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Table of Content - Volume 9 Issue 2 - February 2019

Effect of structured diet and lifestyle counseling in preventing excessive gestational weight gain in pregnancy: A prospective randomized control study

 

Zulfiya Shabnam1*, Rajnish Samal2

 

1Senior Resident, Department of Obstetrics and Gynecology, KS Hegde Medical Academy. Mangalore, Karnataka, INDIA.

2Senior consultant, Bangalore Baptist Hospital, Bangalore, Karnataka, INDIA.

Email: dr.shaikhzulfi@gmail.com

 

Abstract               Background: Effects of gestational weight gain on pregnancy are well recognized. Over the past decades the guidelines for ideal weight gain have been periodically questioned and revised. The present study aimed effect of structured diet and lifestyle counseling in preventing excessive gestational weight gain in pregnancy. Materials: This study was conducted in Department of Obstetrics and Gynaecology, Bangalore Baptist Hospital, Bangalore, Karnataka during the period of January 2016-June 2017. Total 144 pregnant women were included in the study based on inclusion and exclusion criteria. They were divided into two groups each of 72. Intensive counseling was given to Group-I and regular antenatal and OPD based counseling was given to Group-II. Age, height, pre-pregnancy weight, weight gain trimester wise and total weight gain were measured and compared. Results: Group-I and Group-II showed no significant difference when compared to baseline observations. Significant difference was observed in weight gain when Group-I was compared with Group-II. Total weight gain showed significant difference when Group -1 was compared to with Group-II. Conclusion: Excessive weight gain in pregnancy can cause complications during the delivery. The study results concluded that structured diet and lifestyle counseling can prevent the excessive gestational weight gain in pregnancy.

Key Word: Pregnancy, diet, exercise, gestational age, lifestyle counseling, weight

 

 

INTRODUCTION

Effects of gestational weight gain on pregnancy complications are well recognized, and over the past decades the guidelines for ideal weight gain have been periodically questioned and revised1-3. Excessive gestational weight gain (GWG) can be defined as gaining weight during pregnancy that exceeds the recommended range for a woman’s pre-pregnancy body mass index4. The most commonly used GWG recommendations were published by the United States(US) Institute of Medicine (IOM) in 2009, and were re-released with no change in 20135. These recommendations indicate that women who begin pregnancy with a normal pre-pregnancy BMI should gain between 11.5 and 16 kg, whilst women who are underweight should gain more weight and women entering pregnancy overweight or obese should gain less weight6. Subsequent guidelines were revised upward to minimize mortality and morbidity risks for low birth weight infants. The current guidelines provide gestational weight gain ranges based on pre-pregnancy body mass index and were recommended by the Institute of Medicine to again limit adverse pregnancy outcomes. However, the current IOM guidelines for obese women (pre-pregnancy BMI greater than or equal to 30.0 kg/m2) do not provide an upper limit on gestational weight gain, only advising women to gain at least 15lb (6.7 kg), and do not distinguish between the different levels of obesity as defined by the National Institute of Health7.Given the increasing prevalence of obesity among childbearing women, the tendency for postpartum weight retention, the high prevalence of perinatal complications in obese women, and the influence of pregnancy in the development of obesity later in life, re-evaluation of the IOM gestational weight gain guidelines for obese women has important clinical and public health implications. Particularly, a distinction between the different levels of gestational weight change for women entering pregnancy as obese may lead to adequate GWG while maintaining optimal pregnancy and neonatal outcomes. GWG is an important contributing factor to the obesity epidemic in women and is associated with pregnancy complications. There lies a definite relationship between GWG and caesarean delivery in labour and pregnancy induced hypertension and LGA babies. These adverse outcomes are potentially modifiable by achievement of normal GWG, which should be an important focus of antenatal care8,9. This excess weight gain during pregnancy can be prevented by the life style and diet management during the pregnancy period. The present study aimed to evaluate structured diet and lifestyle counseling in preventing excessive gestational weight gain in pregnancy.

 

 

 

 

MATERIALS AND METHODS

Study settings and design: The prospective randomized control study was conducted in the department of Obstetrics and Gynaecology in Bangalore Baptist Hospital. It is conducted during the period of Jan 2016-June 2017.

Inclusion criteria

  • All primigravida pregnant women

Exclusion criteria

  • Pregnant women with chronic hypertension
  • Overt diabetes
  • Miscarriage/termination of pregnancy

Groups: A total of 144 patients were included in the study they were divided into two groups each of 72.

Group-I (n=72): Intensive counseling group

Group-II (n=72): Regular OPD group

Procedure: All the selected pregnant women were explained study protocol in detail. Informed consent was obtained from each patient. Group-I patients were give intensive diet and physical activity counseling in each visit. Group-II was given regular antenatal counseling. Age, height, pre-pregnancy weight and trimester wise weight gain was recorded and analyzed. At the end of experiment 15 in group-I ad 4 in group-II was lost the follow up. The data was collected and analyzed Group-I (n=57) and group-II (n=68).

Statistical analysis: The data was expressed in mean and standard deviation. Statistical Package for Social Sciences (SPSS 16.0) version used for analysis. Unpaired t test and Chi square test applied to find the statistical significant between the groups. p value less than 0.05 (p>0.05) considered statistically significant at 95% confidence interval.


 RESULTS

The mean age, height and pre-pregnancy weight compared between the groups. There was no statistical significant (p>0.05) between the groups (Table-1). Trimester wise weight was compared between the groups. First, second and third trimester showed increased weight in both groups. Within the groups trimester wise weight gain showed significant difference (p<0.05) in both groups. Between the groups at same trimester not showed any significant difference (Table-2). The overall weight gain was more in group-II (12.98 kg) compared to group-I (10.68). This weight gain was statistically significant (p<0.001) (Graph-1).

 

Table 1: Comparison of mean baseline observations between the groups

Baseline observations

Group-I (n=57)

Group-II (n=68)

p value

Age (MEAN±SD)

25.79±3.66

25.45±3.77

0.61

Height (MEAN±SD)

157.49±4.56

156.68±4.53

0.32

Pre-pregnancy weight (MEAN±SD)

55.84±9.03

54.69±8.01

0.45

 

 

 

 

 

 

 

Table 2: Comparison of mean trimester wise weight gain between the groups

Trimester

Weight (kg) (MEAN±SD)

Group-I (n=57)

Weight (kg) (MEAN±SD)

Group-II (n=68)

p value

First

56.22±8.97

54.97±8.11

0.41

Second (Wt1)

57.92±8.95

57.16±8.14

0.62

Second (Wt2)

60.42±8.87

59.60±8.03

0.59

Third (Wt1)

62.59±8.5

62.38±8.19

0.89

Third (Wt2)

64.71±8.65

65.05±8.76

0.82

Third (Wt3)

66.50±8.76

67.51±9.63

0.54

 

Graph 1: Comparison of mean weight gain between the groups

DISCUSSION

This study is a prospective randomized control trial. 144 pregnant women meeting the inclusion criteria were recruited and were randomized into group 1 and group 2 by block randomization. Group 1(intervention group) was given intensive counseling. They were given an appointment with the dietitian, with emphasis on regular exercise. Weight was checked trimester wise i.e once in the first trimester, twice in the second trimester and three times in the third trimester. As most of the patients reported to us in their 6-7 weeks of gestational age, and as there is not much change in the weight gain during the first trimester, it was taken as pre-pregnancy weight gain. Each participant in group 1 was given dietary and physical exercise counseling depending on their pre-pregnancy body mass index. They were counseled to maintain regular meal pattern, emphasizing the importance of breakfast and >1hot meal/day.To eat at least 5 portions(400 g) per day different kinds of vegetables and fruits at-least 5 times/week. To consume high fibre diet. To restrict the consumption of high sugar snacks to <1portion per day.(example 50 gm sweet, 1 pastry, 1 piece of cake, 2 biscuits, 2 scoops of ice-cream or a glass of soft drink). They were explained and emphasized on following moderate activity exercise like brisk walking for 30 minutes on all days of the week or at-least 5 days/week. Weight was checked each visit and booster counseling sessions were arranged with the dietician according to their weight gain pattern. Weight gain within the IOM recommendations was emphasized. Group 2(control group) was given regular OPD based counseling and regular weight gain was monitored. They were also introduced to IOM recommendations, however regular counseling with the dietitian and structured diet was not followed depending on their pre-pregnancy BMI. Except for dedicated counseling session with the dietitian and emphasis of regular exercise all other antenatal care was provided according to ACOG guidelines. Weight gain was recorded. Compared to study done by S Thangaratinam in London 2012, they identified 44 relevant randomized controlled trials (7278 women) evaluating three categories of interventions: diet, physical activity, and a mixed approach. Overall, there was 1.42 kg reduction (95% confidence interval 0.95 to 1.89 kg) in gestational weight gain with any intervention compared with control. This was similar when compared to our study as it was found that there was 2.3 kgs reduction in weight, in group-1(intervention group) which was statistically significant, p value 0.0110. Study done in KhonKaen University, Thailand 2012, by Muktabhant B showed that diet or exercise, or both, during pregnancy can reduce the risk of excessive GWG. They included 65 RCTs, out of which 49 RCTs involving 11,444 women contributed data to quantitative meta-analysis. Study interventions involved mainly diet only, exercise only, and combined diet and exercise interventions, usually compared with standard care. Diet or exercise, or both, interventions reduced the risk of excessive GWG on average by 20% overall (average risk ratio (RR) 0.80, 95% confidence interval (CI) 0.73 to 0.87; participants = 7096; studies = 24; I² = 52%)11. This study results showed the effect of controlled diet and daily physical activity will help to reduce the excess weight gain during pregnancy.

 

CONCLUSION

Inappropriate gestational weight gain is an independent modifiable risk factor for adverse medical, obstetric and neonatal outcomes in pregnancy. Effective diet and lifestyle counseling during pregnancy is helpful in preventing excessive GWG. Hence concluding excessive gestational weight gain can be prevented by structured diet and lifestyle management during pregnancy which can help to reduce the complications.

 

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