Mayo Clinic Proceedings Home
MCP Digital Health Home
Original article| Volume 88, ISSUE 12, P1388-1397, December 2013

Download started.


Supervised Exercise–Based Intervention to Prevent Excessive Gestational Weight Gain: A Randomized Controlled Trial



      To study the effect on maternal weight gain of a supervised light- to moderate-intensity exercise–based intervention performed from the ninth week of pregnancy.

      Participants and Methods

      A total of 962 healthy pregnant women were randomly assigned to a standard care or exercise intervention group conducted between September 1, 2007, and January 31, 2011. The intervention included light- to moderate-intensity aerobic and resistance exercises performed 3 days a week (50-55 minutes per session). Excessive gestational weight gain was calculated on the basis of the 2009 Institute of Medicine (IOM) recommendations. Gestational body weight gain was calculated on the basis of the weight measured at the first prenatal visit (fifth to sixth weeks of gestation) and weight measured at the last visit to the clinic before delivery. Women were categorized into normal weight or overweight or obese.


      Women in the intervention group gained less weight (adjusted mean difference, 1.039 kg; 95% CI, 0.534-1.545 kg; P<.001) and were less likely to gain weight above the IOM recommendations (odds ratio, 0.625; 95% CI, 0.461-0.847) compared with those in the standard care group. The main treatment effects according to body mass index category were that normal weight women in the intervention group gained less weight (adjusted mean difference, 1.393 kg; 95% CI, 0.813-1.972 kg; P<.001) and were less likely to gain weight above the IOM recommendations (odds ratio, 0.508; 95% CI, 0.334-0.774) than normal weight women who received standard care. No significant treatment effect was observed in overweight or obese women.


      Supervised exercise of light to moderate intensity can be used to prevent excessive gestational weight gain, especially in normal weight women.

      Trial registration Identifier: NCT01790347

      Abbreviations and Acronyms:

      BMI (body mass index), IOM (Institute of Medicine), OR (odds ratio), RCT (randomized controlled trial)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Institute of Medicine
        Weight Gain During Pregnancy: Reexamining the Guidelines.
        National Academies Press, Washington, DC2009
        • Drehmer M.
        • Duncan B.B.
        • Kac G.
        • Schmidt M.I.
        Association of second and third trimester weight gain in pregnancy with maternal and fetal outcomes.
        PLoS One. 2013; 8: e54704
        • Chung J.G.
        • Taylor R.S.
        • Thompson J.M.
        • et al.
        Gestational weight gain and adverse pregnancy outcomes in a nulliparous cohort.
        Eur J Obstet Gynecol Reprod Biol. 2013; 167: 149-153
        • Stotland N.E.
        • Cheng Y.W.
        • Hopkins L.M.
        • Caughey A.B.
        Gestational weight gain and adverse neonatal outcome among term infants.
        Obstet Gynecol. 2006; 108: 635-643
        • Nehring I.
        • Lehmann S.
        • von Kries R.
        Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: a meta-analysis.
        Pediatr Obes. 2013; 8: 218-224
        • Ensenauer R.
        • Chmitorz A.
        • Riedel C.
        • et al.
        Effects of suboptimal or excessive gestational weight gain on childhood overweight and abdominal adiposity: results from a retrospective cohort study.
        Int J Obes (Lond). 2013; 37: 505-512
        • Gage S.H.
        • Lawlor D.A.
        • Tilling K.
        • Fraser A.
        Associations of maternal weight gain in pregnancy with offspring cognition in childhood and adolescence: findings from the Avon Longitudinal Study of Parents and Children.
        Am J Epidemiol. 2013; 177: 402-410
      1. ACOG Committee opinion no. 548: weight gain during pregnancy.
        Obstet Gynecol. 2013; 121: 210-212
        • Downs D.S.
        • Chasan-Taber L.
        • Evenson K.R.
        • Leiferman J.
        • Yeo S.
        Physical activity and pregnancy: past and present evidence and future recommendations.
        Res Q Exerc Sport. 2012; 83: 485-502
        • Mudd L.M.
        • Owe K.M.
        • Mottola M.F.
        • Pivarnik J.M.
        Health benefits of physical activity during pregnancy: an international perspective.
        Med Sci Sports Exerc. 2013; 45: 268-277
        • Ruchat S.M.
        • Mottola M.F.
        Preventing long-term risk of obesity for two generations: prenatal physical activity is part of the puzzle.
        J Pregnancy. 2012; 2012: 470247
        • ACOG Committee on Obstetric Practice
        ACOG Committee Opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period.
        Obstet Gynecol. 2002; 99: 171-173
        • Borg G.
        Borg’s Perceived Exertion and Pain Scales.
        Human Kinetics, Champaign, IL1998
        • Barakat R.
        • Lucia A.
        • Ruiz J.R.
        Resistance exercise training during pregnancy and newborn's birth size: a randomised controlled trial.
        Int J Obes (Lond). 2009; 33: 1048-1057
        • Haakstad L.A.
        • Bø K.
        Effect of regular exercise on prevention of excessive weight gain in pregnancy: a randomised controlled trial.
        Eur J Contracept Reprod Health Care. 2011; 16: 116-125
        • Vinter C.A.
        • Jensen D.M.
        • Ovesen P.
        • Beck-Nielsen H.
        • Jorgensen J.S.
        The LiP (Lifestyle in Pregnancy) study: a randomized controlled trial of lifestyle intervention in 360 obese pregnant women.
        Diabetes Care. 2011; 34: 2502-2507
        • Claesson I.M.
        • Sydsjo G.
        • Brynhildsen J.
        • et al.
        Weight gain restriction for obese pregnant women: a case-control intervention study.
        BJOG. 2008; 115: 44-50
        • Phelan S.
        • Phipps M.G.
        • Abrams B.
        • Darroch F.
        • Schaffner A.
        • Wing R.R.
        Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.
        Am J Clin Nutr. 2011; 93: 772-779
        • Olson C.M.
        • Strawderman M.S.
        • Reed R.G.
        Efficacy of an intervention to prevent excessive gestational weight gain.
        Am J Obstet Gynecol. 2004; 191: 530-536
        • Polley B.A.
        • Wing R.R.
        • Sims C.J.
        Randomized controlled trial to prevent excessive weight gain in pregnant women.
        Int J Obes Relat Metab Disord. 2002; 26: 1494-1502
        • Institute of Medicine
        Nutrition During Pregancy: Part I Weight Gain and Part II Nutrient Supplements.
        National Academies Press, Washington, DC1990: 10-23
        • Mottola M.F.
        • Giroux I.
        • Gratton R.
        • et al.
        Nutrition and exercise prevent excess weight gain in overweight pregnant women.
        Med Sci Sports Exerc. 2010; 42: 265-272
        • Artal R.
        • Catanzaro R.B.
        • Gavard J.A.
        • Mostello D.J.
        • Friganza J.C.
        A lifestyle intervention of weight-gain restriction: diet and exercise in obese women with gestational diabetes mellitus.
        Appl Physiol Nutr Metab. 2007; 32: 596-601
        • Shirazian T.
        • Monteith S.
        • Friedman F.
        • Rebarber A.
        Lifestyle modification program decreases pregnancy weight gain in obese women.
        Am J Perinatol. 2010; 27: 411-414
        • Wolff S.
        • Legarth J.
        • Vangsgaard K.
        • Toubro S.
        • Astrup A.
        A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women.
        Int J Obes (Lond). 2008; 32: 495-501
        • Nohr E.A.
        • Vaeth M.
        • Baker J.L.
        • Sorensen T.
        • Olsen J.
        • Rasmussen K.M.
        Combined associations of prepregnancy body mass index and gestational weight gain with the outcome of pregnancy.
        Am J Clin Nutr. 2008; 87: 1750-1759
        • Heiskanen N.
        • Raatikainen K.
        • Heinonen S.
        Fetal macrosomia: a continuing obstetric challenge.
        Biol Neonate. 2006; 90: 98-103
        • Whitaker R.C.
        Predicting preschooler obesity at birth: the role of maternal obesity in early pregnancy.
        Pediatrics. 2004; 114: e29-e36
        • Araujo C.L.
        • Hallal P.C.
        • Nader G.A.
        • et al.
        Effect of birth size and proportionality on BMI and skinfold thickness in early adolescence: prospective birth cohort study.
        Eur J Clin Nutr. 2009; 63: 634-639
        • Barker D.J.
        • Eriksson J.G.
        • Forsen T.
        • Osmond C.
        Fetal origins of adult disease: strength of effects and biological basis.
        Int J Epidemiol. 2002; 31: 1235-1239
        • Kajantie E.
        • Osmond C.
        • Barker D.J.
        • Forsen T.
        • Phillips D.I.
        • Eriksson J.G.
        Size at birth as a predictor of mortality in adulthood: a follow-up of 350 000 person-years.
        Int J Epidemiol. 2005; 34: 655-663
        • Egeland G.M.
        • Skjaerven R.
        • Irgens L.M.
        Birth characteristics of women who develop gestational diabetes: population based study.
        BMJ. 2000; 321: 546-547
        • McCormack V.A.
        • dos Santos Silva I.
        • Koupil I.
        • Leon D.A.
        • Lithell H.O.
        Birth characteristics and adult cancer incidence: Swedish cohort of over 11,000 men and women.
        Int J Cancer. 2005; 115: 611-617
        • Labayen I.
        • Ruiz J.R.
        • Vicente-Rodriguez G.
        • et al.
        Early life programming of abdominal adiposity in adolescents: The HELENA Study.
        Diabetes Care. 2009; 32: 2120-2122
        • Tobias D.K.
        • Zhang C.
        • van Dam R.M.
        • Bowers K.
        • Hu F.B.
        Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis.
        Diabetes Care. 2011; 34: 223-229
        • Wendland E.M.
        • Torloni M.R.
        • Falavigna M.
        • et al.
        Gestational diabetes and pregnancy outcomes: a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria.
        BMC Pregnancy Childbirth. 2012; 12: 23
        • Zhang C.
        • Solomon C.G.
        • Manson J.E.
        • Hu F.B.
        A prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus.
        Arch Intern Med. 2006; 166: 543-548
        • Chasan-Taber L.
        • Schmidt M.D.
        • Pekow P.
        • et al.
        Physical activity and gestational diabetes mellitus among Hispanic women.
        J Womens Health (Larchmt). 2008; 17: 999-1008
        • Oken E.
        • Ning Y.
        • Rifas-Shiman S.L.
        • Radesky J.S.
        • Rich-Edwards J.W.
        • Gillman M.W.
        Associations of physical activity and inactivity before and during pregnancy with glucose tolerance.
        Obstet Gynecol. 2006; 108: 1200-1207
        • Rudra C.B.
        • Williams M.A.
        • Lee I.M.
        • Miller R.S.
        • Sorensen T.K.
        Perceived exertion in physical activity and risk of gestational diabetes mellitus.
        Epidemiology. 2006; 17: 31-37
        • Dempsey J.C.
        • Butler C.L.
        • Sorensen T.K.
        • et al.
        A case-control study of maternal recreational physical activity and risk of gestational diabetes mellitus.
        Diabetes Res Clin Pract. 2004; 66: 203-215
        • Redden S.L.
        • LaMonte M.J.
        • Freudenheim J.L.
        • Rudra C.B.
        The association between gestational diabetes mellitus and recreational physical activity.
        Matern Child Health J. 2011; 15: 514-519
        • Harizopoulou V.C.
        • Kritikos A.
        • Papanikolaou Z.
        • et al.
        Maternal physical activity before and during early pregnancy as a risk factor for gestational diabetes mellitus.
        Acta Diabetol. 2010; 47: 83-89
        • Hopkins S.A.
        • Baldi J.C.
        • Cutfield W.S.
        • McCowan L.
        • Hofman P.L.
        Exercise training in pregnancy reduces offspring size without changes in maternal insulin sensitivity.
        J Clin Endocrinol Metab. 2010; 95: 2080-2088
        • Jovanovic-Peterson L.
        • Peterson C.M.
        Is exercise safe or useful for gestational diabetic women?.
        Diabetes. 1991; 40: 179-181
        • Barakat R.
        • Cordero Y.
        • Coteron J.
        • Luaces M.
        • Montejo R.
        Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial.
        Br J Sports Med. 2012; 46: 656-661
        • Barakat R.
        • Pelaez M.
        • Lopez C.
        • Lucia A.
        • Ruiz J.R.
        Exercise during pregnancy and gestational diabetes-related adverse effects: a randomised controlled trial.
        Br J Sports Med. 2013; 47: 630-636