pregnancy increases women’s exposure to health professionals and health and lifestyle literature, creating opportunities to capitalize on the teachable moment. Unfortunately, women may turn to unreliable sources as a result of their readiness to seek information and counsel. In addition to the fact that they are instantly accessible day or night, internet sources are also tainted by mistakes and intentional falsehoods. Lynch and Nikolova discovered that pregnant women preferred to use the Internet to gather information about their health and pregnancy, and they trusted what they read even if they didn’t question the information’s source. Pregnant women frequently use the internet to help them make decisions because they are not always happy with the information they receive from medical professionals, who are frequently unavailable to them when they have questions.
Pregnancy-related physiological reactions may affect eating habits from conception on, which may make it difficult to make adjustments that limit weight gain. Vomiting and nausea are normal and can occasionally be the earliest indication of conception, showing up between weeks two and six of pregnancy.Between 60% and 80% of women feel nausea, which can affect their eating choices. Most women say that their tastes for particular meals and drinks have changed. While consumption of foods high in carbohydrates tends to increase during the first trimester, caffeine-based beverages, eggs, seafood, meat, and fatty foods are typically avoided. Along with fruit and fruit juices, sweets like cakes, biscuits, and chocolate are popular. Psychological factors are also significant, and some pregnant women use eating as a coping mechanism for worry and other unpleasant emotions.
The availability of a teachable moment and the access to health professionals who can provide it do not ensure that women will make the appropriate decisions, even if the majority of women alter their lifestyles to some extent in reaction to getting pregnant, if not before conception. For instance, in 2020–2021, over 10% of pregnant women were still smoking at the time of delivery, despite the UK Department of Health setting a goal to reduce the prevalence of smoking during pregnancy to 6% or less by 2022. In a similar vein, almost 40% of British women admitted to drinking alcohol while pregnant, which is against recommended. 109 Generally speaking, women who are having their first child and those with higher levels of education are more likely to follow advice on changing their lifestyle during pregnancy. Younger women and those from lower-income families are less compliant.
The chance to have clear conversations with women on weight management and preventing excessive weight gain during pregnancy may be lost. While several nations have explicit restrictions about weight growth during pregnancy and weight monitoring is a standard element of prenatal treatment, the UK’s approach to obesity misses a chance to take action. Pregnant women are frequently given highly generalized and poorly understood advice on what to eat and how much physical exercise to maintain. Similarly, it is ineffective to discuss body weight, how to deal with overweight during pregnancy, and what constitutes healthy weight growth. In the UK, the National Institute for Healthcare and Clinical Excellence (NICE) emphasizes simply tracking weight gain during pregnancy since it suggests that women who are overweight or obese should be encouraged to lose weight before or after becoming pregnant. Height and weight are typically only evaluated at the initial prenatal visit, with no additional follow-up, due to current therapeutic routes.
Despite the significance of maintaining a healthy rate of weight growth, routine weighing of women at prenatal checkups has been largely abandoned in the UK. This can be attributed to several factors. First, regular weight monitoring of women without their consent, without enough explanation or feedback, is unethical, according to NICE recommendations. Studies have also shown that when pregnant women who are overweight or obese are regularly weighed, they experience feelings of shame, anxiety, or guilt. Studies have also shown that when pregnant women who are overweight or obese are regularly weighed, they experience feelings of shame, anxiety, or guilt. According to a comprehensive study by Johnson et al., pregnant women may find it difficult to optimize their nutrition and physical activity if they are preoccupied with their weight. Swift et al., however, found that most women would be happy to receive advice and guidance on their weight from health professionals in a study of nearly 200 women in the first trimester of pregnancy. However, only 15% of women reported receiving any feedback on their weight after being weighed by their midwife, even though 31% of them had been overweight or obese prior to becoming pregnant. Women considered being weighed during pregnancy to be a pleasurable experience and provided them with reassurance over the growth of their unborn children, according to a 2020 feasibility study conducted in Ireland.
Obesity is a delicate topic, and research suggests that patients and medical staff may feel ashamed and hesitant to bring up body weight in basic care. Midwives are typically in charge of providing health education and encouraging a healthy lifestyle throughout pregnancy. Despite having frequent interaction with women and a high degree of confidence as a reliable source of information, they lack the skills necessary to handle discussions concerning overweight. Training programs must address the long-standing stigma associated with weight among health professionals, which may jeopardize those discussions. It can be challenging for midwives to maintain awareness of unconscious bias regarding obese women and to put personal strategies in place to overcome that bias because of heavy workloads and time constraints. They may also be afraid of a negative reaction from women with whom they are attempting to build a professional relationship. Additionally, they suffer from a dearth of precise clinical criteria that would facilitate referrals to appropriate, customized interventions. The widespread prevalence of overweight in society may also normalize the look of obesity in the absence of routine weighing, which could lead to midwives failing to identify women who might require assistance. Without fear tactics or assigning blame for the reasons of overweight, women prefer courteous, truthful communication that offers tailored risk information and encourages them to make educated lifestyle decisions.
STRATEGIES FOR MANAGEMENT OF WEIGHT GAIN IN PREGNANCY
There are no precise rules on when or how to intervene to limit weight increase in pregnancy, despite the fact that the US Institute of Medicine’s GWG recommendations are widely regarded as a useful guide for obtaining healthy outcomes for a pregnancy complicated by overweight or obesity. In the UK, NICE guidelines place a strong emphasis on achieving a healthy weight during the interpregnancy period. Pregnancy interventions may cause weight loss or insufficient weight gain, which could have unidentified effects on the unborn child. Even yet, a lot of NHS Trusts in the UK have put in place local programs to stop excessive weight gain, however they frequently rely on scant data. When it comes to managing weight, pregnant and non-pregnant people should take similar approaches, with the exception that the aim of pregnancy is to permit weight gain within reasonable bounds rather than to lose weight. Physical activity is crucial, and women who have previously been sedentary are encouraged to reduce their sitting, move more, and exercise continuously for up to 15 minutes each day, three times a week (e.g., swimming or brisk walking). If not, 150 minutes a week of moderate-intensity exercise is recommended. Pregnancy is special because it gives women access to medical specialists (midwives, obstetricians, and general practitioners) who, with the right training, may provide them weight advice. The advice of specialized dietitians may be advantageous for women in certain situations. Pregnant women can now access eHealth resources, including smartphone applications, that can be customized based on their weight status. The latter is a particularly creative example of leveraging the teachable moment during pregnancy, with the goal of enabling women to take charge of their own fitness and health without facing stigma and professional judgment. It is crucial that these programs give accurate information and be customized based on the user’s weight condition.
The effectiveness of therapies intended to reduce GWG in overweight and obese women has been the subject of a substantial body of research, and these approaches have shown a wide range of occasionally contradictory results. Mottola et al., for instance, implemented an intervention that combined a program of walking three to four times a week with an individualized nutrition plan (2000 kcal day–1). Although the average gain was still above 12 kg due to excessive gain in the early stages of pregnancy, this decreased the likelihood of women surpassing approved rates of pregnancy weight gain. In primary care, the Mighty Mums intervention exposed women to midwives’ motivational lectures, dietician consults’ dietary recommendations, and physical activity recommendations. Women may also access services that suited their preferences. Compared to controls, participants’ GWG and postpartum weight retention were lower. The primary factor influencing success seemed to be exposure to dietetic consulting. In South Carolina, Liu et al. conducted a fairly rigorous program for women who were overweight or obese. Participants received weekly phone calls from the intervention team, ten weeks of group sessions, an individual counseling session, and weekly access to podcasts. Enhancing nutritional quality, boosting physical activity, and self-monitoring weight were the main goals of these interactions. Overall, the intervention had no effect on GWG. While African American women who were overweight had lower GWG than controls, African American women who were obese had higher GWG in the intervention group. In women who were overweight or obese, a lighter touch intervention using the Healthy Moms smartphone app for six months reduced GWG without changing physical activity, glycaemia, or insulin resistance.
Randomized controlled trials have attempted to target either GWG or newborn health as primary objectives for diet or physical activity interventions in pregnancy, in addition to the numerous small-scale programs that concentrate on controlling maternal weight gain throughout pregnancy. There have been numerous reports of two sizable randomized controlled studies examining methods for preventing weight gain during pregnancy and the risks of unfavorable pregnancy outcomes. During the Australian LIMIT trial, Dodd et al. discovered that a diet and lifestyle intervention decreased the probability of a birth weight above 4000 g by 18% (RR = 0.82, 95% CI = 0.68–0.99, p = 0.04); however, the intervention group’s maternal weight increase findings were not statistically significant. GDM reduction was the main endpoint of the UK’s UPBEAT trial, which involved 2202 participants. While the intervention lowered GWG by 0.55 kg, it had no effect on GDM or other pregnancy problems. According to a meta-analysis of 36 RCTs, the characteristics of the women who were recruited and whether the interventions focused on food, activity, or a mix of the two had a significant impact on the interventions’ success. Interventions based on physical activity were largely unsuccessful. Clinicians, as opposed to non-clinical professionals, seem to be better at delivering interventions.
Diet-based and mixed approaches decreased the risk of excessive GWG in women with low levels of education, but diet-based interventions were the only ones that worked for women with high levels of education. An earlier meta-analysis of 44 RCTs concluded that while diet-based therapies could cut GWG and lessen the risk of GHT, PE, GDM, preterm birth, and labor induction, interventions that combined physical activity goals with dietary changes were unsuccessful. GWG reductions could significantly surpass those achieved by UPBEAT, according to the total research. Therefore, there is little question that therapies that are properly planned and focused might be useful instruments in the management of pregnancies that are complicated by obesity and overweight. We released an analysis of a Lincolnshire Bumps and Beyond intervention pilot project in 2015. All pregnant women in Lincolnshire whose booking BMI was 35 kg m–2 or higher were eligible for Bumps and Beyond, a seven-session program that addressed physical activity, healthy eating, identifying triggers for unhealthy lifestyle behaviors, and relapsing into previous eating and physical activity habits. Healthy lifestyle counselors with prior expertise leading smoking cessation programs led the program.Healthy lifestyle counselors with prior expertise leading smoking cessation programs led the program. According to the pilot trial, the intervention decreased the prevalence of GHT and PE and cut GWG in half. With a larger population, subsequent study (unpublished data S.C. Langley-Evans and S. Ellis) verified that this intervention lowered GWG in women who were extremely obese, and that the decreased GWG was linked to a significantly lower risk of PE (OR = 0.050 95% CI = 0.003–0.642).
The Bumps and Beyond intervention has taught us some valuable things. First, it was incredibly effective in lowering pregnancy problems and meeting the goal of halving GWG in women who were extremely obese, something that the large randomized controlled studies have not been able to accomplish. Although RCTs are regarded as the highest level of epidemiology, they do have limits in the realm of nutrition, since the type of intervention may differ from an RCT that uses a pharmaceutical agent. Both of these trends were evident in Bumps and Beyond, where a third of the women who participated did not finish the entire program, and among some of the women who did not, good control over GWG was still noted, suggesting that they had made the decision to change their lifestyles for the better on their own without the delivery team’s help. In primary care practice, a more flexible, adaptable, and multimodal approach is likely to be more beneficial than rigid RCT procedures, even though they are most helpful when researching a specific subject. This may be why Bumps and Beyond produced results that were significantly better than LIMIT or UPBEAT.
CONCLUSIONS
The risk to the health and well-being of expectant mothers and their unborn children, as well as the expense of treating unfavorable pregnancy outcomes, is growing as the prevalence of overweight and obesity rises each worldwide. There are undoubtedly ways to lower the likelihood of unfavorable outcomes, but in order for them to be effective in primary care, funding will be required for both the education of medical staff and the provision of interventions tailored to the needs of specific women.The first trimester, while difficult, is probably the ideal time to take use of the teachable moment that early pregnancy provides, therefore discussions on weight management must take place during this time for the biggest impact. Future antenatal weight management needs in primary care may be best served by eHealth techniques for maximum impact.