Key Components of Antenatal Lifestyle Interventions to Optimize Gestational Weight Gain: Secondary Analysis of a Systematic Review

Healthful Eating Behaviors among Couples Contribute to Lower Gestational Weight Gain

Through longitudinal analysis from the GLOWING cohort study, we examined the independent and joint relationships between couples' eating behaviors and gestational weight gain (GWG). Pregnant persons (n = 218) and their non-pregnant partners (n = 157) completed an Eating Inventory. GWG was calculated as gestation weight at 36 weeks minus that at 10 weeks. General linear models were used to examine the relationships between GWG and the pregnant persons, non-pregnant partners, and couples (n = 137; mean of pregnant persons and non-pregnant partners) cognitive restraint (range 0-21), dietary disinhibition (range 0-18), and perceived hunger (range 0-14), with higher scores reflecting poorer eating behaviors. The adjusted models included race/ethnicity, education, income, marital status, and age. The pregnant persons and their non-pregnant partners' cognitive restraint, dietary disinhibition, and perceived hunger scores were 9.8 ± 4.7, 4.8 ± 3.2, and 4.4 ± 2.5 and 6.6 ± 4.6, 5.4 ± 3.4, and 4.7 ± 3.2, respectively. Higher cognitive restraint scores among the pregnant persons and couples were positively associated with GWG (p ≤ 0.04 for both). Stratified analyses revealed this was significant for the pregnant persons with overweight (p ≤ 0.04). The non-pregnant partners' eating behaviors alone were not significantly associated with GWG (p ≥ 0.31 for all). The other explored relationships between GWG and the couples' eating behaviors were insignificant (p ≥ 0.12 for all). Among the pregnant persons and couples, reduced GWG may be achieved with higher levels of restrained eating. Involving non-pregnant partners in programs to optimize GWG may be beneficial.

Implementing weight management during and after pregnancy to reduce diabetes and CVD risk in maternal and child populations

Maintaining a healthy weight during pregnancy is critical for both women's and children's health. Excessive gestational weight gain (GWG) can lead to complications such as gestational diabetes, hypertension and caesarean delivery. Insufficient GWG can cause fetal growth restriction and increase infant mortality risk. Additionally, postpartum weight retention raises risk of obesity, type 2 diabetes and other chronic diseases for both mother and child. This review seeks to identify current obstacles in weight management research during and after pregnancy and explore evidence-based strategies to overcome them. Pregnancy offers a window of opportunity for health behaviour changes as women are more receptive to education and have regular contact with health services. Staying within Institute of Medicine's recommended GWG ranges is associated with better maternal and fetal outcomes. Systematic review evidence supports structured diet and physical activity pregnancy interventions, leading to reduced GWG and fewer complications. Health economic evaluation indicates significant returns from implementation, surpassing investment costs due to decreased perinatal morbidity and adverse events. However, the most effective way to implement interventions within routine antenatal care remains unclear. Challenges increase in the postpartum period due to competing demands on women physically, mentally and socially, hindering intervention reach and retention. Flexible, technology-supported interventions are needed, requiring frameworks such as penetration-implementation-participation-effectiveness and template-for-intervention-description-and-replication for successful implementation. Greater research efforts are necessary to inform practice and investigate fidelity aspects through pragmatic implementation trials during the pregnancy and postpartum periods. Understanding the best ways to deliver interventions will empower women to maintain a healthy weight during their reproductive years.

Impact Evaluation of the Get Healthy in Pregnancy Program: Evidence of Effectiveness

The efficacy of lifestyle interventions for reduced gestational weight gain (GWG) is established, but evidence of their effectiveness is limited. The Get Healthy in Pregnancy (GHiP) program is a telephone health coaching program supporting healthy GWG delivered state-wide in New South Wales, Australia. This evaluation explores the impact of GHiP on behavioural outcomes and GWG, analysing GHiP participant data (n = 3702 for 2018-2019). We conducted McNamar's tests to explore within-individual change for behavioural outcomes and logistic regression to assess associations between demographic characteristics, participant engagement and behavioural and weight outcomes for women who completed the program. Participants who completed ten coaching calls made significant improvements (all p < 0.001) in more health-related behaviours (walking, vigorous physical activity, vegetable consumption, takeaway meals and sweetened drink consumption) than those who completed fewer calls. Among women with valid weight change data (n = 245), 31% gained weight below, 33% gained weight within, and 36% gained weight above GWG guidelines. Pre-pregnancy BMI was the only factor significantly associated with meeting GWG guidelines. Women with pre-pregnancy overweight and obesity had lower odds than those with a healthy weight of having GWG within the guidelines. The majority of these women did not gain weight above the guidelines. A higher proportion of women with pre-pregnancy obesity gained weight below the guidelines (33.8%) than above the guidelines (28.5%). GHiP has the potential to support all pregnant women, including those with pre-pregnancy obesity, to achieve a healthier pregnancy.