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CD006576

Antibiotic prophylaxis is effective in preventing infectious complications following TRPB. There is no definitive data to confirm that antibiotics for long-course (3 days) are superior to short-course treatments (1 day), or that multiple-dose treatment is superior to single-dose.

A double-blind study of trimethoprim-sulfamethoxazole prophylaxis in patients having transrectal needle biopsy of the prostate.

We studied 89 men undergoing transrectal prostatic biopsies to determine the efficacy of trimethoprim-sulfamethoxazole in preventing postoperative fever, bacteremia and bacteriuria. Of the patients who received placebo temperatures of 37.6C or more occurred in 18%, bacteremia in 70% and bacteriuria in 21%. Most cases of bacteremia were caused by anaerobic organisms and were asymptomatic. Trimethoprim-sulfamethoxazole did not reduce the frequency of fever or bacteremia but did produce a significant reduction in bacteriuria (0 versus 21%, p equals 0.008).

CD006576

Antibiotic prophylaxis is effective in preventing infectious complications following TRPB. There is no definitive data to confirm that antibiotics for long-course (3 days) are superior to short-course treatments (1 day), or that multiple-dose treatment is superior to single-dose.

Antimicrobial prophylaxis for transrectal prostatic biopsy: a prospective study of ciprofloxacin vs piperacillin/tazobactam.

To compare the efficacy of short-term parenteral prophylaxis with piperacillin/tazobactam (P/T) with long-term oral prophylaxis with ciprofloxacin in preventing infective complications after transrectal prostatic biopsy (TPB). Patients scheduled for TPB were randomized to receive P/T (2250 mg intramuscular) twice daily for 2 days (Group 1), or ciprofloxacin (500 mg orally) twice daily for 7 days (Group 2), beginning on the evening before the procedure in both groups. All patients received a 100-mL phosphate enema 3 h before TPB. Evaluation included self-recording of body temperature in the 3 days after TPB, and culture of mid-stream urine (MSU) samples taken before and 3 and 15 days after TPB. Patients with indwelling urethral catheters or taking antibiotics or immunosuppressive drugs were excluded, as were patients with positive MSU cultures before TPB. Of the 138 evaluable patients, 72 received parenteral P/T and 66 oral ciprofloxacin. Bacteriuria (> 105 c.f.u./mL) after TPB occurred in two of 72 (2.8%) patients in Group 1 and in three of 66 (4.5%) patients in Group 2; this difference was not statistically significant (P > 0.1). However, of the five patients with bacteriuria, two were symptomatic and both were in Group 2. Pyrexia occurred in only one patient in Group 2 with symptomatic urinary tract infection, and required hospitalization. No other patient reported a body temperature openface> 37.5 degrees C or drug-related side-effects. This prospective study showed that short-term prophylaxis with P/T was associated with a low rate of asymptomatic bacteriuria, requiring no further treatment, whereas although the rate was similar on long-term prophylaxis with ciprofloxacin patients required further treatment, with one needing hospitalization. We recommend short-term prophylaxis with P/T despite its disadvantages of cost and parenteral administration.

CD006576

Antibiotic prophylaxis is effective in preventing infectious complications following TRPB. There is no definitive data to confirm that antibiotics for long-course (3 days) are superior to short-course treatments (1 day), or that multiple-dose treatment is superior to single-dose.

Trimethoprim versus gentamicin for the prevention of bacteriuria following transrectal biopsy of the prostate--do patients need additional anaerobic cover?

To study the incidence of aerobic and anaerobic bacteriuria in patients undergoing transrectal ultrasound-guided biopsies of the prostate. A comparative assessment of efficacy of trimethoprim with gentamicin for the prevention of bacteriuria following the transrectal biopsy of the prostate. To assess the need for additional prophylaxis against anaerobes for patients undergoing transrectal biopsies of the prostate gland. In a pilot study during 1995-1997, all the patients undergoing transrectal ultrasound-guided biopsy of the prostate were randomised to receive either trimethoprim or gentamicin prophylaxis prior to the procedure. Midstream urine (MSU) samples were taken just prior to biopsy and 72 h later. A patient questionnaire to determine the symptoms of urinary tract infection (UTI) accompanied the 72-hour MSU request form. Urine samples were cultured aerobically, using a semiquantitative technique if dipstick analysis revealed the presence of blood, pus cell or nitrite. In addition to the routine aerobic culture, post-biopsy samples were also cultured for anaerobes by direct and enrichment methods. Bacteriuria was defined as a pure or mixed growth of 10(5) colony-forming units/ml. Fisher's test of exact probability was used for statistical analysis. 115 patients were available for final analysis. 53 had received gentamicin and 62 trimethoprim. Four patients had pre-existing bacteriuria (3.5%), 3 in the trimethoprim group and 1 in the gentamicin group. Post-operative bacteriuria developed in 5 patients given gentamicin (9.4%) and 1 given trimethoprim (1.6%). This difference was not statistically significant (p = 0.085). Post-procedure bacteriuria was asymptomatic in all but 1 case. Anaerobes were detected in only 5 MSUs (4.3%) post-biopsy. Though there was no statistical significant difference in the rates of bacteriuria following administration of trimethoprim and gentamicin, data appear to favour trimethoprim prophylaxis. Further studies are warranted. Transrectal biopsy of the prostate is associated with a low incidence of anaerobic UTI. In view of the very low incidence of anaerobic bacteriuria, routine antibacterial prophylaxis against anaerobes does not appear to be justified. Copyright 2002 S. Karger AG, Basel

CD006576

Antibiotic prophylaxis is effective in preventing infectious complications following TRPB. There is no definitive data to confirm that antibiotics for long-course (3 days) are superior to short-course treatments (1 day), or that multiple-dose treatment is superior to single-dose.

Efficiency of short and long term antimicrobial therapy in transrectal ultrasound-guided prostate biopsies.

Prostate biopsy is a frequent diagnostic measure to detect prostatic conditions, including primarily prostate cancer. Its performance does not follow a pattern, mainly regarding preparation for the examination through antimicrobial prophylaxis. The aim of this study is to compare the efficiency of short and long term antimicrobial prophylaxis in transrectal ultrasound-guided prostate biopsies. A clinical study was conducted with a total of 140 patients submitted to prostate biopsy with transrectal ultrasonographic control. Patients were randomly separated in two groups: Group 1 receiving norfloxacin 400mg single dose before the procedure and Group 2 receiving norfloxacin 400mg initiating before the procedure and then bid up to 6 doses. Efficiency control was determined by the incidence of urinary tract infection (UTI) and complications in both groups after statistical analysis. The incidence of minor complications in our study was 75%, consistent with data found in the literature. Among the patients with diagnosis of simple UTI, 23% belonged to Group 1 and 8% to Group 2 (p=0.08). Among the patients with complicated UTI, 37% belonged to Group 1 and none belonged to Group 2 (p=0.44). Several advances made transrectal ultrasound-guided prostate biopsies a useful and safe diagnostic tool in the workup of urologic patients. There is no optimal prophylactic preparation to the performance of this procedure. Long term antimicrobial prophylaxis presents a trend toward lower incidence of infectious complications.

CD002918

The practice of surgical and chemical sympathectomy for neuropathic pain and CRPS is based on very little high quality evidence. Sympathectomy should be used cautiously in clinical practice, in carefully selected patients, and probably only after failure of other treatment options.

Management of lower limb complex regional pain syndrome type 1: an evaluation of percutaneous radiofrequency thermal lumbar sympathectomy versus phenol lumbar sympathetic neurolysis--a pilot study.

Complex regional pain syndrome type 1 can be difficult to treat. The purpose of this study was to compare the safety and efficacy of two therapeutic options: percutaneous radiofrequency thermal lumbar sympathectomy and lumbar sympathetic neurolysis. We randomized 20 patients to receive percutaneous radiofrequency lumbar sympathectomy or lumbar sympathetic neurolysis with phenol 7% in lower limb complex regional pain syndrome type 1. The study end points were pain relief and side effects. Within each group, there were statistically significant reductions from baseline in various pain scores after the procedure. However, there was no statistically significant difference in mean pain scores between the groups. Based on this pilot study, radiofrequency lumbar sympathectomy may be comparable to phenol lumbar sympathectomy. A larger trial is required to confirm these findings.

CD004182

There is not sufficient evidence to support or refute the use of D-penicillamine for patients with primary sclerosing cholangitis. We do not recommend the use of D-penicillamine for patients with primary sclerosing cholangitis outside randomised trials.

Prospective trial of penicillamine in primary sclerosing cholangitis.

We evaluated the therapeutic efficacy of penicillamine in primary sclerosing cholangitis. In a randomized, prospective, double-blind trial, 39 patients received penicillamine (250 mg t.i.d.) and 31 received a placebo. The two groups were highly comparable at entry with regard to clinical, biochemical, radiologic, and hepatic histologic features. Although a predictable cupruresis and a decrease in levels of hepatic copper were achieved in patients taking penicillamine, there was no beneficial effect on disease progression within 36 mo or on overall survival. Progressive symptoms, deterioration in serial hepatic laboratory values, or histologic progression on sequential liver biopsy specimens were similar in both groups, occurring in greater than 80% of the entire study population. The development of major side effects led to the permanent discontinuation of penicillamine in 21% of the patients taking the drug. We conclude that the use of penicillamine in primary sclerosing cholangitis is not associated with a beneficial effect on disease progression or survival, and has considerable toxicity. The study also suggests that primary sclerosing cholangitis is a progressive disease in many patients.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Metabolic effects of 1200-kcal diet in obese pregnant women with gestational diabetes.

Calorie restriction is widely used as a primary therapy for obese pregnant women with gestational diabetes. To better understand the metabolic consequences of marked calorie restriction, we performed a randomized prospective trial under metabolic ward conditions. Obese gestationally diabetic women were randomized to control (n = 5) and calorie-restricted (n = 7) groups. All patients consumed an approximately 2400-kcal/day diet during the 1st wk of the study, and at the end of the 1st wk, metabolic features of the two groups were statistically indistinguishable. During the 2nd wk, the control group continued to consume approximately 2400 kcal/day, whereas the calorie-restricted group consumed approximately 1200 kcal/day. Twenty-four-hour mean glucose levels remained unchanged in the control group (6.7 +/- 0.8 mM wk 1 vs. 6.8 +/- 0.8 mM wk 2), although they dropped dramatically in the calorie-restricted group (6.7 +/- 1.0 mM wk 1 vs. 5.4 +/- 0.5 mM wk 2, P less than 0.01). Fasting plasma insulin also declined in the calorie-restricted group (265 +/- 165 pM wk 1 vs. 145 +/- 130 pM wk 2), resulting in a significant change between groups (P less than 0.02). Surprisingly, fasting plasma glucose and glucose tolerance measured by the 3-h oral glucose tolerance test did not change within or between groups. Fasting levels of beta-hydroxybutyrate rose in the calorie-restricted group (290 +/- 240 microM wk 1 vs. 780 +/- 30 microM wk 2) but not in the control group (P less than 0.01). Finally, urine ketones increased significantly (P less than 0.02) in the calorie-restricted group, whereas they remained absent in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Effect of a low-glycemic-index diet during pregnancy on obstetric outcomes.

Pregnancy is a condition in which the glycemic index (GI) may be of particular relevance because maternal glucose is the main energy substrate for intrauterine growth. The aim was to compare the effects of low-GI and conventional dietary strategies on pregnancy outcomes in healthy women. Compliance and acceptability were also investigated. The subjects were assigned alternately to receive dietary counseling that encouraged either low-GI (LGI) carbohydrate foods or high-fiber, moderate-to-high GI (HGI) foods and were studied 5 times between <16 wk gestation and delivery. Of the 70 women who met the inclusion criteria, 62 completed the study (32 in the LGI and 30 in the HGI groups). Primary outcomes were measures of fetal size. The mean diet GI fell significantly in the LGI group but not in the HGI group. Compared with the LGI group, women in the HGI group gave birth to infants who were heavier (3408 +/- 78 compared with 3644 +/- 90 g; P = 0.051) and had a higher birth centile (48 +/- 5 compared with 69 +/- 5; P = 0.005), a higher ponderal index (2.62 +/- 0.04 compared with 2.74 +/- 0.04; P = 0.03), and a higher prevalence of large-for-gestational age (3.1% compared with 33.3%; P = 0.01). Women in the LGI group found the diet easier to follow. Because birth weight and ponderal index may predict chronic disease in later life, a low-GI diet may favorably influence long-term outcomes.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Maternal carbohydrate intake and pregnancy outcome.

Experimental evidence indicates that the primary maternal environmental factor that regulates feto-placental growth is substrate delivery to the placental site, which is the product of maternal substrate levels and the rate of placental-bed blood flow. Thus, maternal factors which change either substrate level or flow alter feto-placental growth rate. The best-studied substrate in human pregnancy is glucose, and there is a direct relationship between maternal blood glucose levels and size at birth. Altering the type of carbohydrate eaten (high- v. low-glycaemic sources) changes postprandial glucose and insulin responses in both pregnant and non-pregnant women, and a consistent change in the type of carbohydrate eaten during pregnancy influences both the rate of feto-placental growth and maternal weight gain. Eating primarily high-glycaemic carbohydrate results in feto-placental overgrowth and excessive maternal weight gain, while intake of low-glycaemic carbohydrate produces infants with birth weights between the 25th and the 50th percentile and normal maternal weight gain. The calculated difference in energy retention with similar total energy intakes is of the order of 80,000 kJ. Preliminary information from subsequent metabolic studies indicates that the mechanisms involved include changes in: daily digestible energy requirements (i.e. metabolic efficiency), substrate utilization (glucose oxidation v. lipid oxidation), and insulin resistance and sensitivity. Thus, altering the source of maternal dietary carbohydrate may prove to be a valuable tool in the management of pregnancies at risk for anomalous feto-placental growth and for the prevention and/or treatment of obesity and insulin resistance in the non-pregnant state.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial.

to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum, or from birth to six months post partum, on weight retention among Taiwanese women. a randomised controlled trial assigned participants to two experimental groups [from pregnancy to six months post partum (EP) and from birth to six months post partum (EPP)] and one comparison group. a 3900-bed medical centre in northern Taiwan with around 3000 births annually. a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre. the comparison group received the routine outpatient department obstetric educational programme. The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum, and received on brochure. The EPP group received the same educational intervention as the EP group from 24-48 hours after birth to six months post partum. body weight, body mass index, health-promoting behaviour and psycho-social variables (self-efficacy, body image, depression and social support). average gestational weight gain was 14.02, 15.27 and 16.22 kg in the three EP, EPP and comparison groups respectively, and average weight retention at six months post partum was 2.34, 4.06 and 5.08 kg in the three groups, respectively. a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention. the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle. Copyright © 2009 Elsevier Ltd. All rights reserved.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

A randomised trial of a four-step multidisciplinary approach to the antenatal care of obese pregnant women.

Obesity is common in pregnancy and results in morbidity to mother and newborn.   To evaluate whether a four-step multidisciplinary protocol of antenatal care for overweight and obese women would reduce the incidence of gestational diabetes.  Pregnant women were approached at their first antenatal visit, and body mass index (BMI) was calculated to determine whether they were overweight or obese (BMI > 25). Eligible women were randomised to standard obstetric antenatal care or four-step multidisciplinary antenatal care. Clinic protocol included (i) continuity of obstetric provider; (ii) weighing on arrival at each visit; (iii) a five brief minute intervention by a food technologist who asked about the women's eating habits of the previous day, provided information on reading food labels, shopping lists of affordable foods available from local shops and recipes for a healthy pregnancy diet; and (iv) clinical psychology management to assess symptoms of depression and anxiety, stressful life events and determine whether psychological factors were involved in eating patterns. Labour and delivery data were audited from the medical records to determine the final incidence of gestational diabetes. The primary outcomes were gestational diabetes and weight gain.  The intervention was associated with a significant reduction in the incidence of gestational diabetes (6 versus 29%, OR 0.17 95% CI 0.03-0.95, P = 0.04). It was also associated with reduced weight gain in pregnancy (7.0 versus 13.8 kg, P < 0.0001). Despite this, birthweight of newborns was similar [3.5 (0.1) kg versus 3.4 (0.1) kg P = 0.16].   A four-step management plan adopted with obese women reduces the incidence of gestational diabetes. © 2011 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Exercise during pregnancy improves maternal health perception: a randomized controlled trial.

We have studied the effect of moderate physical activity that is performed by healthy women during their entire pregnancy on their perception of health status. Eighty sedentary women were assigned randomly to either an exercise group (n = 40) or a control group (n = 40). Maternal perception of health status and several pregnancy outcomes were recorded. Significant differences (P = .03) were found between study groups in the percentage of women who perceived their health status as "very good"; the values that corresponded to the exercise group (n = 18; 54.5%) were better than those of the control group (n = 9; 27.3%). In addition, the women of the exercise group gained less weight (11,885 ± 3146 g) than those of the control group (13,903 ± 2113; P = .03). A moderate physical activity program that is performed over the first, second, and third trimester of pregnancy improves the maternal perception of health status. Copyright © 2011 Mosby, Inc. All rights reserved.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Preventing excessive weight gain during pregnancy through dietary and lifestyle counseling: a randomized controlled trial.

To estimate whether an organized, consistent program of dietary and lifestyle counseling prevents excessive weight gain in pregnancy. This randomized controlled trial assigned women to receive either an organized, consistent program of intensive dietary and lifestyle counseling or routine prenatal care. The primary study outcome was the proportion of patients whose gestational weight gain was within the Institute of Medicine (IOM) guidelines. Secondary outcomes included mode of delivery, rate of operative vaginal delivery, neonatal weight, and the incidence of preeclampsia, gestational diabetes mellitus (GDM), vaginal/perineal lacerations, and shoulder dystocia. A total of 100 women were randomized to the study (lifestyle counseling 57, routine prenatal care 43). Baseline demographic characteristics were similar between the study groups. The lifestyle counseling group gained significantly less weight than did the routine prenatal care group (28.7+/-12.5 lb compared with 35.6+/-15.5 lb, P=.01). The routine prenatal care group had significantly more cesarean deliveries due to "failure to progress" (routine prenatal care 58.3% compared with lifestyle counseling 25.0%, P=.02). Across groups, patients who were not adherent to the IOM guidelines had significantly heavier neonates (adherent 3,203.2+/-427.2 g compared with not adherent 3,517.4+/-572.4 g, P<.01). Nulliparous women gained significantly more weight than did parous women (36.5+/-14.5 lb compared with 27.7+/-12.7 lb, P<.01). The most predictive factor of IOM adherence was having a normal prepregnancy body mass index. No statistically significant differences were noted between the groups in adherence to IOM guidelines, rate of cesarean delivery, preeclampsia, GDM, operative vaginal delivery, or vaginal lacerations. An organized, consistent program of dietary and lifestyle counseling did reduce weight gain in pregnancy. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00792480 I.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Randomized controlled trial to prevent excessive weight gain in pregnant women.

The Institute of Medicine (IOM) recommends that normal-weight women (BMI (body mass index) of 19.8-26.0) gain 25-35 lb (11.4-15.9 kg) during pregnancy, and that overweight women (BMI of 26.1-29.0) gain 15-25 lbs (6.8-11.4 kg). A significant number of normal-weight women and an even greater proportion of overweight women exceed these guidelines, which increases postpartum weight retention and may contribute to the development of obesity. To determine whether a stepped care, behavioral intervention will decrease the percentage of women who gain more than the IOM recommendation. Randomized controlled trial comparing a stepped-care behavioral intervention with usual care. Women (n=120) who had a BMI>19.8, age>18 and <20 weeks gestation were recruited from a hospital-based clinic serving low-income women and randomized by race and BMI category to the intervention or control group. The intervention group received education about weight gain, healthy eating, and exercise and individual graphs of their weight gain. Those exceeding weight gain goals were given more intensive intervention. Women were followed through pregnancy to their first postpartum clinic visit. The main outcome measure was weight gain during pregnancy categorized as above the IOM recommendations vs below or within the IOM recommendations. The intervention significantly decreased the percentage of normal-weight women who exceeded the IOM recommendations (33 vs 58%, P<0.05). There was a non-significant (P=0.09) effect in the opposite direction among overweight women (59% of intervention and 32% of control gained more than recommended). Postpartum weight retention was strongly related to weight gain during pregnancy (r=0.89). The intervention reduced excessive weight gain during pregnancy among normal weight women.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Control of weight-gain during pregnancy: use of diethylpropion hydrochloride.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Continuing regular exercise during pregnancy: effect of exercise volume on fetoplacental growth.

The purpose of this study was to test the null hypothesis that the volume of exercise at different times during pregnancy has no effect on fetoplacental growth. Seventy-five women who exercised regularly were evaluated before pregnancy and randomly assigned at 8 weeks' gestation to one of 3 exercise regimens for the remainder of pregnancy. Primary outcome variables included placental growth rate, birth weight, and placental volume at term. The offspring of the women who were randomly assigned to a high volume of exercise in mid and late pregnancy were significantly lighter (3.39 kg vs 3.81 kg) and thinner (8.3% fat vs 12.1% fat) than those offspring born of women who were randomly assigned to reduce their exercise volume after the 20th week. Maternal weight gain, fresh placental volumes, and histomorphometric indices of placental function were greater in the high-low group. These data indicate that a high volume of moderate-intensity, weight-bearing exercise in mid and late pregnancy symmetrically reduces fetoplacental growth, whereas a reduction in exercise volume enhances fetoplacental growth with a proportionally greater increase in fat mass than in lean body mass.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.

Excessive weight gain during pregnancy is a major risk factor for postpartum weight retention and future weight gain and obesity in women, but few adequately powered randomized controlled trials have examined the efficacy of a behavioral weight-control intervention during pregnancy. This study examined whether a behavioral intervention during pregnancy could decrease the proportion of women who exceeded the 1990 Institute of Medicine (IOM) recommendations for gestational weight gains and increase the proportion of women who returned to pregravid weights by 6 mo postpartum. This study was a randomized, assessor-blind, controlled trial. Participants were pregnant (13.5 wk gestation), normal-weight (NW; n = 201) and overweight or obese (OW/OB; n = 200) women whose average age was 28.8 y. Participants were randomly assigned within the 1990 IOM weight category (NW compared with OW/OB) to standard care (n = 200) or to a behavioral intervention to prevent excessive gestational weight gain (n = 201). The intervention included one face-to-face visit; weekly mailed materials that promoted an appropriate weight gain, healthy eating, and exercise; individual graphs of weight gain; and telephone-based feedback. The retention at the 6-mo postpartum assessment was 82%. Intent-to-treat analyses showed that the intervention, compared with standard care, decreased the percentage of NW women who exceeded IOM recommendations (40.2% compared with 52.1%; P = 0.003) and increased the percentages of NW and OW/OB women who returned to their pregravid weights or below by 6 mo postpartum (30.7% compared with 18.7%; P = 0.005). A low-intensity behavioral intervention during pregnancy reduced excessive gestational weight gains in NW women and prevented postpartum weight retention in NW and OW/OB women. This trial was registered at clinicaltrials.gov as NCT01117961.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

[Impact of a dietary counseling program on the gain weight speed of pregnant women attended in a primary care service].

to evaluate the impact of dietary counseling on controlling weight gain in pregnant women, who were served in a public health service facility. the study was conducted at a known health unit located in the metropolitan region of the city of Porto Alegre, in Rio Grande do Sul, Brazil. Three hundred and fifteen pregnant women between the 10th and 29th week of gestation were randomized to Control and Intervention Groups. The Intervention Group received dietary counseling according to nutritional status, and pregnant women in the Control Group were instructed to follow the routine of the health service facility. Weight and height were measured, and the body mass index (BMI) was calculated. The pre-gestational nutritional status was determined according to the following BMI criteria: low weight (<18.5 kg/m²), eutrophy (18.5 to 24.9 kg/m²), overweight (25.0 to 29.9 kg/m²), and obesity (>30 kg/m²). The nutritional status during pregnancy was determined according to the BMI curve for gestational age adopted by the Health Ministry of Brazil. Data were analyzed by the relative risk and respective 95% confidence interval, and by the Student's t-test and χ2 test. Statistical significance was set at p<0.05. the assessment of nutritional status before pregnancy showed that 28.0% of the women were overweight and 4.1% were underweight. In the first and last interview during pregnancy, the rates of prevalence of excessive weight were 36.2 and 46.0%, respectively. The intervention proved to be effective in reducing the rate of weekly weight gain of pregnant women with excess weight (342.2 versus 420.2; p=0.015) and the prevalence of clinical complications (9.2 versus 24.85; p<0.001). dietary counseling was effective in decreasing the weight gain of pregnant women who were overweight and reducing clinical complications, such as gestational diabetes, preeclampsia, infant low weight, and prematurity in the Intervention Group.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Prevention of gestational diabetes: feasibility issues for an exercise intervention in obese pregnant women.

To examine the feasibility of an individualized exercise program to prevent gestational diabetes mellitus (GDM) in obese pregnant women. The study was a pilot randomized controlled trial with obese pregnant women (intervention group, individualized exercise program [n = 25]; control group, usual care [n = 25]). Average weekly energy expenditure (MET hours per week and kilocalories per week) of exercise-specific activity was assessed during pregnancy using the Pregnancy Physical Activity Questionnaire. Fasting glucose and insulin and homeostasis model assessment of insulin resistance (HOMA-IR) were assessed at baseline and 20, 28, and 36 weeks' gestation. Of the women in the intervention group, 16 of 22 (73%) achieved more than 900 kcal/week of exercise-based activity at 28 weeks compared with 8 of 19 women in the control group (42%), P = 0.047. However, insulin resistance (HOMA-IR) did not differ between the groups. This intervention was feasible and prompted a modest increase in physical activity. However, we are not confident that this intervention would be sufficient to prevent GDM.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Improving diet and exercise in pregnancy with Video Doctor counseling: a randomized trial.

To determine if an interactive, computerized Video Doctor counseling tool improves self-reported diet and exercise in pregnant women. A randomized trial comparing a Video Doctor intervention to usual care in ethnically diverse, low-income, English-speaking pregnant women was conducted. Brief messages about diet, exercise, and weight gain were delivered by an actor-portrayed Video Doctor twice during pregnancy. In the Video Doctor group (n=158), there were statistically significant increases from baseline in exercise (+28 min), intake of fruits and vegetables, whole grains, fish, avocado and nuts, and significant decreases in intake of sugary foods, refined grains, high fat meats, fried foods, solid fats, and fast food. In contrast, there were no changes from baseline for any of these outcomes in the usual care group (n=163). Nutrition knowledge improved significantly over time in both groups but more so in the Video Doctor group. Clinician-patient discussions about these topics occurred significantly more frequently in the Video Doctor group. There was no difference in weight gain between groups. A brief Video Doctor intervention can improve exercise and dietary behaviors in pregnant women. The Video Doctor can be integrated into prenatal care to assist clinicians with effective diet and exercise counseling. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Effects of a low-glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial.

The optimal diet for pregnancy that is complicated by excessive weight is unknown. We aimed to examine the effects of a low-glycemic load (low-GL) diet in overweight and obese pregnant women. We randomly assigned 46 overweight or obese pregnant women to receive a low-GL or a low-fat diet. Participants received carbohydrate-rich foods, fats, and snack foods through home delivery or study visits. The primary outcome was birth weight z score. Other endpoints included infant anthropometric measurements, gestational duration, maternal weight gain, and maternal metabolic parameters. There were no significant differences in birth weight z score or other measures of infant adiposity between groups. However, in the low-GL compared with the low-fat group, gestational duration was longer (mean ± SD: 39.3 ± 1.1 compared with 37.9 ± 3.1 wk; P = 0.05) and fewer deliveries occurred at ≤ 38.0 wk (13% compared with 48%, P = 0.02; with exclusion of planned cesarean deliveries: 5% compared with 53%; P = 0.002). Adjusted head circumference was greater in the low-GL group (35.0 ± 0.8 compared with 34.2 ± 1.3 cm, P = 0.01). Women in the low-GL group had smaller increases in triglycerides [median (interquartile range): 49 (19, 70) compared with 93 (34, 129) mg/dL; P = 0.03] and total cholesterol [13 (0, 36) compared with 33 (22, 56) mg/dL, P = 0.04] and a greater decrease in C-reactive protein [-2.5 (-5.5, -0.7) compared with -0.4 (-1.4, 1.5) mg/dL, P = 0.007]. A low-GL diet resulted in longer pregnancy duration, greater infant head circumference, and improved maternal cardiovascular risk factors. Large-scale studies are warranted to evaluate whether dietary intervention during pregnancy aimed at lowering GL may be useful in the prevention of prematurity and other adverse maternal and infant outcomes. This trial is registered at clinicaltrials.gov as NCT00364403.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial.

Maternal obesity and excessive gestational weight gain (GWG) are major short- and long-term risk factors for maternal and fetal complications. The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits, increase physical activity (PA), and reduce GWG in obese pregnant women. In this randomized controlled trial, 195 white, obese pregnant women [age: 29 + or - 4 y; body mass index (in kg/m(2)); 33.6 + or - 4.2] were randomly assigned into 3 groups: a group that received nutritional advice from a brochure, a group that received the brochure and lifestyle education by a nutritionist, and a control group. Nutritional habits were evaluated every trimester through 7-d food records. PA was evaluated with the Baecke questionnaire. Energy intake did not change during pregnancy and was comparable in all groups. Fat intake, specifically saturated fat intake, decreased and protein intake increased from the first to the third trimester in the passive and active groups compared with an opposite change in the control group. Calcium intake and vegetable consumption increased during pregnancy in all groups. PA decreased in all groups, especially in the third trimester. No significant differences in GWG and obstetrical or neonatal outcome could be observed between the groups. Both lifestyle interventions improved the nutritional habits of obese women during pregnancy. Neither PA nor GWG was affected.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Computer-assisted self-interview and nutrition education in pregnant teens.

The purpose of this study was to conduct computer-assisted self-interview (CASI) nutrition assessment in a pregnant, adolescent African American population to compare the effect of a nutrition education intervention with the standard dietitian consult on gestational weight gain patterns and postpartum weight retention. Control group (n = 24) and experimental group (n = 22) data obtained from the nutritional assessment and measurement of gestational weight gain/postpartum weight retention patterns were compared during the second trimester, third trimester, and 6 weeks postpartum to evaluate the effectiveness of the program. The experimental group gained signficantly less weight during the first and second trimesters than the control group. During the third trimester gestational weight gain was significantly higher for the experimental group. Postpartum weight retention was signifcantly higher for the control group. There were no significant differences between maternal characteristics of the two groups. Fat content and daily caloric content of participants in the control group were significantly higher than the experimental group.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Feasibility of a lifestyle intervention in early pregnancy to prevent deterioration of glucose tolerance.

In conjunction with the growing prevalence of obesity and the older age of pregnant women gestational diabetes (GDM) is a major health problem.The aim of the study was to evaluate if a lifestyle intervention since early pregnancy is feasible in improving the glucose tolerance of women at a high-risk for GDM in Finland. A 75-g oral glucose tolerance test (OGTT) was performed in early pregnancy (n = 102). Women at high risk for GDM (n = 54) were randomized at weeks 8-12 from Apr 2005 to May 2006 to a lifestyle intervention group (n = 27) or to a close follow-up group (n = 27). An OGTT was performed again at weeks 26-28 for the lifestyle intervention and close follow-up groups. The values of the OGTT during the second trimester did not differ between the lifestyle intervention and close follow-up groups. In the lifestyle intervention group three women had GDM in the second trimester and respectively one woman in the close follow up group. Insulin therapy was not required in both groups. The intervention resulted in somewhat lower weight gain 11.4 ± 6.0 kg vs. 13.9 ± 5.1 kg, p = 0.062, adjusted by the prepregnancy weight. Early intervention with an OGTT and simple lifestyle advice is feasible. A more intensive lifestyle intervention did not offer additional benefits with respect to glucose tolerance, although it tended to ameliorate the weight gain. ClinicalTrials.gov: NCT01130012.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

The use of an appetite suppressant (diethylpropion hydrochloride) during pregnancy.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Can a low-glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial.

A low-glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester. A low-glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus (GDM). However, the efficacy of this advice and associated pregnancy outcomes have not been systematically examined. The purpose of this study was to determine whether prescribing a low-glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes. All women with GDM seen over a 12-month period were considered for inclusion in the study. Women (n = 63) were randomly assigned to receive either a low-glycemic index diet or a conventional high-fiber (and higher glycemic index) diet. Of the 31 women randomly assigned to a low-glycemic index diet, 9 (29%) required insulin. Of the women randomly assigned to a higher-glycemic index diet, a significantly higher proportion, 19 of 32 (59%), met the criteria to commence insulin treatment (P = 0.023). However, 9 of these 19 women were able to avoid insulin use by changing to a low-glycemic index diet. Key obstetric and fetal outcomes were not significantly different. Using a low-glycemic index diet for women with GDM effectively halved the number needing to use insulin, with no compromise of obstetric or fetal outcomes.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Perinatal outcomes in nutritionally monitored obese pregnant women: a randomized clinical trial.

Although obesity in pregnancy continues to be associated with ongoing health problems, many clinicians have been reluctant to place nondiabetic, obese, pregnant women on a monitored, calorie-appropriate nutritional regimen for fear of fetal growth restriction, low birth weight, or starvation ketosis. A total of 257 patients were enrolled in the randomized study, with a loss-to-follow-up rate of 9.73%. Patients were assigned randomly to either the control (unmonitored) group (n=116), consisting of conventional prenatal dietary management, or to the study (monitored) group (n=116), which was prescribed a balanced nutritional regimen and were asked to record in a diary all of the foods eaten during each day. Women were eligible for the study if they were pregnant with a single fetus between 12 and 28 weeks of gestation and had a prepregnancy body mass index of more than 30 kg/m2. The primary outcome was to compare perinatal outcomes in the control vs the study groups. The secondary measure was to compare outcomes in adherent and nonadherent patients in the study group. Omnibus MANOVA showed statistically significant differences between the study and control groups regarding 3 variables: (1) gestational hypertension, p < .46; (2) mother's last weight before delivery, p < .001; and (3) mother's 6-week postpartum weight, p < .001. Patients gaining 15 pounds or more during their pregnancy showed statistically significant differences between the groups for 8 variables. Obese pregnant women may be placed on a healthy, well-balanced, monitored nutritional program during their antepartum course without adverse perinatal outcomes.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes.

A randomised controlled trial was designed to determine the effect of moderate 30% maternal dietary energy restriction on the requirement for maternal insulin therapy and the incidence of macrosomia in gestational diabetes. Although the control group restricted their intake to a level similar to that of the intervention group (6,845 kiloJoules (kJ) versus 6,579 kJ), the resulting cohort could not identify any adverse effect of energy restriction in pregnancy. Energy restriction did not alter the frequency of insulin therapy (17.5% in the intervention group and 16.9% in the control group). Mean birthweight (3,461 g in the intervention group and 3,267 g in the control group) was not affected. There was a trend in the intervention group towards later gestational age at commencement of insulin therapy (33 weeks versus 31 weeks) and lower maximum daily insulin dose (23 units versus 60 units) which did not reach statistical significance. Energy restriction did not cause an increase in ketonemia.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial.

Balanced glucose metabolism ensures optimal fetal growth with long-term health implications conferred on both mother and child. We examined whether supplementation of probiotics with dietary counselling affects glucose metabolism in normoglycaemic pregnant women. At the first trimester of pregnancy 256 women were randomised to receive nutrition counselling to modify dietary intake according to current recommendations or as controls; the dietary intervention group was further randomised to receive probiotics (Lactobacillus rhamnosus GG and Bifidobacterium lactis Bb12; diet/probiotics) or placebo (diet/placebo) in a double-blind manner, whilst the control group received placebo (control/placebo). Blood glucose concentrations were lowest in the diet/probiotics group during pregnancy (baseline-adjusted means 4.45, 4.60 and 4.56 mmol/l in diet/probiotics, diet/placebo and control/placebo, respectively; P = 0.025) and over the 12 months' postpartum period (baseline-adjusted means 4.87, 5.01 and 5.02 mmol/l; P = 0.025). Better glucose tolerance in the diet/probiotics group was confirmed by a reduced risk of elevated glucose concentration compared with the control/placebo group (OR 0.31 (95 % CI 0.12, 0.78); P = 0.013) as well as by the lowest insulin concentration (adjusted means 7.55, 9.32 and 9.27 mU/l; P = 0.032) and homeostasis model assessment (adjusted means 1.49, 1.90 and 1.88; P = 0.028) and the highest quantitative insulin sensitivity check index (adjusted means 0.37, 0.35 and 0.35; P = 0.028) during the last trimester of pregnancy. The effects observed extended over the 12-month postpartum period. The present study demonstrated that improved blood glucose control can be achieved by dietary counselling with probiotics even in a normoglycaemic population and thus may provide potential novel means for the prophylactic and therapeutic management of glucose disorders.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Reducing excessive weight gain in pregnancy: a randomised controlled trial.

To determine if regular weight measurement throughout pregnancy can reduce excessive gestational weight gain. A randomised controlled trial. A tertiary obstetric hospital in Melbourne, between July 2007 and May 2008. 236 pregnant women recruited at < or = 14 weeks' gestation. Women allocated to the intervention group were given a personalised weight measurement card, advised of their optimal gestational weight gain (based on their body mass index at the time of recruitment and the United States Institute of Medicine guidelines), and instructed to record their weight at 16, 20, 24, 28, 30, 32 and 34 weeks' gestation. The control group were weighed at recruitment, but were not given instructions about regular weight measurement. All participants were blinded to the purpose of the study. Weight gain from recruitment to follow-up at 36 weeks' gestation. In the study population, there was a trend to less weight gain in the intervention group. The women in the intervention group experienced a mean (SD) per-week weight gain of 0.44 (0.173) kg compared with those in the control group, who gained 0.46 (0.156) kg/week (mean difference, 0.02 kg/week; 95% CI, - 0.02 to 0.07 kg/week). The intervention significantly reduced gestational weight gain in the group of women who were overweight but not obese at recruitment: those in the intervention group (20 women) gained a mean (SD) of 0.42 (0.153) kg/week and the control group (18 women) gained 0.54 (0.123) kg/week (mean difference, 0.12 kg/week; 95% CI, 0.03 to 0.22 kg/week; P = 0.01). Regular weight measurement in pregnancy was not found to be effective in reducing weight gain, except among women who were overweight but not obese before pregnancy. Australian Clinical Trials Registry ACTRN12607000272493.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Primary prevention of gestational diabetes mellitus and large-for-gestational-age newborns by lifestyle counseling: a cluster-randomized controlled trial.

Our objective was to examine whether gestational diabetes mellitus (GDM) or newborns' high birthweight can be prevented by lifestyle counseling in pregnant women at high risk of GDM. We conducted a cluster-randomized trial, the NELLI study, in 14 municipalities in Finland, where 2,271 women were screened by oral glucose tolerance test (OGTT) at 8-12 wk gestation. Euglycemic (n = 399) women with at least one GDM risk factor (body mass index [BMI] ≥ 25 kg/m(2), glucose intolerance or newborn's macrosomia (≥ 4,500 g) in any earlier pregnancy, family history of diabetes, age ≥ 40 y) were included. The intervention included individual intensified counseling on physical activity and diet and weight gain at five antenatal visits. Primary outcomes were incidence of GDM as assessed by OGTT (maternal outcome) and newborns' birthweight adjusted for gestational age (neonatal outcome). Secondary outcomes were maternal weight gain and the need for insulin treatment during pregnancy. Adherence to the intervention was evaluated on the basis of changes in physical activity (weekly metabolic equivalent task (MET) minutes) and diet (intake of total fat, saturated and polyunsaturated fatty acids, saccharose, and fiber). Multilevel analyses took into account cluster, maternity clinic, and nurse level influences in addition to age, education, parity, and prepregnancy BMI. 15.8% (34/216) of women in the intervention group and 12.4% (22/179) in the usual care group developed GDM (absolute effect size 1.36, 95% confidence interval [CI] 0.71-2.62, p = 0.36). Neonatal birthweight was lower in the intervention than in the usual care group (absolute effect size -133 g, 95% CI -231 to -35, p = 0.008) as was proportion of large-for-gestational-age (LGA) newborns (26/216, 12.1% versus 34/179, 19.7%, p = 0.042). Women in the intervention group increased their intake of dietary fiber (adjusted coefficient 1.83, 95% CI 0.30-3.25, p = 0.023) and polyunsaturated fatty acids (adjusted coefficient 0.37, 95% CI 0.16-0.57, p < 0.001), decreased their intake of saturated fatty acids (adjusted coefficient -0.63, 95% CI -1.12 to -0.15, p = 0.01) and intake of saccharose (adjusted coefficient -0.83, 95% CI -1.55 to -0.11, p  =  0.023), and had a tendency to a smaller decrease in MET minutes/week for at least moderate intensity activity (adjusted coefficient 91, 95% CI -37 to 219, p = 0.17) than women in the usual care group. In subgroup analysis, adherent women in the intervention group (n = 55/229) had decreased risk of GDM (27.3% versus 33.0%, p = 0.43) and LGA newborns (7.3% versus 19.5%, p = 0.03) compared to women in the usual care group. The intervention was effective in controlling birthweight of the newborns, but failed to have an effect on maternal GDM. Current Controlled Trials ISRCTN33885819. Please see later in the article for the Editors' Summary.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

Aerobic exercise and submaximal functional capacity in overweight pregnant women: a randomized trial.

To evaluate the effects of aerobic training on submaximal cardiorespiratory capacity in overweight pregnant women. We conducted a randomized clinical trial in a referral center prenatal clinic during the period 2000-2002. Of 132 overweight (body mass index 26-31 kg/m2) but otherwise healthy volunteers, at 20 years of age or older, with gestational age of 20 weeks or less, and without diabetes or hypertension, 92 consented to participate and were randomized. Intervention consisted of 3 one-hour aerobic exercise sessions per week; the control group received weekly relaxation and focus group discussions. The main outcome measure was submaximal exercise capacity evaluated by oxygen uptake at the anaerobic (first ventilatory) threshold during cardiopulmonary treadmill testing 12 weeks after randomization. Oxygen uptake at the anaerobic threshold increased 18% (15.9 +/- 2.6 to 18.1 +/- 3.1 mL . min(-1) . kg(-1)) in the exercise group but decreased 16% (16.9 +/- 3.0 to 15.8 +/- 2.6 mL . min(-1) . kg(-1)) among the control group. Oxygen consumption at the anaerobic threshold, adjusted through analysis of covariance for baseline oxygen uptake, was 2.68 (95% confidence interval 1.23 to 4.12) mL . min(-1) . kg(-1) greater in the exercise group. Women in the exercise group were approximately 5 times more likely than those in the control group to have regular or good cardiorespiratory capacity (12/38 versus 2/38; relative risk 5.2, 95% confidence interval 1.2 to 22.0, number needed to treat 5). Aerobic training in overweight pregnant women substantially increases submaximal exercise capacity, overcoming the otherwise negative effects of pregnancy in this regard. Additional studies are required to evaluate its effect on major clinical outcomes.

CD007145

There is not enough evidence to recommend any intervention for preventing excessive weight gain during pregnancy, due to the significant methodological limitations of included studies and the small observed effect sizes. More high-quality randomised controlled trials with adequate sample sizes are required to evaluate the effectiveness of potential interventions.

A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women.

Can gestational weight gain in obese women be restricted by 10-h dietary consultations and does this restriction impact the pregnancy-induced changes in glucose metabolism? A randomized controlled trial with or without restriction of gestational weight gain to 6-7 kg by ten 1-h dietary consultations. Fifty nondiabetic nonsmoking Caucasian obese pregnant women were randomized into intervention group (n=23, 28+/-4 years, prepregnant body mass index (BMI) 35+/-4 kg m(-2)) or control group (n=27, 30+/-5 years, prepregnant BMI 35+/-3 kg m(-2)). The weight development was measured at inclusion (15 weeks), at 27 weeks, and 36 weeks of gestation. The dietary intakes were reported in the respective weeks by three 7-day weighed food records and blood samples for analyses of fasting s-insulin, s-leptin, b-glucose, and 2-h b-glucose after an oral glucose tolerance test were collected. The women in the intervention group successfully limited their energy intake, and restricted the gestational weight gain to 6.6 kg vs a gain of 13.3 kg in the control group (P=0.002, 95% confidence interval (CI): 2.6-10.8 kg). Both s-insulin and s-leptin were reduced by 20% in the intervention group compared to the control group at week 27, mean difference: -16 pmol l(-1) (P=0.04, 95% CI: -32 to -1) for insulin and -23 ng ml(-1) (P=0.004, 95% CI: -39 to -8) for leptin. At 36 weeks of gestation, the s-insulin was further reduced by 23%, -25 pmol l(-1) (-47 to -4, P=0.022) and the fasting b-glucose were reduced by 8% compared with the control group (-0.3 mmol l(-1), -0.6 to -0.0, P=0.03). Restriction of gestational weight gain in obese women is achievable and reduces the deterioration in the glucose metabolism.