Lyndi Buckingham-Schutt, a doctoral student in food science and human nutrition, is completing a two-year study that shows how pregnant women successfully prevented excessive weight gain. Photos by Ryan Riley.

Diet, exercise, and counseling combine to limit weight gain during pregnancy

New research by Iowa State University shows that women can nearly double their chances of preventing excessive weight gain during pregnancy — and ensure a healthier future for themselves and their babies — with a comprehensive “lifestyle intervention.”

A two-year study led by Lyndi Buckingham-Schutt, a doctoral student in food science and human nutrition, applied a three-prong intervention with pregnant women that included a better diet, more physical activity, and behavioral counseling from a registered dietitian nutritionist.

Results show that 60 percent of women participating in the study met the weight gain recommended by the Institute of Medicine during pregnancy, compared with the usual 30 to 35 percent nationwide. Researchers say the study contains “really good data” and was “hugely successful.”

“Lyndi’s study is the culmination of everything we’ve been doing. This really is 10 years in the making,” said Christina Campbell, the Sandra S. and Roy W. Uelner Professor in food science and human nutrition who in 2009 founded The Blossom Project, which aims to improve women’s diet and exercise habits during pregnancy. “We finally figured out from the literature and from our own data something that appears to work. That’s been really exciting.”

Preventing obesity, future chronic disease

Research shows that maintaining a healthy weight during pregnancy is key to the future health of the mother and baby.

"Pregnancy is really a stress test to the mom for future chronic disease," Campbell said. "What happens to the mom during pregnancy — she gains too much weight, she ends up with gestational diabetes, she has gestational hypertension — that is a pretty good indicator of the fact that she will be overweight or obese into the future. She will have Type 2 diabetes. She will have hypertension or cardiovascular disease. Same thing for the baby. If that fetus was exposed to that glucose-sugar environment, it’s a very strong indicator that that child will at some point in their life end up with Type 2 diabetes."

2017-FSHN-Lyndi-Buckingham-Weight-Gain-During-Pregnancy-Content-1The Iowa State research was funded through a U.S. Department of Agriculture National Needs Fellowship on childhood obesity prevention, and supported by the Uelner professorship.

Buckingham-Schutt and Campbell presented the research findings in June at the annual meeting of the International Society of Behavioral Nutrition and Physical Activity in Victoria, British Columbia. The organization supports innovative research and policy in the area of behavioral nutrition and physical activity toward the betterment of human health worldwide.

The next step in the study will involve further disseminating the findings. Campbell acknowledged that implementation of the comprehensive “lifestyle intervention” during pregnancy will not be easy, and will involve additional partnerships with clinics and registered dietitians. She said it would be ideal if all pregnant women at risk of gaining too much weight could receive counseling from a dietitian several times during their pregnancy, as Buckingham-Schutt did in collaboration with the Doran Clinic for Women in Ames.

Women develop plans, goals for meeting guidelines

The amount of weight a woman should gain during pregnancy is based on body mass index before pregnancy. BMI is a measure of body fat calculated from weight and height.

Weight gain recommended by the Institute of Medicine during pregnancy is 25 to 35 pounds for those who are considered of normal weight, 15 to 25 pounds for those who are overweight, and 11 to 20 pounds for those who are obese.

But national studies show that only about one-third or 32 percent of women meet the recommended weight gain during pregnancy. Most women gain weight outside the recommendations (21 percent too little, 48 percent too much).

In an effort to prevent excessive weight gain during pregnancy, the Iowa State study worked with 50 central Iowa women, starting in their eighth to 14th week of pregnancy. Half the women were in a control group with no intervention. Of those, only 26 percent met the recommended weight gain.

For the other half, Buckingham-Schutt connected with each woman weekly, using the three-prong lifestyle intervention — a better diet, more physical activity, and counseling from a registered dietitian. Researchers say the 40 weeks of pregnancy is a “teachable moment” for pregnant women to make such changes. Each woman had a fitness band to track her physical activity.  

“I used motivational interviewing as a tool. It’s a behavior-change technique,” Buckingham-Schutt said. “Instead of telling someone what to do, you’re eliciting their ideas of how they can make the change themselves. You’re not telling them, you’re working with them to help them discover how they can change. In turn, they’re more likely to actually make that behavioral change.”

The study began in April 2015 and is wrapping up now. While recommendations for diet and exercise were different for each woman, many women were advised to eat fewer sweets. A recommended 30-minute walk could be altered and individualized for each woman to reach 10,000 steps a day.

Almost all women in the study who were overweight gained an appropriate amount of weight during pregnancy, compared with 60 to 80 percent nationally who gain more than recommended.