medwireNews: A telehealth-based lifestyle intervention can significantly reduce excessive gestational weight gain (GWG) relative to usual antenatal care, among pregnant women who are overweight or obese, US study findings indicate.
“The intervention’s effect on reduced GWG might be explained by the observed reductions in total caloric intake, proportion of calories from saturated fat, and sedentary behaviour among women in the intervention group,” write Assiamira Ferrara (Kaiser Permanente Northern California, Oakland) and co-authors in The Lancet Diabetes & Endocrinology.
The GLOW trial randomly assigned women who were between 8 and 15 weeks’ gestation with a singleton pregnancy and a pre-pregnancy BMI of 25–40 kg/m2 to receive a telehealth behavioral lifestyle intervention adapted from the Diabetes Prevention Program (n=199) or usual antenatal care (n=195).
The 13-week intervention consisted of two in-person and 11 telephone sessions, delivered by a dietician, that focused on behavioral strategies to improve weight management, diet, physical activity, and stress management. The interventions were started at a median 14.3 weeks’ gestation.
Ferrara and team report that during the study, women in the lifestyle intervention group had a significantly lower average weekly rate of GWG than those in the usual care group, at 0.26 versus 0.32 kg/week.
They were also a significant 30% less likely to exceed the US Institute of Medicine guidelines for weekly GWG (maximum of 0.33 kg for overweight and 0.27 kg for obesity) than those in the usual care group, at rates of 48% versus 69%.
And the researchers note that “[t]here was a suggestion that the intervention was slightly more effective among women with obesity, among whom the between group differences in GWG were slightly larger than in women with overweight.”
Among the secondary outcomes assessed, total caloric intake, proportion of calories from saturated fat, sedentary behaviors, markers of insulin resistance, and serum leptin concentration were all significantly lower in the intervention group than in the usual care group, which the researchers found could be mostly (68–90%) explained by the lower weekly rate of GWG associated with the intervention.
The investigators also observed, that “consistent with most trials aimed at reducing GWG” there were no between-group differences in perinatal complications, but they point out that “the GLOW trial was not powered to assess differences in these outcomes.”
Ferrara et al conclude: “This intervention could be an evidence-based programme that health-care delivery systems can further adapt to the needs of their clinical settings to prevent excess GWG and improve health behaviours and markers of insulin resistance among women with overweight or obesity.”
In an accompanying comment, Rebecca Reynolds, from Queen’s Medical Research Institute in Edinburgh, UK, says: “The GLOW trial suggests that an appropriate and effective telehealth intervention, when delivered by skilled researchers, offers promise to reduce excess GWG in overweight and obese pregnancy.”
She adds that the findings “are particularly relevant during the current COVID-19 pandemic” when the “option of using telehealth in antenatal care has been brought sharply into focus.”
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