Diet, activity goals may prevent gestational weight gain
A modified DASH* diet and lifestyle intervention for overweight or obese pregnant women appears to reduce the risk of gestational weight gain (GWG), according to a recent study.
The US-based MOMFIT** involved 281 pregnant women (age, 18–45 years) who were overweight (BMI >25 kg/m2) or obese (BMI >30 kg/m2). Participants were randomized to either the MAMA-DASH diet (modified calorie diet to match the recommended weight gain and follow nutrition guidelines for pregnant women) and lifestyle intervention (n=140) or usual care (n=141) at 16 weeks of gestation. Food intake for both treatment groups was tracked using a phone app and a pedometer was given to monitor daily activities (eg, >30 minutes of activity or walking >10,000 steps per day) for the intervention group only. Participants were followed up at 24 and 35 weeks of gestation. [Am J Prev Med 2018;doi:10.1016/j.amepre.2018.06.015]
At 35 weeks, women in the intervention group had significantly lower GWG than those in the usual care group (10 vs 12 kg; p=0.02).
Significantly fewer women in the intervention group also exceeded the recommended GWG compared with the usual care group (68.6 percent vs 84.4 percent; p=0.004).
“The National Academy of Medicine (formerly known as the Institute of Medicine) revised their GWG guidelines in 2009, reiterating the goal of 7.0−11.5 kg for overweight women and specifying a GWG of 5.0−9.1 kg for obese women,” said the researchers.
Individuals in the intervention group demonstrated better adherence to their diet than the usual care group, as determined by significantly higher Dixon DASH (0–9 total points, median, 4 vs 3 points; p=0.01), Fung DASH (8–40 total points, median 27 vs 26; p=0.005), and Healthy Eating Index scores (0–100 total points, median 70 vs 63; p=0.002) at 35 weeks of follow-up.
There was no significant between-group difference in birth weight, neonatal adiposity, gestational age, or adverse pregnancy outcomes. However, more Caesarean sections occurred in the intervention vs the usual care group (39.6 percent vs 27.0 percent; p=0.01), especially among obese women, a finding that the researchers considered “unexpected and disconcerting”.
“Intervention participants found the discipline of daily diet and activity logging challenging, but acknowledged that self-monitoring practices helped control calorie intake,” said the researchers. “The Registered Dietitian Nutritionist coaches generated weekly nutrition reports (comparing participant’s diet [phone] app entries with MAMA-DASH targets) that, based on participant feedback, increased mindfulness of selecting healthier foods thereby strengthening dietary adherence … [but] self-monitoring of step count or engagement in prenatal physical activity was less well adopted,” said the researchers
“Diet changes enhanced overall maternal nutrient quality, but efforts are needed to improve physical activity and overall DASH diet adherence. The absence of signiﬁcant neonatal anthropometric differences at birth requires further follow-up to monitor the trajectory of growth and adiposity among these children,” the researchers said.
“Juxtaposed with advancing intervention technology, MOMFIT focused on improving nutrient quality during pregnancy and post-partum, goals that may transcend weight change and beneﬁt maternal/foetal health and quality of breastmilk. The DASH diet pattern meets the major nutrient recommendations for pregnancy,” they added.
*DASH: Dietary Approaches to Stop Hypertension diet
**MOMFIT: Maternal Offspring Metabolics Family Intervention Trial