Preventing Long-Term Risk of Obesity for Two Generations: Prenatal Physical Activity Is Part of the Puzzle

Table 2

Effects of prenatal intervention studies combining nutrition and physical activity on gestational weight gain, maternal weight retention, and infant birth weight.

(a) Prenatal intervention studies using the 1990 IOM gestational weight gain recommendations

Reference, sample characteristics	Treatment		Gestational weight gain (GWG) (kg)			Maternal weight retention postpartum (PP) (kg)			Infant birth weight (g)
	Control	Intervention	Control	Intervention	P value	Control	Intervention	P value	Control	Intervention	P value
Gray-Donald et al. [64]; Design: Time-series control trial; N = 219; C = 107; I = 112; Country; Canada; Ethnicity; Cree women; Age; C = 23.8 ± 5.86; I = 24.3 ± 6.29; SES; NA; Prepreg BMI; C = 29.6 ± 6.45; I = 30.8 ± 6.85; Parity; C = 73% nulliparous; I = 31% nulliparous; Gestational age at recruitment; C = 18.5 ± 6.9; I = 17.1 ± 7.1; Duration of study; until delivery	Standard prenatal care	Community-based intervention for specific population (Aboriginal Cree); Based on the social learning theory; Nutrition; Pamphlets about; nutritional choices, supermarket tours and cooking demonstrations, individual counseling; Physical activity; Exercise/walking groups; Other; Advice to stay within GWG recommendations; Delivered by dieticians and health workers	At delivery; 13.2 ± 8.3; Weekly GWG; BMI ≤ 29: 0.63 ± 0.32; BMI > 29: 0.44 ± 0.30; Adherence to 1990 IOM; NA	At delivery; 12.0 ± 6.4; Weekly GWG; BMI ≤ 29: 0.62 ± 0.27; BMI > 29: 0.44 ± 0.24; Adherence to 1990 IOM; NA	0.29; NS; NS	At 6 weeks PP; 7.4 ± 8.5	At 6 weeks PP; 6.1 ± 6.7	>0.05	3,741 ± 523; <2,500 g; n = 2 (2%); >4,000 g; n = 31 (30%)	3,686 ± 686; <2,500 g; n = 3 (3%); >4,000 g; n = 37 (35%)	NS; NS; NS
Polley et al. [58]; Design: RCT; N = 110; C = 53; I = 57; Country; United States; Ethnicity; 39% black; 61% white,; Age; 25.5 ± 4.8; Parity; 47%  nulliparous; SES; low income; Gestational; age at recruitment; 14.5 ± 3.1; Duration of study; NA	Standard prenatal care	Nutrition; Bi-weekly newsletters on healthy eating; Physical activity; Bi-weekly newsletters on healthy exercise habits,; increasing walking and developing a more active lifestyle; Other; Written and oral info about appropriate GWG, personalized graphs; showing GWG; Delivered by trained staff	At 36–40 weeks; 13.8 ± 5.4	At 36–40 weeks; 14.5 ± 7.1	NS	NA	NA	—	NA	NA	—
Normal weight group; C = 31; I = 30; Prepreg BMI; C = 22.5 ± 2.0; I = 22.8 ± 1.9			At 36–40 weeks; 16.4 ± 4.8; Adherence to 1990 IOM; 42% did not exceed	At 36–40 weeks; 15.4 ± 7.1; Adherence to 1990 IOM; 67% did not exceed	NS; <0.05	At 8 ± 7 w PP; 6.2 ± 4.5	At 8 ± 7 w PP; 4.4 ± 5.4	NS	3,226; <2,500 g; n = 3 (10%); >4,000 g; n = 0	3,133; <2,500 g; n = 4 (13%); >4,000 g; n = 1 (3%)	NS; NS; NS
Overweight group; C = 22; I = 27; Prepreg BMI; C = 34.1 ± 7.2; I = 31.4 ± 6.0			At 36–40 weeks; 10.1 ± 6.2; Adherence to 1990 IOM; 68% did not exceed	At 36–40 weeks; 13.6 ± 7.2; Adherence to 1990 IOM; 41% did not exceed	NS; 0.09	At 8  ±  7 w PP; 0.3 ± 7.0	At 8  ± 7 w PP; 3.6 ± 5.6	NS	3,349; <2,500 g; n = 2 (9%); >4, 000 g; n = 0	3,283; <2,500 g; n = 1 (4%); >4,000 g; n = 0	NS; NS; NS
Olson et al. [61]; Design; Historical cohort; N = 560; C = 381; I = 179; Country; United States; Ethnicity; 96% white; Age: C = 94% 20–40 yr; I = 94% 20–40 yr; Parity; C = 41% nulliparous; I = 41% nulliparous; SES; C = 43% low income; I = 37% low income; Prepreg BMI; 75% normal weight in early pregnancy; Gestational age at recruitment; <27 weeks; Duration of study; NA	Standard prenatal care	Nutrition; Tips and newsletters about healthy eating, “health checkbook” to help self-monitoring diet; Physical activity; Tips and newsletters about PA during pregnancy; Other; Guidance about self-monitoring of GWG, newsletters about GWG; Delivered by healthcare providers	At delivery; 14.8 ± 4.7; Adherence to 1990 IOM; 55% did not exceed; Sub-group,; Low SES; Adherence to 1990 IOM; NW 55%; OW 28%; did not exceed	At delivery; 14.1 ± 4.5; Adherence to 1990 IOM; 59% did not exceed; Sub-group,; Low SES; Adherence to 1990 IOM; NW 71%; OW 56%; did not exceed	0.09; 0.30; 0.05; 0.04	At 1 year; 1.3 ± 5.6; Sub-group, Low SES; Weight retention ≥2.27 kg; NW 40%; OW 55%	At 1 year; 0.6 ± 4.8; Sub-group, Low SES; Weight retention ≥2.27 kg; NW 37%; OW 25%	0.14; >0.05; 0.04	3,621; (2,060–5,486); <2,500 g; n = 3 (1%); >4,000 g; n = 83 (22%)	3,610; (2,475–5,345); <2,500 g; n = 2 (1%); >4,000 g; n = 32 (18%)	NS; NS; NS
Kinnunen et al. [63]; Design; non RCT; N = 105; C = 56; I= 49; Country; Finland; Ethnicity; Finish; Age; C = 28.8 ± 4.1; I = 27.6 ± 4.5; Parity; 100% nulliparous; SES; C = 36%; Basic/secondary education; I = 57% Basic/secondary education; Prepreg BMI; C = 22.3 ± 2.1; I = 23.7 ± 3.9; Gestational age at recruitment; 8-9 weeks; Duration of study; until 37 weeks of gestation	Standard prenatal care	Nutrition; 4 individual counseling sessions on healthy diet; Physical activity; 5 counseling sessions to increase LTPA and design an individual activity plan. Possibility to join group exercise sessions once a week for 45–60 min; Other; Information on GWG recommendations; Delivered by nurses	At 36-37 weeks; 14.3 ± 4.1; Adherence to 1990 IOM; 70% did not exceed	At 36-37 weeks; 14.6 ± 5.4; Adherence to 1990 IOM; 54% did not exceed	0.77; 0.053	NA	NA	—	≥4,000 g; n = 8 (15%)	≥4,000 g; n = 0	0.006
Asbee et al. [55]; Design; RCT; N = 100; C = 43; I = 57; Country; United States; Ethnicity; mixed; C = 55% Hispanic; I = 58% Hispanic; Age; C = 26.4 ± 5.0; I = 26.7 ± 6.0; Parity; C = 44% nulliparous; I = 46% nulliparous; SES; C = 65% high school or <; I = 68% high school or <; Prepreg BMI; C = 25.6 ± 5.1; I = 25.5 ± 6.0; Gestational age at recruitment; C = 13.6 ± 3.6; I = 13.7 ± 3.6; Duration of study; until delivery	Standard prenatal care	Nutrition; Nutrition plan containing; 40% carbohydrate 30% protein; 30% lipid; Physical activity; Recommendations; Frequency 3–5/week; Intensity; moderate-intensity exercise; Other; Information about GWG guidelines; Delivered by dieticians	At delivery; 16.2 ± 7.0; Adherence to 1990 IOM; 49% did not exceed	At delivery; 13.0 ± 5.7; Adherence to 1990 IOM; 61% did not exceed	0.01; 0.21	NA	NA	—	NA	NA	—
Mottola et al. [44]; Design; Case (historical cohort)-control matched design; N = 325; C = 260; I = 65; Country; Canada; Ethnicity; >50% aboriginal; Age: C = 31.9 ± 3.5; I = 32.4 ± 4.0; Parity; C = 38% nulliparous; I = 38% nulliparous; SES; na; Prepreg BMI; C = 33.4 ± 6.3; I = 32.1 ± 6.2; Gestational age at recruitment; 16–20 weeks; Duration of study; until 34–36 weeks of gestation	Standard prenatal care	Nutrition; Individualized nutrition plan with total energy intake of approx 2000 kcal/d 40%–55% of total energy intake from CHO; Physical activity; Supervised exercise program; Frequency; 3-4/week; Intensity; 30% heart rate reserve; Duration  25–40 min; Type; walking; Delivered by dieticians and kinesiologists	NA	6.8 ± 4.1*; Adherence to 1990 IOM; 80%; *GWG during the intervention	—; —	NA	At 8 w PP; 2.2 ± 5.6; 53% within 2.0 kg of pre-pregnancy body weight	—	3,590 ± 500; <2,500 g; OW 4%; OB 3%; 4,000–4,500 g; OW 18%; OB 13.3%	3,564 ± 600; <2,500 g; OW 0%; OB 0%; 4,000–; 4,500 g; OW 3.2%; OB 26%	NS; NS; NS; 0.05; 0.07
Guelinckx et al. [65]; Design; RCT; Country; Belgium; Ethnicity; Caucasians; Prepreg BMI; >29; Duration of study; until 32 weeks of gestation
C = 43; PI = 37; Age; C = 29.4 ± 4.4; PI = 28.7 ± 4.0; Parity; C = 40% nulliparous; PI = 41% nulliparous; SES; C = na; PI = na; Gestational age at recruitment; C = 10.2 ± 2.4; PI = 10.2 ± 2.6	Standard prenatal care	Passive Intervention: Received a brochure designed for the study providing advice about nutrition, physical activity and tips to limit GWG	At delivery; 10.6 ± 6.9; Adherence to 1990 IOM; 52% did not exceed	At delivery; 10.9 ± 5.6; Adherence to 1990 IOM; 54% did not exceed	NS; NS	NA	NA	—	3,419 ± 425; >4,000 g; n = 3 (7%)	3,585 ± 398; >4,000 g; n = 5 (14%)	NS; NS
C = 43; AI = 42; Age; C = 29.4 ± 4.4; AI = 28.0 ± 3.6; Parity; C = 40% nulliparous; AI = 48% nulliparous; SES; C = na; AI = na; Gestational age at recruitment; C = 10.2 ± 2.4; AI = 9.3 ± 2.8	Standard prenatal care	Active Intervention: Received the same brochure plus received 3 counseling group-sessions given by a dietician; Delivered by dieticians	At delivery; 10.6 ± 6.9; Adherence to 1990 IOM; 52% did not exceed	At delivery; 9.8 ± 7.6; Adherence to 1990 IOM; 59% did not exceed	NS; NS	NA	NA	—	3,419 ± 425; >4,000 g; n = 3 (7%)	3,492 ± 468; >4,000 g; n = 5 (12%)	NS; NS
Phelan et al. [59]; Design; RCT; N = 401; C = 200; I = 201; Country; United States; Ethnicity; C = 68% Caucasian; I = 69% Caucasian; Age; C = 28.8 ± 5.2; I = 28.6 ± 5.2; Parity; C = 77% nulliparous; I = 76% nulliparous; SES; C = 19% unemployed; I = 16% unemployed; Prepreg BMI; C = 26.5 ± 5.9; I = 26.3 ± 5.6	Standard prenatal care	One face-to-face visit at study entry to discuss; Nutrition; Recommendations appropriate calorie goals (20 kcal/kg).; Physical activity; Recommendations; appropriate PA (30 min walking most days of the week).; Other; Recommendations appropriate GWG.; Food records, pedometers and body weight scale were provided, postcard about healthy eating and exercise habits	At final visit; NW 16.2 ± 4.6; OW 15.1 ± 7.5; Adherence to 1990 IOM; NW 48%; OW 39%; did not exceed	At final visit; NW 15.3 ± 4.4; OW 14.7 ± 6.9; Adherence to 1990 IOM; NW 60%; OW 33%; did not exceed	>0.05; >0.05; 0.003; NS	At 6 months; NW 3.3 ± 3.5; OW 4.3 ± 6.2; at or below pre-pregnancy body weight; NW 21%; OW 17%	At 6 months; NW 2.1 ± 4.7; OW 3.7 ± 5.9; at or below pre-pregnancy body weight; NW 36%; OW 26%	OR = 2.1; P = 0.005	NW; 3,271 ± 467; OW; 3,442 ± 629; <2,500 g; NW = 5 (5%); OW = 4 (5%); >4,000 g; NW = 3 (3%); OW = 14 (16%)	NW; 3,367 ± 459; OW; 3,430 ± 650; <2,500 g; NW = 4 (4%); OW = 5 (6%); >4,000 g; NW = 6 (7%); OW = 14 (17%)	NS; NS; NS; NS; NS; NS
Gestational age at recruitment; 10–16 weeks; Duration of study; NA		were mailed weekly. 3 brief phone calls from the dietician; Personalized graph of GWG; Delivered by dieticians

(b) Prenatal intervention studies using the 2009 IOM gestational weight gain recommendations

Reference, Sample characteristics	Treatment		Gestational weight gain (GWG) (kg)			Maternal weight retention; postpartum (PP) (kg)			Infant birth weight (g)
	Control	Intervention	Control	Intervention	P value	Control	Intervention	P value	Control	Intervention	P value
Claesson et al. [56]; Design; non RCT; N = 368; C = 208; I = 160; Country; Sweden; Ethnicity; Swedish; Age; C = 30.2 ± 4.9; I = 29.7 ± 4.5; Parity; C = 48% nulliparous; I = 42% nulliparous; SES; C = 26% unskilled workers; I = 20% unskilled workers; Prepreg BMI; BMI ≥ 30; Gestational age at recruitment; 10–12 weeks; Duration of study; NA	Standard prenatal care	Motivational interview/talk in early pregnancy; Nutrition; Information about nutrition during pregnancy; Physical activity; Possibility to attend aqua aerobic classes (1-2/week); Other; 30 min-visit/week for motivational talks, weight control,; Additional written information about eating and; food intake if needed; Delivered by trained midwives	At delivery; 11.3 ± 5.8; <7.0 kg; (study goal); 21%	At delivery; 8.7 ± 5.5; <7.0 kg (study goal); 36%	<0.001; 0.003	At 10–12 w PP; 0.75 ± 5.34	At 10–12 w PP; −2.15 ± 5.88	<0.001	3,679 ± 571	3,688 ± 681	0.89
Shirazian et al. [57]; Design; Historical cohort; N = 28; C = 20; I = 21; Country; United States; Ethnicity; C = 80% Latina; I = 67% Latina; Age; C = 24.4 ± 5.6; I = 29.0 ± 5.1; Parity; C = 50% nulliparous; I = 19% nulliparous; SES; NA; Prepreg BMI; C = 34.2 ± 5.3; I = 36.2 ± 5.2; Gestational age at recruitment; ≤12 weeks; Duration of study; until delivery	Standard prenatal care	6 seminars and at least 5 one-on-one counseling sessions or phone calls; Nutrition; Written material, seminars and counseling sessions to promote healthy eating, facilitate calories counting, kept food diary; Physical activity; Written material, seminars and counseling sessions to encourage walking, received pedometer to monitor; Other; Written material, seminars and counseling sessions to educate the women on obesity and pregnancy and healthy living; goal: GWG < 7 kg; Delivered by study coordinators	Last body weight; 15.4 ± 7.5*; ≤6.8 kg; (study goal); 15% did not exceed; *Time of last body weight measurement unclear	Last body weight; 8.1 ± 7.4*; ≤6.8 kg; (study goal); 38% did not exceed; *Time of last body weight measurement unclear	0.003; 0.16	NA	NA	—	3,610 ± 548	3,458 ± 603	0.40
Lindholm et al. [66]; Design; single-arm study; N = 25; Country; Sweden; Ethnicity; Swedish; Age; 31.7 ± 3.2; Parity; median = 1 (0–3); SES; na; Prepreg BMI; 35.4 ± 4.4; Gestational age at recruitment; 8–12 weeks; Duration of study; NA		Meeting a midwife every 15 days and 2 group support sessions.; Nutrition; Initial individual consultation, instructed to eat after “the plate model” and to keep an all-inclusive food intake diary.; Physical activity; Supervised exercise program; Frequency; 1/week; Intensity; NA; Duration; 40 min; Type; Water aerobics; Asked to exercise 30 min/day PA on other days; Delivered by midwives and dietician	NA	Last body weight; 6.9 ± 6.4*; ≤6.0 kg; (goal of study); 56%; *Time of last body weight measurement unclear	—; —	NA	NA	—	NA	3,484 ± 453	—
Hui et al. [60]; Design; RCT; N = 190; C = 88; I = 102; Country; Canada; Ethnicity; C = 25% aboriginal; I = 17% aboriginal; Age; C = 28.7 ± 5.9; I = 30.1 ± 5.2; Parity; C = na; I = na; SES; C = 48,602 ± 29,628 (high); I = 50,833 ± 23,792 (high); Prepreg BMI; C = 25.7 ± 5.1; I = 24.9 ± 5.4; Gestational age at recruitment; <26 weeks; Duration of study; until 36 weeks of gestation	Standard prenatal care	Nutrition; Personalized dietary counseling; Physical activity; Supervised exercise session; Frequency; 1/week; Intensity; mild-to-moderate; Duration  30–45 min; Type; aerobic and strength exercise; Women were asked to perform several sessions of exercise sessions at home. VHS and DVD to assist with home-based exercises; Delivered by dietitians and licensed fitness trainers	At delivery; 15.2 ± 5.9; Adherence to 2009 IOM; 45% did not exceed	At delivery; 14.1 ± 6.0; Adherence to 2009 IOM; 65% did not exceed	0.28; 0.008	NA	NA	—	3,516 ± 530; LGA; n = 15 (17%)	3,490 ± 509; LGA; n = 12 (12%)	0.73; 0.41
Vinter et al. [62]; Design; RCT; N = 304; C = 154; I = 150; Country; Denmark; Ethnicity: Danish; Age: C = 29.0 (27–32); I = 29.0 (26–31); Parity; C = 55% nulliparous; I = 53% nulliparous; SES; C = 65% ≥12 yrs; I = 74% ≥12 yrs; Prepreg BMI: C = 33.3 (31.7–36.9); I = 33.4 (30.7–36.5); Gestational age at recruitment; 10–14 weeks; Duration of study; until delivery	Access to a website with nutrition and PA advices	Nutrition; Personalized dietary counseling 4 times during the intervention; Physical activity; free membership to gym; Supervised exercise session 1x week; Frequency; 1/week; Intensity; moderate; Duration60 min; Type; aerobic, elastic band, balance exercise; Other; group sessions 4–6 times.; Women were encouraged to be active every day for 30–60 min; Pedometers were provided; Delivered by dieticians and physiotherapists	At 35 weeks gestation; 8.6 (5.7–11.5); Adherence to 2009 IOM; 53% did not exceed	At 35 weeks gestation; 7.0 (4.7–10.6); Adherence to 2009 IOM; 65% did not exceed	0.01; 0.058	NA	NA	—	3,593; (3,335–3,930); >4,000 g; n = 39 (25%)	3,742; (3,464–4,070); >4,000 g; n = 40 (32%)	0.039; 0.07

Abbreviations: RCT: randomized controlled trial; N: total number; C: control group; I: intervention group; SES: socioeconomic status; prepreg BMI: body mass index prior to pregnancy; IOM: Institute of Medicine; NA: non available; NS: non significant, NW: normal weight; OW: overweight; OB: obese.