Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial

Abstract

Background: Excessive weight gain during pregnancy is a risk factor for postpartum weight retention and future weight gain and obesity. Whether a behavioral intervention in pregnancy can reduce long-term weight retention is unknown.

Objective: This randomized trial tested whether a low-intensity behavioral intervention to prevent excessive gestational weight gain could increase the proportion of women who returned to prepregnancy weight by 12 mo postpartum.

Design: Women (n = 401, 13.5 wk of gestation, 50% normal weight, 50% overweight/obese) were randomly assigned into an intervention or control group; 79% completed the 12-mo assessment. The telephone-based intervention targeted gestational weight gain, healthy eating, and exercise and was discontinued at delivery.

Results: In modified intent-to-treat analyses that excluded women with miscarriages (n = 6), gestational diabetes (n = 32), or subsequent pregnancies (n = 32), the intervention had no significant effect on the odds of achieving prepregnancy weight at 12 mo postpartum (n = 331; 35.4% compared with 28.1%; P = 0.18). Completer analyses suggested that the intervention tended to increase the percentages of women who reached prepregnancy weight (n = 261; 45.3% compared with 35.3%; P = 0.09) and significantly reduced the magnitude of mean ± SD postpartum weight retained (1.4 ± 6.3 compared with 3.0 ± 5.7 kg; P = 0.046) at 12 mo. Women in the intervention group reported higher dietary restraint through 6 mo postpartum (P = 0.023) and more frequent self-monitoring of body weight (P < 0.02 for all) throughout the study.

Conclusions: A low-intensity behavioral intervention in pregnancy can reduce 12-mo postpartum weight retention and improve dietary restraint and self-weighing in study completers. Future research is needed to test the long-term effects of more intensive behavioral interventions in pregnancy. This trial was registered at clinicaltrials.gov as NCT01117961.

FIGURE 1.

Flow diagram.

FIGURE 2.

Mean (±SE) cognitive restraint scores through 1 y postpartum in women who received prenatal lifestyle intervention (n = 128) or standard care (n = 133). The intervention significantly increased restraint scores over time (ANOVA; F = 3.2, P = 0.02, ηp2 = 0.016).

FIGURE 3.

Percentage of women who reported weekly or more frequent self-weighing in the prenatal lifestyle intervention group (n = 128) compared with the standard care (n = 133) group. The intervention significantly increased the proportion of participants who reported weekly or more frequent self-weighing at 30 wk of gestation (OR: 14.7; 95% CI: 5.8, 43.6; P = 0.0001), 6 mo postpartum (OR: 2.7; 95% CI: 1.3, 5.9; P = 0.009), and 12 mo postpartum (OR: 2.7; 95% CI: 1.2, 6.1; P = 0.02).