Sense of Weight Control Prior to Pregnancy Could Help Predict Women at Risk for Excessive Gestational Weight Gain
Authors: Adam Laura M , Madsen Mette S , Lawrence Wendy , Barker Mary , Manca Donna P , Bell Rhonda C 
Published: November 2023

Introduction

Gaining weight in excess of the Institute of Medicine gestational weight gain (GWG) guidelines is associated with adverse health outcomes for mother and child. It is estimated that 49% of women in Alberta gain excess gestational weight. Weight gain in pregnancy is multifactorial and there is a need to better support women during pregnancy to gain weight within the guidelines. A study in Edmonton, AB, aimed to understand if differing amounts of lifestyle support provided by a Registered Dietitian (RD) throughout pregnancy could help women achieve appropriate GWG. The purpose of these analyses is to understand if there was any difference in GWG between the three groups and to explore the gestational weight related perspectives of the women within the study.

Methods

Seventy low‐risk pregnant women, <20 weeks gestation, were randomized to an active control (AC) or intervention (INT) group where they saw a RD for two visits in pregnancy. The two visits occurred at < 24 weeks and 30 weeks gestation. Women completed lifestyle questionnaires throughout pregnancy and a postpartum questionnaire that asked about their prenatal experiences. A passive control group (PC) of women ≤12 months postpartum (n=55) was recruited to only complete the postpartum questionnaire. This group models standard prenatal care in Alberta (no RD visits in pregnancy). GWG information was collected from obstetrical charts and adherence to GWG recommendations was defined in accordance with IOM guidelines. Data were analyzed using chi‐square, t‐test, or one‐way ANOVA.

Results

Pre‐pregnancy BMI, ethnicity, education, marital status, household income and parity did not differ between INT (n=33), AC (n=37), and PC (n=55) groups. However, maternal age was different between the groups with the mean age in the PC group as 32.1 compared to 34.4 years for both the INT and AC groups (p=0.022). When asked about GWG perspectives, 78% (n=81) of women stated the amount of weight they gained was important to them with the top 3 reasons being: “To have a healthy pregnancy”, “To deliver a healthy baby” and “For my health”. Intentional changes were made by 68% of the women to help manage their weight in pregnancy, with ~45% changing the type of foods they ate (n=57) and 28% increasing their physical activity (n=35). Total GWG, rate of weight gain and adherence to GWG guidelines did not differ between the three groups. Overall, 50%, 42% and 8% of the participants exceeded, met and fell below the guidelines, respectively. Guideline concordance differed by pre‐pregnancy BMI category (p=0.024), with 78% of the overweight and 67% of the obese women exceeding the guidelines compared with 34% of women within a normal BMI. Women who agreed to feeling in control of their weight prior to pregnancy were more likely to gain weight within the guidelines during pregnancy (p=0.008).

Conclusion

Most women understand why weight gain in pregnancy is important, yet half exceed the guidelines. Understanding a woman's sense of weight control prior to pregnancy may help aid healthcare providers understand which women who may be at increased risk for excess GWG.

Support or Funding Information

The Danone Institute of Canada, Alberta Innovates Health Solutions