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• W2790817637 abstract "This issue of Obesity includes articles about two randomized trials that were part of the Lifestyle Interventions for Expectant Moms (LIFE-Moms) consortium of seven independent trials (1). The consortium was formed to determine whether various behavioral and lifestyle interventions could reduce excessive gestational weight gain (GWG), adverse maternal and neonatal outcomes, and obesity among the offspring of pregnant women with overweight and obesity (1). Both trials partnered with or used an existing evidence-based program or curriculum as the basis of the lifestyle intervention that was tested, increasing the likelihood of the translation of their interventions into practice. Cahill et al. (2) partnered with an existing community-based organization to deliver the Parents as Techers (PAT) program (3) to the control group and the PAT program plus a lifestyle intervention to the intervention group. Both treatments were delivered by trained parent educators through home visits to socioeconomically disadvantaged African American women in St. Louis, Missouri. Gallagher et al. (4) adapted and integrated the Diabetes Prevention Program (5) and the Look AHEAD: Action for Health in Diabetes curricula (6) for pregnant women, using a 20-module program that was delivered by a professional nutritionist at individual clinical visits in a racially diverse, highly educated sample in New York City. Control arm women received usual care that included a single visit with a nutritionist, and both treatment groups had an opportunity to attend different group sessions held every 8 weeks during pregnancy. Both programs reached participants on a biweekly basis and achieved excellent adherence, including a median of nine out of ten visits for an average of 53 minutes each in the intervention group in the Cahill et al. (2) trial and 72% of clinic visits attended in the intervention group in the Gallagher et al. (4) trial. What is not stated in the articles (and is important because of the relevance to translation into real-world settings) is whether incentives were given to women to attend visits. Different primary outcomes were designated for the two trials. For the Cahill et al. (2) trial, the primary outcome was the proportion of women exceeding the upper limit for total GWG for the BMI subgroup as specified by the Institute of Medicine (7). The trial was powered with an expectation that 69.2% and 75.8% of socioeconomically disadvantaged African American women with overweight and obesity, respectively, would gain weight excessively. The investigators found that 45.9% of women in the PAT control group gained weight excessively, as did 36.1% in the PAT plus intervention group, and these proportions were not significantly different at the P < 0.05 level. For the Gallagher et al. (4) trial, the primary outcome was the newborns' percent body fat determined by air displacement plethysmography using the PEA POD (Cosmed USA, Inc., Concord, California). The trial had 80% power to detect a 1.8% difference in percent body fat with a standard deviation of 4.3% using a t test. Infants born to women in the control group had a body fat proportion of 10.10%, and those born to women in the intervention group had 10.86% body fat; these were not significantly different. While neither trial found significant differences between treatment arms for their primary outcomes, they did find significant differences in several secondary maternal weight gain outcomes. Both studies found a 1.6 to 1.8 kg greater total GWG in the control arm compared with intervention and a difference in the proportion of women who had excessive weekly GWG, which was 77.4% in the PAT control and 62.4% in the PAT plus intervention in Cahill et al. (2) and 38% in the usual care control and 19% in the intervention arms in Gallagher et al. (4). The large differences in the proportions across the two trials are puzzling and deserve further scrutiny by investigators, but they may be due to the focus of the Gallagher et al. (4) intervention on the Institute of Medicine's weekly weight gain upper limits of 0.32 kg/wk for women with overweight and 0.27 kg/wk for women with obesity (7). In terms of infant outcomes for body composition, the Cahill et al. (2) trial also did not find a significant difference in percent body fat via the PEA POD (12.2% in the control and 12.5% in the intervention). On the positive side, Gallagher et al. (4) found a significant difference in lean body mass, which was 2,211 g in the control arm versus 2,327 g in the intervention arm infants measured by quantitative magnetic resonance. This group found very few significant relationships between maternal weight gain and infant body composition. Neither trial found any differences between treatment arms for infant birth outcomes, obstetric complications, or infant complications. Cahill et al. (2) found two differences in the change in cardiometabolic outcomes across pregnancy, favoring the intervention arm for insulin area under the curve and systolic blood pressure. So what is a reader to take from these results? These two trials show that weight management interventions for pregnant women with overweight and obesity can achieve modest positive impacts on some measures of weight gain during pregnancy. Excess GWG is such a strong predictor of postpartum weight retention and the risk of developing obesity as a result of pregnancy in women with overweight, especially low-income and minority women, that these results should be viewed as hopeful for weight management (7). The implications for obesity risk in offspring are less clear. The following two results from these trials contribute to the lack of clarity: no intervention effect on infants' percent body fat (2, 4) and body fat mass (4) and the finding of no significant association between infants' lean body mass and maternal GWG. It is challenging to match these findings with pathophysiological pathways for a causal relationship between excessive GWG and childhood risk for later overweight. Because proof of causality can only come from randomized controlled trials, follow-up of the offspring of the women participating in the LIFE-Moms trials and measurement of body weight across childhood and adolescence are essential. Only then will there be empirical data to support causal statements about the role of maternal weight gain during pregnancy and the development of overweight and obesity in offspring." @default.
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• W2790817637 title "Interventions During Pregnancy Reduce Excessive Gestational Weight Gain but Yield Unexpected Effects on Neonatal Body Composition" @default.
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• W2790817637 doi "https://doi.org/10.1002/oby.22122" @default.
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