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Encouraging appropriate gestational weight gain in high‐risk gravida: A randomized controlled trial

TRIAL DESIGN: Excessive gestational weight gain (GWG) can increase pregnancy morbidity and is particularly problematic for women with pregestational obesity. A lifestyle modification intervention was introduced to gravida with obesity to decrease excessive GWG as compared to usual care (UC). METHODS...

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Autores principales: Mackeen, Awathif Dhanya, Young, Amanda J., Lutcher, Shawnee, Hetherington, Vonda, Mowery, Jacob W., Savage, Jennifer S., Symons Downs, Danielle, Bailey‐Davis, Lisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159567/
https://www.ncbi.nlm.nih.gov/pubmed/35664244
http://dx.doi.org/10.1002/osp4.565
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author Mackeen, Awathif Dhanya
Young, Amanda J.
Lutcher, Shawnee
Hetherington, Vonda
Mowery, Jacob W.
Savage, Jennifer S.
Symons Downs, Danielle
Bailey‐Davis, Lisa
author_facet Mackeen, Awathif Dhanya
Young, Amanda J.
Lutcher, Shawnee
Hetherington, Vonda
Mowery, Jacob W.
Savage, Jennifer S.
Symons Downs, Danielle
Bailey‐Davis, Lisa
author_sort Mackeen, Awathif Dhanya
collection PubMed
description TRIAL DESIGN: Excessive gestational weight gain (GWG) can increase pregnancy morbidity and is particularly problematic for women with pregestational obesity. A lifestyle modification intervention was introduced to gravida with obesity to decrease excessive GWG as compared to usual care (UC). METHODS: A randomized controlled trial was conducted to improve healthy lifestyle behaviors to manage appropriate GWG. Consenting participants with prepregnancy obesity and singletons ≤17 weeks were randomized to (1) Usual Care (UC): usual written educational materials and counseling by obstetric provider or (2) Enhanced Care (EC): UC plus (a) personalized letter from physician detailing appropriate GWG; (b) access to individualized GWG chart; (c) ongoing counseling with registered dietitian/nutritionist (RDN). The primary outcome was proportion with GWG ≤9.1 kg, as this is upper limit recommended by Institute of Medicine (IOM). Total GWG and GWG as less than/within/greater than IOM recommendations (in aggregate and stratified by obesity class), and pregnancy/neonatal outcomes were evaluated as secondary outcomes. RESULTS: Analyses included 105 participants in EC and 109 in UC arms. The groups had similar demographics: 46% with class I obesity, 26% class II, and 28% class III. There were no group differences for any GWG, pregnancy, or neonatal outcomes when analyzed in aggregate. As compared to those randomized to the EC arm, participants in UC arm with class I obesity gained 1.4 kg less and those with class II obesity were significantly more likely to gain within IOM guidelines (14.8% vs. 40.0%, adjusted p = 0.04). Participants with class III obesity randomized to EC arm were more likely to gain within IOM guidelines as compared to participants randomized to UC arm (29.0% vs. 6.7%, adjusted p = 0.02). CONCLUSION: There were no differences in GWG observed between groups when analyzing participants in aggregate. However, a physician's letter detailing appropriate GWG, patient portal access to a personalized GWG chart, and RDN consultation were helpful for encouraging GWG within IOM guidelines for women with prepregnancy class III obesity. Women with class I or II obesity had better GWG outcomes without these additional interventions.
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spelling pubmed-91595672022-06-04 Encouraging appropriate gestational weight gain in high‐risk gravida: A randomized controlled trial Mackeen, Awathif Dhanya Young, Amanda J. Lutcher, Shawnee Hetherington, Vonda Mowery, Jacob W. Savage, Jennifer S. Symons Downs, Danielle Bailey‐Davis, Lisa Obes Sci Pract Original Articles TRIAL DESIGN: Excessive gestational weight gain (GWG) can increase pregnancy morbidity and is particularly problematic for women with pregestational obesity. A lifestyle modification intervention was introduced to gravida with obesity to decrease excessive GWG as compared to usual care (UC). METHODS: A randomized controlled trial was conducted to improve healthy lifestyle behaviors to manage appropriate GWG. Consenting participants with prepregnancy obesity and singletons ≤17 weeks were randomized to (1) Usual Care (UC): usual written educational materials and counseling by obstetric provider or (2) Enhanced Care (EC): UC plus (a) personalized letter from physician detailing appropriate GWG; (b) access to individualized GWG chart; (c) ongoing counseling with registered dietitian/nutritionist (RDN). The primary outcome was proportion with GWG ≤9.1 kg, as this is upper limit recommended by Institute of Medicine (IOM). Total GWG and GWG as less than/within/greater than IOM recommendations (in aggregate and stratified by obesity class), and pregnancy/neonatal outcomes were evaluated as secondary outcomes. RESULTS: Analyses included 105 participants in EC and 109 in UC arms. The groups had similar demographics: 46% with class I obesity, 26% class II, and 28% class III. There were no group differences for any GWG, pregnancy, or neonatal outcomes when analyzed in aggregate. As compared to those randomized to the EC arm, participants in UC arm with class I obesity gained 1.4 kg less and those with class II obesity were significantly more likely to gain within IOM guidelines (14.8% vs. 40.0%, adjusted p = 0.04). Participants with class III obesity randomized to EC arm were more likely to gain within IOM guidelines as compared to participants randomized to UC arm (29.0% vs. 6.7%, adjusted p = 0.02). CONCLUSION: There were no differences in GWG observed between groups when analyzing participants in aggregate. However, a physician's letter detailing appropriate GWG, patient portal access to a personalized GWG chart, and RDN consultation were helpful for encouraging GWG within IOM guidelines for women with prepregnancy class III obesity. Women with class I or II obesity had better GWG outcomes without these additional interventions. John Wiley and Sons Inc. 2021-09-22 /pmc/articles/PMC9159567/ /pubmed/35664244 http://dx.doi.org/10.1002/osp4.565 Text en © 2021 The Authors. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Mackeen, Awathif Dhanya
Young, Amanda J.
Lutcher, Shawnee
Hetherington, Vonda
Mowery, Jacob W.
Savage, Jennifer S.
Symons Downs, Danielle
Bailey‐Davis, Lisa
Encouraging appropriate gestational weight gain in high‐risk gravida: A randomized controlled trial
title Encouraging appropriate gestational weight gain in high‐risk gravida: A randomized controlled trial
title_full Encouraging appropriate gestational weight gain in high‐risk gravida: A randomized controlled trial
title_fullStr Encouraging appropriate gestational weight gain in high‐risk gravida: A randomized controlled trial
title_full_unstemmed Encouraging appropriate gestational weight gain in high‐risk gravida: A randomized controlled trial
title_short Encouraging appropriate gestational weight gain in high‐risk gravida: A randomized controlled trial
title_sort encouraging appropriate gestational weight gain in high‐risk gravida: a randomized controlled trial
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159567/
https://www.ncbi.nlm.nih.gov/pubmed/35664244
http://dx.doi.org/10.1002/osp4.565
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