Abstract：
BACKGROUND: Maternal obesity and excessive gestational weight gain are associated with adverse maternal and neonatal outcomes. There is uncertainty over the most effective antenatal healthy lifestyle service, with little research determining the impact of different lifestyle intervention intensities on pregnancy outcomes.
METHODS: This retrospective cohort study compared pregnancy and birth outcomes in women with a body mass index of 40 or above who were offered a low intensity midwife-led antenatal healthy lifestyle service (one visit) with women who were offered an enhanced service (three visits). The primary outcome was gestational weight gain.
RESULTS: There were no differences between the two healthy lifestyle service intensities (N = 682) in the primary outcome of mean gestational weight gain [adjusted mean difference (aMD) -1.1 kg (95 % CI -2.3 to 0.1)]. Women offered the enhanced service had lower odds of gaining weight in excess of Institute of Medicine recommendations [adjusted odds ratio (aOR) 0.63 (95 % CI 0.40-0.98)] with this reduction mainly evident in multiparous women. Multiparous women also gained less weight per week [aMD -0.06 kg/week (95 % CI -0.11 to -0.01)]. No overall beneficial effects were seen in maternal or neonatal outcomes measured such as birth weight [aMD 25 g (95 % CI -71 to 121)], vaginal birth [aOR 0.87 (95 % CI 0.64-1.19)] or gestational diabetes mellitus [aOR 1.42 (95 % CI 0.93-2.17)]. However, multiparous women receiving the enhanced service had reduced odds of small for gestational age [aOR 0.52 (95 % CI 0.31-0.87)]. This study was however underpowered to detect differences in some outcomes with low incidences.
CONCLUSIONS: Uncertainty remains over the best management of women with severe obesity regarding effective interventions in terms of intensity. It is suggested that further research needs to consider the different classes of obesity separately and have a particular focus on the needs of nulliparous women given the lack of effectiveness of this service among these women.
METHODS: This retrospective cohort study compared pregnancy and birth outcomes in women with a body mass index of 40 or above who were offered a low intensity midwife-led antenatal healthy lifestyle service (one visit) with women who were offered an enhanced service (three visits). The primary outcome was gestational weight gain.
RESULTS: There were no differences between the two healthy lifestyle service intensities (N = 682) in the primary outcome of mean gestational weight gain [adjusted mean difference (aMD) -1.1 kg (95 % CI -2.3 to 0.1)]. Women offered the enhanced service had lower odds of gaining weight in excess of Institute of Medicine recommendations [adjusted odds ratio (aOR) 0.63 (95 % CI 0.40-0.98)] with this reduction mainly evident in multiparous women. Multiparous women also gained less weight per week [aMD -0.06 kg/week (95 % CI -0.11 to -0.01)]. No overall beneficial effects were seen in maternal or neonatal outcomes measured such as birth weight [aMD 25 g (95 % CI -71 to 121)], vaginal birth [aOR 0.87 (95 % CI 0.64-1.19)] or gestational diabetes mellitus [aOR 1.42 (95 % CI 0.93-2.17)]. However, multiparous women receiving the enhanced service had reduced odds of small for gestational age [aOR 0.52 (95 % CI 0.31-0.87)]. This study was however underpowered to detect differences in some outcomes with low incidences.
CONCLUSIONS: Uncertainty remains over the best management of women with severe obesity regarding effective interventions in terms of intensity. It is suggested that further research needs to consider the different classes of obesity separately and have a particular focus on the needs of nulliparous women given the lack of effectiveness of this service among these women.
摘要：
背景：孕妇肥胖和妊娠期体重过度增加与不良的母婴结局有关。最有效的产前健康生活方式服务存在不确定性，很少有研究确定不同生活方式干预强度对妊娠结局的影响。
方法：这项回顾性队列研究比较了体重指数为40或以上的妇女的妊娠和分娩结局，这些妇女接受了低强度助产士主导的产前健康生活方式服务（一次访视）和接受了强化服务（三次访视）的妇女。主要结果是妊娠体重增加。
结果：两种健康生活方式服务强度（N=682）在平均妊娠体重增加的主要结局[校正平均差（aMD）-1.1kg（95％CI-2.3至0.1）]之间没有差异。提供强化服务的女性体重增加的几率低于医学研究所的建议[调整后的优势比（aOR）0.63（95％CI0.40-0.98）]，这种减少主要在多胎女性中明显。经产妇女每周体重增加较少[aMD-0.06kg/周(95%CI-0.11至-0.01)]。在测量的产妇或新生儿结局中没有观察到总体有益效果，例如出生体重[aMD25g（95％CI-71至121）]，阴道分娩[aOR0.87(95%CI0.64-1.19)]或妊娠糖尿病[aOR1.42(95%CI0.93-2.17)]。然而,接受强化服务的多胎妇女小于胎龄的几率降低[aOR0.52(95%CI0.31-0.87)].然而，这项研究在低发病率的某些结果中检测差异的能力不足。
结论：就强度而言，对重度肥胖女性的有效干预措施仍存在不确定性。建议进一步的研究需要分别考虑不同类别的肥胖，并特别关注未分娩妇女的需求，因为这些妇女缺乏这种服务的有效性。
方法：这项回顾性队列研究比较了体重指数为40或以上的妇女的妊娠和分娩结局，这些妇女接受了低强度助产士主导的产前健康生活方式服务（一次访视）和接受了强化服务（三次访视）的妇女。主要结果是妊娠体重增加。
结果：两种健康生活方式服务强度（N=682）在平均妊娠体重增加的主要结局[校正平均差（aMD）-1.1kg（95％CI-2.3至0.1）]之间没有差异。提供强化服务的女性体重增加的几率低于医学研究所的建议[调整后的优势比（aOR）0.63（95％CI0.40-0.98）]，这种减少主要在多胎女性中明显。经产妇女每周体重增加较少[aMD-0.06kg/周(95%CI-0.11至-0.01)]。在测量的产妇或新生儿结局中没有观察到总体有益效果，例如出生体重[aMD25g（95％CI-71至121）]，阴道分娩[aOR0.87(95%CI0.64-1.19)]或妊娠糖尿病[aOR1.42(95%CI0.93-2.17)]。然而,接受强化服务的多胎妇女小于胎龄的几率降低[aOR0.52(95%CI0.31-0.87)].然而，这项研究在低发病率的某些结果中检测差异的能力不足。
结论：就强度而言，对重度肥胖女性的有效干预措施仍存在不确定性。建议进一步的研究需要分别考虑不同类别的肥胖，并特别关注未分娩妇女的需求，因为这些妇女缺乏这种服务的有效性。
