Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial

Objective To determine the effect of antenatal dietary and lifestyle interventions on health outcomes in overweight and obese pregnant women. Design Multicentre randomised trial. We utilised a central telephone randomisation server, with computer generated schedule, balanced variable blocks, and stratification for parity, body mass index (BMI) category, and hospital. Setting Three public maternity hospitals across South Australia. Participants 2212 women with a singleton pregnancy, between 10+0 and 20+0 weeks’ gestation, and BMI ≥25. Interventions 1108 women were randomised to a comprehensive dietary and lifestyle intervention delivered by research staff; 1104 were randomised to standard care and received pregnancy care according to local guidelines, which did not include such information. Main outcome measures Incidence of infants born large for gestational age (birth weight ≥90th centile for gestation and sex). Prespecified secondary outcomes included birth weight >4000 g, hypertension, pre-eclampsia, and gestational diabetes. Analyses used intention to treat principles. Results 2152 women and 2142 liveborn infants were included in the analyses. The risk of the infant being large for gestational age was not significantly different in the two groups (lifestyle advice 203/1075 (19%) v standard care 224/1067 (21%); adjusted relative risk 0.90, 95% confidence interval 0.77 to 1.07; P=0.24). Infants born to women after lifestyle advice were significantly less likely to have birth weight above 4000 g (lifestyle advice 164/1075 (15%) v standard care 201/1067 (19%); 0.82, 0.68 to 0.99; number needed to treat (NNT) 28, 15 to 263; P=0.04). There were no differences in maternal pregnancy and birth outcomes between the two treatment groups. Conclusions For women who were overweight or obese, the antenatal lifestyle advice used in this study did not reduce the risk delivering a baby weighing above the 90th centile for gestational age and sex or improve maternal pregnancy and birth outcomes. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12607000161426).

[1]  S. Wray,et al.  Efficacy of metformin in pregnant obese women: a randomised controlled trial , 2015, BMJ Open.

[2]  B. Kodali,et al.  Transfusion ratios for postpartum hemodilutional coagulopathy: an in vitro thromboelastographic model. , 2014, American journal of obstetrics and gynecology.

[3]  L. Green,et al.  How we manage the haematological aspects of major obstetric haemorrhage , 2014, British journal of haematology.

[4]  C. Cooper,et al.  Maternal plasma polyunsaturated fatty acid status in late pregnancy is associated with offspring body composition in childhood. , 2013, The Journal of clinical endocrinology and metabolism.

[5]  T. Harder,et al.  Birth Weight and Long-Term Overweight Risk: Systematic Review and a Meta-Analysis Including 643,902 Persons from 66 Studies and 26 Countries Globally , 2012, PloS one.

[6]  D. Lawlor,et al.  Maternal adiposity—a determinant of perinatal and offspring outcomes? , 2012, Nature Reviews Endocrinology.

[7]  J. Dodd,et al.  Can shoulder dystocia be reliably predicted? , 2012, The Australian & New Zealand journal of obstetrics & gynaecology.

[8]  L. Poston,et al.  How should women be advised on weight management in pregnancy? , 2012, BMJ : British Medical Journal.

[9]  B W Mol,et al.  Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence , 2012, BMJ : British Medical Journal.

[10]  Helen Croker,et al.  Lifestyle interventions for overweight and obese pregnant women to improve pregnancy outcome: systematic review and meta-analysis , 2012, BMC Medicine.

[11]  J. Wells,et al.  Maternal and infant factors associated with neonatal adiposity: Results from the Tasmanian Infant Health Survey (TIHS) , 2012, International Journal of Obesity.

[12]  S. Hill,et al.  Cost-effectiveness analysis for clinicians , 2012, BMC Medicine.

[13]  H. Beck-Nielsen,et al.  The LiP (Lifestyle in Pregnancy) Study , 2011, Diabetes Care.

[14]  J. Dodd,et al.  Limiting weight gain in overweight and obese women during pregnancy to improve health outcomes: the LIMIT randomised controlled trial , 2011, BMC pregnancy and childbirth.

[15]  Xi-rong Guo,et al.  Birth weight and subsequent risk of obesity: a systematic review and meta‐analysis , 2011, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[16]  M. Gillman,et al.  Prenatal fatty acid status and child adiposity at age 3 y: results from a US pregnancy cohort. , 2011, The American journal of clinical nutrition.

[17]  Jeffrey S. Robinson,et al.  Maternal and perinatal health outcomes by body mass index category , 2011, The Australian & New Zealand journal of obstetrics & gynaecology.

[18]  C. Schauberger,et al.  Predictors of Obesity in Childhood, Adolescence, and Adulthood in a Birth Cohort , 2011, Maternal and Child Health Journal.

[19]  J. Dodd,et al.  Antenatal interventions for overweight or obese pregnant women: a systematic review of randomised trials , 2010, BJOG : an international journal of obstetrics and gynaecology.

[20]  P. Kitsantas,et al.  Risk profiles for overweight/obesity among preschoolers. , 2010, Early human development.

[21]  Marie-Jo Brion,et al.  Association of Maternal Weight Gain in Pregnancy With Offspring Obesity and Metabolic and Vascular Traits in Childhood , 2010, Circulation.

[22]  D. Dries.  A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study , 2010 .

[23]  Ann L. Yaktine,et al.  Weight Gain During Pregnancy , 2009 .

[24]  John B Holcomb,et al.  Resuscitation and transfusion principles for traumatic hemorrhagic shock. , 2009, Blood reviews.

[25]  J. Dellavolpe,et al.  Hemostatic resuscitation during surgery improves survival in patients with traumatic-induced coagulopathy. , 2009, The Journal of trauma.

[26]  S. Chu,et al.  Prepregnancy Obesity Prevalence in the United States, 2004–2005 , 2009, Maternal and Child Health Journal.

[27]  Annabelle ChanJoan ScottAnh,et al.  PREGNANCY OUTCOME IN SOUTH AUSTRALIA , 2008 .

[28]  E. Dodson,et al.  Gestational Weight Gain and Pregnancy Outcomes in Obese Women: How Much Is Enough? , 2007, Obstetrics and gynecology.

[29]  M. Cedergren.  Optimal Gestational Weight Gain for Body Mass Index Categories , 2007, Obstetrics and gynecology.

[30]  C. Wade,et al.  The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. , 2007, The Journal of trauma.

[31]  R. Usher,et al.  Effect of prepregnancy body mass index categories on obstetrical and neonatal outcomes , 2006, Archives of Gynecology and Obstetrics.

[32]  M. Cedergren.  Effects of gestational weight gain and body mass index on obstetric outcome in Sweden , 2006, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[33]  A Metin Gülmezoglu,et al.  WHO analysis of causes of maternal death: a systematic review , 2006, The Lancet.

[34]  J. Prins,et al.  The prevalence and impact of overweight and obesity in an Australian obstetric population , 2006, The Medical journal of Australia.

[35]  M. Druzin.  Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes , 2006 .

[36]  M. Frydenberg,et al.  Prepregnancy Obesity and Fetal Death: A Study Within the Danish National Birth Cohort , 2005, Obstetrics and gynecology.

[37]  J. Hiller,et al.  Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. , 2005, The New England journal of medicine.

[38]  M. Cedergren.  Maternal Morbid Obesity and the Risk of Adverse Pregnancy Outcome , 2004, Obstetrics and gynecology.

[39]  P. Catalano.  Obesity and pregnancy--the propagation of a viscous cycle? , 2003, The Journal of clinical endocrinology and metabolism.

[40]  A. Nguyen,et al.  PREGNANCY OUTCOME IN SOUTH AUSTRALIA 2002 , 2003 .

[41]  Majid Ezzati,et al.  For Personal Use. Only Reproduce with Permission from the Lancet Publishing Group , 2022 .

[42]  M Joffe,et al.  Maternal obesity and pregnancy outcome: a study of 287 213 pregnancies in London , 2001, International Journal of Obesity.

[43]  A. Astrup,et al.  Obesity : Preventing and managing the global epidemic , 2000 .

[44]  J. Higgins,et al.  The detection, investigation and management of hypertension in pregnancy: full consensus statement , 2000, The Australian & New Zealand journal of obstetrics & gynaecology.

[45]  C. West.  Psychology and Health Promotion , 1998 .

[46]  L. Lipworth,et al.  Prepregnancy weight and the risk of adverse pregnancy outcomes. , 1998, The New England journal of medicine.

[47]  P. Beeby,et al.  New South Wales population‐based birthweight percentile charts , 1996, Journal of paediatrics and child health.