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Pregnancy: a “teachable moment” for weight control and obesity prevention

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Excessive gestational weight gain has been shown to relate to high-postpartum weight retention and the development of overweight and obesity later in life. Because many women are concerned about the health of their babies during pregnancy and are in frequent contact with their healthcare providers, pregnancy may be an especially powerful “teachable moment” for the promotion of healthy eating and physical activity behaviors among women. Initial research suggests that helping women gain the recommended amount during pregnancy through healthy eating and physical activity could make a major contribution to the prevention of postpartum weight retention. However, more randomized controlled trials with larger sample sizes are needed to identify the most effective and disseminable intervention. Providers have the potential to prevent high postpartum weight retention and future obesity by monitoring weight gain during pregnancy and giving appropriate advice about recommended amounts of gestational weight gain.

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The link between pregnancy and obesity

An important contributing factor to weight gain among young adult women is sustained weight retention after pregnancy. Although studies of the general population have reported average weight gains of only 0.4-3.8 kg more than aging,8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 there is marked variability in weight changes that are associated with pregnancy. Approximately 25% of women experience weight retention of ≥4.5 kg in association with pregnancy.15, 19, 20, 21 Moreover, weight changes at the

Variables associated with high postpartum weight retention provide targets for intervention

The strongest predictor of 1-year postpartum weight retention is the amount of weight gained during pregnancy.21, 22, 23, 25, 26 The Institute of Medicine (IOM) guidelines were developed in 1990 to provide recommended ranges of weight gain to optimize fetal growth and maternal/infant outcomes. Recently, the recommendations were revised to use the BMI cutpoints from the World Health Organization (eg, overweight = 25.0-29.9 km/m2 instead of 26.0-29.9 km/m2) and provide a specific range of weight

At-risk populations

Certain subgroups of women appear to be at greater risk of high gestational weight gain than others and may benefit from interventions to promote healthy weight gain during pregnancy. Many studies have found that prepregnancy weight is a significant predictor of weight changes during pregnancy. Although overweight women gain less weight than normal-weight women during pregnancy, women who are overweight before pregnancy appear more likely to exceed IOM weight gain guidelines (with the 1990 IOM

Pregnancy as a “teachable moment”

The label teachable moment has been used to describe naturally occurring life transitions or health events that are thought to motivate individuals to spontaneously adopt risk-reducing health behaviors; the concept of “teachable moments” has a strong foundation in widely accepted conceptual models of behavior.93, 94

McBride et al95 recently proposed a model to describe characteristics of effective teachable moments using smoking cessation as an example. Teachable moments were characterized as

Weight gain prevention interventions during pregnancy

A handful of studies have evaluated interventions during pregnancy to promote weight gain within recommendations and prevent postpartum weight retention. Gray-Donald et al100 examined the effects of periodic dietary counseling on weight gain in a nonrandomized study of the Cree population. The intervention was found to have only a minor impact; the authors noted that cultural factors, however, likely limited the intervention's efficacy in the Cree population.100 In another nonrandomized study,

Are there adverse effects of intervening during pregnancy?

Available data suggest that the prevention of excessive weight gain during pregnancy does not have adverse consequences and may, in fact, benefit the developing fetus and mother. In Asbee et al's105 randomized trial, the intervention significantly reduced the number of cesarean deliveries due to “failure to progress” compared with standard care (25% vs 58.3%). In the randomized trial of Wolff et al,106 the intervention did not have any detectable adverse effects on fetal growth, and fewer

Talking to patients about appropriate weight gain

There is strong evidence that prenatal care providers are either not providing weight gain advice or not following the IOM guidelines when they advise their patients. Approximately one-third of women report receiving no weight gain advice from their prenatal care provider;111, 112 among those patients who receive advice, approximately one-third of the women report receiving advice that is inconsistent with the 1990 IOM guidelines.111 Stotland et al111 evaluated 1198 women and found that 50% of

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    This study was sponsored by Grant National Institute of Diabetes and Digestive and Kidney DiseasesR01 071667-01.

    Cite this article as: Phelan S. Pregnancy: a “teachable moment” for weight control and obesity prevention. Am J Obstet Gynecol 2010;202:135.e1-8.

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