Ing-Marie Claesson

Weight gain restriction for obese pregnant women : A case-control intervention study

Objective  To minimise obese women’s total weight gain during pregnancy to less than 7 kg and to investigate the delivery and neonatal outcome.

Prevalence of anxiety and depressive symptoms among obese pregnant and postpartum women: an intervention study

BackgroundAlthough 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.Methods151 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 Students 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.ResultsThe 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.ConclusionObese 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.

Physical activity and psychological well-being in obese pregnant and postpartum women attending a weight-gain restriction programme

OBJECTIVE the objective of the study was to compare the differences in psychological well-being and quality of life during pregnancy and post partum of obese physically active women and obese physically inactive women enroled in a weight gain restriction programme. We also wanted to explore whether physical activity influences weight change or health status during pregnancy. DESIGN a prospective intervention study. SETTING antenatal care clinic. PARTICIPANTS a total of 74 obese pregnant women in a physically active group and 79 obese women in a physically inactive group. MEASUREMENTS the women kept diaries of their physical activity during pregnancy and answered the Beck Anxiety Inventory, the Edinburgh Postnatal Depression Scale and Medical Study Short-Form Health Survey in gestational weeks 15 and 35 and 11 weeks post partum. Physical activity was measured in metabolic equivalents. FINDINGS the physically active women experienced fewer depressive symptoms and estimated an improved quality of life during their pregnancies as measured by physical functioning, bodily pain, social functioning, role limitations due to emotional problems and general mental health as compared with the physically inactive women. There were no differences between the groups in gestational weight gain or weight change from early pregnancy to post partum or in prevalence of complications. KEY CONCLUSIONS physical activity among obese pregnant women provides better psychological well-being and improved quality of life, but does not prevent weight change. IMPLICATIONS FOR PRACTICE staff at Antenatal Care Clinics that face obese pregnant women, should encourage and emphasise the benefits of being physically active throughout pregnancy.

Weight after childbirth : A 2-year follow-up of obese women in a weight-gain restriction program

Objective. To investigate the effects of a weight‐gain restriction program on weight development or weight maintenance 2 years after childbirth. Design. A case‐control intervention study. Setting. Antenatal care clinics in the southeast of Sweden. Sample. One hundred and fifty‐five obese pregnant women who participated in a weight‐gain restriction program with weekly support during pregnancy and every 6 months during the two first years after childbirth. The control group consisted of 193 obese pregnant women. Methods. Follow‐up weight measurements were done at 12 and 24 months after childbirth. Main Outcome Measures. Weight change in kilogram at 12 and 24 months postpartum. Results. 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= 0.034). 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= 0.018). 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= 0.046). Conclusions. 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.

Weight gain restriction during pregnancy is safe for both the mother and neonate.

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.

Leptin and adiponectin in cord blood from children of normal weight, overweight and obese mothers

To study cord blood concentrations of adiponectin and leptin in children born by normal weight, overweight and obese mothers and to study these parameters in relation to a weight gain intervention programme for obese mothers.

Total cost comparison of standard antenatal care with a weight gain restriction programme for obese pregnant women

OBJECTIVE To perform a cost comparison of a weight gain restriction programme for obese pregnant women with standard antenatal care, and to identify if there were differences in healthcare costs within the intervention group related to degree of gestational weight gain or degree of obesity at programme entry. STUDY DESIGN A comparison of mean healthcare costs for participants of an intervention study at antenatal care clinics with controls in south-east Sweden. METHODS In total, 155 women in an intervention group attempted to restrict their gestational weight gain to <7 kg. The control group comprised 193 women. Mean costs during pregnancy, delivery and the neonatal period were compared with the costs of standard care. Costs were converted from Swedish Kronor to Euros (€). RESULTS Healthcare costs during pregnancy were lower in the intervention group. There was no significant difference in total healthcare costs (i.e. sum of costs during pregnancy, delivery and the neonatal period) between the intervention group and the control group. Within the intervention group, the subgroup that gained 4.5-9.5 kg had the lowest costs. The total cost, including intervention costs, was € 1283 more per woman/infant in the intervention group compared with the control group (P=0.025). The degree of obesity at programme entry had no bearing on the outcome. CONCLUSIONS The weight gain restriction programme for obese pregnant women was effective in restricting gestational weight gain to <7 kg, but had a higher total cost compared with standard antenatal care.

Effects of a Gestational Weight Gain Restriction Program for Obese Pregnant Women: Children's Weight Development during the First Five Years of Life

BACKGROUND Maternal prepregnancy obesity (BMI ≥30 kg/m(2)) and excessive gestational weight gain (GWG) have shown a strong positive association with a higher BMI and risk of obesity in the offspring. The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the childrens BMI at 5 years of age and weight-for-length/height (WL/H) development from 2 months of age until 5 years of age. METHODS This was a follow-up study of 302 children (137 children in an intervention group and 165 children in a control group) whose mothers participated in a weight gain restriction program during pregnancy. RESULTS BMI at five years of age did not differ between girls and boys in the intervention and control group. The degree of maternal GWG, <7 kg or ≥7 kg, did not affect the offsprings WL/H. Compared with Swedish reference data, just over half of the children in both the intervention and control group had a BMI within the average range, whereas slightly more than one-third of the children had a higher BMI. CONCLUSION Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes, there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group.

Weight six years after childbirth: a follow-up of obese women in a weight-gain restriction programmme

OBJECTIVE to compare weight development in an intervention group and a control group, six years after participation in a gestational weight-gain restriction programme. DESIGN follow-up of a prospective intervention study. SETTINGS antenatal care clinics. PARTICIPANTS a total of 129 women (88.4%) from the original intervention group and 166 women (88.8%) from the original control group. MEASUREMENTS the women answered a study specific questionnaire, covering socio-demographic data and health- and weight status. FINDINGS after adjusting for socio-demographic factors, the mean weight was lower (4.1kg) among the women in the intervention group, compared to the controls (p=0.028). Furthermore, the mean weight change, e.g. the weight at the six year assessment compared with the weight at the start of the intervention at the first antenatal care visit, was greater in the intervention group than in the control group. The women in the intervention group had a larger mean weight change (-5.2kg), e.g. weighed less than the women in the control group (-1.9kg) (p=0.046). Mean weight change expressed in 5kg classes also showed a significant difference between the two groups (p=0.030). KEY CONCLUSIONS the results indicate that attending a gestational weight-gain-restriction programme can have a positive effect on weight up to six years after the intervention. IMPLICATION FOR PRACTISE a restrictive gestational weight gain can result in a positive weight development during the first years after childbirth. It might provide both short- and long term medical health benefits for the mother as well as the child.

Effects of a weight-gain restriction programme for obese pregnant women on sickness absence and pregnancy benefits.

Abstract Objective. To evaluate the effect of a weight-gain restriction programme for obese pregnant women on sickness absence days and pregnancy benefit days during pregnancy and postpartum. Design. A prospective, controlled intervention study. The Swedish Social Security Agencys records were utilized to compile sickness absence and pregnancy benefit information. Setting. Antenatal care clinics in the south-east of Sweden. Subjects. One hundred fifty-five obese pregnant women who participated in a weight restriction program with weekly structured motivational and behavioural talks combined with aqua-aerobics during pregnancy. A total of 193 obese pregnant women with no intervention served as controls. Main outcome measures. Sickness absence benefits and pregnancy benefits expressed as a percentage. Results. On average women in the intervention group had 76.68 total full days of sickness absence benefit compared with 53.09days in the control group. Total full days of pregnancy benefits were 39.66% days and 41.41% for the intervention and control groups respectively. For the women who were on sick leave there were no differences between the groups in the amount of days taken. Conclusions. Given the complexity of factors that have an influence on sickness absence leave, it is possible that programmes that do not address the influence of social aspects and attitudes towards sickness absence have limited effect.