The Effect of a Lifestyle Training Package on Physical Activity and Nutritional Status in Obese and Overweight Pregnant Women: A Randomized Controlled Clinical Trial

Abstract

Abstract Background and Objectives: Obese and overweight women require specific planning to regulate their gestational weight gain and improve their nutrition quality, which are possible through the adjustment of their nutritional intake and physical activity. The aim of this study was to determine the effect of a lifestyle training package on physical activity and nutritional status (primary outcomes), weight gain and frequency of gestational diabetes (secondary outcomes) in obese and overweight pregnant women. Materials and Methods: This randomized controlled trial was conducted on 140 obese and overweight pregnant women who visited health centers in Tehran, Iran. The participants were assigned into two groups of intervention and control by blocked randomization. The training program given to the intervention group consisted of a 60-90-minute session of group training using lectures, booklets and text messages. The educational content was based on lifestyle during pregnancy with regard to nutrition and physical activity. Participants completed the food frequency questionnaire (FFQ) and international physical activity questionnaire (IPAQ) before the intervention and fourth and eighth weeks after intervention. Gestational diabetes was diagnosed based on a two-hour 75 g oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. Bfore intervention and eight weeks after intervention, the weight of participants was measured and recorded. ANCOVA, Fisher’s exact, Independent t, Mann-Whitney and chi-square tests were used for data analysis. Results: Before the intervention, there was no significant difference between two groups in terms of socio-demographic characteristics (with the exception of spouse's job, gravidity and weight). The mean weekly frequency of intake of the fruits subgroup increased significantly in the intervention group compared with the control group four weeks (P=0.016) and eight weeks (P=0.016) after the intervention. The mean weekly frequency of intake of the the confections subgroup (P= 0.041) and the fats and oils subgroup (P=0.020) at four weeks after intervention and the breads and cereals subgroup (P= 0.002), confections subgroup (P= 0.032) and the fats and oils subgroup (P=0.001) at eight weeks after intervention was significantly higher in the control group compared with the intervention group. The mean weekly intake (in grams) of the milk and dairy products (P= 0.037) and fruits (P= 0.004) subgroups at four weeks after the intervention and the fruits subgroup (P= 0.004) at the eight weeks after the intervention was significantly higher in the intervention group compared with the control group. Also, The mean weekly intake (in grams) of the fats and oils subgroup at four weeks (P=0.003) and eight weeks (P= 0.020) after intervention was significantly higher in the control group compared with the intervention group. No significant differences were observed between the two groups in the other food subgroups before and after the intervention (P>0.05). Although physical activity increased in the intervention group eight weeks after the intervention, this change was not statistically significant. Overall, there were no significant differences between the two groups in terms of the mean total physical activity before and after the intervention (P>0.05). The mean weight gain was found to be 3.4 kg in the intervention group and 3.8 kg in the control group, suggesting no statistically significant differences between the two groups after the intervention (P=0.634). The test results of FBS and GTT showed 15 cases of gestational diabetes in the intervention group and 17 in the controls after the intervention, suggesting no statistically significant differences between two groups (0.505). Conclusion: The results of this study showed the effect of training based on lifestyle on food subgroups in obese and overweight pregnant women but had no effect on physical activity, weight gain and gestational diabetes Considering that the beginning of education in the pre-pregnancy period and increasing the time interval of education for example up to the end of pregnancy and the use of other modern educational methods may have a greater effect on improving the lifestyle of pregnant women, especially in obese and overweight mothers. Therefore, it is recommended that the education of the mothers' lifestyle be started and continued for a longer period to improve their lifestyle.