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Counseling slows weight gain in obese moms-to-be

By Kerry Grens

NEW YORK (Reuters Health) - Motivational counseling can slow down pregnancy weight gain in obese women and may take the edge off their anxiety, too, according to a new study from Belgium.

It's recommended that obese women gain no more than 11 to 20 pounds during pregnancy to avoid health complications in both baby and mother.

By the end of their pregnancies, women who got counseling had added about 23 pounds to their weight, compared to nearly 30 among women getting standard care.

"The difference was quite big," said Dr. Roland Devlieger, head of obstetrics and fetal medicine at University Hospitals KU Leuven in Belgium.

It's estimated that about 30 percent of pregnant women in the U.S. and 10 percent in Belgium are obese. Excessive pounds during pregnancy can increase the risks of health problems such as diabetes and high blood pressure among women and birth defects among babies.

According to Devlieger, previous studies focusing on diet and exercise to cut weight gain in expectant moms have not always shown an impact. He suggested the success of the counseling program is "related to the intensity of the follow-up and also that we very much focused on motivation."

In the Belgian study, published in the International Journal of Obesity, 205 obese pregnant women were randomly assigned to get either routine prenatal care, a brochure on healthy lifestyle or motivational counseling on nutrition, exercise and weight gain.

The counseling consisted of four group sessions, each lasting about two hours and led by a trained midwife. The meetings focused on helping women identify barriers to lifestyle changes and finding ways to overcome those barriers.

Each trimester the researchers compared the mood, health and weight gain of the women in each group.

Suzanne Phelan, a psychologist at California Polytechnic State University in San Luis Obispo who studies pregnancy-related weight gain, said the effects of counseling were promising.

"It's a small sample size, so we don't want to over interpret, but I think it's worthy of further investigation," she told Reuters Health.

Surprisingly, offering women an informational brochure also appeared to help keep them near the recommended limits for weight gain. These women had gained 21 pounds by the end of their pregnancy.

"So you could just give a woman a brochure and have that exert an impact on her gestational weight gain. That was incredible," said Phelan, who was not part of the study.

The brochure, however, had no impact on women's anxiety or depression levels throughout their pregnancy.

Women who received standard care reported an increase in anxiety by the third trimester, going from 35 on an 80-point scale in the first trimester to 38 in the third trimester. Those in the counseling group saw a reduction in their anxiety levels from more than 36 to less than 34.

Devlieger said that although these changes are statistically reliable, they are not big enough that a woman would notice a change from being anxious to not anxious.

Still, "they would be considered interesting in the psychology world," he added. "The aspects of improving the psychological health (among pregnant obese women) have been largely neglected."

Other health problems related to pregnancy, such as gestational diabetes, were equally common among all three groups of women. Devlieger said it's likely that his study was too small to detect any potential impact that counseling might have.

He said that he believes the sessions are worthwhile to offer to obese moms-to-be, but that they require a considerable time investment from the midwife or another health care provider.

Phelan added that in the U.S. it would be hard for obstetrics offices to find the time to devote to lifestyle counseling, but that handing out a brochure is not much effort.

SOURCE: http://bit.ly/R9Wj5F The International Journal of Obesity, online October 2, 2012.

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